STOCKHOLM — After nearly three decades of broad agreement that hardware subsidies alone do not work in the rural sanitation sector, the practice of using financial incentives to encourage people to build latrines appears to be making a comeback — causing old arguments to flare up again.
The debate over whether or not to use subsidies for sanitation has resurfaced in recent years as governments — as well as water, sanitation, and hygiene experts — grapple with how to deal with the world’s looming sanitation crisis. Recent statistics reveal that 2.3 billion people do not have access to a decent toilet and many still defecate in the open. Furthermore, in some countries, levels of sanitation access are declining — and this trend is likely to continue as growing populations and increasing urbanization put new strain on the sector’s limited budget.
Experts agree that a radical rethink of how sanitation programs are financed and implemented is needed if the ambitious Sustainable Development Goals — which call for universal access to basic sanitation by 2030 — are to be met.
Read more related stories:
For some, this means considering a return to the idea of subsidies — an option that came up frequently during the recent Stockholm World Water Week conference, the biggest dedicated conference in the WASH calendar. Delegates spoke of the need to apply “smart subsidies” to drive sanitation coverage, especially in urban areas, and as a mechanism for reaching the poorest and most marginalized people who tend to have the lowest levels of sanitation access. For example, a World Bank report released during the conference stated that public funds need to be better targeted, including the use of subsidies to benefit the ultra-poor rather than the middle class.
But others say the practice of offering hardware subsidies doesn’t work since it fails to create the behavior change and community ownership needed to ensure toilets are maintained and used.
An outdated method
Until the 1990s, governments and donors saw sanitation largely as a “hardware” issue and focused on increasing sanitation coverage by building toilets at no cost to the recipient. However, these approaches frequently saw poor sustainability and user adoption rates, with toilets going unused or being misused as goat sheds and firewood stores in India, for example. A study in Bangladesh revealed that 17 percent of subsidized latrines were not working.
Experts argue these programs failed because they were supply-led, and therefore failed to generate demand for improved sanitation and to achieve the necessary behavior change to sustain it among communities. Furthermore, poor households were frequently unable, and often unwilling, to pay for the continued upkeep of the toilets they had been given without being either emotionally or financially involved.
In response to these shortfalls, a new approach — community-led total sanitation, or CLTS — was developed in 2000 as a no-subsidy, demand-driven alternative. CLTS was unique at the time for its use of participatory methods to provoke a collective sense of shame and disgust toward the practice of open defecation and the health hazards it creates. That, in turn, translates into demand for toilets.
Pioneered by an Indian development consultant named Kamal Kar, it was based on his realization, while evaluating a traditional subsidy-based sanitation program in Bangladesh, that it would be possible to get communities to build, pay for, and maintain their own toilets using participatory approaches to “trigger” them into demanding facilities for themselves until a village could be classified “open defecation free.” Kar’s approach has since been mainstreamed into the policies of national governments, donors, and implementers, including the World Bank, UNICEF, WaterAid, and Plan International.
Search for new options
Speaking to Devex during Stockholm World Water Week, Robert Chambers — a development and CLTS expert who has co-authored research papers with Kar — argued that the subsidy approach “simply didn’t work” because communities “didn’t own [the toilets] and they didn’t build them themselves.”
Yet CLTS itself has been criticized in recent years, with studies revealing instances of “slippage” among communities supposedly free of open defecation, and emerging evidence that the approach does not support the most disadvantaged, who are the most likely to revert, often due to being unable to build and sustain toilets. The ethics of triggering shame and disgust among participants has also been widely debated by practitioners.
Chambers acknowledges these problems, saying that while CLTS “has really worked quite well in some contexts … it hasn’t worked as well as has been portrayed in my view.” In response to these shortcomings and the growing pressures facing the sanitation sector as it strives to meet the ambitious demands of the SDGs, the professor described a “groping to find good ways forward” among experts.
However, he warned donors and actors to be “cautious” about reintroducing subsidies, since it could disrupt progress in dedicated CLTS countries such as Nigeria and Chad, which have turned down donors, including the World Bank and the European Union, in the past over the issue of subsidies. If subsidies are introduced to CLTS programs, Chambers said, “the danger is that it could be taken as undermining the stance of these governments.”
Chambers, who is a professor at the Institute of Development Studies in the U.K., also told Devex he was worried that, by offering financial incentives for toilet construction, subsidies could lead to increased levels of misreporting about the number and quality of sanitation facilities being built, and could also lead to corruption. In addition, the original concerns around the sustainability of subsidy-based programs remain.
According to Chambers, many of these concerns are already playing out in India under the “Swachh Bharat” campaign, introduced by Prime Minister Narendra Modi, to end open defecation in rural areas by 2019. The campaign uses a combination of CLTS and hardware subsidies to encourage communities to construct toilets. Chambers told Devex he had doubts about the quality of reporting under the program. “I’m full of awe at the scale and intensity of effort,” he said. “It’s very impressive what’s being achieved … But the reality falls short of what is [being] reported.”
A smarter kind of subsidy
Other sanitation experts agree that, while CLTS has been fairly successful to date, it can only take communities so far.
“CLTS gets you on the first step of the ladder [of sanitation] and then you go onto other things,” said Patrick Moriarty, head of IRC WASH. For example, CLTS does not offer communities faecal sludge management options, he explained.
“Behavior change as the sole intervention never made any sense if you thought one step further than stopping open defecation,” he added.
One sanitation marketing approach scaled by development NGO iDE attempts to pick up where CLTS leaves off by offering “triggered” communities access to aspirational and high-quality sanitation products, while also developing supply capacity to meet that demand.
iDE also works in communities that have not experienced CLTS through independent sales agents, who are trained by the NGO to sell sanitation to households and are paid a commission by the local latrine producer.
“Under the SDGs, where the focus is on sustained sanitation service delivery, we should make more efforts to have users upgrade their sanitation solution to a more durable, aspirational solution that is easily accessible,” according to Yi Wei, head of WASH at iDE.
Wei explained that in order to prevent slippage and reversion to open defecation — as seen in many CLTS communities — it is necessary to offer people a toilet that gets them beyond just “the first rung of the ladder,” which is often a dry pit latrine. Instead, efforts should enable those who can pay to “directly leapfrog to a more hygienic latrine solution” such as the kind iDE offers through the sanitation market. Those who are not able to pay should be offered consumer financing or targeted subsidies, she added.
Subsidies will be necessary in order to increase access to toilets in urban areas, according to Sophie Trémolet, a senior advisor in the World Bank’s water global practice. But she was clear that there is no desire to go back to the “old days,” when the World Bank would provide loans to subsidize up to 80 percent of sanitation services. Instead, she called for a smarter approach that makes use of this public funding in the most effective and equitable way.
“The whole CLTS, no-subsidy movement has been quite successful … [but] there’s been a tendency to try and translate that into the urban sector, where it doesn’t necessarily work because you’ve got more expensive sanitation solutions, crowded environments, [and] problems of land tenure,” she said.
As a result, there has been “more appetite for reintroducing subsidies for urban sanitation” in recent years, along with a realization that “smarter” ways of deploying them are needed. This could include more results-based approaches, she said.
While market-based models are also traditionally opposed to hardware subsidies since they can distort markets, iDE offers “smart subsidies” in its Cambodia SanMark program in order to include poorer households. These subsidies aim to minimize market distortion through the use of voucher systems and effective targeting to make sure only the poor are included.
The results of a randomized control trial assessing the impact of these smart subsidies on the NGO’s flagship Cambodia program revealed that uptake among poorer households was far higher within communities where subsidies were offered than in places where they were not, according to an iDE document.
A nuanced approach
Polarized positions in the debate over subsidies are not helpful and threaten progress, sanitation experts told Devex.
iDE’s Wei warned that actors — including her own NGO — were in danger of becoming too dogmatic about the no hardware subsidy policy. “Both CLTS and market-based approaches have promoted a no-subsidy policy. This rhetoric has become so ingrained that it's now more acceptable to say ‘shit’ than ‘subsidy,’” she said.
Such a position is hypocritical since “everything we in the development sector do is subsidized” if supported by public and philanthropic funds, she said. It is also an unhelpful distraction from the real question, which should not be whether or not to use subsidies “but rather, how might we use [them] most effectively … so that we can get those who are willing and able to pay to pay first, and those who are not able to pay to benefit from more direct forms of subsidy.”
Wei said this shift in thinking is already underway within the sector, which is “embracing a much more nuanced understanding of subsidy, and there is growing convergence in our understanding of how to best deploy it.”
Moriarty agreed, arguing that sanitation actors should use the “best bits” of CLTS combined with targeted subsidies for the poor.
In response to the challenges that CLTS has faced, its advocates have been working to come up with improvements, including the reintroduction of certain kinds of subsidies under specific contexts, as seen in a recent paper. UNICEF and the CLTS Knowledge Hub — a donor-funded online platform managed by the Institute of Development Studies — also organized a session titled “Subsidies revisited: Supporting the poorest and most vulnerable in CLTS” during the Stockholm meetings.
Chambers told Devex he prefers the term “support” to “subsidy,” since it incorporates a range of financial and non-financial options, as well as intra-community support — such as free labor, provision of locally owned materials, and permission to use land — alongside external offerings, such as contracted service providers, vouchers for materials, rebates, and subsidized transport costs.
Michael Gnilo, a WASH expert at UNICEF — which uses CLTS for the majority of its sanitation work — agreed that attitudes are evolving.
“We can’t be dogmatic about no subsidy, especially when trying to reach the last mile,” he said, adding that “it’s about being able to identify the conditions where it is appropriate,” which is something the sector is still trying to figure out how to do.
A key concern is about how to avoid undermining a community’s ability to “address things for themselves,” the UNICEF expert said.
A possible solution would be to offer subsidies in a “phased approach,” he suggested — only offering them in places where there is no demand for sanitation, and then phasing them out once households reach the “stage where they are trying to address the issue for themselves.”
This would help make sure that any support offered is “aligned with people’s own choices rather than being told what to do,” Gnilo said.
Read more international development news online, and subscribe to The Development Newswire to receive the latest from the world’s leading donors and decision-makers — emailed to you free every business day.