Equity and inclusion in sanitation and hygiene in South Asia A regional synthesis paper WSSCC UNICEF and WaterAid

This working paper by the Water Supply and Sanitation Collaborative Council (WSSCC), UNICEF and WaterAid highlights the fact that a staggering 716 million men, women and children defecate in the open every day, in South Asia, contributing to the most appalling concentration of poverty and disease and the poorest standards of hygiene in the world.

There are two facets to this problem in South Asia, both of which are unacceptable:

• The first is a problem of scale. The issue is one of breaking the inertia and developing the momentum to accelerate and scale up appropriate sanitation programmes. These areas suffer from barriers such as mass poverty, weak or corrupt administration, general lack of awareness of personal hygiene and difficult physical/environmental conditions such as hard rock, high water tables, disaster or conflict. All these make the construction, maintenance and use of hygienic toilets, difficult or unsustainable. It also involves changing the habits of a lifetime since open defecation is the societal norm in many communities
• The second and in many ways more pernicious problem, particularly in South Asia, is one of exclusion, where different categories of people are not able to access and use safe sanitation facilities. These categories of people include those who are socially and economically marginalised or excluded, and those who cannot use standard designs, such as women and children and people from certain castes and ethnicities

The paper argues that an equity based approach would accelerate progress towards the health MDGs faster than the current path, and will be considerably more cost-effective and sustainable. However, action needs to be based on the principle of equity, which requires clear identification of and effective response around specific barriers in the following three categories:

• Attitudinal barriers
• Environmental barriers
• Institutional barriers

Different countries with their own governance systems and unique challenges provide evidence of exclusion in relation to sanitation and hygiene, and they show how it is possible to address the barriers, attitudinal, environmental and institutional in their own context.The factors for success include :

• Political commitment
• Monitoring
• Institutional structure and capacity
• Approach to creating demand and scaling up
• Technology promotion and supply chain
• Finance and incentives
• Looking at services with an equity lens

The paper ends by proposing a framework for assessment of commitment, capacity and practical options for ensuring and benchmarking equity and inclusion in sanitation and includes:

• Political Commitment and strategy for implementation
• Monitoring
• Institutional Structure and Capacity
• Approach to creating demand and scaling up
• Technology promotion and supply chain
• Finance and Incentives

However, none of these steps will be effective or sustainable, unless they are driven by committed leadership at the highest level in each country in South Asia and then put into action drawing on collective strengths, argues the paper.

A copy of the paper can be accessed from this link