BY CAMILLE SACHS
Camille Sachs is a second year International Development student at Johns Hopkins SAIS and a Senior Editor for SAIS Perspectives.
Background:
Globally, more than 670 million people still practice open defecation. Open defecation contaminates water supplies, leads to repeated diarrhea and chronic malnutrition, and poses health and safety risks to all people, particularly girls and women. Sustainable Development Goal Target 6.2 aims to “achieve access to adequate and equitable sanitation for all and end open defecation, paying special attention to the needs of women and girls in those vulnerable situations.” In order to meet this target, governments, NGOs, and donors need to work together and find creative solutions. These creative solutions need to be continually reevaluated and improved upon in order to serve people’s evolving sanitation needs.
In 2005, nearly 80 percent of the rural population in Cambodia and over 29 percent of the urban population practiced open defecation. As of 2017, rural open defecation had been nearly halved to approximately 40 percent and urban open defecation is all but non-existent (Figure 1). A large part of the reduction in open defecation in rural areas was driven by the Sanitation Marketing Program and Sanitation Marketing Scale-Up (SMSU) program implemented by International Development Enterprises (iDE). The Sanitation Marketing Program launched in 2009, with an aim to meet the demand for latrines that fit household aspirations at an affordable price point. The model was largely successful, and iDE has since scaled it up through the SMSU program. The program has three iterations - SMSU (2011 - 2014), SMSU 2.0 (2014 - 2018) and SMSU 3.0 (2018 - 2022).
Figure 1: Rural and Urban Sanitation in Cambodia 2005 and 2017
Source: WHO and UNICEF JMP, WASH Data Dashboard – Cambodia, 2020
Sanitation Marketing Scale-Up Model
The iDE program has assisted in the sales and installation of over 300,000 latrines, making it one of the largest market-based rural latrine interventions in the world. There were several key aspects to the program that made it particularly successful. The program started with extensive market research to identify what customers want in a household latrine. Market research into customers’ needs is an all too often overlooked first step in international development projects. The project utilized human centered design to identify solutions that were “desirable, viable, and feasible.” In other words, they matched what users wanted, with designs that would improve the production and installation on the part of the masons and ring producers. Figure 2 illustrates the final Easy Latrine design, SMSU’s first and primary sanitation product. It is an off-set pour-flush latrine with an option for one or two leach pits. Since then, SMSU has worked with masons to expand product offerings to include shelters, disability accessible latrines, and alternating dual pits.
Figure 2: iDE’s Easy Latrine
Source: iDE, Designing the Easy Latrine, 2019
Another reason for the project’s success was the responsiveness to the market supply. In the first iteration of the project, iDE planned to have small and micro-enterprises who produced the latrines (Latrine Business Owners or LBOs) also drive sales. However, the manufacturers had little interest in doing so. During SMSU 2.0, iDE employed professionalized sales agents who worked with LBOs to sell the latrines. These sales agents met customers where they lived, explained the health and safety benefits of latrine installation, and helped to reduce inefficiencies in the market. Additionally, when doing follow up surveys with customers, iDE found that some latrines were not being installed after purchase. As a result, they changed the price model halfway through SMSU 2.0 to include latrine installation in the cost to ensure that latrine purchases actually resulted in latrine use.
Remaining Challenges:
While this project has seen great success, and the model is being used in other locations, there are enduring challenges that are impeding progress toward full improved-sanitation coverage in Cambodia. One key area of concern is reaching the poorest customers. In Cambodia, 80 percent of the poorest households in rural areas still practice open defecation (Figure 3). The price of the marketable latrine desired by the majority of rural households is likely too expensive for the poorest households. On average, SMSU 2.0 evaluation found that 20 percent of latrine sales are to poor customers.[1] Government estimates of IDPoor population in the project areas is 16 percent of the total population. Given that roughly 20 percent of iDE’s customers are IDPoor, they are overserving the poor market relative to size. However, during SMSU 2.0 sales to the poorest customers (IDPoor1) decreased from 14 percent to six percent of total sales. In order to reach these households, SMSU 3.0 has expanded to include a targeted subsidy and community engagement program to reach the remaining population that still practices open defecation. As SMSU 3.0 is still ongoing, it is unclear whether the targeted subsidy will have the intended impact.
Figure 3: Cambodia Rural Sanitation Coverage By Wealth Quintile, 2017
Source: WHO and UNICEF JMP, WASH Data Dashboard – Cambodia, 2020
Another challenge is fecal sludge management (FSM). Sanitation coverage in rural Cambodia has more than tripled since 2005 (Figure 1). As a result, many new latrine owners are experiencing their latrine pits filling for the first time. If the fecal sludge is not properly managed, the health benefits of expanded sanitation coverage will be dramatically reduced. Recent studies have found that most rural households in Cambodia are using unsafe methods to empty their pits. A 2018 study by WaterSHED found a general lack of knowledge about the risks associated with fecal sludge removal. For those who do empty their pits, they typically do so manually using buckets or a suction pump and then dispose of the untreated waste in waterways or on fields, or store it for future use as fertilizer. Another common method is ‘pit piercing’ where households simply punch a hole in the pit or install a drain pipe to drain off extra waste. All of these unsafe FSM practices reduce the benefits of household latrines.
Future iDE considerations should work with past customers on FSM solutions. Many households report wanting to hire an FSM removal service, but these services are limited and unregulated in rural Cambodia. The Cambodian government recommends on-site FSM solutions – in particular, an alternating two-pit design.[2] While expanding pit construction and training individuals to safely manage and remove fecal sludge could be a new market that iDE could work with, there needs to be a national effort put forth to find long-term treatment solutions in rural communities. In general, the Sanitation Marketing Program and iDE’s continual scale-up efforts have served to expand access to basic sanitation. However, the persistent challenges in reaching extremely poor customers and the difficult realities of FSM highlight the need for more expansive national service interventions.
PHOTO CREDIT: Free use image from Canva Pro.