By Kate Fogelberg

I am fresh off the plane from Springfield’s semi-annual “Making Markets Work” (M4P) training programme. I first attended this programme four years ago when my previous employer was tasked with “making markets work for the poo-er” by exploring private sector provision of sanitation goods and services. At the time, I was one of two lone participants from the water and sanitation (WASH) crowd, but this time, nearly a dozen WASHers showed up.

What’s happened to drive six times as many people to an intensive two-week training course away from the frontlines of improving access, use, and emptying of the beloved John? In a nutshell, there is growing recognition that business as usual hasn’t worked to solve the sanitation crisis and it’s time for a change.
For those who only have personal relationships with toilets, as opposed to the professional faecalphiles, a brief snapshot of the global sanitation sector paints a rather sh*tty picture of progress to date:

1. Diarrhoea is still the second-largest killer of kids under five-in 2016
2. Sanitation received the dubious honour of “most off-track MDG
3. More people lack access to a toilet now than when the world started counting in 1990
4. Because we humans are complicated beings, a minimum of 1/3 of toilets remain unused
5. Slippage – which refers not to slipping off a dodgy toilet but to abandoning a toilet in favour of “open defecation” (the technical term for having a crap anywhere that isn’t a toilet) – ranges from 21% to 92%
6. Nearly all of the wastewater in developing countries is released back into the environment with no treatment.

It is well known and well documented that access to and use of toilets improves the health and wealth of people and populations, so why such a poor track record? Some of the reasons lie in the approaches taken to date:

• If we build it, they will use it: supply-side interventions focused on donating toilet infrastructure dominated the early years of government or development partner programmes, but did not have the expected results
• If they build it, they will use it: demand-side interventions directed at changing people’s behaviours to build and use their own toilet with minimal or no subsidy have also not had the intended results.
• If they buy it, they will use it: an approach that grew out of social marketing to work on both supply- and demand-side constraints – a move in the right direction, but hasn’t closed the sanitation gap yet either.

A recent meta-analysis of sanitation programmes concluded that despite the investment in the sector, there are no examples of externally-led sustainable sanitation at scale. So something must change and the six-fold increase of participants at the training programme is evidence of the interest in trying to make markets work for the poo-ers. While language doesn’t always translate into new or different actions, the last two years have seen increased recognition of the systemic nature of the sanitation problem in sector literature and conference topics. Donors and implementers alike are wrestling with how not to just provide toilets or convince people to get on the pot, but how external investment can and should be directed at supporting functions of the toilet system-like finance, information, new products and services-or formal and informal rules-such as regulations requiring landlords to provide toilets in urban slums or “Toilet Nightmare” reality television shows to change social norms.

Paying greater heed to organisations’ and individuals’ incentives and capacities is one concrete way to begin to tackle sanitation systemically. An example of increasing first-time access comes from water.org, an American non-profit organisation, which decided to do something about the oft-cited complaint of lack of finance. Complaining about the lack of money available for sanitation has been a common refrain since 19th Century British MPs didn’t want to finance London’s sewers, but water.org have been one of the first to do more than just whinge and ask for increased donations. Instead, they recognised that existing microfinance institutions (MFIs) could be convinced of the opportunity to lend to low-income households. Thus water.org shifted their philanthropic funding from building toilets to building the capacity of MFIs to secure commercial finance. The results are impressive: over ten years they’ve leveraged USD150m in commercial finance from an USD13m investment in market studies, MFI staff training, product development, and monitoring systems, resulting in 3m new toilet users. Working with MFIs to provide sanitation financing has become quite common, but hats off to water.org, who recognised the opportunity and provided right-sized support to make it happen.

Any place described as the “hotbed of septage tourism” gets my attention. The Philippines holds this honour because of its recent efforts at addressing the red-headed step child of sanitation, faecal sludge management (FSM). The status quo approach to FSM in many cities around the world is to charge pit emptiers a fee to be able to dump the waste in a treatment plant. Unsurprisingly, this results in non-compliance more often than not, as it is cheaper and more convenient to dump directly into the environment. But a while back, environmental groups – not sanitation experts – actually sued ten Filipino government agencies for failing to protect Manila Bay – and they won. Thus, the political incentives to do something about the problem became much more urgent and resulted in new arrangements to FSM. For example, in Manila, the water and sanitation utility recognised that by paying –instead – of charging-pit emptiers to deposit waste in their plant, they could incentivise emptiers to comply, and thus, improve public and environmental health.

Changing political will is an uphill task is any sector, but much, much worse when the topic is poop. But the Philippines example demonstrates that allies in other sectors can be effective persuaders. And if the sector is going to have a fighting chance of reaching the SDGs by 2030, something has to change. Assuming similar financial investments to the last years of the MDGs, optimists suggest that universal basic access might be possible by 2030. To reach the even more ambitious SDGs, investment must triple, which will require greater political will to invest public sources and new sources of private investment and individual sources.

We have come a long way from the time of lawmakers in the UK covering up the stench of the Great Stink by spreading chemicals on the curtains of Parliament instead of addressing the root causes of the Stink. But there is still a long way to go in ensuring that all 7bn of us have a toilet that we use. And even further to go until the waste from billions of toilets end up where they should. But with more and more professionals starting to take systemic sanitation seriously, I’m hopeful that we’re a wee bit closer.

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