Sustainable Sanitation and Hygiene for All (SSH4A) - Rural Sanitation Sustainability Review
Sustainable Development Goal (SDG) target 6.2 aims to achieve access to adequate and equitable sanitation and hygiene for all and to end open defecation by 2030, yet 2.3 billion people still lack basic sanitation services. Among the many strategies for improving rural sanitation in low and middle-income countries, a recent systematic review showed that interventions tend to produce modest increases in latrine coverage, limiting potential health benefits.
Our partner, SNV: Netherlands Development Organization, solicited this study to assess the impact, equity, and sustainability of their widely implemented Sustainable Sanitation and Hygiene for All (SSH4A) approach, and to gain a deeper understanding of how rural sanitation service delivery modalities are adapted and implemented across various contexts. SSH4A has been executed in 19 countries in Africa and Asia for over a decade and focuses on four key components of rural sanitation and hygiene: 1) demand creation, 2) supply chain and financing, 3) behaviour change communication, and 4) WASH governance. The primary focus of the approach is to build capacity within the local government, considered the duty-bearers of sanitation improvements, and to provide technical support.
Over the last four years, Emory University (Matthew Freeman) and University of Nevada, Reno (Joshua Garn and Paschal Apanga) have analyzed secondary data from household surveys from 11 countries where SSH4A has been implemented. Analysis has investigated impact and equity of the program across districts in Ghana, Ethiopia, Kenya, Uganda, Tanzania, Zambia, Mozambique, Nepal, Bhutan, Indonesia, and South Sudan, and has demonstrated promising results. Surveys focused on access and use of latrines as well as handwashing with soap. Data was disaggregated for potentially vulnerable households including those in the lowest wealth quintile, persons with disabilities, the elderly, and female-headed households. Initial findings can be found on SNV’s website with the final paper to be published this summer.
The purpose of the qualitative research component is to thoroughly describe rural sanitation service delivery modalities in Africa and Asia, highlight context-specific adaptations to universal frameworks, and address common challenges to sustaining latrine coverage and usage. Findings from this research can be used by international organizations to develop, describe, and adapt established modalities for rural sanitation programs focused on technical support and capacity building. We plan to develop an evidence-based theory of change for rural sanitation service delivery targeting universal, equitable coverage.
We have adopted a case study approach. Several districts in Kenya, Zambia, Nepal, and Bhutan will illustrate various modalities and contextual adaptations. Qualitative investigation will produce a deeper understanding of barriers and enablers to sustained access and usage, where and why slippage occurs, and how contextual factors influenced implementation and success of rural sanitation service delivery modalities. Findings could improve how organizations and stakeholders within the rural sanitation sector handle problem solving, planning, investment priorities, and budgeting. Our research may also improve approaches to documenting and understanding successes and challenges, and support sector-wide learning towards the goal of sustainable sanitation for all.
Publications:
Briefs, reports, case studies:
In the press:
Study Location
Kenya, Zambia, Nepal, Bhutan
Target Population
Rural and peri-urban households within SNV program areas
Principal Investigators
Emory University: Matthew Freeman and Zoe Sakas,
University of Nevada, Reno: Joshua Garn
Funders
SNV: Netherlands Development Organization
Graduate Research Assistants
Emory University: Ebere Uwah
University of Nevada, Reno: Paschal Apanga
IMPLEMENTING partners
SNV: Netherlands Development Organization
Collaborators
Global: Antoinette Kome, Anne Mutta, Gabrielle Halcrow
Kenya: Fanuel Nyaboro, Joseph Oluoch, Michael Bomji, Samson Wachara, Bendy Kipchoge
Zambia: Kumbulani Ndlovu, Chainga Zulu, Edgar Chaamwe
Nepal: Gian Melloni, Krishna Hari
Bhutan: Ugyen Rinzin, Kencho Wangdi, Raj Kumar
Field Staff
Kenya: Jane Njuguna, Diane Bett, Dolphine Okoth, Alfred Keter, Robert Osir, Wycliffe Obonyo
Zambia: Champo Mwelwa, Alpha Samboco, Monica Banda, Musyani Siame
Nepal: Anuska Karki, Pankaj Nabh, Rajan Kumar Karn, Sharmila Chimouriya
Bhutan: Phurpa Thinley, Karma Lodey Dema, Sangay Choden