WATER AND SANITATION PROGRAM: WORKING PAPER
Scaling Up Rural Sanitation
Enabling Environment
Endline Assessment:
Himachal Pradesh and
Madhya Pradesh, India
Andy Robinson
April 2012
The Water and Sanitation Program is a multi-donor partnership administered
by the World Bank to support poor people in obtaining affordable, safe, and
sustainable access to water and sanitation services.
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By Andy Robinson
This report is based on fieldwork and research funded by the Water and
Sanitation Program (WSP). The fieldwork and research could not have taken place
without the support and assistance of the Government of Himachal Pradesh
(Rural Development Department, Irrigation and Public Health Department), the
Government of Madhya Pradesh (Panchayat and Rural Development Department,
Public Health Engineering Department), the Government of India, and the Water
and Sanitation Program—South Asia.
Special thanks are due to Ajith Kumar, K. Arokiam, Lira Suri, and Nitika Surie for
their kind assistance and support in India.
Designated a core business area in 2011, WSP’s Scaling Up Rural Sanitation
is working with governments and the local private sector to develop the
knowledge needed to scale up rural sanitation for the poor. The programmatic
approach combines Community-Led Total Sanitation (CLTS), behavior change
communication, and sanitation marketing to generate sanitation demand and
build up the supply of sanitation products and services at scale. In addition,
WSP works with local and national governments and the local private sector
to strengthen the enabling environment—including institutional, regulatory,
financial, service-delivery, and monitoring capacities—to achieve change that is
sustainable. Starting in India, Indonesia, and Tanzania in 2006, Scaling Up Rural
Sanitation is currently being implemented in over a dozen countries. For more
information, please visit www.wsp.org/scalingupsanitation.
This Working Paper is one in a series of knowledge products designed to showcase
program findings, assessments, and lessons learned through WSP’s Scaling Up Rural
Sanitation initiatives. This paper is conceived as a work in progress to encourage the
exchange of ideas about development issues. For more information please email
Eddy Perez at wsp@worldbank.org or visit www.wsp.org.
WSP is a multi-donor partnership created in 1978 and administered by the World Bank to
support poor people in obtaining affordable, safe, and sustainable access to water and sanitation
services. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill &
Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland,
United Kingdom, United States, and the World Bank.
WSP reports are published to communicate the results of WSP’s work to the development
community. Some sources cited may be informal documents that are not readily available.
The findings, interpretations, and conclusions expressed herein are entirely those of the author
and should not be attributed to the World Bank or its affiliated organizations, or to members
of the Board of Executive Directors of the World Bank or the governments they represent. The
World Bank does not guarantee the accuracy of the data included in this work.
The material in this publication is copyrighted. Requests for permission to reproduce portions of
it should be sent to wsp@worldbank.org. WSP encourages the dissemination of its work and will
normally grant permission promptly. For more information, please visit www.wsp.org.
© 2012 Water and Sanitation Program
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Scaling Up Rural Sanitation
Enabling Environment
Endline Assessment:
Himachal Pradesh and
Madhya Pradesh, India
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Executive Summary
The Water and Sanitation Program (WSP) has been implementing the Scaling Up Rural Sanitation initiative since
2007. One of the central objectives of the program is to
improve sanitation at a scale sufficient to meet the 2015
sanitation MDG targets in Indonesia, Tanzania, and the
Indian states of Himachal Pradesh (HP) and Madhya
Pradesh (MP).
Although WSP provided similar levels of support and promoted similar approaches and tools in both HP and MP,
the starting contexts were different, with HP recognized as
a small, relatively progressive, and wealthy state, and MP as
one of the largest and least developed states in India. Rural
sanitation coverage was higher in HP, but was still low at
only 28 percent in 20011, creeping up to 34 percent by
2006; rural sanitation coverage in MP was extremely low
at baseline, reaching only 10 percent in 2006. Both states
faced a huge sanitation challenge, but it was clear that the
larger challenge was in MP.
One of the key differences between the methodology for
the program in India and that in either Tanzania or Indonesia is the pre-existence of a large-scale, national rural
sanitation program, The Total Sanitation Campaign
(TSC). TSC is a huge and ambitious program—in its
current phase, the national TSC budget exceeds US$3.9
billion, with a goal in the next five-year phase (2008–
2012) of providing toilets to 115 million households.
It aims to achieve open defecation free status across the
country by 2012.
TSC provides a broad financial, policy and institutional
framework for sanitation improvement in India, but allows individual states and districts the freedom to develop local policies and interventions according to their
specific needs and priorities. This freedom limits central
control of program methodology, but allows more progressive local governments to develop and implement
new approaches and policies. As a result, there is a wide
variation in the effectiveness and outcomes of TSC in different states.
1
Although TSC has been operating since 1999, it has promoted the elimination of open defecation and the achievement of collective sanitation outcomes only since the
introduction of the complementary Nirmal Gram Puraskar (NGP) awards in 2004. In the last few years, TSC and
NGP guidelines provided a well-understood framework for
sanitation and hygiene improvement, with most state and
district governments now actively engaged in rural sanitation promotion and sanitation-related activities.
Prior to the program, WSP had established a good relationship with the Governments of HP and MP, and during the
program has supported the TSC in both states, working
to enhance and broaden the level of support provided: to
leverage TSC resources and sector opportunities at the national level; to extend its pre-existing engagements at the
state level; and to facilitate achievement of the program objectives and outcomes.
Methodology
A baseline assessment of the enabling environment in Himachal Pradesh and Madhya Pradesh was carried out in July
and August 2007. An endline assessment of the enabling
environment took place in mid-2010 using a similar methodology and interview guide to the baseline assessment.
To ensure consistency in the assessment findings, WSP developed a conceptual framework for assessing the enabling
environment for sanitation. This framework, developed on
the basis of a literature review and discussions with key actors, consists of eight dimensions considered essential to
scaling up rural sanitation, including:
•
•
•
•
•
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•
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Policy, strategy, and direction
Institutional arrangements
Program methodology
Implementation capacity
Availability of products, tools, and information
Financing and incentives
Cost effective implementation
Monitoring and evaluation
Government of India (2001) Census of India 2001.
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Findings
TSC and NGP continue to provide excellent frameworks
for rural sanitation development through the provision of
adequate finance, basic technical guidelines, and institutional incentives. Sanitation is a state subject, allowing considerable latitude in how these resources and mechanisms
are used by local governments, and resulting in highly variable outcomes across states. Therefore, despite rural sanitation development being guided by the TSC and NGP, the
enabling environment at state level has a significant impact
on sanitation activities and outcomes.
In 2010, rural sanitation coverage in HP is estimated to
have passed 80 percent, an increase of around 50 percent
in only four years; whereas coverage in MP is estimated
at around 17 percent, barely 7 percent growth during the
same four-year period. Given similar government programs
and program support, it is significant that the HP program
has accelerated dramatically over the last three years, while
the MP program has struggled to reach the average coverage
level in India.
There was a huge difference in the scale of challenge in
MP, and some credit is due as both states have managed
to provide sustainable sanitation to a similar number of
households over the last three years, with an additional
600,000 or so households covered in each state. However,
HP is a much smaller state and achieved this coverage gain
with rural sanitation expenditures of around US$8 million,
compared to more than US$80 million invested in MP.
While there are undoubtedly higher cost factors in the huge
scale of the MP program, and in the higher proportions of
poor and marginalized households, this endline assessment
found that the significantly better cost-effectiveness in HP
reflects a much stronger enabling environment than that
found in MP.
Enabling environment in Himachal Pradesh
Significant improvements were apparent in the enabling
environment for rural sanitation in Himachal Pradesh since
baseline. Strong political support for sanitation, led by the
Chief Minister, has galvanised local leaders and administrators, enabling already competent local governments to
use all of their capacity and resources to address sanitation
deficits.
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Executive Summary
The state government stood firm on the no-subsidy policy
introduced in 2005, despite concerns that HP was losing out by not utilizing the growing BPL latrine incentive
funds available through TSC. There was a consensus that a
demand-led approach, rather than a supply-driven and subsidized approach, was working well. This consensus was fed
by widely reported open defecation free (ODF) successes and
expanding evidence of the benefits of improved sanitation,
which led to strengthened local government commitment to
TSC implementation and rapid scaling up of progress.
Regular monitoring and benchmarking of TSC progress,
including spot checks by senior state officials and weekly
videoconferences with the chief minister, at which TSC
progress was discussed, provided incentives for district
administrators to prioritize the program, and encouraged
improved coordination and cooperation between local
government departments. Competition between neighboring areas was also an important motivation, driven by the
regular WSP benchmarking reports that the government
adopted as its key performance monitoring tool.
Nirmal Gram Puraskar (NGP) awards remain an important
incentive for sanitation development by local governments,
but the institutionalization of the state sanitation awards in
HP over the last three years has been even more effective in
generating political and popular support for rural sanitation
improvement. The state sanitation awards target a broader
group of stakeholders, including school children and women’s
self-help groups, and have deliberately involved elected representatives from local government in judging and presenting
the awards. As a result, a large proportion of the population is
familiar and engaged with the awards, which are seen to recognize and promote a Himachali vision of purity and cleanliness.
Good use was made of WSP technical support, with capacity building organized in advance of strategic needs, and
regular demands made for WSP support in new areas as
the program progressed and scaled up. Exposure visits were
used to introduce and validate new approaches, and the
full-time presence of the WSP state coordinator was important in maintaining momentum and interest.
Overall, a more institutional and enabling approach has been
developed, with continuous sanitation development now
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seen as an integral part of the government program. The vision of an open defecation free Himachal Pradesh (Nirmal
Himachal) by 2012, which seemed unlikely at the outset of
the program in 2007, is now viewed as a realistic and achievable goal. At baseline, two or three exceptional districts were
performing well whereas today, at endline, only two or three
districts out of the twelve in Himachal Pradesh are lagging
behind, and even these supposed laggards report that more
than half of their villages are now ODF.
Enabling Environment in Madhya Pradesh
There is little evidence that the enabling environment for
rural sanitation has improved in MP since baseline, despite
the relocation of TSC within the Panchayat and Rural Development department (PRD). Significant implementation
efforts and investments have been made in rural sanitation
through the program, TSC, NGP, and NREGA programs
and projects, and through substantial technical support
provided by UNICEF, WaterAid, and other development
partners. However, this work has translated into relatively
meager benefits due to the lack of high-level engagement,
commitment, or priority.
Political support for sanitation remains limited. There was
little evidence that local leaders or administrators see sanitation improvement as a priority: the chief minister has not
yet presented the 2009 NGP awards to the winning village heads, and no state sanitation awards had been made
more than two years after inception. There is little involvement or coordination of TSC activities with those of other
government departments, and there appears little recognition of the cross-sectoral benefits of effective sanitation
improvement.
While few reliable data were available, the policies and approaches adopted in MP do not appear cost-effective. Total
investments in rural sanitation over the last three years are
estimated to be about ten times higher than those in HP
and, while TSC online monitoring data report dramatic
increases in sanitation coverage, more rigorous large-scale
household surveys and recent WSP assessments suggest that
many of the latrines built through TSC in MP are not being
used. In addition, the use of multiple program subsidies to
finance latrine construction means that the leverage ratio
is also low—program investments are not leveraging much
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Executive Summary
household investment in latrines—which is limiting the
scale and spread of improved outcomes.
WSP has undertaken similar activities to strengthen the
enabling environment in both HP and MP, including exposure visits, capacity building, performance benchmarking, targeted assessments, and sharing of best practices. This
approach proved successful in HP, where local government
was receptive and engaged in the process but has had only
limited success in MP. While some of the problems stem
from the more challenging context in MP, the conclusion
of this assessment is that the failure of the state government
to embrace critical elements of the approaches promoted
by the program—such as the need to move away from a
supply-driven approach toward a demand-based total sanitation approach—limited high-level recognition of the
problems and prevented the reforms required to improve
the enabling environment.
Enabling Environment at National Level
One of the lessons from the HP and MP assessments is that
high latrine subsidies can create implementation problems
because of the temptation to revert to supply-driven approaches and short-circuit demand creation processes. The
rising BPL incentive in MP has increased the use of supplydriven approaches, which in turn has diminished efforts to
generate genuine demand for latrines or to encourage user
involvement in the process. In contrast, the zero hardware
subsidy adopted in HP, which resulted from the decision
not to use the BPL incentive funds provided by the TSC,
encouraged local governments to develop cost-effective approaches to demand generation and institutional support,
and ensured that households who built latrines felt ownership, responsibility, and pride in their facilities.
The recent WSP rapid assessment of TSC processes and outcomes provided good evidence of the association between
process quality and TSC project performance. Discussions
with the Department of Drinking Water Supply (DDWS)
revealed that support for the total sanitation approach,
which was relatively low in central government at baseline,
has increased substantially as evidence of the higher sustainability and cost-effectiveness of this approach over more
supply-driven approaches has emerged. However, DDWS
has little authority to impose specific approaches and tools
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
on independent state and district projects, and is thereby
restricted to knowledge management and advocacy activities to share best practices, highlight implementation issues,
and strengthen accountability for program outcomes.
Executive Summary
as cost-effective as hoped. The lesson appears to be that
implementation support should not be scaled up until the
government is fully engaged and some minimum enabling
environment conditions are met; otherwise there will be a
significant opportunity cost to any investment.
Nirmal Gram Puraskar
NGP continues to be a controversial program. Recent
evaluations by UNICEF and others found NGP-awarded
villages with low sanitation coverage and significant levels
of open defecation, raising questions about the integrity
of the NGP verification process and the sustainability of
sanitation outcomes generated by the NGP awards. This
assessment concludes that the positive effects of NGP in
generating political attention to sanitation improvement,
and in galvanizing local government activity, far outweigh
the problems associated with the process.
Potential to Achieve Sanitation MDG
NGP fulfils its original function well, in that it creates incentives for local governments to achieve collective sanitation outcomes and it draws considerable political attention
to rural sanitation improvement. NGP was never meant to
be a mechanism for ensuring the long-term sustainability
of these outcomes. Since baseline, NGP has been strengthened to add some emphasis to sustainability, but a complementary program is needed to provide the long-term
institutional support and monitoring that will ensure more
sustainable improvements in rural sanitation.
At the end of the program, it appears that HP has already
surpassed its 2015 MDG target. The 2008 District Level
Household and Facility Survey (DLHS) reported rural sanitation coverage of 53 percent, while recent estimates suggest that coverage has passed 80 percent in 2010. In MP,
the 2008 DLHS found that rural sanitation coverage had
increased to only 10 percent, while recent forecasts suggest
that coverage is unlikely to be much higher than 17 percent
in 2010. At the current rate, which is around 2.5 percent
increase in rural sanitation coverage per year, MP will not
reach its MDG until 2025.
The 2015 MDG for sanitation is to halve the proportion
of the population without access to basic sanitation (using
a 1990 baseline). The lack of sanitation data disaggregated
by state makes it difficult to estimate the 1990 baseline, but
it has been assumed that 1990 rural sanitation coverage in
MP was close to the national average of 7 percent, which
would set the 2015 MDG for rural sanitation at 54 percent
coverage; and the 1990 baseline in HP was around 15 percent, setting the MDG at 58 percent.
WSP Enabling Environment Role
The WSP team played an important role in developing the
enabling environment for rural sanitation at both the national and at the state level in HP. However, it has had only
limited success in influencing the enabling environment in
MP, and it lacks the staff capacity to implement parallel
support programs in a number of other Indian states that
have asked WSP for assistance of the type provided by the
program.
The WSP team acknowledged that it became apparent over
the last year or so that the program in MP lacked the high
level political influence required to shift the policy on latrine subsidies and supply-driven approaches or to generate
real political engagement with both TSC and NGP programs. As a result, many of the lower level activities related
to program implementation have not been as successful or
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Key Lessons
The success of the HP TSC project, to which the program
contributed, has shown that, under the right conditions,
rapid and large-scale sanitation progress is possible in only
a few years; and that ODF success rates need not be limited
to the 35 percent suggested by previous implementation
experiences. When the enabling environment is well developed, and strong political support drives implementation,
universal sanitation can become a realistic and achievable
goal within a relatively short period.
This endline assessment found that political support and
priority were central to the success of TSC and NGP programs in HP. While the reasons for the development of this
political support are complex, it seems likely that the early
successes provided by a combination of progressive state
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
sanitation policies and exceptional leadership in Mandi
District were sufficient to demonstrate that new approaches
worked and that rapid sanitation improvements were possible. In addition, there was some convergence between the
aims of TSC, Himachali cultural mores, and a growing environmental movement, which made sanitation improvement a politically viable and attractive cause for leaders like
the chief minister.
Recommendations
As a result of this endline assessment of the enabling environment, there are specific recommendations for support
to non-performing states. The experience in MP suggests
that where the enabling environment is not supportive or
developed, the initial focus should be on the development
of model districts rather than large-scale implementation or
technical assistance, so that local approaches and successes
can be showcased to increase support for rural sanitation
improvement.
The intention is to limit investment until the enabling
environment improves, and to use program funds to reward improved performance and good governance (for example through scaling up in model districts) rather than
spreading efforts thin before supportive conditions are in
place. Wherever possible, model districts should introduce
evidence-based approaches to challenge supply driven implementation and subsidy cultures, attempt to demonstrate
that poor households can build improved sanitation facilities without up-front subsidies, and that more sustainable
outcomes result from the generation of genuine demand
and ownership for household latrines.
Recommendation 1: Reformulate the Total Sanitation
Campaign
TSC was designed as a framework for five-year district projects. It therefore assumed an intensive, campaign-mode approach suited to a short lifespan. In practice, it has already
run for 10 years in some districts, and looks likely to operate on a long-term basis in many more. Furthermore, it
was developed from the more technical and constructionoriented Central Rural Sanitation Program (CRSP), whereas
the emphasis is now largely on behavior change and public
health issues. As such, the program design should be reformulated to reflect the longer-term objectives of sanitation
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Executive Summary
improvement, and to incorporate a more public health-based
framework for measuring sanitation and hygiene outcomes.
In addition, TSC guidelines, which have been evolving
gradually as TSC itself changes, should be developed into
a more formal rural sanitation policy—one that is relevant
for all rural sanitation interventions not just those under
TSC. A rural sanitation policy based on TSC guidelines
would provide opportunities to involve stakeholders from
other sectors and encourage an evidence-based policy development process building on the strengths of TSC, without
being limited by its programming needs.
Recommendation 2: Develop More Effective High-level
Advocacy
In order to present Government with clear, consistent, and
evidence-based messages that are designed to influence
high-level decision makers, development partners should
work to harmonize their advocacy, enabling environment,
and performance assessment activities. In particular, reliable cost-effectiveness data should be collected and used
more widely to demonstrate the wasted investments and
opportunity costs of some current sanitation strategies and
implementation approaches, and the greater effectiveness
and sustainability of alternatives.
Recommendation 3: Recognize That One Strategy
Does Not Fit All
Better information and data on latrine usage, sustainability of behavior change, and targeting accuracy (i.e. success
in improving sanitation for the poorest households) are required to develop strategic plans to meet the government’s
sanitation targets.
In particular, efforts need to be made to identify hard-toreach areas and groups, to examine issues that limit the costeffectiveness and sustainability of sanitation improvements,
and to recognize that different strategies, resources and tools
are required in different contexts and stages of development.
Recommendation 4: Encourage a Two-stage Incentive
System
At endline, the HP experience clearly demonstrates the benefits of a two-stage process, whereby the momentum and
support generated by widespread ODF achievement has
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Executive Summary
developed the comprehensive enabling environment required for rapid progress
towards the harder-to-achieve environmental sanitation and hygiene improvement requirements of the NGP award.
It is recommended that WSP encourage other progressive states to employ a twostage process to provide further evidence of the benefits of this approach, with
a longer-term view to convincing the Department of Drinking Water Supply
(DDWS) to formalize the inclusion of a two-stage approach in TSC guidelines.
Recommendation 5: Invest in Cost-effectiveness Data
The publication and dissemination of reliable evidence of wasted investments
and opportunity costs remains one of the most powerful motivators for government reform and improvement, especially when those costs relate to emotive
issues like children’s health, environment, and poverty. More effort is needed to
collect and analyze information on sanitation program costs, outcomes, and impacts into simple cost-effectiveness measures and advocacy materials that can be
used to encourage competition among districts and states, to identify optimal
strategies, and to influence high-level decision and policy makers.
Recommendation 6: Incorporate Latrine Usage and Sustainability into
Benchmarking Systems
While latrine usage and sustainability data are not as easy to collect as information
on the number of latrines built, it is important that sanitation programs begin
to work toward routine monitoring and benchmarking of sanitation outcomes.
Initially, it may be necessary to undertake annual rapid assessments in order to
generate latrine usage and sustainability data that can inform annual performance
reviews, but eventually this data should be collected as part of routine public
health monitoring systems.
Recommendation 7: Develop State Capacity for Knowledge Management
Exposure visits and horizontal learning events were identified as the most important knowledge management tools for local governments. At present, local governments are reliant on agencies like WSP and UNICEF to organize these visits
and events, which often makes them dependent on external program finance and
constrained development partner capacity.
The development of state capacity to organize knowledge management events
should form part of the program exit strategy in both states, through the formulation of a phased annual knowledge management program that outlines
the diminishing role to be played by WSP. Local governments will require some
hand-holding during early events, but the additional value provided by these
events should allow the development of sustainable mechanisms to finance and
manage them, while WSP gradually builds local capacity for their planning and
facilitation.
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Contents
Executive Summary.................................................................. iii
Abbreviations and Acronyms .................................................. xii
Definitions ............................................................................... xiv
I.
Introduction ............................................................................... 1
II.
Assessment Framework and Methodology ............................. 2
2.1 Assessment Dimensions ...................................................... 2
2.2 Methodology of Assessment ................................................ 3
2.3 Sampling Protocol ................................................................ 4
III. Context ...................................................................................... 6
3.1 General ................................................................................. 6
3.2 Health ................................................................................... 6
3.3 Sanitation and Hygiene ........................................................ 7
3.4 Legal Framework .................................................................. 7
IV. Total Sanitation Campaign ........................................................ 8
4.1 Evolution of the Total Sanitation Campaign ......................... 8
4.2 TSC Methodology ................................................................ 9
4.3 TSC Latrine Subsidies ........................................................ 10
4.4 TSC Incentive Framework .................................................. 11
V.
Baseline Findings .................................................................... 12
5.1 Himachal Pradesh: Sanitation Coverage at Baseline ......... 12
5.2 Madhya Pradesh: Sanitation Coverage at Baseline ........... 12
5.3 Baseline Assessment Findings ........................................... 12
VI. Endline Findings ...................................................................... 15
6.1 Policy, Strategy, and Direction ........................................... 15
6.2 Institutional Arrangements ................................................. 20
6.3 Program Methodology........................................................ 23
6.4 Implementation Capacity ................................................... 28
6.5 Sanitation Goods, Services, and Information..................... 30
6.6 Financing ............................................................................ 32
6.7 Cost-Effective Implementation ........................................... 38
6.8. Monitoring and Evaluation................................................. 41
VII. Conclusions ............................................................................. 48
7.1 Enabling Factors in HP ....................................................... 48
7.2 Disabling Factors in MP ..................................................... 49
7.3 Return to the CRSP? .......................................................... 50
7.4 Enabling Environment at the National Level ....................... 51
7.5 Nirmal Gram Puraskar ........................................................ 51
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Contents
7.6 WSP Enabling Environment Role ....................................... 52
7.7 Potential to Achieve Sanitation MDG ................................. 52
7.8 Key Lessons ....................................................................... 53
VIII. Recommendations .................................................................. 54
References ............................................................................... 57
Annexes
1:
2:
3:
4:
Assessment Meetings and Activities ................................. 60
Terms of Reference for Consultancy ................................. 62
Endline Interview Guide ..................................................... 67
Program Benchmarking Assessments by District, MP ...... 72
Figures
1:
2:
3:
4:
5:
6:
Infant Mortality Rates ........................................................... 6
Trend in Rural Sanitation Coverage—India .......................... 7
Improved Sanitation Coverage in Rural Areas, HP ............ 43
Improved Sanitation Coverage in Rural Areas, MP ........... 43
Latrine Usage in HP and MP ............................................. 44
Access to Improved Sanitation Since 1995 by Wealth
Quintile ............................................................................... 46
Tables
1:
2:
Program Areas and Number of Beneficiaries..................... 2
TSC Components: Revised Earmarking and Funding
Pattern ............................................................................... 9
3: Comparative TSC and NGP Performance ...................... 14
4: Enabling Environment Improvements: Policy, Strategy,
and Direction .................................................................... 19
5: Enabling Environment Improvements: Institutional
Arrangements................................................................... 22
6: Enabling Environment Improvements: Program
Methodology .................................................................... 27
7: Enabling Environment Improvements: TSC
Implementation Capacity ................................................. 30
8: National Growth in Nirmal Gram Puraskar Awards .......... 35
9: State Growth in Nirmal Gram Puraskar Awards ............... 36
10: Enabling Environment Improvements: Finance and
Incentives ......................................................................... 37
11: Enabling Environment Improvements:
Cost-Effectiveness ........................................................... 41
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12:
13:
14:
15:
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Contents
TSC Physical Progress: Individual Household Latrines ... 42
TSC Physical Progress: Institutional Toilets..................... 42
Enabling Environment Improvements: Monitoring and
Evaluation ........................................................................ 47
Geographic Areas and Beneficiaries ............................... 63
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Abbreviations and Acronyms
Anganwadi
ADC
APL
BDO
BPL
BRC
CBO
CCDU
CLTS
Crore
CRSP
DC
DDWS
DLHS
DLM
DRDA
DWSM
GoI
GP(s)
Hhd
HP
IEC
JMP
Lakh
MDG
M&E
MP
MVSSP
NREGA
NGO
NGP
Nirmal Watika
NRDWP
NRHM
ODF
Panchayat
PHED
PRD
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Childcare center
Assistant District Collector (also known as Assistant District
Magistrate)
Above Poverty Line
Block Development Officer
Below Poverty Line
Block Resource Centers
Community-Based Organization
Communication and Capacity Development Unit
Community-Led Total Sanitation
10,000,000 (ten million) Rupees
Central Rural Sanitation Program
District Collector (or District Commissioner, or District
Magistrate)
Department of Drinking Water Supply
District Level Household and Facility Survey
District Level Monitoring (program of TSC)
District Rural Development Agency
District Water and Sanitation Mission
Government of India
Gram Panchayat(s), local political body
Household
Himachal Pradesh
Information, Education and Communication
WHO-UNICEF Joint Monitoring Program for Water Supply
and Sanitation
100,000 (one hundred thousand)
Millennium Developmental Goals
Monitoring and evaluation
Madhya Pradesh
Maharishi Valmiki Sampoorn Swachata Puraskar (State Sanitation Reward Scheme)
National Rural Employment Guarantee Act
Non-Governmental Organization
Nirmal Gram Puraskar (Clean village award)
Clean Garden
National Rural Drinking Water Program
National Rural Health Mission
Open Defecation Free
An elected body at village level.
Public Health Engineering Department
Panchayat and Rural Development Department
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PRI
RDD
RGNDWM
RSM
SSA
SDM
SLWM
SRSP
SWSM
TSC
UNICEF
WHO
WASH
WSP
ZP
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Abbreviations and Acronyms
Panchayati Raj Institutions (local government system)
Rural Development Department
Rajiv Ghandi National Drinking Water Mission
Rural Sanitary Mart
Sarva Shiksha Abhiyan (SSA) Education for All program
Sub Divisional Magistrate
Solid and Liquid Waste Management
State Rural Sanitation Program
State Water and Sanitation Mission
Total Sanitation Campaign
United Nations Children’s Fund
World Health Organization
Water, Sanitation and Hygiene
Water and Sanitation Program (South Asia)
Zila Parishad (district council)
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Definitions
To ensure a common understanding of the concepts and
terms used in the report, the following definitions are
provided:
CLTS: Community-Led Total Sanitation (CLTS) is the
original variant of the total sanitation approach, a process
to inspire and empower rural communities to stop open
defecation and start using sanitary toilets, without offering
external subsidies for the purchase of hardware such as toilets pans and pipes.2 CLTS uses a participatory analysis of
community sanitation to identify key triggers to motivate a
community to take collective action to improve its sanitation status.
Handwashing: Hands become contaminated with fecal
material after anal cleansing, or after cleaning children’s
bottoms or handling their feces. Rinsing with water alone is
not enough to remove sticky microbe-containing particles
from hands. Some form of soap is required: hands need
to be rubbed with soap and water until fully covered with
soapsuds, and then rinsed off with water.
Hygiene promotion: A planned approach to prevent diarrheal disease (and other health problems) through the widespread adoption of safe hygiene practices, e.g. campaigns to
encourage regular handwashing at appropriate times. Note:
hygiene promotion is usually a much broader intervention
than sanitation promotion, which focuses solely on the safe
management and disposal of excreta.
Informed choice: Demand-based programming places
the community in the role of decision-maker in the selection, financing, and management of their water supply
and sanitation system. In order to effectively implement a
demand-responsive approach, the government should take
the role of facilitator and provide informed choices to the
community regarding the development and construction of
sound infrastructure and services, taking into account local
financial, technical, environmental, social, and institutional
factors. Informed choices are provided in participatory
2
3
sessions, covering technology and service options based on
willingness to pay, and provide insight on the service provision schedule and know-how, management of funds and
responsibilities, and management of services.
Program software: Activities that support and promote the
provision of program services and facilities, for example:
media campaigns, capacity building activities, or community hygiene promotion sessions. Note: program software
must be differentiated from program hardware (infrastructure), which includes tangible program products and facilities such as toilets, soakaways, and handwashing facilities.
Rural: That which is not urban, with urban spaces in India
defined as towns (places with municipal corporations, municipal area committees, town committees, notified area
committees or cantonment boards); also, all places with
5,000 or more inhabitants, a population density not less
than 390 persons per square kilometer, or at least threequarters of the adult male population employed in pursuits
other than agriculture.
Sanitation: Interventions for the safe management and disposal of excreta, with the principal safety mechanism being
the separation of excreta from all future human contact.
The term improved sanitation is used in this report to denote private facilities that provide safe management and
disposal of excreta. The WHO-UNICEF Joint Monitoring
Program (JMP) offers the following simple definitions3 of
improved sanitation facilities that provide “sustainable access to basic sanitation”:
•
•
•
•
Pit latrine with slab,
Ventilated improved pit latrine,
Composting toilet, and
Flush or pour-flush to latrine pit, septic tank, or
piped sewerage.
Unimproved sanitation facilities, which do not provide adequate access to basic sanitation, include:
Kar 2005.
JMP 2006.
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•
•
•
•
•
Definitions
Pit latrine without slab (open pit),
Shared or public sanitation facilities,
Hanging latrine,
Bucket latrine, and
Flush or pour-flush to elsewhere (street, yard, ditch, open drain, or other
location).
Sanitation marketing: An approach that utilizes the power of the small- and
medium-scale private sector in the provision of sanitation services and uses techniques of commercial marketing and behavior change communication to create
demand.
Sanitation promotion: Encourages the safe management and disposal of excreta
through the widespread adoption of safe sanitation facilities and practices, for
example, programs promoting the construction and universal use of improved
sanitation facilities.
Scheduled castes (SCs): Historically disadvantaged, low ranking, hereditary
classes of Indian society, now under formal government protection.
Scheduled tribes (STs): Tribal communities now under formal government protection, with key characteristics being traditional occupation of a definitive geographical area, culture that includes tribal modes of life including tribal language,
customs, traditions, religious beliefs, arts, and crafts.
Total sanitation approach: A community-wide approach whose main aim
is universal toilet use (total sanitation) in each community covered. The total
sanitation approach focuses on stopping open defecation on a community-bycommunity basis through recognizing the problems caused to all by open defecation within and around the community, and ensuring that every household
uses either their own affordable toilet, or a shared toilet situated close to their
home. The total sanitation approach is a broader variant of Community-Led
Total Sanitation (see definition above) that may involve financial incentives (e.g.
post-construction subsidies provided by the Total Sanitation Campaign in India);
the promotion of broader environmental sanitation objectives such as drainage
and solid waste management; and the promotion of hygiene improvement activities such as handwashing.
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I.
Introduction
The Water and Sanitation Program (WSP) has implemented the Global Scaling
Up Rural Sanitation (TSSM) project since 2007. One of the central objectives of
the program is to improve sanitation at a scale sufficient to meet the 2015 sanitation Millennium Developmental Goals (MDG) targets in Indonesia, Tanzania,
and the Indian states of Himachal Pradesh (HP) and Madhya Pradesh (MP).
A consultant was contracted to perform an endline assessment of programmatic
and institutional conditions (referred to by the program as the enabling environment) needed to scale up, sustain, and replicate the total sanitation and sanitation
marketing program approaches in two Indian states, HP and MP. The Terms of
Reference (TOR) are detailed in Annex 2. This report is the main output of that
consultancy.
The baseline assessment of the enabling environment was completed in May and
June 2007, during the start up phase of the overall program. This follow up endline assessment was carried out three years later in mid-2010, following a oneyear extension of the program from its original mid-2009 end date.
The purpose of the endline assessment is to:
• Assess the extent to which the enabling environment for scale up and sustainability have improved by the end of the program;
• Recommend what should be done to address any gaps identified by the
assessment during the remainder of the program implementation period,
or in the future if a follow-on program is undertaken; and
• Determine whether an appropriate enabling environment is in place to
meet the 2015 MDG sanitation target, and assess whether these conditions are likely to be sustained.
The fundamental determination that the endline assessment should clarify is if,
in India (and specifically these two Indian states) the enabling environment has
been institutionalized to support scaling up in a sustainable manner, and whether
that scale up can continue after 2010: without assistance, with less assistance, or
with difference assistance from the program.
This report presents the main findings and recommendations from the endline
assessment of the ability of the enabling environment to scale up, sustain, and
replicate sanitation improvements in HP and MP, India.
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II.
Assessment Framework and Methodology
In order to improve the comparability of the findings from
the assessment in India with those from the assessments in
Indonesia and Tanzania, a common assessment framework
was developed by the WSP headquarters team and its specialist advisors in Washington DC. The assessment framework
consists of eight dimensions that are considered essential to
scaling up, sustainability, and replication of the total sanitation and sanitation marketing approaches in rural areas:
•
•
•
•
•
•
•
•
Policy, strategy, and direction
Institutional arrangements
Program methodology
Implementation capacity
Availability of products, tools, and information
Financing and incentives
Cost effective implementation
Monitoring and evaluation
Definition of Scale-up: Increase the scale, rate of provision,
and sustainability of sanitation services to reach the threeyear 2010 targets in the program and the MDG targets for
2015 (see Table 1).
2.1 Assessment Dimensions
The eight assessment dimensions4 represent a conceptual
framework for assessing scalability and sustainability.
2.1.1 Policy, Strategy, and Direction
Establishing a shared vision and strategy and ensuring
the political will to implement a program is the starting point for scale up. Developing this shared vision and
strategy in a collaborative manner is also the foundation
for coordination and for creating motivation all levels.
Policy is defined as the set of procedures, rules, and allocation mechanisms that provide the basis for programs
and services. Policies set the priorities and often allocate resources for implementation. Policies are reflected
in laws and regulations, economic incentives, and the
assignment of rights and responsibilities for program
implementation.
2.1.2 Institutional Arrangements
In order for the total sanitation and sanitation marketing
approaches to be scaled up, the right institutions must
be in place with all key roles and functions covered and
clearly understood. These institutions must also have the
resources to carry out their roles. In addition to clear
roles and responsibilities, institutional arrangements include the mechanisms for actors at all levels to coordinate their activities and establish partnerships between
the public, private and non-governmental organization
(NGO) sectors, and between communities and local
governments.
TABLE 1: PROGRAM AREAS AND NUMBER OF BENEFICIARIES (MILLIONS)
People Who Will Gain Access
Additional Access to Sanita-
People without Access to San-
to Sanitation During Three-
tion Needed to Meet 2015
Program Areas (population)
itation in 2006 (estimate)*
Year Program (estimate)
MDG Targets**
Tanzania (26.7 million rural)
14.25
0.75
6.5
East Java, Indonesia (36.5
18.60
1.40
10.0
HP, India (5.5 million rural)
4.30
0.70
1.2
MP, India (45 million rural)
43.60
1.10
20.0
Total
80.75
3.95
37.7
million)
* Best estimates given poor status of data
** Accounts for population growth estimates
4
The baseline report included nine assessment dimensions, but the Partnerships dimension was particular to the handwashing project and was therefore merged with the
institutional arrangements dimension for this endline assessment.
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2.1.3 Program Methodology
The program methodology consists of the program rules,
specific activities, and their timing and sequence. Each country will adapt and apply the program methodology making it
specific and appropriate to the country context. A workable
program methodology that is clear and agreed upon by all
key stakeholders is a key programmatic condition.
2.1.4 Implementation Capacity
At all levels institutions must have the capacity to carry out
their roles and responsibilities. Institutional capacity includes adequate human resources with the full range of skills
required to carry out their functions, an “organizational
home” within the institution that has the assigned responsibility, mastery of the agreed upon program methodology,
systems and procedures required for implementation, and
the ability to both monitor program effectiveness and make
continual adjustments.
2.1.5 Availability of Products, Tools, and Information
The ability of target consumers to adopt the promoted
behavior(s) is highly dependent on the existence and availability of products, tools, and information that respond to
consumer preferences and their willingness and ability to
pay for them. Any and all relevant products and services
need to be considered, specific to each country situation.
2.1.6 Financing
This dimension assesses the adequacy of arrangements
for financing the programmatic costs. These costs include
training, staff salaries, transportation, office equipment and
supplies, and the development of communication and education materials as well as programmatic line items in budgets for program and promotion activities.
2.1.7 Cost-effective Implementation
Although it will not be possible to assess the cost-effectiveness
of the approach or how best to achieve economies of scale
and scope until the end of the program, data must still be
collected during implementation to make this determination at the end of the program. Therefore, the focus in this
assessment category is to ensure that information will be
5
Assessment Framework and Methodology
collected from the outset and that the capacity to collect
the information is in place—that systems and procedures
for collecting cost information and the capacity to use and
collect the information exist.
2.1.8 Monitoring and Evaluation
Large-scale sanitation programs require regular monitoring
and periodic evaluation and, perhaps more importantly,
the willingness and ability to use the monitoring process
to make adjustments in the program. Effective monitoring will identify strengths and weaknesses in the program
methodology, implementation arrangements, and cost efficiencies. Overall monitoring responsibility must be at the
highest level of the program, but must be based on information collected at the local government or community level.
2.2 Methodology of Assessment
An international consultant carried out the endline assessments in India with support from the WSP state Coordinator for MP5 during the fieldwork in both HP and MP,
with overall direction and support from the WSP Country
Task Manager for the program (Ajith Kumar) and the WSP
team.
The endline assessments were conducted through a series
of one-to-one interviews with key stakeholders at national,
state, division, district, block, Gram Panchayat (GP), and
village level. Based on the assessment framework, a generic
interview guide was prepared, and was further revised and
developed by the consultants and the program team in order
to match the questions and language more closely to local
contexts and norms. The India-specific interview guide
was used in each interview, although some dimensions and
questions were not considered relevant (or appropriate) to
some stakeholders (e.g., asking local retailers about national
strategy issues). All the dimensions of the assessment framework were covered, but not by every stakeholder.
The interview guide is included as Annex 3.
Primary data sources were main stakeholders and partners
for the in-country program work, including but not limited
Appointed in May 2007 for a three-year period, now working as a short-term consultant.
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Assessment Framework and Methodology
to government agencies, international agencies, international
non-governmental organizations (NGOs), local NGOs,
private-sector businesses, and community-based organizations (CBOs). These primary data sources were contacted at
all appropriate levels: national, state, district, and local. Secondary data sources comprised key documents, and potential
influencers or secondary implementers such as media, ministries with no direct involvement, advocacy groups and so on.
In HP, the following two districts were randomly selected
for assessment from each of the two middle performance
quartiles of the WSP benchmarking data:
2.3 Sampling Protocol
Sampling was purposive for all primary data sources.
During the assessment, a review of the benchmarking data
revealed that Kullu district had been wrongly ranked due to
an error in the automatic benchmarking spreadsheet. Kullu
is the highest ranked district for household latrine coverage (104 percent of TSC target achieved in May 2010); has
achieved 99.5 percent ODF coverage (203 out of 204 GPs
have been declared ODF); and has the best “financial efficiency” with an expenditure of only Rs 0.55 lakh per ODF
community (US$1,220).7 Unfortunately, no score was allocated to Kullu for its financial efficiency, and it has not
yet applied for many Nirmal Gram Puraskar or clean village
awards (NGP) awards,8 thus it was graded as a below average performer. Following a correction to the financial efficiency score, which awards an over-large 15 points to the
top performer in this category, Kullu was re-ranked as the
second best performing district.
Criteria for selection for both interviews and self-reports
included stakeholders that:
• Had participated in a sanitation program (or related
program) for at least six months;
• Represented a main workforce type—a decisionmaker, an implementer, or a mid-line supervisor or
manager of the program; and
• Represented one of the different levels of the organization that are involved in the program: national,
regional, district, and local.
The stakeholders interviewed and the main assessment activities are listed in Annex 1.
District Selection Process
Due to the limited time available, only two districts were
visited in each state. Based on program performance information provided by the program team, one above-average
district and one below-average district were selected in both
HP and MP.6 High and low performing districts were not
included in the sample frame as the exceptional contexts
and institutional conditions in these districts are unlikely
to be replicated in other districts. However, representatives
from high-performing districts were invited to a stakeholder
review and learning event held in each state at the end of
the fieldwork period in order to capture learning from the
innovations and successes in these areas.
6
7
8
• Kullu (ranked 9th out of 12 districts = randomly selected “below average” district)
• Una (ranked 6th out of 12 districts = randomly selected “above average” district)
In contrast, the benchmarking data suggested that Una
district was an above average performer, yet it was found
during the fieldwork to be one of only three “lagging
districts” in HP. Again, the financial efficiency score appears to be the main culprit here—Una was the second
best performer on financial efficiency, achieving 193 ODF
gram panchayats (GPs) despite spending only 21 percent
of its TSC allocation, thereby gaining an additional ten
benchmarking points that carried it into the above average
category.
In MP, the following two districts were randomly selected
for assessment from each of the two middle performance
quartiles of the WSP benchmarking data:
The project team developed a performance benchmarking system that ranked district sanitation performance, and was utilized for cluster randomized sampling of one district
from each of the two middle performance quartiles (excluding the best performing and lowest performing quartiles).
At the time of the endline assessment in September 2010, the official exchange rate was: US$1 = Indian Rupees (Rs) 45
Thirty-five percent of the benchmarking score is allocated for NGP achievements (15 percent for the number of NGPs achieved, 10 percent for the percentage NGP coverage,
and another 10 percent for the NGP success rate in the last year).
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Assessment Framework and Methodology
• Jhabua (ranked 24th of 48 districts = randomly selected “above average”
district)
• Chhindwara (ranked 27th of 48 districts = randomly selected “below average” district)
Jhabua district reports high performance in household latrine coverage and school
sanitation coverage, with TSC online monitoring data suggesting 124 percent
latrine achievement (top ranked in state) and 101 percent school toilet achievement (2nd ranked in state), but these apparent outputs are not matched by its
outcome-based indicators. Jhabua ranks 23rd for the number of NGPs achieved;
30th for NGP coverage; 37th for NGP success rate; and 29th for financial efficiency. The lower outcome and financial efficiency indicators suggest either that
the latrine output data have been over-stated, or that they have not translated
into sustainable outcomes, both of which support the classification of this district
as above-average (rather than the higher classification implied by the reported
household latrine coverage data).
Chhindwara district is a lower performer than Jhabua in terms of outputs,
but has similarly average to below average outcome achievements. However,
Chhindwara’s performance has been unusually turbulent: a supportive and
committed district collector led a successful program that achieved 21 of its
current total of 27 NGP awards during 2007–08, but the district then failed to
get its TSC proposal approved due to bureaucratic issues and was without financing for almost 18 months. During this time the campaign stalled and little
progress was made. As a result, the number of NGP applications has declined
over the last three years: 120 in 2008, 74 in 2009 (largely re-applications from
failed 2008 applicants), and only 57 applications in 2010 (including 40 GPs
re-applying for the third time).
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3.1 General
3.1.1 Himachal Pradesh (HP)
HP is a small state in the mountainous northwest section
of India, bordered by Tibet to the east and Jammu and
Kashmir to the north. The lowest point in the state is at an
altitude of 450m above sea level, and the highest reaches
6,500m. As a result, some parts of HP experience extremely
cold winter temperatures.
The state is divided into 12 districts, which contain 75 blocks
and 3,243 Gram Panchayats (GPs). It is a predominately
rural state, with 90 percent of the population (5.5 million
people) living in rural areas. About 25 percent of the population belongs to scheduled castes. HP has one of the highest per capita state incomes in India, deriving from a strong
economy built around agriculture, hydroelectric power, and
tourism. HP also receives substantial remittances, particularly from army personnel and other Government of India
(GoI) officials. A 2005 Transparency International survey
ranked HP as the second least corrupt state in India, after
Kerala out of twenty states assessed in the survey.
3.1.2 Madhya Pradesh (MP)
MP is often called the ‘Heart of India’ because of its landlocked location in central India. Until 2000, when the state
of Chattisgarh was carved out from its bounds, MP was the
largest state in India. It is now the second largest Indian
state, covering 308,000 square kilometers, and is the seventh most populous with a total of about 60 million inhabitants. Its huge land area means that the population density
in MP is 40 percent lower than the national average.9
In 2003, MP formed three additional districts by further
sub-dividing existing districts, bringing the state total to 48
districts, which contain 313 blocks and close to 23,000 GPs.
There is a significant tribal population in MP: 89 blocks
(28 percent) are considered ‘tribal blocks,’ and one third of
all children attend residential tribal schools. Furthermore,
incomes are low and MP is reported10 to have the lowest per
capita expenditure on food of all Indian states, reflecting
widespread poverty and lack of livelihood security.
9
10
11
The 2008 District Level Household and Facility Survey
(DLHS 2008) published by the Ministry of Health and
Family Welfare reported that 35.7 percent of rural households in MP are in the lowest wealth quintile in India, compared to only 0.8 percent of rural households in HP. The
same survey also found that only 8 percent of rural households in MP live in pucca houses (made from permanent
materials), compared with 42 percent in HP.
The previously mentioned Transparency International survey rand MP as the third most corrupt state out of twenty
states assessed in the survey.
3.2 Health
Despite its rural nature, HP has above average human development indicators for India, and is bettered only by Kerala in both infant mortality rate (36 deaths per 1,000 live
births) and literacy rate (77 percent).
MP has low human development indicators: the underfive mortality rate is the highest of any state in India at 137
deaths per 1,000 live births11 (compared with an all-India
average of 95 under-five deaths per 1,000), and reaches as
FIGURE 1: INFANT MORTALITY RATES
100
Infant deaths per 1,000 births
III.
Context
90
86
85
78
80
60
70
68
70
57
56
50
40
36
34
30
20
10
0
1993
1998
2005
Key
Himachal Pradesh
All India
Madhya Pradesh
Source: NFHS I, II, III
According to the 2001 Census of India, MP has a population density of 194 persons per sq. km compared with average 324 per sq. km in India.
National Council for Applied Economic Research (NCAER), 1999 India: Human Development Report
National Family Health Survey II (mortality rates for the five year period preceding the 1998-99 survey)
6
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high as 152 deaths per 1,000 live births (15 percent) in rural
areas. Infant mortality rates in Madya Pradesh have dropped
by 19 percent since the 1998 National Family Health Survey
(NFHS), but they remain 23 percent higher than the allIndia average (see Figure 1) and almost double those in HP.
3.3 Sanitation and Hygiene
The practice of open defecation has long been traditional
in rural India. According to the 2001 Census data, only 22
percent of the rural population in India owned latrines (see
Figure 2).
In addition, the supply-driven nature of previous sanitation interventions such as the 1986–1998 Central Rural
Sanitation Program (CRSP), in which highly subsidized
sanitation facilities were provided to rural households unconvinced of their benefits, meant that a large number of
these latrines were not used.
3.3.1 Scale of Challenge
Simple linear projections of rural population growth show
that in order to achieve the target of universal sanitation by
2012 accelerated progress is required. National progress has
been reasonably good, with some surveys estimating that
2.8 million individual household latrines (IHLs) were constructed annually over the 2001–2005 period. However,
at that rate, universal sanitation would not be achieved
until 2024. In addition, latrine usage remains a problem—
sample surveys carried out by Government of India (GoI)
10 11
05
20
95
19
90
00
6
4 3
19
85
1
19
80
1
20
11
22
17 18
17
14
Year
Source: India Assessment 2002 (PC) and Census of India 2001
12
assessment teams in 478 districts (under the district level
monitoring program) indicate that latrine usage rates are
only around 80 percent nationally, with significant variations across and within states.
3.4 Legal Framework
The Constitution of India determines that water supply, sanitation and other public health services are state
responsibilities. However, the 73rd and 74th Constitutional Amendments allow states to pass the responsibility
and powers for water supply and sanitation down to local
governments.
In HP, the Himachal Pradesh Panchayati Raj Act 1996
(updated 2001) states that sanitation is a local body (GP)
function, but prior to TSC few GPs were aware of their
responsibility or showed any interest in undertaking sanitation activities. Specifically, GPs are responsible for:
•
•
•
•
Sanitation,
Clearing of roads and drains,
Organizing school health check-up programs,
Reporting the outbreak of gastroenteritis and any
other epidemic,
• Construction and maintenance of village drains and
disposal of wastes, and
• Prevention and control of water pollution.
In MP, the Panchayati Raj and Gram Swaraj Act 1993 delegates responsibility for rural water supply and rural sanitation to the Gram Sabha,12 including:
• Sanitation,
• Regulation of the construction of household latrines,
urinals, drains and water closets, and
• Construction, maintenance and clearing of public
streets, latrines, drains, and other public facilities.
24
19
75
30
25
20
15
10
5
0
19
Proportion of Rural
Households with Latrines (%)
FIGURE 2: TREND IN RURAL SANITATION COVERAGE—INDIA
Context
Despite the existence of a Model Public Health Act 1987
(revised) prepared by the Government of India, and the
clear responsibility of the state for public health services,
neither HP nor MP has adopted a Public Health Act. As a
result, there is no legislative framework for the regulation of
public health services in the state.
General village-level body consisting of persons registered in the electoral rolls
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IV.
Total Sanitation Campaign
A key differences between India and either Tanzania or Indonesia is the pre-existence of a large-scale rural sanitation
program. As described in more detail in the following section, the Total Sanitation Campaign (TSC) is a huge and
ambitious program—in its current phase, the total TSC
budget now exceeds US$3.9 billion, with US$267 million
(Rs 1200 crore) budgeted for the 2009–10 financial year,
with a goal in the current five-year phase (2008–2012) to
provide toilets to 115 million households and achieve ODF
status across India by 2012.
The program worked through TSC in both HP and MP.
Prior to the start of the program, the WSP team had already established a good relationship with the Government
of HP by 2005, resulting in the formulation of a strategy
for rural sanitation in HP, and the secondment of a senior
HP government official to WSP for two years. It was hoped
that the program would enable the WSP team to enhance
and broaden the level of support provided in both states:
to leverage TSC resources and sector opportunities at the
national level, to extend its pre-existing engagements at
the state level, and to facilitate achievement of THE PROGRAM objectives and outcomes. At national level, THE
PROGRAM would also allow WSP to provide practical
guidance on policy and implementation at scale, and to
strengthen the analytical framework of TSC.
4.1 Evolution of the Total Sanitation
Campaign
India’s first nationwide program for sanitation was the Central Rural Sanitation Program (CRSP), which was initiated
in 1986. This program focused on provision of household
sanitation facilities using a hardware subsidy to “generate
demand” for pour-flush toilets. In light of relatively poor
national sanitation coverage, a revised CRSP (RCRSP) was
launched in April 1999. The revised program advocated: a
shift from a high-subsidy to a low-subsidy regime; greater
household involvement and demand responsiveness; promotion of a range of toilet options to promote increased
affordability; and strong emphasis on information, education, and communication (IEC) and social marketing. The
13
program envisaged complementary activities such as mason
training and supply of materials through rural sanitary
marts and production centers, and promoted school sanitation as an entry point for encouraging wider acceptance of
sanitation by the rural population.
After pilots in selected states, the program was announced
as the Total Sanitation Campaign (TSC) for roll-out on a
national level in 2003. The program included assistance
for construction of individual household toilets, sanitary
complexes for women, school sanitation, and the setting up
of alternative delivery systems such as rural sanitary marts.
The recognition that water and sanitation in schools are
critical to the formation of proper attitudes and habits for
hygiene, sanitation, and safe water use and that schools are
powerful channels for communicating hygiene messages to
households and communities was reflected in the emphasis on school sanitation programs. Likewise, measures were
advocated to raise awareness levels and improve hygiene
behavior, while simultaneously advocating the “capacitybuilding” of program delivery staff and other stakeholders
through training initiatives.
The TSC is a comprehensive national program designed to
improve rural sanitation coverage and latrine use, and to eliminate the practice of open defecation. TSC was initiated in
seven of the twelve districts in HP by 2005, and had expanded
into every district by 2007. The program and was started in
MP in 2000, expanding to all forty-five districts by 2003.
The key objectives of TSC are to:
• Improve the quality of life in the rural areas,
• Accelerate sanitation coverage in rural areas,
• Generate felt demand for sanitation facilities through
awareness creation and health education,
• Provide rural schools and nursery schools13 with sanitation facilities and promote hygiene education and
sanitary habits among students, and
• Encourage cost-effective and appropriate technologies in sanitation.
Nursery schools (crèches) are known as Anganwadis in India.
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The approach adopted by the campaign aims at motivating
rural households to build latrine facilities and encouraging
them to use them. Thus, the emphasis is on designing strategies to motivate individual households so that they realize
the need for good sanitation practices, and as a result, over
time not only construct toilets but also have the members of
the family use them. In addition, the program also aims to
modify and improve personal hygiene behavior.
Total Sanitation Campaign
• Eliminate open defecation to minimize risk of contamination of drinking water sources and food,
• Convert dry latrines to pour flush latrines, and
• Eliminate manual scavenging practices.
4.2 TSC Methodology
The Department of Drinking Water Supply (DDWS) is responsible for the Total Sanitation Campaign, through the
mission director of the Rajiv Gandhi National Drinking
Water Mission and its CRSP. In most states, either the Rural
Development Department (RDD) or the Public Health Engineering Department (PHED) are given responsibility for
state-level management of TSC project, with a state Water and
Sanitation Mission (SWSM), which is a multi-stakeholder
body including all relevant government departments and
non-government stakeholders, mandated as the main body
responsible for planning, supervising and monitoring the
implementation of drinking water and sanitation programs
in the districts. The program management arrangements also
provide for suitable institutional arrangements at the district
and sub-district levels. The fund flow for the centrally sponsored programs like TSC is directly to the district, with the
matching state share being released when the utilization and
request is put in by the district agency.
The school sanitation and hygiene component was
strengthened; with the provision of toilets extended to
Anganwadi centers, all levels of schools (primary, middle,
secondary, etc.) and all village government buildings.
The GoI sought to re-orient the focus of the sanitation
program to achieving the outcome of an open defecation
free (ODF) environment. As a result, not only individual
households, but also villages and panchayat governments
were targeted.
TSC operates through district projects of three to five years
in duration, each jointly financed by the GoI, the state government, and the beneficiary households. The funding split
varies according to the program component, but averages
about 65 percent from the GoI, 23 percent from the state
government, and 14 percent from the beneficiaries. TSC financial framework specifies exactly how the program funds
are to be earmarked and divided between components and
funding sources (see Table 2).
Following a mid-term review of TSC, a new set of revised
guidelines was issued in 2004. These guidelines accorded
emphasis on sanitary arrangements, not merely on the construction of household latrines. Two outcome-based objectives were highlighted:
TABLE 2: TSC COMPONENTS: REVISED EARMARKING AND FUNDING PATTERN
Relative Contribution (%)
Component
IEC campaigns and start-up activities
Amount Earmarked
Up to 15%
GoI
State
HHD
80
20
—
Alternate delivery mechanisms (production centers, sanitary marts) Up to 5%
80
20
—
(i) Individual latrines for BPL hhds
60
28
12
(ii) Community sanitary complexes
Amount required for full coverage 60
30
10
Individual latrines for APL hhds
Nil
—
—
100
Institutional sanitation (anganwadi, school & public facilities)
Amount required for full coverage 70
30
—
Administration (training, overheads, M&E)
Less than 5%
80
20
—
Solid and liquid waste management (capital costs only)
Up to 10%
60
20
20
Source: DDWS (2010) Total Sanitation Campaign: Guidelines Central Rural Sanitation Programme.
Note: Revised patterns per June 2010 Guidelines
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The district is required to submit a program proposal (in
line with the guidelines issued by GoI) and a program implementation plan to the state government to receive GoI
funding. Each state is required to establish appropriate institutional arrangements to facilitate program implementation by districts and monitor implementation. Specialist
consultants from the fields of communication, human resource development, monitoring, and school sanitation and
hygiene education can be appointed as consultants at the
state level, and where required at the district level.
The states remain free to devise their own specific approaches within the broad framework provided by the program. Several states, notably Maharashtra and West Bengal,
have modified TSC guidelines to mesh better with their
existing sanitation initiatives, such as the use of part of the
latrine subsidy funds in the promotion of improved sanitation and hygiene practices. In addition, TSC guidelines
provide a flexible framework for district projects, allowing different methodologies to be adopted depending on
the different contexts, demands, and capacities within the
district.
While the program delivery strategy in most states follows the
overall TSC framework, the structure and institutional linkages varies with the situation of local self-government systems
and the mode of development program administration in
the state. In states where the local governments system (Panchayati Raj Institutions or PRI) is mature, and financial and
functional devolution has taken place, the fund flow continues down to the sub-district (block) level for awareness creation and overall program management, while in other states
the program (and fund) management is centralized with the
district administration and sub-district tier functionaries are
directed and managed from the district level.
4.3 TSC Latrine Subsidies
Under TSC, financial incentives were to be paid to belowpoverty-line (BPL) households up to 80 percent of the cost
(Rs 625) for a basic latrine unit (usually a single pit latrine
without a superstructure), and 60 percent for latrine models
costing up to Rs 1000. However, TSC guidelines state that:
14
15
Total Sanitation Campaign
“The construction of household toilets should be undertaken by the BPL household itself, and on completion and
use of the toilet by the BPL household, the cash incentive
can be given to the BPL household in recognition of its
achievement.”14
In addition, TSC guidelines clearly state that individual
rural households should have a choice as to the type of latrine that is built:
“The physical implementation gets oriented towards
satisfying the felt needs, wherein individual households
choose from a menu of options for their household latrines. The built-in flexibility in the menu of options
gives the poor and disadvantaged families opportunity
for subsequent upgradation depending on their requirements and financial position.”15
The same text regarding the provision of the cash incentive to the BPL household after “completion and use of
the toilet”, and households choosing from a menu of latrine options, is retained in the June 2010 revision of TSC
guidelines.
2006 TSC Guidelines Revisions: Raised Subsidy
Further revisions to TSC guidelines were issued in March
2006, stipulating that the incentive for BPL household latrines would increase from Rs 500 to Rs 1200. This apparently inflation-driven revision doubled the maximum
latrine cost to Rs 2000, in large part because the basic low
cost unit now included the superstructure. This revision
represented a substantial change for TSC, both in terms of
the higher financial requirements of the campaign because
the amount of the BPL latrine incentive increased by 240
percent, and an adequate superstructure must be provided
before completion and usage can be verified.
In addition, the 2006 revisions state that financing for
household latrine incentives should now cover the “actual
amount required for full coverage [of the BPL households].”
Similarly, financing for institutional toilets (including
school and anganwadi toilets) includes the “actual amount
GoI TSC Guidelines 2004a
GoI TSC Guidelines 2004b
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Total Sanitation Campaign
required for full coverage.” Community contributions for school and anganwadi
toilets, which were previously set at 10 percent, were no longer required.
4.4 TSC Incentive Framework
Following the success of state incentive schemes like the Sant Gadge Baba Gram
Swachayata Abhiyan scheme in Maharashtra, which is an annual competition for
the cleanest village, the GoI introduced the Nirmal Gram Puraskar (Clean Village
Award or NGP) in October 2003. Local governments are eligible to apply for the
NGP award on achieving the following collective outcomes across their entire
jurisdiction:
• One hundred percent sanitation coverage of individual households,
• One hundred percent school sanitation coverage (with separate facilities
for boys and girls),
• Being free from open defecation, and
• Maintenance of a “clean environment.”
GPs, blocks, and districts are eligible for the award, as are individuals and organizations that contributed significantly to achieving the goals within a particular
area. The cash award16 ranges (depending on population size) from Rs 0.5 to 5
Lakh17 (for GPs); Rs 10 to 20 Lakh (for blocks with all their GPs being covered);
to Rs 30 to 50 Lakh (for districts, with 100 percent blocks and GPs covered).
Individuals and organizations can win cash awards of Rs 10,000 to Rs 50,000.
The cash incentive provided to local governments is to be used for improving
and maintaining sanitation facilities in their respective areas, with a focus on safe
disposal of solid and liquid wastes and maintenance of sanitation standards.
16
17
The amounts mentioned are according to the revised incentive provision as of 2007. In the earlier two years, the
incentives for panchayat ranged from Rs 2–4 Lakh.
Note: One lakh rupees = one hundred thousand rupees (US$2500).
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V.
Baseline Findings
The baseline assessments of the enabling environment for
rural sanitation improvement in HP and MP were conducted in mid-2007. The following section summarizes the
key findings from these baseline assessments in order to set
the scene for the endline findings.
5.1 Himachal Pradesh: Sanitation Coverage
at Baseline
Access to improved sanitation in HP was marginally above
average prior to the program, with 28 percent sanitation
coverage reported in 2001. About 380,000 toilets were built
through subsidy-based programs in the 1990s: the CRSP
and state Rural Sanitation Program (SRSP) provided upfront hardware subsidies of Rs 1,700–2,000 per household
toilet, but a 2003 rapid assessment in six districts18 found
that these supply-driven programs resulted in toilet usage
of only 20-30 percent, with some surveys reporting usage as
low as 15 percent,19 indicating that there was little sustainable impact on sanitation coverage during this period.
The 2003 rapid assessment also found that, despite perceptions that latrines were expensive to construct, more
than 60 percent of the household latrines surveyed were
constructed by private individuals without any external
assistance, and that usage levels were close to 100 percent
among private latrine owners. Stakeholder interviews suggested that the people of HP perceive themselves to have a
relatively unpolluted environment and a healthy lifestyle.
However, despite a cultural affinity with the mountains and
forests, this perception is not supported by conditions in
the wider communal environment; unsafe excreta disposal
and indiscriminate waste disposal were widespread outside the immediate domestic sphere. Another assessment20
found that 90 percent of the population still practiced open
defecation, with nearby forests, nalas,21 and riverbanks reported as common defecation sites.
TSC online monitoring data suggest that sanitation coverage began to rise fairly rapidly from 2005 onwards, reaching
18
19
20
21
around 39 percent in mid-2007. While little large-scale latrine usage data were available at baseline, TSC district level
monitoring surveys from early 2007 suggested that latrine
usage was above 90 percent in HP; it was therefore assumed
that most of these new latrines provided sustainable access
to improved sanitation.
5.2 Madhya Pradesh: Sanitation Coverage at
Baseline
Access to improved sanitation in MP was particularly low
prior to the program. The 2001 Census reported 8.9 percent rural sanitation coverage in MP, while other surveys
suggested that this figure may have been an over-estimate.
A number of districts in MP face water scarcity problems,
which further inhibits sustainable use of sanitation facilities
and improved hygiene behavior, as reliable water supply is
often required for anal cleansing, toilet flushing, and handwashing. In addition, the social and cultural challenges
faced in the tribal belts have led to dependence on handouts
and supply driven approaches that tend to be ineffective in
generating sustainable sanitation behavior change.
TSC online monitoring data suggest that sanitation coverage began to rise from 2002 onward, reaching around
30 percent in mid-2007. Although little large-scale latrine usage data were available at baseline, TSC district
level monitoring surveys found that latrine usage was only
around 50 percent in MP, thus the effective increase in sustainable access to improved sanitation was probably much
lower than that indicated by TSC online monitoring data.
5.3 Baseline Assessment Findings
In general, the enabling environment for rural sanitation
improvement in India was already strong at baseline. TSC
provided a solid financial and policy framework for the national goal of universal sanitation by 2012, which exceeds
the 2015 MDG sanitation goal pursued by TSSM, TSC
is further supported by the NGP sanitation incentive program, which rewards local governments and individuals
Strategy for Total Rural Sanitation in HP 2005, 2.
Ibid, 1.
Knowledge Links 2005.
Natural drainage channels (which are often dry in northern and central India).
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that achieve well-defined collective sanitation outcomes. In
addition, India has an extensive local government system
that reaches most rural communities, and has long experience of implementing large rural development programs.
Although TSC has operated since 1999, it is only since
2004 that the elimination of open defecation and the
achievement of collective sanitation outcomes have been
promoted. Nonetheless, TSC at baseline was broadly in
keeping with the total sanitation approach, and TSC and
NGP guidelines provided a well understood framework for
sanitation and hygiene improvement, with the result that
most state and district governments were actively engaged
in sanitation promotion, implementation and monitoring.
The budget allocated to TSC almost doubled in the two
years prior to TSSM program implementation, indicating
growing political awareness and support for the rapid sanitation improvements achieved by TSC and NGP programs.
However, the growing management requirements of TSC
have not been matched with sufficient state or district level
personnel, and there remains a shortage of implementation
partners with adequate experience of rural sanitation and
community development.
Nevertheless, the broad financial and policy framework
provided by TSC allowed individual states and districts
significant latitude to develop local approaches and interventions according to their specific needs, priorities, and
preferences. While this freedom limits central control of
program implementation, it allows more progressive local
governments to innovate and develop effective approaches,
policies, and practices. As a result, there is also a wide variation in TSC effectiveness and in household outcomes in
different states: for instance, the total sanitation approach
had been embraced in HP, but support for this approach
remained low in MP.
The institutional arrangements in MP were due to change
at the time of the baseline assessment, with responsibility
for TSC planned to shift from the PHED to the RDD.
It was anticipated that this shift would increase focus on
the achievement of collective sanitation outcomes by local
governments, and lessen the supply and technology-driven
approaches favored by the engineers from the PHED.
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Baseline Findings
UNICEF has been a significant development partner in
MP, working closely with the government on a number
of water, sanitation, and hygiene (WASH) activities over
several years through a state program office staffed by an
international UNICEF WASH specialist. As a result, the
introduction of program activities in this state has been
against the backdrop of the slightly different policies and
interventions previously promoted by UNICEF. Efforts to
harmonize the WSP and UNICEF sanitation support activities, and to align better with the government’s planning
and priorities, were ongoing at the time of the assessment.
No other development partners were working on rural sanitation in HP at the time of the baseline assessment.
Sanitation marketing had been limited to the promotion
of production centers and rural sanitary marts that supply components for government-designed latrine models,
based entirely around the BPL cash incentive provided by
TSC with almost no allowance for variations in household
taste, willingness to pay, or local constraints.
The baseline assessment found that TSC and NGP programs focus on the achievement of the NGP award, but
lack any active mechanisms to extend, sustain, and monitor
sanitation development after this achievement. In addition,
the wider environmental sanitation requirements of the
NGP award appeared too difficult for many local governments to achieve, thus some become disenchanted after the
initial process is completed.
The District Level Monitoring (DLM) process conducted
by the Department of Drinking Water and Sanitation
(DDWS) sampled community sanitation coverage and
latrine usage among BPL households in 478 districts in
early 2007, providing useful sanitation outcome data for
comparison against the detailed supply-side data from TSC
on-line monitoring system, and the less frequent nationally-representative household surveys. While some reservations were expressed about the quality of the DLM data,
the baseline assessment found that this large-scale system
was an important component of the enabling environment.
The baseline performance data indicated differences in sanitation outcomes in HP and MP. The TSC was doing relatively well in HP, despite the late start in several districts,
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Baseline Findings
TABLE 3: COMPARATIVE TSC AND NGP PERFORMANCE
TSC Expenditure
Household Toilets
(Rs million)
(number)
2007 NGP Awards
TSC Progress (%)
BPL Toilet Usage (%)
HP
86
102,428
16
100
28
MP
1,639
1,748,874
23
65
191
Maharashtra
2,132
3,127,223
34
87
1,974
30,353
33,261,001
29
81
4, 959
All India
(number)
with the DLM survey reporting almost universal toilet usage among poor households compared to 81 percent toilet usage by poor households in the rest of India.
In contrast, despite higher progress the TSC did not appear to be performing as
well in MP: only 65 percent of poor households were using their toilets, and the
expenditure per NGP award is almost three times that in HP (see Table 3).
Although the performance data might reflect, at least to some extent, the different implementation paths taken by the two states, the baseline assessments
suggested that the limited political commitment, weaker governance, and greater
poverty in MP undermined the strong national enabling environment.
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VI.
Endline Findings
TSSM supported rural sanitation improvement through
TSC in all twelve districts of HP, whereas in MP the program team decided to concentrate the majority of its activities in districts that expressed demand for support, and took
part in capacity building, coordination, and strategy development activities. In all, the program supported twentytwo out of the fifty districts in MP, of which about fourteen
districts were active and benefited from direct WSP support
over the three-year program period.
slow to become involved in the campaign, by 2003 MP had
five-year TSC projects operating in all of its 45 districts.23
Seven years later and still far short of the government’s sanitation targets, it is clear that TSC operates as a long-term
national program rather than as a short-term campaign of
fixed duration. Despite this recognition, there has been
only limited discussion of the need for revisions to the format or design of TSC to reflect the different handling and
objectives of the current program.
6.1 Policy, Strategy, and Direction
WSP is currently assisting the GoI to develop a long-term
rural sanitation strategy as part of wider efforts to formulate
the 2012–2022 National Development Strategy. The future
roles and objectives of both TSC and NGP are among the
issues under discussion, although it seems likely that TSC
and NGP will remain the main vehicles for the Government of India’s Nirmal Bharat (Clean India) vision of access
to toilets for all by 2012.
Key Findings:
• Political support for TSC had improved and was highly
evident in HP, whereas little change in political priority
for rural sanitation was apparent in MP
• Despite significant increases in the BPL latrine incentive provided by TSC, HP has not provided subsidies
for latrine construction by poor households; in contrast,
MP has increased the size of the BPL incentive, and
provided some subsidy to non-poor households, using
resources from other rural development programs.
• HP has developed a clear strategy and direction for
the achievement of universal sanitation, supported by
effective policies and incentives; MP sets ambitious
annual sanitation targets, but has made few real improvements in policy, strategic planning, performance
monitoring, or program support.
At national level, TSC remains significantly less important
than flagship rural development programs such as the National Rural Employment Guarantee Act (NREGA), the
Indira Awaas Yojna housing program, Swarnjayanti Gram
Swarozgar Yojana income-generation program, and the National Watershed Development Program. However, despite
this relatively low national priority, a large budget has been
allocated to TSC, and the central program targets, guidelines, and implementation models continue to dominate
rural sanitation programming and policy across India.
TSC was originally seen as a five-year campaign22 implemented through district projects. While some states were
22
23
DDWS organized a state minister’s sanitation conference
in late September 2010 to present some of the more recent
TSC and NGP evaluation and assessment findings to the
states, with the intention of highlighting the higher performance found in states using better policies and processes,
and encouraging reforms in those states with low performance. This conference would have been the first highlevel sanitation-related conference for almost a decade,
and was generating some excitement and interest among
development partners that have been pushing for reforms
for some time, but it was postponed due to a clash with
another event.
6.1.1 Direction at State Level
In HP, the state government had set itself the ambitious
goal of making the state open defecation free by the end of
2009, some three years ahead of the national target; then
extended this deadline to the end of 2010 when it became
clear that the 2009 deadline would not be met. The Government of MP has declared its intention for Nirmal MP
(Clean MP) by 2012, in line with the GoI goal for universal
sanitation by that date.
2010 TSC guidelines state that “TSC project cycle in the project districts is expected to take about 4 years or less for implementation”.
Due to the sub-division of several large districts, there are now 50 districts in MP.
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The varying urgencies of the state targets reflect both the
different initial conditions and the differing political support for sanitation. HP had 28 percent sanitation coverage
in 2001, whereas MP had only 9 percent coverage, and HP
has higher levels of human development than MP. However, perhaps more important to the success and ambition
of the program has been the way in which the states decided
to use TSC resources and the priority attached to the program by state politicians.
Direction in HP
The Government of HP has continued to follow the principles of its progressive 2005 Strategy for Rural Sanitation
in HP, which stated that no latrine subsidies would be paid
to below poverty line households. This radical decision,
first taken when the BPL latrine incentive was only Rs 500
(US$11), has meant that a significant proportion of TSC
funds were not used, and that district governments have
had to develop highly cost-effective approaches to creating
demand for sanitation without the incentive of hardware
subsidies for latrine construction.
Interestingly, the main focus in HP over the last three years
has been on achieving ODF communities rather than on
the higher profile and more difficult goal of NGP awards.24
As a result, a more phased approach to sanitation development has been followed: more than 85 percent of GPs
have been declared ODF, but only 16 percent have won the
NGP award. Now that the primary challenge of eliminating open defecation is largely overcome, the government is
turning its attention to the higher order problems of addressing the sustainability of institutional sanitation facilities and the safe management of solid and liquid wastes.
It seems remarkable that the government and people of HP
have achieved so much in such a short time, until notice is
taken of the high level political support for sanitation improvement. Every stakeholder remarked that the chief minister mentioned sanitation in every speech. Government
officials stated that, where TSC was rated as the fourth (or
lower) priority rural development program at baseline, it
has now become the second most important rural development program in the state, with regular monitoring by the
24
Endline Findings
chief minister and other high-level state officials. As a result, there is widespread awareness of the raised priority for
sanitation throughout the local government system, which
in turn has led to strong coordination and collaboration
between stakeholders, more effective implementation processes, and increased monitoring and attention to sanitation outcomes like latrine usage and sustainability.
Senior government officials, including the chief secretary of
HP (who was formerly the union secretary for rural development responsible for TSC nationally, and therefore has a particular interest) and the secretary of rural development, took
time out of their busy schedules to discuss TSC and NGP
progress with the assessment team, demonstrating a good understanding of the issues, a realistic stance on the challenges
involved in reaching the 2012 state sanitation target, and
considerable interest in the initial findings of this assessment.
The improvements in political support and program leadership since baseline appear to reflect a form of virtuous
circle in which increased political attention strengthened
commitment and accelerated progress, which further raised
the program profile and broadened its appeal, resulting in
wider improvements to inter-sectoral support, implementation and progress monitoring, thereby generating dramatic
and extensive recent progress.
Direction in MP
MP was the first state to implement TSC in every district,
but rural sanitation still remains a low priority when compared to NREGA, road building, watershed development
and rural water supply. Despite comments that senior state
politicians were committed to sanitation improvement, there
was little hard evidence that political commitment had increased greatly at either state or district level since baseline. A
few district exceptions were reported, with good performance
in a handful of the 50 districts, but this appeared to reflect the
commitment and application of specific local governments
and individuals rather than a wider enabling environment.
The focus in MP remains on toilet building and targetdriven NGP activities, which results in a more supply driven
approach than that in HP. TSC guidelines state that “the
The NGP criteria include broader environmental sanitation outcomes such as the safe management and disposal of household solid and liquid wastes.
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construction of household toilets should be undertaken by
the BPL household itself, and on completion and use of the
toilet by the BPL household, the cash incentive can be given
to the BPL household in recognition of its achievement.”
Despite this clear central guideline, common practice in MP
is to use the BPL incentive funds to purchase latrine materials and hire contractors or masons to build household toilets,
with little household involvement and rare instances when
cash payments are made to individual BPL households.
It proved very difficult to meet senior state government officials in MP. Neither the secretary of rural development
nor the director responsible for TSC were able to make time
available for a formal meeting to discuss TSC progress and
TSSM support, although both did attend one hour of the
Bhopal workshop organized to discuss and ground truth
the initial findings of this assessment. While the limited
access to senior officials undoubtedly reflects their busy
schedules, it contrasted strongly with the experience in HP
where high-ranking officials went out of their way to assist
and inform the assessment. The implications are that TSC
has a lower priority within the state government of MP, and
that WSP has not managed to establish as close and productive a partnership with government in MP as in HP.
6.1.2 TSC Policy Changes Since Baseline
Several significant changes have been made to TSC guidelines since the baseline assessment of the enabling environment for rural sanitation improvement was completed in
mid-2007.
A revised set of guidelines was issued in October 2007,
which included the explicit objective to “accelerate sanitation coverage in rural areas to access to toilets by all by
2012” and to provide sanitation facilities in all rural schools
and anganwadis by March 2009. In addition, the objective
to “convert dry latrines to pour flush latrines and eliminate
manual scavenging” was dropped, with the more detailed
wording of the guidelines revised to state that “construction of bucket latrines is not permitted in the rural areas”
and that “existing bucket latrines, if any, should be converted to sanitary latrines” where previously these policy
statements referred to the prohibition and conversion of all
25
Endline Findings
dry latrines. The new guideline recognizes the utility of dry
latrines in cold and water-scarce zones, and allows the use
of ecological sanitation facilities.
A new objective was also added to “develop community
managed environmental sanitation systems focusing on
solid and liquid waste management.” Up to 10 percent of
the program cost can now be used to provide infrastructure
for solid and liquid waste management. This revision reflects
the inclusion of the solid and liquid waste management criteria in the NGP without any finance mechanisms being included under TSC or through other development programs.
The October 2007 guidelines also included for provision
of a revolving fund in the district program, with up to Rs
50 Lakhs (US$109,000) funds to be taken from the five
percent allocated to rural sanitary marts and production
centers, for the provision of toilet loans to BPL and above
poverty line (APL) households.
A further revision to TSC guidelines was issued in June 2010,
immediately prior to this endline assessment. The new guidelines revised the deadline for the full coverage of sanitation
facilities in schools and anganwadis to March 2012, but otherwise retained the same objectives as the previous guidelines.
A new section was introduced to promote and detail the use
of ecological sanitation facilities, including urine-diverting
toilets and waterless urinals, with these new concepts to be
promoted alongside existing total sanitation approaches.
Another major change in the 2010 TSC guidelines is that
TSC funds are now released to the SWSMs rather than directly to districts, with the SWSM now responsible for verifying that the districts have met the criteria for the release
of funds.
2008 Increase to TSC Incentive to BPL Households
The DDWS issued a government order25 in October 2008
to increase the unit cost of individual household latrines
provided under TSC from Rs 1,500 to Rs 2,500, with the
BPL incentive increased from Rs 1,200 to Rs 2,200, while
the household contribution was kept at Rs 300. This policy revision amounts to an 83 percent increase in the BPL
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incentive in the 2.5 years since the previous March 2006
revision. The inclusion of finance for the latrine superstructure explains part of the large increase, while DDWS officials also noted that the price of construction materials had
risen dramatically in the last few years.
The June 2010 revision to TSC guidelines retained the
Rs 2,500 unit cost and the Rs 2,200 BPL incentive, meaning that the BPL incentive has more than quadrupled
from Rs 500 (US$12) at baseline to Rs 2,200 at endline
(US$48). There were also suggestions that the DDWS
plans to increase the BPL incentive further in the near future, perhaps by as much as Rs 1,000, due to continuing
pressure from states that already provide large discretionary
additions to the minimum TSC incentive for below poverty line households.
TSC Incentive Policy in MP
In 2008, when TSC latrine incentive rose to Rs 2,200
(US$48) per BPL household, many local governments in
MP continued to complain that this amount was insufficient for the construction of a hygienic toilet with an adequate superstructure. As a result, the state government
decided to allow some of the NREGA cash-for-work funds
to be used for the construction of brick-lined latrine pits.
The Nirmal Watika (Clean Garden) scheme uses NREGA
cash-for-work funds to provide Rs 2,700 to Rs 5,000
(US$59–109) per household for the construction of two
brick-lined latrine pits and the planting of five fruit trees,26
with the intention that the latrine pits will provide additional nutrients for fruit production.
As a result, local governments in MP now have as much
as Rs 7,200 (US$157) per BPL household available for the
construction of toilets, and can spend up to Rs 5,000 on
toilet construction for APL households that have job cards.27
This additional financing has increased the supply-driven
nature of the program, with every household (both APL
and BPL) in some poor communities now qualifying for
hardware subsidies of Rs 3,000–7,000, which enables these
village government to finance entirely free, contractor-built
toilets for all.
26
27
Endline Findings
6.1.3 Comparative Analysis of Policies and Outcomes
The strategy and policies adopted in MP at endline contrast markedly with those in HP, where the majority of TSC
expenditures have been for sanitation promotion and community mobilization, and where poor households reported
that improved sanitation facilities could be built for as little
as Rs 1,200 (US$26).
The significant government subsidies available for toilet construction in MP have enabled the government to accelerate
toilet provision in areas where progress was previously slow,
as the large subsidy facilitates a contractor-based approach
and means that little or no contribution is required from
the household. Unfortunately, this additional construction
finance reduces the need for community participation in the
sanitation development process as household contributions
are no longer needed, which tends to decrease attention to
the important areas of demand creation, sanitation promotion, and behavior change communication—with a consequent detrimental effect on latrine usage and sustainability.
A comparison of the supply-side data from TSC online
monitoring system with household survey data from the
2001 Census, DLHS-2 and DLHS-3 surveys confirms
the sustainability problems in MP: TSC online monitoring data show rapid coverage gains since 2006, whereas the
demand-side household survey data show that sanitation
coverage has barely changed since 2001. The household
survey data suggest that few—perhaps only one in four—of
the new latrines reported by TSC monitoring system are
in use. In HP, the household survey data confirm the high
latrine usage and sustainability rates suggested by the evaluation data, with around 90 percent of new latrines reported
by TSC system found to be in use.
Strategic Planning
Significant changes have occurred in the strategy followed
in HP. At baseline, a few districts had adopted progressive
and strategic approaches but the majority continued to use
a conventional toilet building approach with little interference from the state level. In the last three years, high-level
interest in the program and visible success in the more
Strictly, NREGA funds pay Rs 100 per person per day (for up to 100 days work), thus a Rs 5,000 Nirmal Watika investment should be payment for 50 days’ work, representing
50 percent of the total annual NREGA income available to a poor individual.
In some of the tribal areas of MP visited during the assessment, every single household qualified for Nirmal Watika assistance through their job cards.
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Endline Findings
strategic districts have been sufficient to persuade the state
government to promote the more cost-effective approaches
used by the successful districts, to encourage a phased strategy to sanitation development, to identify poor performing
districts and areas, and to develop effective solutions for lagging, difficult, and remote communities.
The strategy has been successful. In nine out of the twelve
districts in HP, more than 80 percent of GPs are now ODF,
and five districts are close to achieving 100 percent ODF
status. The other three districts (Lahaul and Spiti, Chamba,
and Sirmaur) have reached 50–65 percent ODF coverage
and are now receiving additional support and attention from
the Government of HP. In several cases, government officials
from districts with more successful sanitation programs have
been transferred to the lagging areas to introduce more effective approaches, mobilize resources, and accelerate progress.
Furthermore, the state government’s attention has shifted
from achieving sanitation coverage and ODF targets to the
higher level objectives of improving latrine usage, addressing
the sustainable operation and maintenance of institutional
sanitation facilities, and strengthening capacity for solid
and liquid waste management. Following explicit demands
for assistance in these areas, WSP recently arranged exposure visits to solid and liquid waste management (SLWM)
schemes in Maharashtra and Kerala, and organized SLWM
training courses in Nainital.
In contrast, there was little evidence of strategic planning in
MP (see Table 4). Implementation appears to be driven by
the number of villages to be covered each year in order to
reach universal coverage by 2012, with little adjustment for
the available resources, strategic challenges, sustainability
losses, or the likelihood that coverage will become harder to
achieve towards the end of the process.
In the two districts visited during the assessment, the statedetermined targets for each district dictated the annual
number of NGP applications rather than the number of
villages that met the NGP criteria and were ready to apply.
This target-driven planning has encouraged coercive and
short-term approaches, with a fixed number of village governments—usually those with the highest baseline sanitation coverage—being told that they must achieve NGP
status each year. As a result, local implementation teams
often over report progress and conceal problems as they
struggle to meet these externally imposed targets.
TABLE 4: ENABLING ENVIRONMENT IMPROVEMENTS: POLICY, STRATEGY, AND DIRECTION
Indicator
2007 Baseline
2009 Target
2010 Achieved
HP: District strategies implemented
1
12 (100%)
9 (75%)*
MP: District strategies implemented
0
10 (25%)
4 (8%)**
HP: expenditure on state awards
0
US$163,000
US$600,000 (368%)
MP: expenditure on state awards
0
US$435,000
US$ 0 (0%)***
HP: BPL subsidy paid to household
US$0
US$0
US$0
MP: BPL subsidy paid to household
US$13
US$0
US$60–110
HP: % investment by BPL household
100%
100%
100%
MP: % investment by BPL household
10%
50%
0%
UNICEF
No
Yes
Yes
WaterAid
No
Yes
Partial
DDWS
No
Yes
Partial
Strategic planning
Political support
Effective policy
Policy alignment: total sanitation
* Nine of 12 districts were reported to have implemented district sanitation strategies (compared to target of all 12 districts).
**Four of 50 districts were reported to have implemented district sanitation strategies (compared to target of 10 districts)
***The Government of MP allocated funds allocated to a sanitation award, but no awards have yet been made, therefore there has been no expenditure to date.
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6.2 Institutional Arrangements
Key Findings
• The Government of HP has strengthened TSC units at
both state and district levels, providing considerably
improved capacity to monitor and support program
activities.
• TSC’s institutional home and arrangements within the
state government make little difference if there is no
high-level pressure for improved performance, and no
monitoring of the sustainability and quality of program
outcomes.
• Improved coordination of all government and sanitation
stakeholders has been an important success factor in HP.
• Because NGO involvement is limited in MP, the state
government decided to strengthen TSC coordination
by recruiting block coordinators below the existing district coordinators.
There have been no significant changes in the institutional
arrangements set out by TSC guidelines, although a new
sector institution was proposed in September 2010 when
guidelines were issued for the establishment of Block Resource Centers (BRCs) to support both the National Rural
Drinking Water Program (NRDWP) and TSC. BRCs will
contain between two and four paid government functionaries, and are intended to provide sub-district support for
training, surveys, construction supervision, coordination,
and promotional activities relating to rural water supply
and sanitation.
BRC expenditures will be financed from the NRDWP
allocation for support activities rather than from TSC,
and the job description for the BRC block coordinators
confirms that water supply services are likely to be the
main focus of BRC activities. It is currently uncertain
how significant or effective this new institution will be,
but it should provide additional block-level resources for
sanitation activities and thus may strengthen TSC implementation and provide a sustainable support mechanism
to improve the long-term monitoring of sanitation and
public health outcomes.
28
Endline Findings
6.2.1 State-level Arrangements
The baseline assessment found that insufficient resources
were attached to state-level management of TSC. Since
then, the Government of HP has strengthened TSC units
at both state and district levels. TSC funds have been used
to finance the activities of both government officials and
contracted consultants, providing considerably increased
capacity to monitor and support TSC activities across the
state.
State-level monitoring in HP confirmed better performance
among districts that had employed local NGOs with large
community-based networks to strengthen and expand TSC
implementation. While not every district has a local nongovernmental organization (NGO) with sufficient experience and outreach, the state sanitation unit has encouraged
lagging districts to seek out alternative solutions through
employing successful NGOs from neighboring districts or
convincing good local NGOs from other sectors to undertake sanitation and hygiene activities.
Where NGO support has been successful, the district governments worked closely with the NGOs and encouraged
all levels of PRIs to provide active support to the NGO
activities. Several NGOs commented that the level of payment made by the district government was inadequate, particularly given the scale and intensity of activities, but that
the campaign’s public health focus and the visible support
of local leaders allowed their grass roots networks of committed volunteers and activists to mobilize communities effectively. Women’s self-help groups (Mahila Mandal) were
reported to be particularly effective channels for sanitation
promotion.
In contrast, NGO involvement has been relatively limited
in MP. As a result, the state government made the decision to strengthen TSC coordination by adding a layer of
contracted block coordinators below the existing district
coordinators. Thirty-six TSC district coordinators (72 percent coverage) and 249 TSC block coordinators (80 percent coverage28) were working at the time of the assessment,
There are 313 development blocks in MP.
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all financed from the administration budget in the district
TSC projects.
The block coordinators cover large areas and are therefore
unable to provide detailed support to implementation activities, but they have improved monitoring at the GP level and
provide regular feedback to the district coordinators. Unfortunately, much of the pressure for rapid progress falls on the
district and block coordinators. Given that they are also responsible for TSC monitoring, this top-down pressure creates
a conflict of interest and encourages over-optimistic reporting
of results.
6.2.2 TSC Institutional Home
The baseline enabling environment assessment found that
the PHED in Madhya Pradesh favored supply-driven and
more technical approaches to sanitation development, and
lacked the manpower or skills to undertake the behavior
change based approach advocated by most stakeholders.
As a result, both WSP and UNICEF encouraged the MP
government to shift control of TSC from the PHED to
the Panchayat & Rural Development Department (PRD).
This transition had not yet happened at the time of the
baseline assessment, but it was hoped that the PRD management of TSC would ensure stronger participation by
village governments and allow the introduction of more
progressive and cost-effective approaches to sanitation
improvement.
The PRD was given responsibility for TSC in MP in late
2007, shortly after the baseline assessment. Disappointingly, three years later this endline assessment found
that the reallocation has had little impact on policy, approaches, activities undertaken, or outcomes. In practice,
PHED delegated much of the work to the same district
and village officials that are now responsible for program implementation, and there has been little pressure
from above to change the way in which TSC funds are
used. As a result, most districts have continued with the
contractor-based and supply-driven approach, and use
the same standard latrine designs, favored by the PHED,
with little recognition that latrine usage and sustainability remain low.
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Endline Findings
This finding suggests that the institutional home and arrangements make little difference if there is no political
pressure for improved performance, and no monitoring
of the sustainability and quality of program outcomes.
Where elected representatives and senior administrators
are committed to making TSC a success, the full government machinery is utilized to implement the campaign, with regular monitoring and evaluation to ensure
that activities are well coordinated and that resources are
used cost effectively. Where TSC remains a low priority and TSC online monitoring system shows reasonable
progress, there is little incentive for those involved in
implementation to follow up with the more comprehensive monitoring and evaluation that might expose any
shortcomings.
6.2.3 Coordination
One of the key findings in HP was that successful implementation was due to impressive coordination between the
different levels of government and the different departments at each of these levels.
Effective government coordination remains an unrealized
goal in many development arenas, despite the myriad coordination mechanisms available and concerted efforts by
interested stakeholders. It is not easy to align the different
agendas, motivations and preferences of numerous government departments and officials across large areas. Once
again, the key factor here appears to be strong political
commitment at state level. District commissioners and program officers reported that the chief minister of HP used a
weekly video conference with the district heads to follow
up on TSC progress, putting heavy pressure on any lagging areas. They reported that the importance of sanitation
was now mentioned in every political speech and that local
political leaders had become involved in the presentation of
sanitation awards. As a result, all elected and administrative
officials were aware that TSC was a priority and that any
shortcomings would be noted at the highest level.
The state governments also noted that the WSP state
coordinators had played an important role in supporting TSC management at both state and district levels.
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In addition to hands-on assistance in arranging capacity building and other support activities, the presence of
a full-time coordinator prevented the state governments
from letting TSC slip down the list of priorities, and
encouraged more regular meetings and performance reviews. In HP, the state government noted that the recent
lack of a state coordinator had allowed focus to drift from
important strategic issues to more pressing local matters,
and suggested that the state coordinator had been good at
providing guidance and regular reminders to keep things
on track.
The endline assessment found that the state and district
missions were meeting more frequently than at baseline,
with all but the MP State WASH Mission now meeting
at least every two months (see Table 5). While it is hard to
assess whether the regular coordination meetings have any
significant impact on performance, the greater frequency
provides solid evidence that busy government officials attach sufficient priority to rural sanitation improvement to
organize and attend the meetings. It was also apparent that
most rural development officials were aware of TSC status
and progress
6.2.4 Sector Coordination in MP
The baseline assessment of enabling environment noted
that there was an element of competition between WSP
and UNICEF in MP, with both development partners
Endline Findings
presenting the state government with different sanitation policies and strategies at the outset of the program,
and both promoting slightly different implementation approaches and institutional arrangements.
UNICEF has had a longer presence in MP, and has significant influence with the state government through a
permanent office staffed by an international UNICEF
WASH specialist and a significant budget for state activities. As a result, some of the early WSP initiatives were
undermined by parallel UNICEF activities and vice versa,
which led to only limited cooperation and collaboration
between the two agencies during the early phases of the
program.
Over the last three years, inter-agency coordination has improved substantially. The arrival of a new UNICEF WASH
specialist in early 2010, who had favorable experiences
with Community-Led Total Sanitation (CLTS) in a previous position, has galvanized joint activities and encouraged
convergence on many key issues. Nevertheless, it was apparent that the state government has been able to play the
two agencies off against each other for some time, for instance by preferring the UNICEF TSC performance ranking system over the program benchmarking system, and
by adopting the consultant-based UNICEF approaches to
institutional support ahead of the more sustainable arrangements promoted by WSP.
TABLE 5: ENABLING ENVIRONMENT IMPROVEMENTS: INSTITUTIONAL ARRANGEMENTS
Indicator
2007 Baseline
29
2009 Target
2010 Achieved
Sector coordination
Last meeting :
Last meeting:
Last meeting:
National sanitation group
—
—
—
HP: State WASH Mission
12 months
3 months
2 months
MP: State WASH Mission
15 months
3 months
8 months
HP: District WASH Missions
14 months
6 months
1 month
MP: District WASH Missions
14 months
6 months
2 months
29
Number of months since last meeting took place.
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6.3 Program Methodology
Key Findings
• The 2010 update to the TSC guidelines focused on
building toilets, rather than stopping open defecation,
and lacked any explicit total sanitation objectives or
approaches.
• Despite the strong policy and financing framework provided by the TSC and NGP, there remains limited consensus on program methodology among national and
state stakeholders.
• Program methodologies differ widely by state, with HP
using a demand-driven approach, and MP using a supplydriven approach.
TSC and NGP guidelines do not specify detailed program
methodology, but instead provide a general policy and financing framework for the district projects. As a result,
the methodologies used for critical components of the program, for instance how to stimulate household demand,
promote sanitation improvement, and ensure sustainable
behavior change, must be determined by individual states
and district projects. The intention behind the broad TSC
and NGP guidelines is to focus attention on achieving sanitation outcomes rather than just counting outputs (which
may or may not lead to positive outcomes, depending on
how appropriate, useful, and sustainable the inputs and
outputs turn out to be).
The program has three components that require detailed
methodologies:
• Creating demand (using CLTS and BCC approaches),
• Strengthening supply (using sanitation marketing
and BCC approaches), and
• Improving the enabling environment for rural
sanitation.
6.3.1 Policy Impact on Methodology: Total Sanitation
The 2004 update to TSC guidelines stated that the elimination of “open defecation to minimize risk of contamination of
drinking water sources and food” was one of the program’s
primary objectives. However, this objective was not included in the six objectives listed in either the 2007 or 2010
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Endline Findings
updates to TSC guidelines, perhaps to reflect the increased
emphasis on a broader concept of sanitation including solid
and liquid waste management, institutional toilets, and
personal hygiene.
The 2010 TSC guidelines focus more on toilet building than on stopping open defecation and, despite the
name, include no explicit total sanitation objectives or
approaches other than “to cover all rural families” by
2012. However, the 2010 update to the NGP guidelines
gives one of the four primary objectives as the development of “open defecation free and clean villages that will
act as models for others to emulate.” In addition, the eligibility criteria for the award include “complete elimination of open defecation within the boundaries of the PRI.
Nobody, including floating population, defecates in the open
and child feces are disposed of in toilets” and the guidelines
now include a section on disincentives in case of a relapse
from ODF status.
As at the beginning of the program, TSC guidelines focused
on incremental increases in sanitation coverage, with the
below poverty line (BPL) household latrine incentive payable on completion and use of an individual latrine rather
than on achievement of a collective sanitation outcome in a
village or GP. However, the NGP awards promote collective
sanitation outcomes and encourage local governments to
aim for community-wide improvements. In combination,
TSC and NGP schemes provide a strong framework for
sanitation improvement, with TSC ensuring that resources
and mechanisms are available for effective implementation
and the NGP encouraging comprehensive and communitywide sanitation improvements.
These policy adaptations have an important impact on the
program methodologies adopted by state and district TSC
projects, as they define the objectives and rules of the program, and therefore influence efforts to improve and refine
program methodologies.
6.3.2 Support for Total Sanitation Approach
Support for the CLTS approach, which aims to trigger sanitation behavior changes that eliminate open defecation, has
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grown since the start of the program. There is now widespread recognition among government and development
partners that CLTS is an effective approach to demand-generation and is a useful behavior change tool. In HP, CLTS
techniques have been combined with more traditional IEC
approaches, such as kala jattar street theatre, to develop a
methodology that is considered appropriate and effective by
both local implementers and local communities.
WSP-organized exposure visits to areas where CLTS has
been successfully used were instrumental in persuading
practitioners and decision-makers to adopt the CLTS approach in the face of considerable misgivings by senior
officials. In particular, the March 2009 exposure visit to
Bangladesh triggered a significant scaling up of efforts in
HP, including recognition that more widespread and effective training in the total sanitation approach would be required in order to achieve statewide sanitation targets.
6.3.3 Achievement of the Desired Outcomes
The program efforts to develop performance-benchmarking systems have been important in developing support for
the total sanitation approach in HP. At baseline, several districts had expended their entire IEC budget, either through
external support organizations or through their own efforts,
with little to show for their expenditures other than a list
of outputs (brochures distributed, posters printed, camps
completed). However, there was little measure of effectiveness available other than the number of NGP awards garnered by each district.
The HP benchmarking system incorporates eight different
performance indicators, including a 20 percent weighting for the number of ODF GPs declared in the previous
six months and a financial efficiency indicator that examines TSC expenditure per ODF GP. These measures have
highlighted areas where TSC expenditures have been ineffective,30 and have convinced both state and district stakeholders that a CLTS-based approach is highly cost-effective.
It is important to note that the methodology adopted in
HP does not rely on hardware subsidies and is in keeping
30
Endline Findings
with the total sanitation approach. Originally the state government intended to use BPL household incentive funds to
reward communities that achieve ODF status but this policy was blocked by the central government due to concerns
that these funds, which were allocated to BPL households,
might benefit APL households if provided in the form of
a community grant. Fortunately, since the use of BPL incentives has been shown to be counterproductive, the state
government had already noticed the impressive progress
being made in Mandi District without hardware subsidies,
and so decided that the significant finance available for BPL
household incentives would not be used.
The lower poverty levels in HP, where less than one percent of rural households are reported to be in the bottom
wealth quintile nationally, was, and remains, an important
factor in the success of the program methodology without
payment of BPL latrine incentives. The elimination of the
BPL incentive from the implementation process greatly
simplifies the approach, removing the temptation to speed
up progress using supply-driven interventions, and making
outcomes dependent on the creation of genuine demand
and commitment to rural sanitation improvement by local
households, communities and governments.
In addition, the districts in HP have followed a two-stage
process, focusing first on achieving ODF status, and then
on meeting the NGP criteria. This longer process allows
a narrower and more targeted approach during the initial
stages, and does not attempt to tackle the difficult areas of
solid and liquid waste management until some capacity, experience, and confidence have been developed in achieving
an easier collective sanitation outcome.
This two-stage approach has led to relatively slow progress
in the NGP awards, with only 16 percent of GPs in HP
having won an NGP award despite the state achievement
of meeting 93 percent of its TSC household latrine target;
but it has been highly successful in achieving self-declared
ODF communities, with 85 percent of GPs now reported
to be ODF. As districts approach 100 percent ODF coverage, the focus is shifting to NGP progress and the number
A drawback to the current cost-effectiveness indicator is that it penalizes districts that have progressed to higher-level activities such as solid and liquid waste management. Since
these expenditures are not deducted. As a result, their higher total TSC expenditures suggest a higher cost per ODF GP.
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of applications is increasing rapidly. In 2010, 1258 NGP
applications were submitted by GPs (39 percent of all GPs)
as well as 10 Block NGP applications. Given an NGP application success rate of 48 percent in 2009, compared to
only 24 percent application success in MP, the state government is confident that NGP progress will accelerate rapidly
over the next year or two.
6.3.4 Remaining Resistance to the Total Sanitation
Approach
Despite increased central support for the total sanitation approach, there remain several states that argue that the current
BPL latrine incentive is inadequate, and provide significant
additions to this household incentive from state funds. TSC
guidelines make it clear that the BPL incentive should be
paid to the household on completion and use of the facility.
However, in many states, including MP, local governments
use the increased incentive amount for up-front purchase of
latrine materials and direct payments to private latrine contractors. In these cases, the beneficiary household does not
receive any of the incentive amount since the local government spends the entire sum on the bulk purchase of materials and latrine construction activities.
Endline Findings
using the BPL incentive as intended, since the amount provided is more than enough to finance (or reimburse) the
construction of a durable and improved sanitation facility;
or towards developing tools and techniques capable of triggering sanitation development in previously disinterested
and resistant groups. In addition, TSC technical requirements have now been lowered so that dry latrines and ecosan facilities are now acceptable, which should allow the
promotion of more appropriate options in water-scarce and
chronically poor areas.
The lower emphasis on the total sanitation approach in
MP is also reflected in the monitoring system, which does
not collect data on the number of ODF communities. As
a result, the performance benchmarking in MP is based
on the number of latrines built, NGP progress and TSC
expenditures. While NGP success suggests a higher sanitation standard than ODF status, only 7 percent of GPs have
been awarded the NGP which means that progress in the
remaining 93 percent of communities is assessed only on
incremental and self-reported latrine coverage without any
information on collective outcomes.
In MP, the state government obtained permission to use
payments made under NREGA to supplement the funds
available for household latrine construction. In practice,
NREGA and TSC funds31 are usually combined to pay
contractors to build twin pit latrines and plant fruit trees,
with little or no involvement from the user household. The
enhanced hardware subsidy provided by the Nirmal Watika
scheme makes it easier for the GP to build the sort of familiar brick-built latrines that are favored by many government officials, and enables latrines to be built for all BPL
and some APL households without the need to generate
genuine demand.
The differences between the program methodologies adopted in HP and MP illustrate the broad scope provided by
TSC framework. The methodology utilized in HP broadly
follows a total sanitation approach. In contrast, the methodology in most areas of MP is based on a supply-driven
approach, through which local governments employ private
contractors to build standard toilets. There are variations
across districts, with the more successful districts in MP
adopting elements of the total sanitation approach, including sanitation promotion and behavior change activities,
but most prefer the easier supply-driven approach despite
the best efforts of WSP to promote and spread the total
sanitation approach within MP.
The higher poverty levels in MP, where 36 percent of rural
households are reported to be in the bottom wealth quintile nationally, have undoubtedly made it harder to mobilize communities to build household latrines that meet
TSC requirements. Nevertheless, insufficient effort has
been directed towards more creative and effective ways of
The endline assessment found that the number of districts
using the total sanitation approach in HP had increased
from five to nine (75 percent of all districts), but the scale
of adoption had not changed in MP from the original five
districts (10 percent of all districts) found using total sanitation approaches at baseline (see Table 6).
31
Only BPL households with job cards qualify for both TSC latrine incentives and the Nirmal Watika NREGA payment.
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6.3.5 Methodology: Sanitation Marketing
As at baseline, there was little evidence of any explicit methodology for sanitation marketing. This gap reflects the good
availability and affordability of sanitation products and services in most rural parts of India, and the supply-driven
nature of TSC in places like MP, which together limit the
need for formal sanitation marketing interventions.
Masons have been trained to construct latrines in both
states, including more than 150 master masons in MP, but
few have emerged as entrepreneurs willing to market their
services or to innovate new products. In part, this reflects
the application of fairly rigid standards regarding latrine
type and quality. TSC technical guidelines and training
courses in MP were reported to define the number and
spacing of bricks in a honeycomb brick lining, the exact
size and composition of concrete slabs, and to state that
only steeply sloping low-flush latrine pans, known as “rural
pans,” should be installed.
The more supply-driven approach used in MP involves
bulk purchases by local governments and mass contracts
for local building firms to build latrines. As a result, user
households have little choice in the design or quality of
the latrine and all of the latrines built in a particular area
tend to be the same. Those responsible for TSC project in
MP argue that large contracts and bulk purchases remove
transport problems and reduce costs, but the lack of user
involvement in the design or construction process appears
to result in low ownership, limited latrine usage, and the
development of program-based supply chains for latrine
construction that leave little scope for sanitation marketing
by the private sector.
In HP, where total sanitation approaches have been used
more extensively to develop demand for sanitation improvement, a combination of existing local services and
self-supply has been sufficient to enable most households to
build adequate latrines. A range of different latrine designs
was found, although many households favored a variation
on a pour-flush latrine connected to a large, stone-lined latrine pit or septic tank. The main latrine components, such
as the ceramic latrine pan, are bought from local markets,
and local masons are usually employed to construct the
slab, pipework, and pit lining.
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Endline Findings
In 2010, WSP developed a behavior change communications strategy that aimed to reduce open defecation,
increase knowledge of low-cost latrine products, and motivate people to seek information, products, and services at
local sanitation suppliers. This strategy may have helped in
the development of a sanitation marketing methodology,
but the Government of HP reported that this communications strategy arrived too late. By the time the strategy
was completed, the government’s main challenges were no
longer stopping open defecation and building latrines, as
significant progress had already been made in these areas,
but rather tackling institutional sanitation, solid and liquid
waste management, and improvements to the sustainability
of sanitation outcomes.
6.3.6 Methodology: Enabling Environment
WSP has used a broad spectrum of approaches to improve
the enabling environment for rural sanitation. In each of
the two states, WSP has undertaken performance benchmarking based on the routine monitoring data collected
by the district and state governments, organized exposure
visits to introduce and spread new ideas and approaches, arranged capacity building to develop and improve skills and
capabilities, conducted rapid assessments and evaluations
to provide detailed information on performance, outcome
and impact, and produced knowledge products to disseminate the learning from these various activities. WSP has also
undertaken wider assessments to demonstrate the importance of process on TSC performance, such as the 21-state
study Rapid assessment of processes and outcomes: a Decade of
the Total Sanitation Campaign completed in August 2010.
The program methodology for improving the enabling environment has been effective in increasing support for the
total sanitation approach, and in generating pressure for
state governments to improve the program methodologies
and monitoring used in their TSC and NGP programs.
However, one of the central elements of the enabling environment efforts has been to demonstrate that increased
hardware subsidies are not necessary to build hygienic latrines, and in some cases can hinder cost-effective rural sanitation improvement. In particular, efforts have been made
to highlight the problems caused by the supply-driven use
of BPL incentive funds to finance latrine construction by
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contractors, in contravention of TSC guidelines on the payment of BPL incentives after the household has built its
latrine. The evidence from successful programs like that in
HP appears convincing but, while the technical nature of
this evidence has been well received and understood by administrators, it has proved insufficient to counter concerns
that poor households cannot afford to build hygienic toilets
under the current program, which has generated strong political pressure from state and union ministers for further
increases to the BPL latrine incentive.
The enabling environment methodology has been effective
in developing conditions for the acceleration of rural sanitation progress in HP, but has failed to generate the same supportive conditions or positive progress in MP despite the
use of similar techniques, activities, and advocacy channels.
This point is illustrated by the wide variation in performance and enabling environment found in the twentytwo WSP assisted districts in MP (see Annex 4: Program
Benchmarking Assessments). Only nine of the programsupported districts are in the top half of the benchmarking
ranking, with the remaining thirteen program supported
districts all ranked below average, including seven of the
ten worst performers. These low performing districts all requested assistance from the program, but did not engage
with or follow up on any of the program activities. As a
result, no further support was provided after the initial
Endline Findings
period. There was also no evidence of any performance
dividend in program-supported districts, and no reports of
any substantial strengthening of the enabling environment
in the fourteen districts in MP that received direct support
for the duration of the program.
UNICEF supported six “integrated districts” through its
program in MP, and three of these are among the six highest performing districts ranked by the program benchmarking assessment. While this high performance may reflect
the comprehensive support provided by UNICEF, several
stakeholders noted that support to these districts was provided because of their progressive approaches and effective
programs, and that the other three integrated districts are
ranked 21st, 39th and 40th and that there is no suggestion
that the UNICEF support has provided any more consistent benefits than the WSP program.
The benchmarking assessment does not directly measure
any of the components of the enabling environment, but it
suggests that there is currently little difference between the
sanitation outcomes in districts supported directly by the
program or UNICEF programs and those implementing
without external assistance. This finding indicates that the
wider enabling systems, mechanisms, and incentives that
should drive rural sanitation improvement have not been
sufficiently institutionalized for consistent or large-scale
progress.
TABLE 6: ENABLING ENVIRONMENT IMPROVEMENTS: PROGRAM METHODOLOGY
Indicator
2007 Baseline
2009 Target
2010 Achieved
HP: use of TS approach
5 districts (25%)
12 districts (100%)
9 districts (75%)
MP: use of TS approach
5 districts (10%)
24 districts (48%)
5 districts (10%)
HP: use of SM approach
0 districts (0%)
6 districts (50%)
0 districts (0%)
MP: use of SM approach
0 districts (0%)
12 districts (24%)
0 districts (0%)
Total sanitation at scale
Sanitation marketing at scale
Knowledge management
HP: Exposure visits (people/year)
44
50
20 (40%)
MP: Exposure visits (people/year)
20
200
0 (0%)
HP: Best practice seminars
0
12
4 (33%)
MP: Best practice seminars
0
4
3 (75%)
WSP field & learning notes
0
2
1 (50%)
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6.4 Implementation Capacity
Key Findings
• Both HP and MP state governments have developed
increased capacity for TSC management at state level.
• Large amounts of local capacity building have been undertaken, but no systems are in place to check whether
capacity building is appropriate or effectively utilized.
• HP government has identified three areas in which
greater capacity is needed: strategies to reach difficult areas and groups (remote, disadvantaged, and
excluded households and communities); improving the
sustainability of household and institutional sanitation
facilities; and solid and liquid waste management.
Few countries can claim to have rural sanitation programs
that match the scale and scope of either TSC or the NGP.
As a result of the massive investments associated with TSC
and NGP programs and the extensive local government
system, there are few resource constraints for rural sanitation improvement. However, each state and district uses the
available resources in different ways. The implementation
capacity of local governments varies dramatically depending on the institutional support and training provided to
the main implementers as well as on the implementation
approaches adopted by each local government.
6.4.1 State-level Capacity
Since the baseline, both HP and MP state governments have
recognized the need for increased management capacity at
state level. In part, this change reflects increased monitoring
and evaluation requirements imposed by central government to improve the quality of the NGP application and
verification system, and increased financial requirements
since the central TSC funds are now released to the SWSM
for payment to the appropriate district or other beneficiary.
The SWSM is also responsible for compiling individual district TSC plans into a state annual implementation plan
that is submitted to the central DDWS for approval. These
administrative requirements impose a heavy workload on
the state TSC unit, which most state governments have addressed by using consultants from the Communication and
Capacity Development Unit (CCDU).
In HP, there is now an assistant director in the RDD assigned to manage the state TSC project, with five staff
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Endline Findings
including three consultants from CCDU and two administrative staff. While this is a rather small team to manage
such a dynamic and extensive program, the establishment
of a dedicated unit has greatly increased the regular monitoring and support provided by the state government (see
Table 7).
Capacity-building mechanisms appeared effective in HP,
with most districts reporting that they had been given
effective training in key areas, and few reports of capacity shortages. Most recently, capacity had been built in
SLWM, with a large team from Kullu District sent to
Nainital for a one-week course, and representatives from
across the state sent to visit successful SLWM projects in
Southern India.
The TSC unit in MP has also increased in size, and now has
seven technical staff and 20 administrative staff. A team of
state quality monitors tasked with reviewing district level
TSC progress further supports the state TSC unit. The additional review capacity provided by these monitors should
be a useful supplement to the state TSC unit capacity, but
there is little accountability for their activities, and there
was little evidence that they were either well-used or adding any value to the state sanitation activities.
Huge numbers of local stakeholders have been trained in
MP through the three state resource centers (State Institute of Rural Development, Water and Land Management
Institute, and the Administration Academy) and twenty
NGOs that operate regional training centers, but several
stakeholders noted that much of the trained capacity is not
utilized effectively at district level or below. In particular,
150 master masons were trained to provide cascade training to masons at district level, but few of the districts were
reported to have used these training resources consistently
or effectively.
No mechanisms were apparent for evaluating the effectiveness or use of the capacity building activities, or for providing the reliable feedback and data needed to improve
selection processes and course content. As a result, there is
limited awareness of the value added by capacity-building
activities, and little recognition of the need to reform and
improve approaches to capacity building.
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6.4.2 District-level Capacity
Similarly to the state level, TSC administrative requirements have increased significantly at the district level. TSC
reporting systems now require that detailed progress data to
be entered for each GP in order to verify its progress before
accepting NGP applications, and to allow more thorough
auditing of the use of TSC funds such as the BPL incentive payments. These requirements have led most districts
to employ one or two TSC administrative staff in addition
to the normal rural development staffing.
In HP, most districts use an NGO “support organization” to
manage TSC activities and provide support at block and GP
levels. Many GP officials lack the soft skills, temperament
and time required to undertake intensive social mobilization
and behavior change activities. This means that the support
organizations play a vital role in providing capacity and experience in these areas, and in playing a social intermediary
role between the local government and the community.
As the program moves to tackle higher-level goals in HP,
the state government has identified three areas in which
greater capacity is needed:
• Strategies to reach difficult areas and groups (remote, disadvantaged, and excluded households and
communities),
• Improving the sustainability of household and institutional sanitation facilities, and
• Solid and liquid waste management.
A different approach has been used in MP, with a network
of TSC coordinators contracted to strengthen capacity at
district and block levels. In addition, each district has been
asked to identify and employ “reform champions” from the
outstanding natural leaders that emerge during community
sanitation development processes, and select “brand ambassadors” from the village heads in NGP-winning communities. While a promising concept, there is little evidence that
either the reform champions or brand ambassadors have yet
had any significant impact on capacity to implement activities or improve outcomes.
TSC district and block coordinators spend much of their time
and energy on administrative tasks, and are provided little in
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Endline Findings
the way of resources to support or strengthen implementation at the village level. In the absence of any other local support, only exceptionally motivated village governments find
time to undertake genuine demand generation and behavior
change activities that might improve latrine usage and the
sustainability of sanitation outcomes. In practice, the village
governments rarely face the challenge of motivating households to build or use toilets because the capacity to build the
toilets is provided by local contractors financed with TSC
funds. Furthermore, TSC’s online monitoring system does
not require any post-construction assessment of latrine usage
or sustainability, so there is little incentive to invest scarce
capacity and resources in social mobilization and follow up.
Selective examples were found of district projects in MP
engaging local NGOs to provide community mobilization
and social intermediation services, but few positive experiences were reported. One district collector stated that he
had contracted a number of small NGOs on identical performance contracts that would reward the achievement of
specified rural sanitation targets, but that the NGOs were
so unsure about their ability to achieve the targets that none
of them did any further work or applied for any further
payments after receiving the initial mobilization payment.
The frequent transfer of district administrators and local
officials noted during the baseline assessment remains a significant problem. Many of the senior district officials in the
areas visited during the assessment had been in position for
less than one year. The lack of continuity limits the potential
to implement any medium-term or long-term strategy, and
requires regular retraining and re-orientation. Frequently, it
was the support NGO or contracted consultants who held
institutional memory, rather than the government officials
responsible for the program.
6.4.3 WSP Capacity
WSP has strengthened its program team further since the
baseline assessment. The Delhi-based team has extensive experience in rural sanitation development in India, and remains
responsive to state and local government demands. WSP state
coordinators have played an important role in supporting state
TSC implementation, and it is clear from the assessment that
this sort of close and long-term support builds trust with the
state government and adds value to program interventions.
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Endline Findings
TABLE 7: ENABLING ENVIRONMENT IMPROVEMENTS: TSC IMPLEMENTATION CAPACITY
Indicator
2007 Baseline
2009 Target
2010 Achieved
HP Districts/state technical staff
0
12/3 = 4
12/4 = 3 (133%)
MP Districts/state technical staff
0
50/3 = 17
50/7 = 7 (233%)
HP District TSC staff (total)
3
24
28 (117%)
HP District TSC staff (total)
0
48
36 (75%)
6.5 Sanitation Goods, Services, and
Information
Key Findings
• In recognition of the utility of dry latrines in cold and
water-scarce areas, the 2007 and 2010 revisions of
TSC guidelines dropped the prohibition of dry latrines.
• The HP sanitation strategy is based on allowing freedom of technology options and avoiding interference
with market supply.
• Local governments in MP continue to promote the
construction of standard latrines that meet technical
specifications set by the PRD, which may not be as
technically advanced as reported.
• The differences between supply chains in HP and
MP are marked, with those in HP gaining strength
and divergence, and those in MP are temporary and
program-driven.
6.5.1 Policy: Conversion of Dry Latrines into PourFlush Latrines
The 2004 TSC guidelines stated that one of the main objectives of TSC was “to convert dry latrines to pour flush latrines,
and eliminate manual scavenging practice, wherever in existence in rural areas.” This policy statement was significant
as it set the minimum level of service in India higher than
that recommended by the UNICEF-WHO Joint Monitoring Program for Water Supply and Sanitation (JMP) by excluding dry latrines from the options promoted by the Total
Sanitation Campaign.
In recognition of the utility of dry latrines in cold and waterscarce areas, the 2007 and 2010 revisions of TSC guidelines
dropped the prohibition of dry latrines. A revised guideline
stated that existing bucket latrines should be converted to
sanitary latrines, and the 2010 guidelines include a section
detailing the benefits of ecological sanitation facilities such
as urine-diversion composting toilets and waterless urinals.
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6.5.2 Sanitation Goods, Services, and Information in HP
The HP sanitation strategy is based on allowing freedom of
technology options and avoiding interference with market
supply. Most stakeholders agree that market supply is working
well. Products remain reasonably priced at about Rs 150–250
(US$4–6) for a ceramic latrine pan, and widely available despite the large distance from the major ceramic goods manufacturers in Gujarat. Retailers and other service providers
report few government restrictions on their business activities.
Cold conditions, and generally higher standards of living,
mean that the typical latrine in HP is some way up the
‘sanitation ladder.’ Most self-provided household latrines in
HP have ceramic pans, large lined latrine pits, and solid
superstructures (often a combined bathroom and latrine).
Many latrines appear over-designed, often due to technical misconceptions regarding the need to line latrine pits
(e.g., in rocky ground where the risk of collapse is low),
the provision of impermeable linings in leach pits (which
should be permeable), the provision of vent pipes (in watersealed latrines), and over-sizing of the latrine pit. However,
the solid designs favored in HP perhaps reflect the harsh
climatic conditions and the traditional building techniques
used in most local housing.
Despite the presence of many expensive latrines, poor
households in HP reported that they had been able to build
a hygienic and durable pour-flush latrine for as little as
Rs 1,200 (US$26). The cost estimated by the household
ignored the opportunity cost of the labor supplied by the
household and the value of any self-supplied materials,
which were considerable in many cases due to the construction of stone-lined latrine pits and stone-walled superstructures. The household cost estimates tended to be lower in
more remote rural areas where traditional building materials were easier to obtain, and where a lower value was attached to time spent constructing the facility.
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Endline Findings
A technical manual detailing the advantages and disadvantages of the different sanitation technologies was produced32
and circulated by the HP RDD, but does not appear to
have been widely used at district level.
footrests, which cost an additional Rs 30 to supply with the
rural pan). Suppliers also noted that the deeper rural pan was
more difficult and expensive to install due to the larger volume of excavation and enclosing materials required.
No significant changes were apparent in the availability and
affordability of goods and services for rural sanitation improvement in HP since baseline. However, local government
officials, service providers, and rural households were far better
informed on the range of possible latrine options and prices.
An absence of information on low-cost latrine options in rural
communities, which leads poor households to conclude that
they cannot afford a latrine, can be a critical constraint in developing countries. The widespread latrine development in
HP has resulted in almost universal awareness of latrine prices
and options, with most stakeholders in agreement that poor
households face few constraints in building simple latrines.
Most significantly, suppliers noted that they have no private
customers for the rural pans, which are only bought by government officials and NGOs supplying materials to TSC
projects. When asked why private customers always preferred
the supposedly inferior conventional pans, the suppliers noted
that these pans are available in many colors (whereas the rural
pans are only available in white), are bigger and come with
built-in footrests, are considered more beautiful (perhaps because they are the model favored by non-poor households),
and are widely available for a similar price. Few suppliers
stocked the rural pans, and even these suppliers stated that
the rural pans were “difficult to sell” and that they would not
stock them if TSC officials stopped asking for them.
6.5.3 Sanitation Goods, Services, and Information in MP
Local governments in MP continue to promote the construction of standard latrines that meet technical specifications
set by the PRD. While the standard design varies slightly
from district to district depending on local costs and material availability, in most areas latrines constructed with TSC
support are easily identifiable by their roof-less brick superstructures, low-cost metal doors and steeply-sloping “rural
latrine pans.” This technical standardization has been further reinforced by the recently published DDWS-UNICEF
Technology Options for Household Sanitation, which states:
“rural [pour-flush] pans having higher gradient with less
water consumption for flushing are technologically superior
to flat pans which require more water for flushing.”
A brief review of the “rural pans” available in MP questioned
whether these advantages are as significant as suggested in the
technology option document. The rural pour-flush latrine
pan is reported to require a lower quantity of water for flushing due to the steeper slope of the pan, but flushing volumes
are often more heavily influenced by the size of the water
container than by the slope of the pan. Price differences between rural and conventional pans were also nominal in MP,
with imported rural pans costing Rs 150–180 whereas conventional pans were available from Rs 200 (including built-in
32
It is argued that only low-flush rural pans should be installed in water-scarce areas, hence that this is the best technology to promote in states like MP. However, the water
saving provided by the rural pan pour-flush is not nearly as
significant as that provided by a dry latrine, such as the dry
composting latrines promoted in the 2010 version of TSC
guidelines. Given the wide variations in physical conditions, prices, willingness to pay, and preferences across any
state, the optimal solution would be to provide GPs and
individual households with information on all of the latrine
options available and let them make their own decisions
based on individual requirements.
Another factor affecting demand for rural latrine pans is
the NGP verification process. Pressure from the state government for NGP performance means that district governments respond rapidly to any comments or signals from
NGP verification teams. When asked about the strong
preference for rural latrine pans, several district and block
officials noted that some NGP verification teams had questioned or rejected household toilets with conventional latrine pans due to concerns that these might use more water
and be unsuitable for rural use. While this concern is not
supported by any of TSC or NGP guidelines, the suggestion
Knowledge Links (2005) Discussion of technologies for sanitation in rural HP.
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that NGP status might be endangered by the installation of
non-rural pans has been sufficient for district teams to be
rigid in their preference for rural latrine pans.
The systematic preference for government-determined latrine
components and designs, which is reinforced by the technical
manuals, training courses, and program criteria adopted in
MP, makes it extremely difficult to encourage innovation, or
promote household responsibility and ownership for facilities, or implement demand-led sanitation development.
6.5.4 Sustainable Supply Chains
The HP sanitation strategy has helped to strengthen sustainable local supply chains, and to ensure that most local
governments and rural households are aware of appropriate
latrine options, prices and availability. Some longer-term issues, such as safe emptying or replacement of full latrine
pits and septic tanks, have not yet been tackled, but the
market-based approach has ensured that households and
communities feel strong ownership for their sanitation facilities, and are likely to seek out practical and affordable
solutions to maintain and upgrade these facilities.
In contrast, the approach adopted in MP has resulted in
entirely temporary and program-driven supply chains that
run parallel to, and thus undermine, market supply. In most
parts of MP, the GP orders latrine materials (pans, bricks,
cement, sand, pipework, doors) in bulk from local suppliers, and then pays a local contractor to build the facilities.
There is little innovation or variation in the standard latrines built, and the beneficiary households have little or no
control over the facilities that are built for them.
There is little transparency, participation, or accountability in the process. As a result, many latrines are built
using cheap materials and poor workmanship. Few of the
recipients are sufficiently engaged in or aware enough of
the process to complain that the latrines are not worth the
large amount invested by the government on their behalf.
This opaque process provides enormous scope for corruption and profit, so those involved in procuring, managing,
or monitoring these latrine programs have little interest in
changing implementation practices, assessing value-formoney, or improving household outcomes.
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Endline Findings
6.6 Financing
Key Findings
• Twenty-five percent of the total TSC budget is earmarked for total sanitation, sanitation marketing, and
the enabling environment. The balance of funds are earmarked for cash incentives and facility constructions.
• Because of its demand-driven approach HP has used
only a small percentage of the funds available from
TSC. MP, with its supply-driven approach has used a
much higher percentage.
• The unprecedented success of the NGP award has had
unexpected side effects, resulting in changes in the
way the program is administered.
• State reward schemes have seen varied success.
• Financing for public facilities is only available for publicly owned facilities.
Approximately 25 percent of the total TSC budget is
earmarked for investment in the three main areas of the
program:
• Total sanitation (up to 15 percent on IEC and startup activities);
• Sanitation marketing (up to 5 percent on alternate
delivery mechanisms); and
• Enabling environment (up to 5 percent on raising
awareness, capacity building, and administration)
Substantial sums are available for creating sanitation demand, increasing the supply of appropriate sanitation
goods and services, and improving the enabling environment. At present, many districts have been under-utilizing
the software elements of their TSC budgets. Therefore,
given the additional support from WSP and the five-year
duration of TSC, there is unlikely to be a shortage of funds
for implementation.
The remaining 75 percent of TSC budget is earmarked
for cash incentives to BPL households, and for facility
construction (community sanitary complexes, institutional toilets, and solid and liquid waste management
facilities).33 This substantial hardware investment should
stimulate private sector supply and strengthen supply
chains.
The proportion of each component varies depending on the local context and requirements.
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The endline assessment confirms that TSC financing is
more than sufficient for the improvement of household
sanitation facilities. Indeed, states like HP have used the
IEC funds to mobilize household investment so effectively
that they have not had to use almost Rs 22 crore (US$5
million) in TSC funds allocated for BPL household incentives. However, it was clear that program assistance played
an important role in developing the strategies, approaches,
capacity, and systems that enable the state government to
manage the program, and enable district governments to
use their TSC project funds effectively.
TSC funds available for the provision of institutional sanitation facilities and for solid and liquid waste management
are less generous, and as local governments grapple with
the challenge of providing these facilities in order to meet
the onerous NGP requirements, it is clear that more costeffective approaches are required for these components, and
that more flexibility in the use of TSC funds is needed to
allow for the variable needs and priorities in different areas.
In the areas where TSC has not been performing well, the
GoI has encouraged its development partners to provide
additional support to improve policies, approaches and
practice. Recently the Global Sanitation Fund approved
US$5 million for a program to support TSC in Assam and
Jharkhand using approaches that will build on the learning
from the program in India.
6.6.1 Program Influence on TSC Outcomes
Over the last three years, the combined central and state
TSC expenditures in HP total around Rs 3.0 crore (US$6.5
million).34 This total is 80 percent lower than the US$32.7
million TSC allocation originally approved for HP, largely
because of the non-utilization of the BPL incentive funds.
Another US$0.5 million or so has been provided through
first installment payments of the NGP awards.35
At the outset of the program in HP, the planned program
investment of around US$0.6 million over three years appeared small in comparison to the US$12 million likely to
be spent on rural sanitation by the government during the
program period. In practice, TSC and NGP expenditures
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Endline Findings
have been lower than anticipated, thus the program funds
account for about 10 percent of the total rural sanitation expenditures in HP over the last three years. While it is hard to
separate out the contribution made by the program to TSC
activities and outcomes, the majority of the program funds
have been used for capacity building, evaluation, strategy
development, and knowledge management, which are areas
not well covered by the conventional TSC expenditures.
The higher TSC expenditures in MP, where combined
central and state TSC expenditures totaled US$79.4 million
since 2007; and the larger NGP contribution, which has
reached at least US$3.3 million, mean that the US$1 million invested by the program in MP amounts to only
1.2 percent of the government’s spending. Although program funds have clearly played a small part in the overall
MP program, WSP decided to concentrate the majority of
its activities in districts that expressed demand for support,
and took part in capacity building, coordination, and strategy development activities. In all, twenty-two out of the
fifty districts were supported by the WSP program, of which
about fourteen districts were active and benefited from direct WSP support over the three-year program period.
6.6.2 Sanitation Subsidy Policy in HP
The 2005 “Strategy for total rural sanitation in HP” proposed that the funds allocated to BPL latrine incentives
should be used to finance collective incentive payments for
villages that achieve ODF status, with the lump sum payment then used by the GPs to achieve other sanitation improvements such as solid and liquid waste management, or
improvements to institutional sanitation.
The GoI subsequently ruled that the BPL incentive funds
could not be used for the finance of community sanitation
infrastructure or services because these services would also
benefit APL households and therefore would not meet the
pro-poor objective of the original incentive design. As a result, the BPL incentive funds have been unused during the
last three years of the program.
The Government of HP has now applied to the GoI for the
release of the currently unused BPL incentive funds, with
US$1.6 million in TSC funds was spent in HP prior to the 2007 baseline assessment.
Fifty percent of the NGP award is paid initially. It remains unclear whether the second installments of the NGP awards have been paid.
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the intention of distributing the funds to BPL households
that are using toilets built since TSC began. However, the
Government of HP noted that the steadily rising BPL incentive amount would penalize early adopters if distributed
according to the date of first latrine use and, therefore, it
now plans to average the incentive amount across all BPL
beneficiaries.
6.6.3 Sanitation Subsidy Policy in MP
As noted earlier, the BPL incentive funds have been central
to the implementation of TSC in MP. These funds have
been used to purchase latrine materials and hire contractors
to build toilets for BPL households, but have rarely been
paid directly to the BPL households as stipulated in TSC
guidelines.
Endline Findings
In the districts visited, local government officials reported
that the use of NREGA funds for latrine construction had
made their work easier. Funds are now available to construct latrines for most APL and BPL households, which
allows latrine construction to move faster and output-based
district targets to be met more easily. It was not possible to
do a rigorous assessment of the impact of the additional
NREGA funds on sanitation improvement, but there were
widespread reports that the funds are being used inefficiently to build latrines that are unnecessarily expensive,
over-priced, and poor quality, and that latrine usage rates
are very low because of the supply-driven nature of the program. Consequently, a huge amount of TSC and NREGA
investment in latrine building in MP is going to waste.
6.6.4 Nirmal Gram Puraskar
In September 2009, the MP SWSM issued a circular to
all district collectors to confirm that there is provision
within TSC for payment of the Rs 2,200 latrine incentive
to BPL households “after the completion of [the] toilet,”
and that this incentive payment could be made through
the respective bank or post office accounts opened for these
households under the NREGA. This circular was issued to
counter claims that local governments were not allowed to
pay the incentive directly to BPL households, but there remains little evidence that local governments in MP have
been making cash payments to BPL households that build
their own latrines.
As noted earlier, the BPL incentive in MP has been augmented by the Nirmal Watika scheme, which uses NREGA
funds to finance the construction of twin latrine pits and
plant fruit trees. In HP, eligible households can earn up
to Rs 11,000 (US$239) for 100 days of NREGA work,
and some BPL households have chosen to use Rs 1,000–
1,200 of their NREGA cash, the equivalent of around 11
days’ work, to finance latrine construction. In MP, up to
Rs 5,000 of the NREGA funds are being used to construct
toilets for qualifying APL households, or to supplement
the Rs 2,200 incentive available to BPL households. As a
result, up to half of the NREGA wages available to qualifying households are being used for latrine construction, and
these households have little choice in how this money is
used since it is controlled by the local government and paid
directly to local contractors.
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Because the NGP is an open and one-time only award, the
GoI hopes that every GP in India will qualify and apply for
the NGP before 2012. Therefore, the 11th Five Year Plan
(2008–2012) budget included Rs 6,000 crore (US$1.48
billion) for the separately financed NGP, which is Rs 300
crore (US$74 million) higher than TSC budget over the
same period.
In addition to the financial incentive attached to the award,
the NGP benefited from an early decision to add some
prestige and profile to the NGP awards by asking the President of India to make the awards in person. As a result, the
initial winners of the NGP awards, who were largely elected
village leaders, were honored by the president at a ceremony
in Delhi attended by ministers and high-ranking officials
from all over India. The prestige and positive publicity generated by this high-profile ceremony was far greater than
anticipated, giving considerable impetus to local government involvement in TSC, and resulting in strong interest and competition for the NGP awards at all levels of
government.
The unprecedented success of the NGP award has had unexpected side effects. The number of awards has increased
dramatically from 38 NGP GPs at the first ceremony in
2005 to 12,144 NGP GPs in 2008, with a commensurate
increase in the number and spread of NGP applications,
and in the finances and resources required to process, validate, and verify these applications (see Table 8).
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Endline Findings
TABLE 8: NATIONAL GROWTH IN NIRMAL GRAM PURASKAR AWARDS
2005
2006
2007
2008
2009
Total
NGP applications (nr)
481
1,421
9,745
—
—
—
NGP GP awards (nr)
38
760
4,945
12,144
4,556
22,443
NGP Block awards (nr)
2
9
14
112
28
165
States involved (nr)
6
16
22
27
25
27
This rapid expansion has stretched the resources available
to provide independent assessments of the applications, necessitated a reduction in the amounts awarded to smaller
GPs (from Rs 200,000 down to Rs 50,000), and made it
impossible for the President to congratulate each recipient personally. As a result, the NGP awards were delayed
in 2007 (from January to May), and several stakeholders
complained that the positive impact of the awards had
been diminished by the reductions in financial rewards and
prestige.
Increased efforts are being made to improve the sustainability of the NGP achievements. In order to limit last minute
efforts to meet the NGP criteria NGP applications are now
only allowed from local governments whose online monitoring data show that they have achieved their household
latrine targets before March 31st of the application year,
Furthermore, the payment of the NGP cash incentive is
now split into two equal installments: the first released immediately upon award, and the second contingent on the
sustainability of the ODF and Nirmal Gram status as verified by random checks carried out by the SWSM at least
six months after the award. In addition, the right to declare
ODF and Nirmal Gram status will be withdrawn from a
GP, and any related NGP blocks and districts, if an awarded
GP is persistently fails in its efforts to retain this status.
Despite concerns about the sustainability of the NGP
outcomes, the number of states proffering applications increased from only six (West Bengal, Maharashtra, Tamil
Nadu, Tripura, Kerala and Gujarat) at the outset to twentyseven states by 2008. The ever-widening pool of NGP applicants reflects the growing political and popular interest
in the awards, which in turn have important incidental
36
effects on the wider support for, and involvement in, TSC
implementation program.
NGP Performance
The NGP remains one of the biggest drivers of sanitation improvement in India. In the two states visited, NGP awards have
considerable political capital and NGP targets remain among
the most closely followed indicators of sanitation success.
However, the NGP awards continue to attract strong criticism,36 with the DDWS poised to publish a joint GoIUNICEF study entitled “NGP at risk” at the time of the
endline assessment. In part, the problems relate to the widespread success and scale of the NGP program, which peaked
at more than 12,000 Gram Panchayat awards in 2008 (see
Table 9). The annual application and verification process
has become so large that it is difficult to find enough verification teams with the experience, capacity, and integrity
needed to make independent assessments of community
sanitation outcomes. In addition, there have been suggestions that the one-time only NGP award combined with a
single verification process can encourage short-term, intensive, and coercive efforts to win awards rather than create
the more sustainable development intended.
As a result of these practical problems and concerns, the
NGP process and guidelines have been revised and improved since baseline. The scale of the awards mean that it is
no longer practical for the President of India to present each
award in Delhi, so it was decided that the awards should
be presented by the respective chief ministers in the state
capitals. Improvements to the verification process include
the requirement that the applicant GP shows 100 percent
latrine coverage in the online monitoring system before the
TARU, 2008; WaterAid, 2008; Bhaskar, 2009; Snehalatha et al, 2010; Alok K, 2010.
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Endline Findings
application can be accepted; more spot checks have been
added to the verification system; and the award has been
divided into two installments of 50 percent of the award,
the second of which cannot be paid until the sustainability
of the achievements has been confirmed by checks made at
least six months after the initial award.
Satna) with 42 percent of all NGP awards in the state found
within these few districts. However, the success in these five districts appears to reflect the particular approaches adopted and
the exceptional committed individuals managing the district
projects rather than a more institutional statewide approach or
more supportive conditions for sanitation improvement.
While these changes have tightened and improved the process, the assessment found that some district coordinators
in MP were reporting 100 percent latrine coverage in NGP
applicant communities well before actual achievement of
this objective. Discussions with block and GP officials revealed that, despite showing 100 percent coverage in the
online system, some applicant GPs had less than 60 percent
latrine coverage at the time of NGP application.
It was also reported that NGP award payments had been delayed in MP, that recent winners had not been presented to
the chief minister in MP, and that there had been no second
verification or payment of the second NGP installment. Consequently, the NGP winners and TSC stakeholders in MP
were starting to lose some of their enthusiasm for the NGP.
There was less evidence of these problems in HP, where
more attention has been given to achieving Open Defecation Free (ODF) status before moving on to the higher
NGP criteria. As a result of this two-stage process, and the
demand-led approach that requires households to finance
their own latrines, the NGP application success rate has
been almost twice as high in HP as in MP. In addition, the
rapid assessment of NGP GPs in HP indicated much better long-term outcomes as 90 percent of households were
found to own functional toilets, and 97 percent of these
toilets were in use at the time of the assessment.
The premature or false reporting of achievements reflects state
and district pressure for NGP success, which encourages those
lower down the monitoring chain to exaggerate progress in
order to ease the pressure. It also results in extreme pressure on
verification teams, as there is a lot at stake for TSC coordinators and local government officials if NGP applications fail.
A visit by the assessment team to a previous NGP winner in
MP supported the findings37 of the recent rapid assessment of
15 NGP GPs in MP, which found that 23 percent of households had no toilet; 26 percent had non-functioning toilets; six
percent were not using functional toilets; and only 44 percent
were using hygienic toilets. These data suggest not only that
NGP status is not being sustained by some NGP winning villages, but that—in some cases—it was never achieved.
6.6.5 State Reward Scheme
Several stakeholders in HP commented that the state reward scheme has now become a more powerful incentive
than the NGP. Over the last three years, the Government of
HP has invested considerable effort and finance in developing a comprehensive incentive framework, with awards now
given for local government sanitation (Maharishi Valmiki
The WSP benchmarking suggests that five districts in MP are
performing relatively well (Jabalpur, Dhar, Indore, Rewa and
TABLE 9: STATE GROWTH IN NIRMAL GRAM PURASKAR AWARDS
2007–08
2008–09
2009–10
2010–11
HP
—
—
526
1,258
MP
—
—
2,663
4,280
Total
NGP applications (nr):
NGP awards (nr):
HP
MP
India
37
22
245
253
—
520 (16%)
190
682
639
—
1,512 (7%)
4,945
12,144
4,556
—
22,443
The assessment team found that 25 percent of poor households visited during a transect walk in an NGP GP in MP had never owned a latrine (despite long-term residence in the
village and awareness of TSC and NGP campaigns).
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Sampoorn Swachata Puraskar), school sanitation and sanitation achievements by women’s self-help groups (Mahila
Mandal).
Applications for the MVSSP State Sanitation Reward scheme
were received from only 4 GPs in 2007, but had expanded to
1,033 GPs in 2010 with applications received from all 77 blocks.
The combined budget for the MVSSP and school sanitation
awards in 2010 has reached Rs 2.285 crore (US$500,000), all
of which is provided by the state government (see Table 10).
One of the successful features of the state sanitation award
scheme has been the involvement of local leaders in the presentation of the awards, which has galvanized political interest
and considerably raised the profile of sanitation.
In contrast, the state sanitation award scheme in MP (Ujmal)
has not been successful. Despite starting at a similar time to
the HP awards, just 40 applications were received in 2009
and all of them were rejected. No awards have been made
to date, and the state government suggested that perhaps
the award criteria were too stringent, but there is little evidence that the state award scheme has received any priority
or attention, nor that it is providing any incentive for local
governments to improve their sanitation performance.
6.6.6 Funding Flows
Most stakeholders report that the transfer of TSC funds
to the SWSM has improved both financial flows to the
districts and general financial management. Prior to this
change in financial arrangements, several districts in MP
experienced long delays in payments due to incomplete or
incorrect program implementation plans being rejected by
the DDWS.
One of the MP districts visited during the assessment had no
funds for 18 months of the program period. The program
Endline Findings
started well, with 27 NGPs awarded in 2007, but the number of NGP winners has declined every year since, down to
only 6 NGP winners in 2009. The lack of funds after the first
year was given as one of the major reasons for the slowdown
of progress, although the district collector also changed and it
has since proved difficult to regenerate the initial enthusiasm.
Despite these problems, the WSP benchmarking assessment
ranked this district as an average performer, with overall performance better than some twenty other districts.
A major factor in the early problems with financial flows
was the limited state-level capacity and engagement, which
meant that insufficient attention was given to the district
plans before passing them to central government for approval. The state TSC unit in MP is now more familiar and
engaged with the process, as a result there have been few
recent problems with the approval of district plans or the
financial flows.
6.6.7 Financing: Institutional Sanitation
Despite TSC financing framework stating that district proposals should include the “actual amount required for full
coverage” of institutional toilets (including school and anganwadi facilities), it is only possible to obtain funding for
improvements to public owned facilities. In practice, a significant proportion of institutional sanitation facilities are
privately owned due to rented accommodation or entirely
private educational establishments.
This proved a serious stumbling block during early implementation, but local governments are now finding ways to
mobilize funds from other sources, such as the Sarva Shiksha Abhiyan (SSA) Education for All program, and have
been more successful in leveraging private investments now
that local politicians are involved and the profile of the sanitation program has been raised.
TABLE 10: ENABLING ENVIRONMENT IMPROVEMENTS: FINANCE AND INCENTIVES
Indicator
2007 Baseline
2009 Target
2010 Achieved
HP: State award expenditure
US$187,000
US$163,000
US$500,000
MP: State award expenditure
US$0
US$435,000
US$0
HP: NGP GP awards
28
300
253 (84%)
MP: NGP GP awards
191
600
639 (107%)
Sanitation finance
Sanitation incentives
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6.7 Cost-Effective Implementation
Key Findings
• Outcome-based goals are increasingly being used to
assess effectiveness.
• Despite its shortcomings, HP has adopted the program benchmarking assessments. MP uses the lessstringent assessments of cost effectiveness provided
by UNICEF.
• ODF success rates seem to be over-reported in MP, but
less so in HP.
• Cost effectiveness calculations show that cost-peroutcome is lower in HP than in MP.
• There are currently no mechanisms for assessing
the cost of government involvement in sanitation
interventions.
In India, the outcome-based goals promoted by the national
TSC and NGP programs are increasingly being used to assess effectiveness. In the past, state governments wanted
to know how many latrines had been built, and how this
affected state sanitation coverage; but, increasingly, state
ministers and secretaries are asking about the number of
ODF communities, and the number of NGP awards. These
indicators represent an important step forward from simple
output indicators, but provide only a one-time snapshot of
sanitation outcomes, rather than the more regular measures
needed for reliable monitoring and evaluation of effectiveness and sustainability.
Few state and district governments have managed to spend
the full TSC funds approved for their programs, so there
are few financial constraints, and cost effectiveness remains
a low priority. WSP introduced a cost-effectiveness indicator into the benchmarking system supported in each state,
but it has proved difficult to attract much interest in this
measure.
In HP, the cost-effectiveness indicator used was the cost per
ODF community, with 15 percent of the total benchmarking score allocated to this measure. However, it was decided
to score only the top three performers in this category38
which, given a 30 point spread between the total scores
from the other seven indicators, meant that this indicator
38
Endline Findings
has a dramatic effect on overall performance. Furthermore,
the cost element is based on “total TSC expenditure,” which
includes expenditures on both institutional sanitation and
on solid and liquid waste management, thereby unfairly
rewarding low-spending districts that have not progressed
beyond ODF achievement (i.e. have not incurred additional expenditures for broader environmental sanitation
improvements).
Nevertheless, despite these shortcomings, the benchmarking system has been adopted by the HP state government
and, due to regular sharing and broadcasting of the benchmarking results, has a significant influence on district
performance.
No data on ODF status were available in MP, in which
case the WSP benchmarking system uses the cost per NGP
award as the main measure of cost-effectiveness. Unfortunately, the state government in MP has not adopted WSPsupported benchmarking, choosing instead to adopt the
simpler district grading system developed by UNICEF. As
a result, no cost-effectiveness measures are being regularly
monitored in MP.
6.7.1 ODF Success Rate
The program’s design in HP assumed that 300 GPs would
be verified as ODF by the end of the program. In practice,
TSC achievement has far surpassed this target, with 2,694
GPs declaring ODF status during the three-year program
period. Approximately 85 percent of all GPs in HP have
now declared themselves to be ODF.
Due to concerns about the reliability of self-declared ODF
status, the state government introduced an improved monitoring system, linked to the state sanitation award system,
to verify ODF status. In the two districts visited during the
fieldwork for this assessment, it was clear that there was
some variation in the reliability of self-declarations. Sanitation outcomes were universally impressive in Kullu District
where only one community is yet to declare ODF status,
but in Una district about 20 percent of households in one
of the self-declared ODF communities were found to have
no toilet and to practice open defecation. The GP declared
Benchmarking scores are increased by 15 percent for the highest “financial efficiency,” 10 percent for second, 5 percent for third and 0 percent for all other districts.
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ODF status at the Gram Sabha six weeks previously, but
noted that this was a declaration of its intention to become
ODF within three months. Una is rated as one of the three
low performing districts by the state government, despite
a relatively high ranking in the WSP benchmarking, and
a brief review of implementation in two sub-districts suggested that self-declared ODF status in less committed districts may be unreliable.
No data on ODF success rate were available from MP, and
the findings of the recent WSP rapid assessment cast some
doubt over ODF status in even NGP winning villages. Seven
percent of GPs in MP have been awarded the NGP, compared to 16 percent in HP, and there was some suggestion
in the two MP districts visited that few interventions were
taking place outside of the 2010 NGP applicant villages. The
NGP success rate was 24 percent in 2009, but it was apparent that a significant number of these were re-applications
from GPs that had previously failed to win the award. As a
result of this trend for multiple re-applications by failed applicants, the 2010 NGP guidelines include a clause that prohibits re-application by local governments that “have applied
and disqualified for NGP thrice during the previous years.”
6.7.2 Cost per Sanitation Outcome
The program encouraged the two state governments to develop detailed systems to monitor performance and costeffectiveness. Performance monitoring has been greatly
improved by the benchmarking system adopted in HP,
but even this system includes only one coarse measure of
cost-effectiveness. Therefore, as at the baseline assessment,
some endline estimates of cost-effectiveness have been produced in order to examine whether cost-effectiveness has
improved over the three years of the TSSM.
Simple calculations based on cost and effectiveness data
taken from the WSP benchmarking assessments, TSC
39
40
41
42
43
Endline Findings
online monitoring system, WSP program finance data, and
the rapid assessments conducted by Wilbur Smith Associates suggest the following averages for the HP TSC project
(see Table 11 for summary of improvements):39
• Cost per ODF community: decreased from
US$27,400 to US$3,075 (11 percent)
• Cost per NGP community:40 decreased from
US$58,700 to US$16,800 (29 percent)
• Cost per latrine in use: decreased from US$22 to
US$13
• Leverage ratio (household latrine investment: program investment):41 increased from 18:1 to 30:1
These cost-effectiveness estimates suggest dramatic improvements as the HP program has scaled up and become
more effective. In particular, the leverage ratio, although an
under-estimate because TSC costs include all institutional
sanitation and SLWM expenditures, is remarkably high:
each dollar invested by TSC and the program has leveraged
US$30 investment by the household. These data confirm
previous reports that households in HP have made large
investments in their latrines, and suggest that the program
investments have been highly cost-effective in encouraging
them to build these latrines.
The same calculations for the TSC in MP suggest:
• Program cost per ODF community;42 no data
available
• Program cost per NGP community: decreased from
US$141,700 to US$60,800 (43 percent)
• Program cost per latrine in use: decreased from
US$57 to US$51
• Leverage ratio (household latrine investment: program investment);43 increased marginally from 6.6:1
to 7.4:1
Endline estimates calculated by the author based on cost and effectiveness data provided by the TSSM team and by the Government of India TSC online monitoring reports;
baseline estimates taken from the 2008 TSSM baseline assessments of enabling environment.
Average GP size in HP estimated at 338 households (1.097 million rural households in 3,243 GPs in 2008).
Household latrine investments based on the latrine cost survey data from the rapid assessments (Wilbur Smith Associates, 2010) and the number of latrines recorded in TSC
physical reports. The household latrine cost estimates prepared by Wilbur Smith Associates included imputed labor costs (Rs 100 per day) based on the days of self-supplied labor
estimated by the household.
Average GP size in MP estimated at 364 households (8.125 million rural households in 22,341 GPs in 2008).
Household latrine investments based on the latrine cost survey data from the rapid assessments (Wilbur Smith Associates, 2010) and the number of latrines recorded in TSC
physical reports.
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While there has been some improvement in the costeffectiveness estimates for MP, it is striking that both the
cost per latrine in use and the leverage ratio have changed
by barely 10 percent over the three years of the program
(compared to roughly 50 percent improvements in HP).
Furthermore, these cost estimates do not include recent
large latrine investments through the NREGA program
(as insufficient data were available on the extent of these
investments), which were as high as US$1 million per district per year in the two districts visited during the fieldwork. The inclusion of these data would have a significant
negative impact on the program cost per latrine and the
leverage ratio.
The leverage ratios are based on estimated household latrine
costs, but the survey only collected these costs from households with functioning latrines. In MP, where a significant
proportion of subsidized latrines have collapsed or been
abandoned, most of the functioning latrines are owned by
non-poor households, meaning that these costs are likely to
be over-estimates. The assessment fieldwork suggested that
very few poor households had invested any cash or labor in
their government-provided latrines, or were using these latrines. On this basis, the leverage ratio for BPL households
in MP would be lower than 1:1.
There are dramatic differences between the cost-effectiveness
estimates for HP and those for MP. Some of these differences reflect the better economic and social context
in HP, which makes implementation easier and allows
higher household investments, but much of the difference relates to policy decisions, such as not to use the
BPL incentive funds, and to the higher effectiveness
represented by the significantly better latrine usage rates
found in HP.
The cost per NGP community is more than three times
higher in MP than in HP; the cost per latrine in use is almost four times higher, at US$51 compared to only US$13
in HP; and the leverage ratio is less than a quarter of that
in HP, at 7:1 compared to 30:1. These rough estimates
need further work before being used more widely, but are
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Endline Findings
intended to illustrate the value gained from better employment of the available data.
6.7.3 Impact of Cost-effectiveness Estimates
The estimates provided above were presented to both state
governments and to the GoI during feedback sessions on
the enabling environment assessments. In all cases, there
was considerable interest in the estimates (and in the data
from which they were derived), which illustrates the potential power of efforts to improve the regular monitoring and
benchmarking of cost-effectiveness.
The WSP team noted that there is considerable sensitivity regarding any comparisons across states, with representatives from MP quick to point out their lower starting
conditions and more difficult context whenever there is
any suggestion of low performance. In addition, the secretary of rural development in MP noted that WSP has a
tendency to be too negative in its assessments, which was
thought to be demotivating for those responsible for TSC
implementation.
Nevertheless, comparisons like those above should help the
DDWS and other national stakeholders to better understand the factors that influence cost-effectiveness, and persuade them to influence TSC and state policy in order to
make the best use of the government’s resources.
6.7.4 Unmeasured Costs
There are currently no mechanisms for assessing the cost of
government involvement in sanitation interventions. Significant RDD and PRI time and resources are required to
implement TSC effectively, but their routine costs (salaries,
training, overheads) are rarely included in cost assessments.
Several stakeholders commented that the resource-intensive
campaign mode required by TSC could not be sustained
for longer than a year or two in each area without having
a detrimental impact on other activities. These comments
highlight the currently unmeasured direct and opportunity
costs of diverting valuable government staff and resources
from other duties. Future cost-effectiveness assessments
should attempt to quantify these costs.
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Endline Findings
TABLE 11: ENABLING ENVIRONMENT IMPROVEMENTS: COST-EFFECTIVENESS
Indicator
2007 Baseline
2009 Target
2010 Achieved
60
600
2,754 (460%)
MP: Nr. ODF communities
557
1,200
1,512 (126%)
HP: ODF success rate
15%
40%
85%
15%
35%
7%
US$27,400
—
US$3,075
Effectiveness
HP: Nr. ODF communities
44
MP: ODF success rate
45
Cost-effectiveness (TSC + WSP Program)
HP: Cost per ODF community
MP: Cost per ODF community
—
—
—
HP: Cost per NGP community
US$58,700
US$17,400
US$16,800
MP: Cost per NGP community
US$141,700
US$43,500
US$60,800
HP: Cost per latrine in use
US$22
US$10
US$13
MP: Cost per latrine in use46
US$57
US$15
US$51
HP: Leverage ratio (hhd: program)
18:1
4:1
30:1
MP: Leverage ratio (hhd: program)
6:1
4:1
7:1
6.8 Monitoring and Evaluation
Key Findings
• TSC on-line monitoring system now records latrine provision data by village.
• TSC district level monitoring survey (DLM) was stopped
in 2007, thus no demand-side or time series sanitation
data are available through the TSC on-line system.
• Household survey data demonstrate that the current
TSC monitoring and NGP verification processes are not
adequately capturing the latrine usage and sustainability outcomes that are central to effective monitoring of
sanitation progress.
The GoI operates an online monitoring system for TSC,
which requires that each district provide monthly updates
on its physical and financial progress. Tables 12 and 13
summarize reported progress since mid-2007 (as at midSeptember 2010).
TSC online monitoring data suggest that HP has shown
dramatic progress since the baseline assessment, improving
44
45
46
from only 16 percent physical progress in 2007 to 96 percent in 2010; whereas progress in MP has mirrored the national average, improving from 23 percent in 2007 to 59
percent in 2010. These figures represent progress compared
to TSC household latrine targets, which were based on an
estimate of the number of households without improved
sanitation facilities at the outset of TSC project. Therefore,
these figures do not include the baseline sanitation coverage, or allow for population growth since TSC began, and
therefore need to be re-calibrated in order to provide the
actual rural sanitation coverage in each area.
The major shortcoming remains the lack of any reliable system to monitor sanitation outcomes such as latrine usage.
The current TSC online monitoring system is an impressive
achievement, in that it records the number of toilets built in
each GP, with recent refinements requiring that each household has a unique identifier to record its sanitation status.
However, it does not require follow-up visits to find out
whether the beneficiary households started using the new
latrines, nor is there any incentive for local governments
Based on verified NGP awards as no data is available on ODF achievement.
Based on estimated costs from TSC financial records and from the project.
Includes latrines built by APL households, which comprise 57 percent of all new latrines built in MP during the TSSM project period.
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Endline Findings
TABLE 12: TSC PHYSICAL PROGRESS: INDIVIDUAL HOUSEHOLD LATRINES
Target (no. latrines)
Achieved (no. latrines)
BPL
APL
Total
BPL
Percent
APL
Percent
Total
Percent
2007
108,017
543,032
651,049
32,549
30
69,879
13
102,428
16
2010
218,154
632,583
850,737
197,335
90
619,987
98
817,322
96
2007
3,368,972
4,273,749
7,642,721
963,563
29
785,311
18
1,748,874
23
2010
3,614,346
4,852,847
8,467,193
2,334,194
65
2,662,372
55
4,996,566
59
2007
56.3m
58.7m
114.9m
19.7m
35
13.6m
23
33.3m
29
2010
61.8m
63.9m
125.7m
37.8m
61
32.2m
50
70.0m
56
HP
MP
All India
to monitor subsequent collapse, abandonment, or dysfunction of these latrines. As a result, the detailed TSC reports
tend to ignore sustainability losses and over-estimate latrine
coverage, with the degree of accuracy determined by the
effectiveness of the state or district TSC project in creating
genuine demand and ownership for the latrine facilities.
TSC monitoring system in HP is well used and provides a
reasonable picture of progress, with evaluations suggesting
that 90 percent of the latrines recorded in TSC online system
are functional and in use. The self-reported system works
less well in MP. In one tribal community, abandoned and
collapsed latrines built only three years ago by the PHED
were observed alongside brand new latrines built recently
for the same households by the PRD. None of the latrines,
either old or new, had been used by these tribal households,
yet all of them were financed by TSC, and entered as completed latrines in TSC online monitoring system.
6.8.1 Alignment with JMP
Another issue is the lack of alignment with the JMP, the
body tasked by the UN with monitoring MDG progress
for water supply and sanitation. The JMP MDG indicator
for basic sanitation is the “proportion of population using
an improved sanitation facility,” and this category does not
include use of shared sanitation facilities of any type.
The latest JMP progress report states that only 21 percent
of the rural population in India used improved sanitation
facilities in 2008, whereas the Government of India reported that 50 percent rural sanitation coverage had been
achieved in 2008. The vast difference is largely due to the
TABLE 13: TSC PHYSICAL PROGRESS: INSTITUTIONAL TOILETS
Target (no. institutional toilets)
School
Anganwadi
Achieved (no. institutional toilets)
School
Anganwadi
HP
2007
6,926
1,090
1,162 (17%)
210 (19%)
2010
17,863
10,408
10,320 (58%)
4,256 (41%)
2007
76,128
10,592
36,760 (48%)
2,626 (25%)
2010
137,730
27,595
88,385 (64%)
19,182 (69%)
2007
1,009,814
362,926
383,787 (38%)
117,096 (32%)
2010
1,314,636
506,968
1,026,929 (78%)
345,062 (68%)
MP
All India
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Government’s use of supply-side TSC monitoring data
whereas the household surveys provide data on household
latrine usage.47 In addition, the JMP do not count the four
percent of the rural population estimated to use shared
sanitation facilities. It is reported that the GoI is awaiting
the results of the 2010 Census before providing a definitive
policy statement on this issue. The DDWS is hoping that
the census will reflect the rapid progress made in the two
or three years since the last household survey, and that the
smaller gap will make this issue easier to resolve.
Endline Findings
FIGURE 4: IMPROVED SANITATION COVERAGE IN RURAL
AREAS, MADHYA PRADESH
100
90
80
70
Percentage
Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
60
50
40
30
6.8.2 Household Survey Data on Sanitation Usage
20
The household survey data (see Figures 3 and 4) demonstrate
clearly that the current TSC monitoring and NGP verification processes are not adequately capturing the latrine usage
and sustainability outcomes that are central to sanitation
improvement. These data imply that there are significant
differences between the quality and cost-effectiveness of the
implementation processes in the two states, with very little
benefit (in terms of improved access to basic sanitation) apparent in MP despite the theoretical progress reported by
TSC and NGP systems.
10
FIGURE 3: IMPROVED SANITATION COVERAGE IN RURAL
AREAS, HIMACHAL PRADESH
100
90
80
Percentage
70
60
50
53%
40
30
20
28%
10
0
2001 2002 2003 2004 2005 2006 2007 2008 2009
Key
TSC sanitation coverage
Household survey sanitation coverage
Forecast
Source: TSC online reports; census 2001; DLHS 2004; DLHS 2008
47
10%
9%
0
2001 2002 2003 2004 2005 2006 2007 2008 2009
Key
TSC sanitation coverage
Household survey sanitation coverage
Source: TSC online reports; census 2001. DLHS 2004; DLHS 2008
These charts suggest that the sustainability loss, which is the
difference between the sanitation coverage reported by the
supply-side program monitoring data and that from the demand-side household usage data, is relatively small in HP, that is,
the gains in latrine usage (marked in blue) mirror the increased
coverage reported by TSC online system. In contrast, TSC online monitoring system reports a rapid growth in the number of
sanitation facilities built in MP, whereas the household survey
data show that latrine usage has barely changed since 2001, rising only 1 percent over seven years of TSC activity.
Given the huge government investment in TSC and NGP
programs, it is important that these investments generate sustainable benefits. WSP and other stakeholders, including UNICEF, have conducted rapid assessments and
evaluations of sanitation improvement that suggest a strong
correlation between the quality of the processes used to create demand, build supply chains, and improve the enabling
environment, and the performance of TSC projects.
The Government of India recognizes that some states are
slipping behind on TSC progress, both in terms of reported
The core sanitation survey question for the DHS, MICS and related surveys is “What kind of toilet facility do members of your household usually use?”
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progress through the online monitoring system and through
more reliable data from rapid assessments and evaluations.
In particular, the DDWS has identified five states—Assam,
Bihar, Jharkhand, Rajasthan and Uttar Pradesh—as priorities for future program support.
6.8.3 WSP Rapid Assessments
In early 2010, the lack of reliable or regular data on sanitation outcomes (see Table 14) led WSP to contract an independent rapid assessment of the usage rates and quality of
recently constructed latrines in HP and MP (see Figure 5).
The assessment methodology involved randomly selecting48
15 NGP GPs and 15 non-NGP GPs in each state, with 20
randomly selected households surveyed in each GP.
The rapid assessments found significant latrine usage and
sustainability problems in MP, with only 44 percent of
households in the 15 NGP-winning MP villages (verified
through the NGP process as having 100 percent latrine
FIGURE 5: LATRINE USAGE IN HIMACHAL PRADESH AND
MADHYA PRADESH
100
Percentage
80
60
40
20
0
NGP
villages
Non-NGP
villages
Himachal Pradesh
NGP
villages
Non-NGP
villages
Madhya Pradesh
Source: Rapid Assessments of Global Scaling Up Rural Sanitation Project: MP and
HP, 2010
48
49
50
Endline Findings
coverage) found to be using latrines, compared to 87 percent latrine usage in NGP-winning villages in HP. Unfortunately, these findings have not been well accepted by the
Government of MP, with several senior officials suggesting
that the sample size and assessment methodology were inadequate, or that the assessors had deliberately looked for
problems in order to contradict broader TSC monitoring
and NGP verification results.
Limited political or bureaucratic recognition of the problems in MP reflects superficial engagement with sanitation
improvement, and low accountability for program outcomes. At present, the success of TSC projects is measured
largely by self-reported progress in TSC online monitoring
system and by the number of NGP awards each year.
MP is doing reasonably well by these measures, with 59 percent of the unserved households identified by TSC now reported to have toilets49 and more than 1,500 NGP awarded
GPs. However, district stakeholders reported that data indicating 100 percent latrine coverage are routinely entered
into TSC online monitoring system before achievement
in order to allow applications for the NGP awards (which
now require 100 percent coverage before applications are
accepted). TSC’s online monitoring system also fails to capture non-usage or abandonment of latrines. Both the fieldwork for this assessment and the WSP rapid assessments
indicate that the sustainability of sanitation outcomes is low
in some NGP GPs, and suggest that the variable quality and
integrity of the NGP verification process may have resulted
in some undeserved awards.
A 2008 NGP impact assessment financed by UNICEF50
found similar problems. In the 162 NGP GPs assessed,
36 percent had less than 80 percent latrine coverage. Ten
NGP communities from Chhattisgarh state, which used
to be part of MP, were included in the assessment. Latrine coverage was reported to be very high in the Chhattisgarh communities, but only 39 percent of households
in these NGP winning communities were using functional toilets. The main reasons given for the high rates
Stratified random sampling was utilized to ensure a representative sample across each state.
A baseline of 9 percent coverage plus 59 percent progress in the unserved 91 percent = 63 percent total rural sanitation coverage.
TARU (2008).
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
of non-use and non-functionality were the low quality
of the facilities (34 percent), lack of behavior change (23
percent), no superstructure (16 percent), and wrong location (12 percent).
As noted earlier, the WSP rapid assessment findings confirmed those from the limited fieldwork for this enabling
environment assessment, and from the large-scale household surveys discussed previously. These findings suggest
that sustainable use of improved sanitation facilities in
MP may have improved from the 10 percent found by the
DLHS in 2008 to around 17 percent in 2010,51 and confirm that total sanitation coverage in HP lies somewhere
between 44 percent and 87 percent.
6.8.4 Household Surveys
The baseline assessment noted that the DDWS-managed
DLM survey was last undertaken in the second quarter of
2007. At the time, the DLM survey sampled 500 households from each of 478 out of the 602 districts in India.
The intention was to provide a randomized check on the
achievements claimed by the districts through TSC online
monitoring database, focusing on two indicators: overall
sanitation coverage and latrine usage by BPL households.
Although there were some questions regarding the quality
and reliability of the initial DLM survey findings, it was
expected that these would improve as the DLM survey matured. Unfortunately, the DDWS officials responsible for
developing and managing the DLM survey left in 2007,
and no further surveys were completed.
At present, the only reliable measure of household sanitation coverage is from large-scale household surveys such as
the nationally-representative District Level Household and
Facility Survey (DLHS-3) undertaken in 2008, the DHScompliant National Family Health Survey (NFHS-3) undertaken in 2005-06, and the 2001 Census. While these
large-scale surveys provide a reliable and demand-side assessment of sanitation practices, they are not undertaken
frequently enough to provide the regular progress monitoring data required by program managers and government
planners.
51
Endline Findings
The MP Government has suggested that the DLHS 2008
data is now three years old, and that both sanitation coverage and program effectiveness have accelerated rapidly in
the last three years. However, the 2008 household survey
data imply that only one in four (26 percent) of the latrines
reported by TSC monitoring system at that time were functioning and in use. While it is possible that latrine usage
rates have improved since 2008 as more effective approaches
have been introduced, the latrine usage rate implied by the
household surveys is remarkably similar to the latrine usage
rates found by recent WSP-supported rapid assessments.
Therefore, it seems likely that the 2010 Census data will
show only limited growth in sanitation coverage in MP.
In HP, the same analysis implies a latrine usage rate of 87
percent, which corresponds closely with the rate reported
by the recent rapid assessment. It is significant that this rate
is more than three times higher than that estimated in MP.
6.8.5 Evaluation by Sanitation Incentive Systems
The NGP and state award systems provide limited annual
evaluation systems, but both systems have weaknesses. The
NGP is a stand-alone process: once the award has been
made to a GP, it is no longer eligible, and therefore no longer features in the process—every community can apply for
the NGP but there is no guarantee that the sanitation outcomes will be sustained once the award is gained. The state
clean village competitions have a different problem—these
awards are made only to an elite group, the cleanest villages in each area, and subsequently are unlikely to reach
the much larger and more critical group of averagely clean
and below-average communities.
The challenges faced by the NGP verification process, which
has become increasingly difficult as the scale of the award
scheme has increased, suggest that the most practical solution
to large-scale monitoring or evaluation of sanitation outcomes
is some form of sampled annual household sanitation survey
that provides more regular and detailed data than the national
household surveys undertaken every three or four years.
Both WaterAid and UNICEF were planning largescale sanitation surveys in 2007, but have subsequently
Only 7 percent of GPs in MP are NGP winners, which increases average sanitation coverage from 15 percent to 17 percent.
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20
80
64
95
83
94
83
2
4
94
94
5
56
99
75
0
40
4
20
1st
Key
4
13
0
6
0
32
44
4th
08
95
20
08
95
3rd
2nd
20
19
08
95
20
19
08
95
17
20
0
1
19
2
3
08
0
6
0
19
60
95
One of the critical policy and program issues for TSC is
the effectiveness of the BPL latrine incentive. TSC guidelines are posited on the assumption that the BPL incentive encourages poor households to build toilets, and then
reimburses them for this achievement, thus ensuring that
sanitation improvement is not an economic burden. Evolving TSC guidelines, which include dramatic increases in
the BPL latrine incentive, are driven by a sense that poor
households are not building toilets because they are too expensive, and that higher subsidies or incentives will enable
even the poorest to benefit from improved sanitation.
100
20
6.8.6 Equity Issues
FIGURE 6: ACCESS TO IMPROVED SANITATION SINCE 1995
BY WEALTH QUINTILE
19
abandoned these surveys due to the logistical challenges
involved. While these organizations could provide technical support for subsequent surveys, it seems likely that the
government will have to take the initiative to develop an
annual survey process along the lines of the DLHS terminated in 2007.
Endline Findings
Percentage
Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
5th
Wealth Quintile
Improved and shared facilities
Unimproved facilities
Open defecation
Source: Trend analysis based on three or more DHS, AIS, and/or MICS.
The social protection literature supports this approach, suggesting that optimal benefits derive from transfers that target the poorest first, and that societal benefits will accrue
from the lower health, social, environmental, and economic
costs resulting from the use of improved sanitation by those
with the highest disease and other burdens.
A huge investment has been made in this approach. In the
last three years, approximately 18 million BPL households
have been provided with some form of latrine subsidy or
incentive, at a cost approaching US$500 million.
A recent UNICEF analysis of the disaggregated wealth
quintile data from nationally representative household surveys in India found that while the use of improved sanitation facilities had increased dramatically in the middle
and fourth wealth quintiles, only 13 percent of the second
wealth quintile used improved sanitation facilities and, remarkably, improved latrine use was only 3 percent in the
poorest wealth quintile (see Figure 6). These data suggest
that, while latrine use in India is increasing, few of the
poorest 20 percent, who include those with the highest disease burdens, are being reached by the BPL latrine incentive
provided through TSC.
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6.8.7 Impact Evaluation
Impact evaluation remains a major area of weakness. Few
national or local institutions have the specialized knowledge
and expertise required to design and conduct rigorous impact evaluations. As a result, few reliable impact evaluations
are conducted, the findings are rarely shared or disseminated (especially if they demonstrate lower impacts than
anticipated), and therefore, program design rarely includes
the lessons learned from previous programs and impact
evaluations.
Unfortunately, the program impact evaluation will not be
completed in HP because progress accelerated so fast that
the state government decided not to wait for the endline
impact evaluation before allowing interventions in the
control sites. As a result, complete impact evaluation data
will only be available from the less successful interventions
in MP.
WSP also attempted to conduct a shorter-term evaluation
that examined the impact of improved sanitation on clinical data from rural health centers and primary health data
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Endline Findings
TABLE 14: ENABLING ENVIRONMENT IMPROVEMENTS: MONITORING AND EVALUATION
Indicator
2007 Baseline
2009 Target
2010 Achieved
No
Yes
No
Harmonization with JMP indicators
No
Yes
No
HP: ODF monitoring
Yes
Yes
Yes
MP: ODF monitoring
No
Yes
No
WSP financed (rapid assessments)
0
2
3
Govt. financed (national)
0
2
0
Monitoring systems
National outcome monitoring
Sanitation evaluations
from NGP villages in Haryana, Maharashtra and Andhra Pradesh, but the limited
availability of disaggregated data restricted the analysis, and the primary research
found evidence of open defecation in the supposedly NGP villages, effectively
minimizing any differences between these villages and the control villages. These
examples highlight the difficulty of conducting rigorous impact evaluation studies, even with the resources and expertise available to the WSP team.
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VII.
Conclusions
TSC and NGP programs continue to provide excellent
platforms for rural sanitation development, through the
provision of adequate finance, basic technical guidelines,
and institutional incentives. Yet there remains considerable
latitude in how these resources and mechanisms are used by
local governments, and outcomes are highly variable across
states. Sanitation is a state subject. Therefore, despite rural
sanitation development being guided by central TSC and
NGP programs, the enabling environment at state level has
a significant impact on sanitation activities and outcomes.
WSP provided similar levels of support and promoted similar approaches and tools in both HP and MP. The starting contexts were different, with HP recognized as a small,
relatively progressive and wealthy state, and MP as one of
the largest and least developed states in India. Rural sanitation coverage was higher in HP, but was still low at only 28
percent in 2001, creeping up to 34 percent by 2006. Rural
sanitation coverage in MP was extremely low at baseline,
reaching only 10 percent in 2006. Both states faced a huge
sanitation challenge, but it was clear that the larger challenge was in MP.
In 2010, rural sanitation coverage in HP is estimated to
have passed 80 percent, an increase of around 50 percent
in only four years; whereas coverage in MP is estimated
at around 17 percent, barely 7 percent growth during the
same four-year period. Given similar government programs
and program support, it is significant that the HP program
has accelerated so dramatically over the last three years,
while the MP program has struggled to reach even average
national coverage levels.
There was a huge difference in the scale of challenge in
MP, and some credit is due as both states have managed
to provide sustainable sanitation to a similar number of
households over the last three years, with an additional
600,000 or so households covered in each state. However,
HP achieved this with rural sanitation expenditures of
around US$8 million, compared to more than US$80 million invested in MP. While there are undoubtedly higher
cost factors in the huge scale of the MP program, and in the
higher proportions of poor and marginalized households,
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this endline assessment found that the significantly better
cost-effectiveness in HP reflects a much stronger enabling
environment than that found in MP.
7.1 Enabling Factors in HP
Significant improvements were apparent in the enabling environment for rural sanitation in HP since baseline. Strong
political support for sanitation, led by the chief minister,
has galvanized local leaders and administrators, enabling already competent local governments to use all of their capacity and resources to address sanitation deficits.
The state government stood firm on the no-subsidy policy
introduced in 2005, despite concerns that HP was losing
out by not utilizing the BPL latrine incentive funds available through TSC. There was a growing consensus that a
demand-led approach was working well. This consensus
was fed by widely reported ODF successes, and expanding
evidence of the benefits of improved sanitation, which led
to strengthened local government commitment to program
implementation and rapid scaling up of progress.
Regular monitoring and benchmarking of TSC progress,
including spot checks by senior state officials, and weekly
video conferences with the chief minister at which TSC
progress was discussed, provided incentives for district
administrators to prioritize the program, and encouraged
improved coordination and cooperation between local government departments. Competition between neighboring
areas was also an important motivation, driven by the regular WSP benchmarking reports.
The state government encouraged the spread of the successful institutional arrangements piloted in Mandi District,
including the use of an NGO support organization and a
district sanitation mission. Many districts introduced more
strategic planning as coverage rose, in order to tackle the
different community contexts and problems encountered
when implementation is no longer targeted at only progressive, dynamic, and cooperative communities, as well as to
ensure that optimal use was made of district resources to
keep on track for long-term targets. Similar strategic processes are now being used to address solid and liquid waste
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Conclusions
management, and higher level issues like the long-term sustainability of outcomes.
laggards report that more than half of their villages are now
open defecation free.
Although the availability and affordability of sanitation
goods and services has not changed greatly over the life of
the program, information about goods and services has become widely available through the scaling up of sanitation
promotion activities by local governments. Latrine construction is not difficult, but many rural households previously perceived hygienic latrines as unattainable luxuries.
Many stakeholders now have in-depth knowledge of lowcost latrine options, with the result that thousands of poor
households have been assisted in finding affordable and appropriate sanitation facilities.
7.2 Disabling Factors in MP
There is little evidence that the enabling environment for
rural sanitation has improved in MP since baseline, despite the relocation of TSC within the PRD. Significant
implementation efforts and investments have been made in
rural sanitation through the program and TSC, NGP, and
NREGA programs and projects, and through substantial
technical support provided by UNICEF, WaterAid, and
other development partners. All of this work, however, has
translated into relatively meager benefits due to the lack of
high-level engagement, commitment, or priority.
NGP awards remain an important incentive for sanitation
development by local governments, but the institutionalization of the state sanitation awards in HP over the last three
years has been even more effective in generating political
and popular support for rural sanitation improvement. The
state sanitation awards target a broader group of stakeholders, including school children and women’s self-help groups,
and have deliberately involved elected representatives from
local government in judging and presenting the awards. As
a result, a large proportion of the population is familiar and
engaged with the awards, which are seen to recognize and
promote a Himachali vision of purity and cleanliness.
Political support for sanitation remains limited. There was
little evidence that local leaders or administrators see sanitation improvement as a priority: the chief minister has not
yet presented the 2009 NGP awards to the winning village
heads, and no state sanitation awards were yet been made
more than two years after inception. There is little involvement or coordination of TSC activities with those of other
departments, and there appears little recognition of the
cross-sectoral benefits of effective sanitation improvement.
Good use was made of WSP technical support, with capacity building organized in advance of strategic needs, and
regular demands made for WSP support in new areas as
the program progressed and scaled up. Exposure visits were
used to introduce and validate new approaches, and the
full-time presence of the WSP state coordinator was important in maintaining momentum and interest.
Overall, a more institutional and enabling approach has
been developed, with continuous sanitation development
now seen as an integral part of the government program.
The vision of an ODF HP (Nirmal Himachal) by 2012,
which seemed unlikely at the outset of the program in 2007,
is now viewed as a realistic and achievable goal. At baseline,
two or three exceptional districts were performing well,
whereas at endline, only two or three districts out of the
twelve in HP are lagging behind, and even these supposed
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8241-CH07.pdf 49
At baseline, it was hoped that shifting responsibility for
TSC from the PHED to the PRD would increase the engagement of local governments, and decrease the overly
technical and supply-driven approach favored by government engineers. In practice, little improvement was apparent in the implementation approaches used, or in the
institutional arrangements. The new institutional home has
made little difference because the same Gram Panchayat officials are being tasked to implement the same approaches
as at baseline, without any noticeable increase in priority or
attention from above.
Most government officials in MP see TSC as a subsidydriven latrine-building program. Sanitation activities are
largely target-driven with little strategic planning, little
evaluation of effectiveness, and little allowance for the different ways in which communities and households respond
to interventions. There was no evidence that either total
sanitation or sanitation marketing approaches were being
employed consistently or at any scale: standard PHED
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
latrine designs were promoted and installed in most areas,
with little or no allowance for household variations in preference or needs, and little attempt to build sustainable private supply chains.
The district projects have recruited district and block TSC
coordinators, but these coordinators currently lack the
capacity, experience, or resources for effective support to
community level implementation by the GPs. The GPs are
asked to mobilize households, organize activities, purchase
materials, and supervise contractors, but have few incentives to perform well or to sanction poor performance by
service providers. In a context of poor governance and high
poverty, the large sums of money involved in program implementation, when combined with limited independent
monitoring or accountability for expenditures, mean that
TSC is often an opportunity for additional income generation by local officials.
Although few reliable data were available, the policies and
approaches adopted in MP do not appear cost-effective.
Total investments in rural sanitation over the last three
years are estimated to be about ten times higher than those
in HP and, while TSC online monitoring data report
dramatic increases in sanitation coverage, more rigorous
large-scale household surveys and recent WSP assessments
suggest that a similar number of households have gained
sustainable access to improved sanitation facilities in both
states. Many of the latrines built through TSC in MP are
not being used, while the use of multiple program subsidies to finance latrine construction means that the leverage
ratio is also low—program investments are not leveraging
much household investment—which is limiting the scale
and spread of improved outcomes.
WSP benchmarking suggests that five districts are performing relatively well (Jabalpur, Dhar, Indore, Rewa, and
Satna) with 42 percent of all NGP awards in the state found
within these few districts. However, there is little evidence
of any large-scale improvements in enabling environment
that have changed practices or lifted performance across
the entire state. The five successful districts are driven by
exceptional, committed individuals rather than by a more
institutional approach or more supportive conditions for
sanitation improvement.
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8241-CH07.pdf 50
Conclusions
WSP has undertaken similar activities to strengthen the
enabling environment in both HP and MP, including exposure visits, capacity building, performance benchmarking, targeted assessments, and sharing of best practices. This
approach proved successful in HP, where local government
was receptive and engaged in the process, but has had only
limited success in MP. While some of the problems stem
from the more challenging context in MP, the conclusion
of this assessment is that the failure of the state government
to embrace critical elements of the approaches promoted
by the program—such as the need to move away from a
supply-driven approach toward a demand-based total sanitation approach—limited high-level recognition of the
problems, and prevented the reforms required to improve
the enabling environment.
7.3 Return to the CRSP?
In many ways, TSC in MP has come full circle back to the
CRSP paradigm of the 1990s. At the outset of TSC, the
relatively small amount provided for the BPL latrine incentive, Rs 500 (US$12) per household, forced local governments to generate demand for sanitation facilities, utilize
cost-efficient approaches, and encourage households to invest some of their own time and resources to build facilities.
As the BPL incentive amount has risen, and as additional
sources of subsidy have become available through programs
like NREGA, local governments have been able to return to
the entirely supply-driven approach and standard technical
designs favored under CRSP.
CRSP ended when low latrine usage rates and sustainability
of facilities, along with the massive waste of government investment that these entailed, became apparent. At present,
the Government of MP appears reluctant to accept that the
current subsidy policy, and the implementation approaches
that this policy encourages, are resulting in low ODF and
NGP success rates, low latrine usage rates, little sustainable
behavior change, and low cost-effectiveness. As a result,
there is little recognition of the need for any reform in implementation approaches, or for any improvements in the
enabling environment for rural sanitation improvement.
The pro-poor arguments being used to support an increase
in the BPL incentive assume that the reason for low latrine
uptake and usage is that the latrines currently promoted
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Conclusions
by TSC are unattractive and inadequate, and that a larger
incentive will afford more durable and attractive latrines.
However, the HP assessment suggests that demand creation
and ownership are critical ingredients of large-scale rural
sanitation improvement, and that rural households and
communities often find far more cost-efficient solutions
to latrine construction than supply-driven government
projects.
build consensus on what works best. As a result, influential
union and state politicians are able to present any increase
in the BPL latrine incentive as a pro-poor measure needed
to tackle the long-running sanitation deficit, with little
resistance from vested interests that benefit from higher
subsidies, and little accountability for the ineffective use of
government funds due to the limited reporting of past or
present program outcomes.
India has some of the lowest cost factors—materials, transport, labor, and skilled services—in the world. The current
BPL incentive of US$49 per BPL household should be sufficient to build a durable and hygienic latrine in even in the
most remote and difficult contexts of MP, provided that
more effective and sustainable approaches to promotion
and implementation are widely adopted.
The recent WSP rapid assessment of TSC processes and
outcomes52 provided good evidence of the association between process quality and TSC project performance. Discussions with the DDWS revealed that support for the
total sanitation approach, which was relatively low in central government at baseline, has increased substantially as
evidence of the higher sustainability and cost-effectiveness
of this approach over more supply-driven approaches has
emerged. However, the DDWS has little authority to impose specific approaches and tools on independent state
and district projects, and is thereby restricted to knowledge
management and advocacy activities to share best practices,
highlight implementation issues, and strengthen accountability for program outcomes.
7.4 Enabling Environment at the National
Level
One of the lessons from the HP and MP assessments is that
high latrine subsidies often create implementation problems because of the temptation to revert to supply-driven
approaches and short-circuit demand creation processes.
The rising BPL incentive in MP has increased the use of
supply-driven approaches, which in turn has diminished efforts to generate genuine demand for latrines or to encourage user involvement in the process. In contrast, the zero
hardware subsidy adopted in HP, which resulted from the
decision not to use the BPL incentive funds, encouraged
local governments to develop cost-effective approaches to
demand generation and institutional support, and ensured
that households who built latrines felt ownership, responsibility, and pride in their facilities.
The absence of any reliable or regular measure of the use
of improved sanitation facilities, and the relationship between these outcomes and the state policies and processes,
has limited understanding of this lesson in central government. The DDWS remains vulnerable to charges that
the BPL incentive is insufficient to create demand in poor
areas, and does not allow the construction of the durable
and attractive facilities needed to encourage sustainable use,
because it lacks a convincing evidence base with which to
52
Another important national constraint identified was the lack
of flexibility in the TSC financing model. TSC guidelines
earmark fairly rigid proportions of each district TSC project
to specific implementation components, but these earmarks
fail to recognize the massive variation in requirements and
approaches across rural India. Several districts in HP had developed cost-effective approaches to latrine development, and
only used a fraction of the allocated budget in achieving the
program targets for this component, but then found themselves short of TSC funds for the development of institutional
sanitation facilities and communal drainage and solid waste
infrastructure despite large amounts of their original TSC
project budget remaining unused. More flexibility in the use
of these district TSC funds would encourage innovation and
greatly enhance the effectiveness of implementation.
7.5 Nirmal Gram Puraskar
NGP continues to be a controversial program. Recent
evaluations by UNICEF and others found NGP-awarded
WSP 2010.
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
villages with low sanitation coverage and significant levels
of open defecation,53 raising serious questions about the integrity of the NGP verification process and the sustainability of sanitation outcomes generated by the NGP awards.
This assessment concludes that the positive effects of NGP
in generating political attention to sanitation improvement
and in galvanizing local government activity far outweigh
the problems associated with the process.
NGP fulfils its original function well, in that it creates incentives for local governments to achieve collective sanitation outcomes and it draws considerable political attention
to rural sanitation improvement in the process. It was never
meant to be a mechanism for ensuring the long-term sustainability of these outcomes. NGP has been strengthened
to add some emphasis to sustainability, but a complementary program is needed to provide the long-term institutional support and monitoring that will ensure more
sustainable improvements in rural sanitation.
7.6 WSP Enabling Environment Role
The program team has played an important role in developing the enabling environment for rural sanitation at national level, and at state level in HP. However, it has had
only limited success in influencing the enabling environment in MP and it lacks the staff capacity to implement
parallel support programs in the three or four other Indian
states that have asked WSP for project-type assistance.
The WSP team acknowledged that it became apparent over
the last year or so that the program in MP lacked the high
level political influence required to shift the policy on latrine
subsidies and supply-driven approaches or to generate real
political engagement with both TSC and NGP programs. As
a result, many of the lower-level project implementation-related activities have not been as successful or as cost-effective
as hoped. The lesson appears to be that implementation support should not be scaled up until some minimum enabling
environment conditions are met; otherwise there will be a
significant opportunity cost to any investment.
In the three years since the baseline assessment in mid
2007, the BPL latrine incentive has quadrupled from Rs
53
Conclusions
500 to Rs 2,200, and the GoI has indicated that it is likely
to be increased to Rs 3,200 (US$70) in the near future. The
significant increases to the latrine incentive indicate that
influential stakeholders remain unconvinced that India’s
ambitious sanitation goals can be met without higher subsidies. This assessment concludes that the main constraint
is not the level of the BPL latrine subsidy, but the way in
which these subsidy funds have been used to strengthen
supply-driven approaches to latrine construction that are
not the most cost-effective or sustainable use of government resources. Unfortunately, WSP has not yet been able
to develop sufficiently compelling evidence, or present it
well enough to the right people, to convince key decision
makers of the huge opportunity costs associated with some
current practices.
7.7 Potential to Achieve Sanitation MDG
The 2015 MDG for sanitation is to halve the proportion
of the population without access to basic sanitation using a
1990 baseline. The lack of sanitation data disaggregated by
state makes it difficult to estimate the 1990 baseline, but it
has been assumed that rural sanitation coverage in MP was
close to the national average of 7 percent, and in HP was
around 15 percent.
These baseline estimates set the 2015 sanitation MDGs at
54 percent in MP and 58 percent in HP. Differential sanitation progress up to 2006 meant that the MDG challenge
was substantially harder in MP at program baseline since it
needed to increase rural sanitation coverage from 10 percent in 2006 up to 54 percent in 2015: a gain of 44 percent
in only 9 years, which required more than 4 million new latrines; compared to the HP challenge to raise coverage from
34 percent in 2006 up to 58 percent in 2015: 24 percent in
9 years, which required 0.5 million new latrines.
At the end of the program, it appears that HP has already
surpassed its MDG target. The 2008 DLHS reported rural
sanitation coverage of 53 percent, while recent estimates
suggest that coverage has now passed 80 percent. As noted
earlier, the 2008 DLHS found that rural sanitation coverage in MP had only increased to 10 percent, and recent
forecasts suggest that coverage is unlikely to be much higher
TARU, 2008; WaterAid, 2008; Bhaskar, 2009; Snehalatha et al, 2010; Alok K, 2010.
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Conclusions
than 17 percent in 2010. At the current progress rate, which is around 2.5 percent increase in rural sanitation coverage per year, MP will not reach its MDG
until 2025.
7.8 Key Lessons
The success of the HP TSC project, to which the program contributed, has
shown that, under the right conditions, rapid and large-scale sanitation progress is possible in only a few years; and that ODF success rates are not limited
to the 35 percent suggested by previous implementation experiences. When the
enabling environment framework is well developed, and strong political support
is available to drive implementation, universal sanitation becomes a realistic and
achievable goal within a relatively short period.
This endline assessment found that political support and priority were central to
the success of TSC and NGP programs in HP. While the reasons for the development of this political support are complex, it seems likely that the early successes
provided by a combination of progressive state sanitation policies and exceptional
leadership in Mandi District were sufficient to demonstrate that new approaches
worked and that rapid sanitation improvements were possible. In addition, there
was sufficient convergence between the aims of TSC, Himachali cultural mores,
and a growing environmental movement, to make sanitation improvement a politically viable and attractive cause for influential figures like the chief minister.
Given the importance of context, timing, and culture to this process, the challenge for any other program will be to generate a similar level of political support
and priority, particularly in states with less supportive starting conditions.
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VIII.
Recommendations
As a result of this endline assessment of the enabling environment, there are specific recommendations for support
for non-performing states. The experience in MP suggests
that where the enabling environment is not supportive or
developed, the initial focus should be on the development
of model districts rather than large-scale implementation or
technical assistance, so that local approaches and successes
can be showcased to increase support for rural sanitation
improvement.
The intention is to limit investment until the enabling
environment improves, as well as to use program funds
to reward improved performance and good governance
(e.g., through scaling up in model districts) rather than
spreading efforts thin before supportive conditions are in
place. Wherever possible, model districts should introduce
evidence-based approaches to challenge supply-driven implementation and subsidy cultures, attempt to demonstrate
that poor households can build improved sanitation facilities without up-front subsidies, and that more sustainable
outcomes result from the generation of genuine demand
and ownership for household latrines.
It is also important to strengthen the enabling environment at state level through building the evidence base and
undertaking high-level advocacy activities. Wherever possible, senior development partner staff should be employed
to access and influence decision-makers. Explicit enabling
environment targets should be negotiated with state governments, with the agreement that the scaling up of implementation support will not take place until these targets
have been met.
The experience in HP provides useful lessons on scaling up
towards universal sanitation. In particular, it is important
to identify the specific problems faced by lagging districts,
areas and groups, and to develop appropriately tailored
strategies to tackle these problems. Given the capacity
shortages and incentive problems often found in poor performing areas, it is recommended that additional resources
are provided by state government and its development
partners to any lagging districts that agree to implement
tailored sanitation strategies and accept more intensive
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monitoring and evaluation of progress. The intention is to
focus attention on the different challenges faced by outliers,
to develop specific approaches and arrangements to tackle
these challenges, and to provide sufficient resources and expertise to develop the capacity needed to implement and
sustain improvements.
The following sections contain generic recommendations
arising from the assessment and from subsequent discussions of the assessment findings with in-country stakeholders and WSP staff:
Recommendation 1: Reformulate the Total
Sanitation Campaign
TSC was designed as a framework for five-year district projects. It therefore assumed an intensive, campaign-mode approach suite to a short lifespan. In practice, it has already
run for 10 years in some districts, and looks likely to operate on a long-term basis in many more. Furthermore, it
was developed from the more technical and constructionoriented CRSP, whereas the emphasis is now largely on behavior change and public health issues. As such, the program design should be reformulated to reflect the longer
term objectives of sanitation improvement, and to incorporate a more public health-based framework for measuring
sanitation and hygiene outcomes.
There is a need for longer-term institutional support and
monitoring of sanitation outcomes, which is not currently
filled by TSC or NGP. This sort of public health monitoring and regulation is usually the responsibility of local
health services; it is recommended that efforts should be
made to develop a sustainable system for sanitation outcome monitoring through local health services (rather
than through the rural development department or public
health engineering department). This approach will have
the advantage of using existing networks of health extension workers and volunteers, and of encouraging stronger
linkages and collaboration with other initiatives aiming to
reduce diarrheal disease and lower child mortality.
In addition, TSC guidelines, which have been evolving gradually as TSC itself charges, should be developed
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
into a more formal rural sanitation policy—one that is
relevant for all rural sanitation interventions not just
those under TSC. A rural sanitation policy based on
TSC guidelines would provide opportunities to involve
stakeholders from other sectors and encourage a more
evidence-based policy development process that builds
on the strengths of TSC, without being hamstrung by its
programming needs.
Recommendation 2: Develop More Effective
High-level Advocacy
Improving political support and priority for sanitation improvement is one of the central challenges of strengthening the enabling environment. The MP assessment suggests
that advocacy and enabling environment activities were not
at a sufficiently high level to influence key decision makers,
and that key development partners promoted different and
conflicting support strategies, implementation approaches,
and monitoring tools.
In order to present Government with clear, consistent and
evidence-based messages that are designed to influence
high-level decision makers, development partners should
work to harmonize their advocacy, enabling environment,
and performance assessment activities. In particular, it is
recommended that reliable cost-effectiveness data should be
collected and used more widely to demonstrate the wasted
investments and opportunity costs of some current strategies and approaches, and the greater effectiveness and sustainability of the alternatives.
Recommendation 3: Recognize That One
Strategy Does Not Fit All
Better information and data on latrine usage, sustainability of behavior change, and targeting accuracy (i.e. success
in improving sanitation for the poorest households) are required to develop strategic plans to meet the government’s
sanitation targets.
In particular, efforts need to be made to identify hard-toreach areas and groups, to examine issues that limit the
cost-effectiveness and sustainability of sanitation improvements, and to recognize that different strategies, resources
and tools are required in different contexts and stages of
development.
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Recommendations
Recommendation 4: Encourage a Two-stage
Incentive System
The HP assessment confirms the value in a two-stage incentive system, whereby ODF achievement by local governments is monitored separately from NGP applications
and awards. The two-stage process is more palatable for
less dynamic and able village governments, and results in a
more focused and less rushed process that allows activities
to develop in scale and complexity as community capacity
and experience builds and improves. The two-stage process
also provides finer-grained information for district and state
governments, informing better planning, resource allocation, and capacity building.
WSP has long championed a two-stage process at national
level, but met with resistance from central and state stakeholders who questioned the utility of ODF achievement
without wider environmental sanitation and hygiene improvements. At endline, the HP experience clearly demonstrates the benefits of a two-stage process, whereby the
momentum and support generated by widespread ODF
achievement has developed the comprehensive enabling
environment required for rapid progress towards the
harder-to-achieve environmental sanitation and hygiene
improvement requirements of the NGP award.
It is recommended that WSP encourage other progressive
states to employ a two-stage process in order to provide
further evidence of the benefits of this approach, with a
longer-term view to convincing the DDWS to formalize
the inclusion of a two-stage approach in TSC guidelines.
Recommendation 5: Invest in
Cost-effectiveness Data
The publication and dissemination of reliable evidence of
wasted investments and opportunity costs remains one of
the most powerful motivators for government reform and
improvement, especially when those costs relate to emotive issues like children’s health, environment, and poverty.
More effort is needed to collect and analyze information
on sanitation program costs, outcomes, and impacts into
simple cost-effectiveness measures and advocacy materials
that can be used to encourage competition among districts
and states, to identify optimal strategies, and to influence
high-level decision and policy makers.
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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Recommendations
Recommendation 6: Incorporate Latrine Usage and
Sustainability into Benchmarking Systems
While latrine usage and sustainability data are not as easy to collect as information
on the number of latrines built, it is important that sanitation programs begin
to work towards routine monitoring and benchmarking of sanitation outcomes.
Initially, it may be necessary to undertake annual rapid assessments in order to
generate latrine usage and sustainability data that can inform annual performance
reviews, but eventually this data should be collected as part of routine public
health monitoring systems.
Recommendation 7: Develop State Capacity for
Knowledge Management
Exposure visits and horizontal learning events were identified as the most important knowledge management tools for local governments. At present, local governments are reliant on agencies like WSP and UNICEF to organize these visits
and events, which often makes them dependent on external program finance and
constrained development partner capacity.
Given the significant government budget available, efforts should be made to
convince decision makers to allocate budget to organize and implement periodic
exposure visits and multi-level horizontal learning events. WSP can continue to
provide technical assistance to these events but it is important that the direction
and finance should come from sustainable government sources.
The development of state capacity to organize knowledge management events
should form part of the program exit strategy in both states, through the formulation of a phased annual knowledge management program that outlines
the diminishing role to be played by WSP. Local governments will require some
hand holding during the early events, but the additional value provided by these
events should allow the development of sustainable mechanisms to finance and
manage them, while WSP gradually builds local capacity for their planning and
facilitation.
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References
Alok, K. 2010. Squatting with dignity: Lessons from India.
New Delhi: Sage Publications. India.
Bhaskar, T. 2009. Sustaining the sanitation revolution: India
country sanitation status. ADB-DMC Sanitation Dialogue, Ministry of Rural Development. Government
of India.
DDWS (2010a) Guidelines Central Rural Sanitation Program: Total Sanitation Campaign. New Delhi: Government of India, Ministry of Rural Development.
Department of Drinking Water Supply.
DDWS (2010b) Nirmal Gram Puraskar: Guidelines New
Delhi: Government of India, Ministry of Rural Development. Department of Drinking Water Supply.
DDWS (2010c) Technology options for household sanitation
New Delhi: Government of India, Ministry of Rural
Development, Department of Drinking Water Supply.
Government of Himachal Pradesh (2004) Strategy for Total
Rural Sanitation in Himachal Pradesh.
Government of India (1999) National Family Health
Survey (NFHS-1) Mumbai: Ministry of Health and
Family Welfare, International Institute for Population
Sciences.
Government of India (2001) Census of India 2001 http://
www.censusindia.gov.in/Census_Data_2001/States_
at_glance/state_profile.aspx
Government of India (2003) National Family Health
Survey (NFHS-2) Mumbai: Ministry of Health and
Family Welfare, International Institute for Population
Sciences.
Government of India. (2004a) Guidelines on Central Rural
Sanitation Program: Total Sanitation Campaign New
Delhi: 9, paragraph 9(d). Ministry of Rural Development. Department of Drinking Water Supply.
Government of India. (2004b) Guidelines on Central Rural
Sanitation Program: Total Sanitation Campaign New
Delhi: 7, paragraph 7. Ministry of Rural Development. Department of Drinking Water Supply.
Government of India (2006) National Family Health
Survey (NFHS-3) Mumbai: Ministry of Health and
Family Welfare, International Institute for Population
Sciences.
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Government of India (2006) Modification in TSC
guidelines: Increase in unit cost of household toilets.
New Delhi: Ministry of Rural Development. Department of Drinking Water Supply. Memo No.
W-11013/4/2000-CRSP (Pt. III).
Government of India (2008) District level household and
facility survey: fact sheet—Himachal Pradesh. New
Delhi: Government of India. Ministry of Health and
Family Welfare.
Government of India (2008) District level household and
facility survey: fact sheet—Madhya Pradesh. New Delhi:
Government of India. Ministry of Health and Family
Welfare.
JMP (2006) Meeting the MDG drinking water and sanitation target: the urban and rural challenge of the decade
Geneva: World Health Organization and United Nations Children’s Fund Joint Monitoring Programme
for Water Supply and Sanitation, progress report.
Kar, K. (2005) Subsidy or self-respect? Community led total
sanitation. An update on recent developments Brighton:
University of Sussex, Institute of Development
Studies.
Knowledge Links (2005) Formative research: development
of sanitation IEC manual for HP
NCAER (1999) India: Human Development Report
New Delhi: National Council of Applied Economic
Research
RGNDWM (2005) Nirmal Gram Puraskar: a national
award under Total Sanitation Campaign. New Delhi:
Rajiv Gandhi National Drinking Water Mission. Government of India website: www.ddws.nic.in
Robinson, A. (2005) Scaling up rural sanitation in South
Asia: Lessons learned from Bangladesh, India and Pakistan New Delhi: The World Bank. Water and Sanitation Program South Asia.
Snehalatha M, V. Ratna Reddy, and N. Jayakumar (2010)
Assessing sanitation costs and services in Andhra Pradesh,
India. IRC Symposium 2010: Pumps, pipes and
promises.
TARU (2008) Impact assessment of Nirmal Gram Puraskar
awarded Panchayats: final report. UNICEF.
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WaterAid (2006) Total sanitation in South Asia: the challenges ahead. Discussion
Paper. London: WaterAid.
WaterAid (2008) Feeling the pulse: a study of the Total Sanitation Campaign in
five states. Report. New Delhi: WaterAid India.
WHO-UNICEF (2010) Progress on sanitation and drinking water: 2010 update.
Geneva: World Health Organization.
Wilbur Smith Associates (2010) Rapid assessment of total sanitation and sanitation marketing (Global Scaling Up Rural Sanitation) project: Madhya Pradesh
and Himachal Pradesh. WSP report. Unpublished.
WSP (2007) An approach that works: Community Led Total Sanitation in rural
areas. New Delhi: The World Bank. Water and Sanitation Program South
Asia.
WSP (2010) A decade of the Total Sanitation Campaign: Rapid assessment of processes and outcomes. Study report. Water and Sanitation Program South Asia.
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Annex 1: Assessment Meetings and Activities
Annex 1: Assessment Meetings and Activities
Activities in Himachal Pradesh
The following list details the stakeholders interviewed by
the assessment team in HP during 01–09 September 2010:
1. Jasywant, PO RDD Kullu, Kullu 02 Sept.
2. Journalists (Ajay Kumar, Sumeet Johan & Ashish
Sharman), Kullu 02 Sept
3. Retailers, Kullu 02 Sept
4. Indar Dev, ZSS (NGO) Kullu 03 Sept
5. Chairman, Zila Parishad, Kullu 03 Sept
6. District Health Officer, Kullu 03 Sept
7. BM Nanta, District Commissioner, Kullu 03 Sept
8. Block Development Officer, Banjar Block, Kullu 04
Sept
9. LSEO, Banjar Block, Kullu 04 Sept
10. Block Coordinator, ZSS (NGO), Banjar Block,
Kullu 04 Sept
11. Gram Panchayat, Balaghad, Kullu 04 Sept
12. District Commissioner, Una 06 Sept
13. ADC, Una 06 Sept
14. Ravinder Sharma, PO RDD, Una 06 Sept
15. Media representatives, Una 06 Sept
16. Chief Medical Officer, Una 06 Sept
17. Gautam Sharma, ICDS, Una 06 Sept
18. Utri (NGO), Block Coordinator, Una 06 Sept
19. BDO, Una Block, Una 06 Sept
20. Pradhan, Bedhala GP, Una 07 Sept
21. Panchayat Secretary, Bedhala GP, Una 07 Sept
22. Pradhan, Dehlan GP, Una 07 Sept
23. Panchayat Secretary, Dehlan GP, Una 07 Sept
24. RD Dhiman, State Secretary RDD, Shimla 08 Sept
25. Robin George, Assistant Director TSC-RDD,
Shimla 08 Sept
26. Ravinder Kumar, CCDU consultant, Shimla 08
Sept
27. RN Bhatta, Director RDD, Shimla 08 Sept
Following the main interview schedule and fieldwork, a
short feedback meeting was held in Shimla on Wednesday 08 September 2010 (14:00–17:00). At this feedback
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meeting, the assessment team presented their initial findings to a small group of key stakeholders (including the
PRD Secretary, Assistant Director TSC, and assorted State
and District officials) for verification, discussion and further clarifications.
Activities in Madhya Pradesh
The following list details the stakeholders interviewed by
the assessment team in Madhya Pradesh during 10–17 September 2010:
1. Dr Puranik, Assoc. Professor WALMI, Bhopal 10
Sept
2. Engineer-in-Chief, PHED, Bhopal 10 Sept
3. SC Jaiswal, Technical Officer, WaterAid MP, Bhopal
10 Sept
4. Ravindra Pra, CCDU consultant, Bhopal 10 Sept
5. District Collector, Bhopal District, Bhopal 10 Sept
6. Gajendra Rathod, Block Coordinator, Rama Block,
Jhabua 12 Sept
7. Gram Panchayat, Gundipara GP, Jhabua 12 Sept
8. Amit Dubey, District Coordinator, Jhabua 12 Sept
9. Kalawati Buria, President Zila Panchayat, Jhabua 12
Sept
10. Deputy Director, Branch Office NCHSE (NGO),
Jhabua 12 Sept
11. Shobhit Jain, District Collector, Jhabua 12 Sept
12. SDO, Rural Engineering Services PHED, Jhabua
12 Sept
13. Ahed Khan, Sub-Editor, Hindi Daily (Rajasthan
Patekha), Jhabua 12 Sept
14. Retailer, Jhabua bazaar, Jhabua 12 Sept
15. GP Secretary, Temaria GP, Petlawad Block, Jhabua
13 Sept
16. TSC District Coordinator, Chhindwara 15 Sept
17. District Collector, Chhindwara 15 Sept
18. Retailer, Chhindwara bazaar, Chhindwara 15 Sept
19. Chief Medical Officer, Chhindwara 15 Sept
20. Superintending Engineer, PHED, Chhindwara 15
Sept
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21.
22.
23.
24.
25.
26.
27.
Annex 1: Assessment Meetings and Activities
Sanjay Goutam, Editor Dhanik Bhaskhar, Chhindwara 15 Sept
Gram Panchayat, Ridhora GP, Parasia Block, Chhindwara 16 Sept
Block Development Officer, Parasia Block, Chhindwara 16 Sept
Block Coordinator, Parasia Block, Chhindwara 16 Sept
Gregor von Medeazza, WASH specialist, UNICEF, Bhopal 17 Sept
MR Soni, Deputy Commissioner TSC, PRD, Bhopal 17 Sept
Secretary, PRD, Bhopal 17 Sept
Following the main interview schedule and fieldwork, a short feedback meeting
was held in Bhopal on Friday 17 September 2010. At this feedback meeting, the
assessment team presented their initial findings to a small group of key stakeholders (including the Secretary of Rural Development, Director PRD, Deputy
Commissioner TSC, and assorted state and district officials) for verification, discussion and further clarifications.
Activities in New Delhi
The following list details the national stakeholders interviewed by the assessment
team in New Delhi during 30 August–24 September 2010:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Ajith Kumar, WSP Country Task Manager for the program, 30 August
Manu Prakash, WSP consultant, 30 August
Aruvindar Satiawada, WSP consultant, 30 August
Arokiam Kakumanu, WSP MP State Coordinator, 30 August
Juan Costain, Regional Team Leader, WSP South Asia, 31 August
JS Mahur, Joint Secretary DDWS, 20 Sept
Lourdes Baptista, CEO, WaterAid India, 20 Sept
Ashufta Aslam, DFID India, 20 Sept
Moni Sagar, BCC and Marketing specialist, USAID, 22 Sept
Jeremy Gustafson, Director CLEEO, USAID 22 Sept
RVV Raghava, Senior Infrastructure Specialist, World Bank India, 22 Sept
Sumita Ganguly, UNICEF India, 22 Sept
A learning event was held in New Delhi on Tuesday 21 September to present the
initial findings of the enabling environment assessments in Himachal Pradesh
and Madhya Pradesh, and to brainstorm on enabling environment issues with
a group of engaged and active stakeholders. Key participants included: Lizette
Burgers (Chief of Child Development and Environment, UNICEF India); Vijay
Mittal, Director TSC DDWS, Dirk Walther, GTZ adviser).
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Annex 2: Terms of Reference for Consultancy
Annex 2: Terms of Reference
for Consultancy
Endline Assessments of the Enabling Environment
to Scale up, Sustain, and Replicate Sanitation
Approaches in the Global Scaling Up Rural Sanitation
Program
In Indonesia, India, and Tanzania
DRAFT Revised: 25 February 2010
1. Overview of TOR
The Water and Sanitation Program (WSP) is in the final
phase of a project entitled “Total Sanitation and Sanitation Marketing: New Approaches to Stimulate and Scale
up Sanitation Demand and Supply.” The program has as
one of its central objectives to improve sanitation at a scale
sufficient to meet the sanitation MDG targets by 2015 in
Indonesia, Tanzania, and the Indian states of Himachal
Pradesh and Madhya Pradesh.
The purpose of this consultancy is to carry out an endline
assessment of the programmatic conditions needed to scale
up, sustain and replicate the total sanitation and marketing approaches. The programmatic conditions are the eight
dimensions that are defined in the conceptual framework
in Section 3 of this TOR. Scale up is defined as meeting
the 2015 MDG targets in each country. Sustainability is
defined as the ability to maintain programs after external
funding has ended. Replication is the eventual application
of the TSSM approach in other countries at scale.
The endline assessments will be carried out during the
final phase of the overall program during late 2010 and
early 2011. The endline assessments in each country will
be carried out by two-person team consisting of an international specialists and a local consultant of country WSP
staff member. The consultant teams will be hired as independent consultants but will function as one overall team
under the direction of the WSP Country Task Manager
for the TSSM program with support from the Global Task
Team Leader.
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2. Background/General Description
The Water and Sanitation Program (WSP) is an international partnership to help the poor gain sustained access to
water supply and sanitation services. Administered by the
World Bank with financial support from several bi-lateral,
multi-lateral, and private donors, WSP is a decentralized
partnership and operates through offices in Africa, East
Asia, Latin America and South Asia. A major thrust of the
programs is to help its clients prepare for and implement
actions towards meeting the water supply and sanitation
(WSS) Millennium Development Goals (MDGs). In pursuing their mission, WSP staff provides advisory support to
projects and policies to help identify and disseminate best
practices and lessons from experience across countries, assist clients in the implementation of pilot projects to test
out new ideas, and facilitate informal networks of practitioners and sector stakeholders. Additional information about
WSP can be found on the program website (www.wsp.org).
The Water and Sanitation Program is implementing the
“Total Sanitation and Sanitation Marketing (TSSM): New
Approaches to Stimulate and Scale Up Sanitation Demand
and Supply Project.” This program has the primary goal of
learning about scaling up and about effective and efficient
sanitation interventions that improve health. The TSSM program is a large-scale effort to meet the basic sanitation needs
of the rural poor who do not currently have access to safe
and hygienic sanitation. That aim will be accomplished by
developing the practical knowledge for designing sanitation
and hygiene programs that are effective at improving health
and are sustainable at large scale for rural areas. The program
will test proven and promising approaches to create demand
for sanitation, and to use marketing techniques to improve
the supply of sanitation-related products and services.
The program is designed to achieve key milestones in each
country at the end of four years of program implementation
(including the start up period that will facilitate the achievement of the MDG 2015 sanitation targets. These milestones
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Annex 2: Terms of Reference for Consultancy
TABLE 15: GEOGRAPHIC AREAS AND BENEFICIARIES
Estimated Number of
Vision of Number of
People Who Will Gain
Additional People Who
Estimated Number of
Access to Sanitation
Will Get Access to
People without Access
during Two-year Pilot
Sanitation by 2015 to
to Sanitation in 2006*
Phase
Meet MDG Targets**
Tanzania (rural)/26.7 million in 2006
14.25 million
750,000
6.5 million
Indonesia (East Java province)/36.5 million
18.6 million
1.4 million
10 million
4.3 million
700,000
1.2 million
population
43.6 million
1.1 million
20 million
Total
80.75 million
3.75 million
37.7 million
Geographic Areas Where the Program
Will Take Place/Population
Indian state of Himacahal Pradesh (rural)/5.5 million
rural population
Indian state of Madhya Pradesh (rural)/45 million rural
* Best estimates given poor status of data.
** Accounts for population growth estimates
should indicate if the key program elements are in place by
mid-2010 to meet the 2015 MDG targets. The specific targets for scaling up in each country are in Table 15.
The purposes of this terms of reference are to 1) assess to extent to which the programmatic conditions for scale up and
sustainability have improved by the end of the TSSM program and, 2) on the basis of the endline assessment findings
and learnings, recommend what should be done to address
the gaps during the remainder of the TSSM program implementation period or for the future if a follow on project
is undertaken. Determine if the programmatic conditions
are in place to meet the 2015 MDG targets and are likely
to be sustained over time. The fundamental question that
the assessment is intended to answer is whether the country
can continue to scale up after 2010 without assistance, with
less assistance or with different assistance, from the TSSM
program and whether the TSSM program conditions are
institutionalized to support scaling up in a sustainable manner. Strengthening the enabling environment is integral to
increasing demand at the household and community levels and improving the supply of affordable and appropriate
sanitation products and services.
The overall TSSM program is four years in duration with
three distinct phases. Phase I—December 2006 to August
2007—is the initial six to nine month start-up period for
detailed studies, planning, and procurement at the global
and country level. Several assessments including the one for
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scalability, approaches for demand creation, sanitation marketing, and the baseline for the impact evaluation will be
carried out during this period. Phase II is the three-year implementation period and Phase III is the three to six month
wrap-up phase that will include the final evaluation and
dissemination of lessons learned. This final programmatic
assessment will take place during Phase III.
In the larger sense, the assessment will answer the question
whether there is an enabling environment in place in each
country that can continue after the end of this program and
meet the MDG targets by 2015.
3. Conceptual Framework
In order to ensure consistency in the assessment findings, WSP
developed a conceptual framework for assessing scalability.
This framework was developed based on a review of relevant
literature and discussions with key individuals. The framework
consists of eight dimensions that are considered essential to
scaling up the total sanitation and sanitation marketing approaches in rural areas using on-site sanitation facilities.
•
•
•
•
•
•
•
Policy, strategy, and direction
Institutional arrangements
Program methodology
Implementation capacity
Availability of products, tools and information
Financing and incentives
Cost effective implementation
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Annex 2: Terms of Reference for Consultancy
• Monitoring and evaluation
[NB: the detailed descriptions of the framework dimensions have been omitted to shorten the TOR].
4.4.
4. Scope of Work
International Specialist Consultant
The tasks in the scope of work are divided into three overall phases: preparation, endline assessment in the field and,
capturing and documenting learnings. The international
consultant will carry out all of the tasks in these three
phases, with assistance from the WSP country teams during the main periods of fieldwork.
4.1. Review key background and program documents
provided by WSP. Participate in a planning meeting with the Global TSSM Task Team Leader. This
may take place in WDC or in a mutually convenient
meeting place in Europe. The objectives of the planning meeting will be to ensure that the international
consultant understands the background and objectives of the assessment; what expectations are in
terms of deliverables, etc.
4.2. Work with the respective WSP Country TSSM
Task Managers via email and phone as needed to
develop a work plan and schedule for the endline
assessments, including agreement and arrangement
of preliminary meetings (in order to reduce the time
spent in the capital on arrival).
4.3. Travel to each country and participate in a planning
meeting in each of the countries with the TSSM
country task manager, the WSP coordinator or STC
consultant assignment to be part of the endline assessment team in support of the international specialist, and other TSSM team members as appropriate.
The purpose of the meeting will include providing
the international consultant with an update on work
done and related accomplishments in the enabling
environment and also to include a review and discussion of the self-assessed “spider diagram” progress
reports showing progress in strengthening the enabling environment. This initial meeting should also
allow the country team to share learnings about the
process of strengthening the enabling environment
since the baseline with the consultant. Finally, as
needed, the meeting should also confirm any related
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4.5.
4.6.
4.7.
4.8.
administrative or travel related logistics for the field
assignment.
Finalize the interview protocols for the respective countries based on the baseline documents and any new information or revised analytical framework provided by
WSP-WDC or WSP-Countries either before or during
the initial planning meeting ( as per 4.3 above). For example, while the original concept and related baseline
focused on the enabling environment at the national or
state government level, WSP countries have in many
cases extended the concept to local government levels.
The conceptual framework is intended to provide a
common approach to the assessment so that the results
are comparable across countries. Each dimension has a
set of questions to be answered during the assessment.
The consultant will be responsible for determining
what information needs to be collected to answer these
questions, how the information will be collected, and
for developing interview protocols.
Carry out the endline assessment of the programmatic elements required for scale up of the total sanitation and sanitation marketing approaches. While
the specific activities for each assessment will be determined by the consultant team, the assessment is
expected to include the following aspects:
• Review of key documents (assessment reports, progress reports, sector strategies, laws, regulations, etc.)
• Meetings with key stakeholders including government officials at the national, provincial, and local
government levels; private sector providers of sanitation products and supplies; NGOs; and donors.
• Debriefing State, Provincial National governments
as appropriate to test the validity of key findings
Based on the results of the endline assessments, formulate recommendations for improved implementation and for creation of the enabling environment
necessary to meet the 2015 MDG targets.
Debrief the WSP Country TSSM Task Manager, and
as appropriate, other WSP country staff and key government officials responsible for the program. The
consultant should discuss the recommendations and
actions needed to strengthen those elements that were
found to be blockages to scaling up rural sanitation.
Write a report with findings, recommendations for
moving forward and filling remaining gaps in the enabling environment and, lessons learned by the WSP
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team, government partners and other stakeholders
as appropriate using the format that is agreed upon
in the team planning meeting. As a starting point,
the basic report will look like the baseline reports
(see WSP website to review each of the reports) and
revise and improve as appropriate and agreed to with
the Global TSSM Task Team leader.
4.9. When all the country reports are completed, the
consultant will then prepare a global report that synthesizes the findings and recommendations from all
three countries. Among other things, the synthesis
report should identify and discuss common crossglobal findings and recommendation. The starting
point for the format of the approach should be the
synthesis report prepared on the baselines assessments (report can be found on WSP website).
4.10. Based on this assignment, prepare a guidance document for carrying out enabling environment assessments for rural sanitation programs. This document
will be similar to the guidance note developed for
carrying out a Handwashing enabling environment
assessment that can be found of the WSP website.
4.11. Based on the lessons from this assignment and the
overall TSSM Global program experience, prepare
a WSP Learning Note on the challenges and opportunities for strengthening the enabling environment
for large scale rural sanitation programs.
WSP Coordinator
WSP should provide one experienced staff member (preferably one of the TSSM program field coordinators) to assist
with the implementation of the endline assessments.
Preparation
• Develop list of stakeholders (at central, provincial
and district levels)
• Collect local policies, strategies, and other background documents
• Collect and organize all enabling environment spider diagrams and related documentation
• Assist in review of background documents (arrange
translation where appropriate)
• Set up meetings and plan field visits for assessment
(with WSP assistance)
• Plan feedback/debrief sessions
• Organize logistics for assessment
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Annex 2: Terms of Reference for Consultancy
Endline Assessment
• Participate in team planning meeting
• Participate in finalizing (and translating if needed)
interview protocols and questionnaires
• Participate with international consultant in all field
work related to the endline assessment
• Assist with translation (if needed), processing and
analysis of information from assessment
• Assist with debrief of WSP and government officials
5. Expected Products/Outcomes
5.1. The international consultant will be responsible for
the following deliverables
An Enabling Environment Endline Assessment Report for each country (India report to include both
HP and MP in separate sections). As a starting point,
the outline for the report should be as below. Final
revision of the outline should be carried out during
the initial global planning meeting.
• Introduction. This section should explain the
context and purpose of the assessment, summarize the TOR, and explain the methodology of
the assessment.
• Summary of conceptual framework and assessment dimensions that guided the assessment
• Summary of findings
– Policy, strategy, and direction
– Institutional arrangements
– Program methodology
– Implementation capacity
– Availability of products and tools
– Financing
– Cost effective implementation
– Monitoring and evaluation
• Conclusions. Based on the specific findings, this
section should summarize the overall conclusions
of the assessment team, especially those that are
cross-cutting and not captured in the findings for
each assessment dimension.
• Recommendations. These are specific recommendations that may still be needed to fill any
remaining gaps in the conditions necessary for
scale up and sustainability.
• Action plan directly based on the recommendations in the assessment report. This section
should include the following:
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a. Actions that need to be taken. Where possible, these actions should be linked to existing
programs that are seeking similar reforms.
b. Sequence in which they should be addressed
and a timeline
c. Skills and expertise and estimated LOE
needed to implement the actions
d. Expected implementation challenges, risks,
and assumptions
• A final section in the report with Lessons learned
by the WSP team and government partners in
strengthening the enabling environment for a
large scale rural sanitation program.
5.2. A global synthesis report. This should be a short (no
more than 30 pages) synthesis of the findings, conclusions and recommendations from the enabling
environment endline assessments in all three countries. The suggested draft outline is based on the synthesis report for the baseline enabling environments
and can be revised based on an agreement with the
global task team leader:
• Executive summary
• Introduction with relevant background and context
• Summary of Country Projects
• Analysis by dimension
1. Policy, strategy and direction
2. Institutional Arrangements
3. Program Methodology
4. Implementation Capacity
5. Availability and Knowledge of sanitation
products and services
6. Financing and incentives
7. Cost-Effective implementation
8. Monitoring and evaluation
• Overall Conclusions
5.3. A guidance document for carrying out enabling environment assessments for rural sanitation programs
that are large scale and sustainable. The following
draft outline is based on a similar guideline developed for handwashing and should be considered as a
starting point:
• Purpose of the Guideline
• Background
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Annex 2: Terms of Reference for Consultancy
• Understanding What is Meant by Scalability and
Sustainability
• Assessment Methodology including description
of conceptual framework and related dimensions
• Annexes ( Resources and tools to be used by assessment team):
– Sample TOR
– Sample Study protocol
– Sources by Dimensions Table (BLANK
TABLE FOR USE TO IDENTIFY
THE DIMENSIONS RELEVANT TO
AND COVERED IN INTERVIEWS
WITH DIFFERENT STAKEHOLDER
ORGANIZATIONS)
• Proposed Report Outline
• Interview Guide
5.4. A WSP Learning Note on the, experience, challenges
and opportunities for strengthening the enabling environment for large scale rural sanitation programs.
Learning Notes are 2–4 pages long and designed to
be accessible for a wide audience. Therefore, they
should be written in a non-technical language and
can incorporate graphics (maps, photographs, charts,
etc). Each Note includes the following sections: Introduction, Problem Statement, Action, Key Learnings and What Else do We Need to Know?
6. Personnel and Estimated Level of Effort
The assessment in each country will be carried out by a
two-person team consisting of an international consultant
and a WSP coordinator.
The international consultant should have the following
qualifications:
• 15 years of experience in the water supply and sanitation sector, especially in project design and implementation and sector reform
• Extensive consulting experience
• Significant and in-depth experience in institutional
development
• Knowledge of sanitation and the related institutional
and programmatic issues
• Excellent communication and report writing skills
in English
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Annex 3: Endline Interview Guide
Annex 3: Endline Interview Guide
Introductions (5 minutes)
•
•
•
•
Introductions
Appreciation for time
Purpose of interview
Confidential, won’t use name or other identifying
information
• Have series of questions, but not exclusive of other
questions
NB—For TSSM, it will be essential to define “rural sanitation” and what is being promoted in the national/state context
(in the purpose of interview).
Opening (10 minutes)
• Tell me something about the importance of
Sanitation
• Tell me something about your organization and
briefly what your organization does to support
TSSM/sanitation work. And what you plan to do.
Dimensions Interview (50–60 minutes)
Use attached interview guide.
Closing (5 minutes)
• What do you see as the single most important success factor in the TSSM program?*
• And what would you recommend be done to improve the environment in which this sort of project
will be successful and sustainable?*
• Thanks for his/her time.
Notes:
1. Questions highlighted in bold type are considered “core questions” that should always be
asked (if that dimension is relevant to the
interviewee).
2. Questions marked with an asterisk “*” are considered suitable for use in FGDs
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1. Policy, Strategy, and Direction
Establishing a shared vision and strategy and ensuring the political will to implement a program is the starting point for
scale up. Developing this shared vision and strategy in a collaborative manner is also the foundation for coordination and
for creating motivation at all levels.
1. To what extent is there political will and support
to expand access to and use of sanitation facilities, and at what levels (national, state, district,
local)?*
2. If not, what is needed to generate stronger political
will and support? Who are the key decision-makers
whose political support is needed?
3. What are the best channels for influencing policy
relevant to a state program?* How are sanitation policy and decision-makers held accountable by rural
households?
4. If there is a political will for sanitation in general,
to what extent is there political will to use:
• the total sanitation approach (focused on ODF)?
• the sanitation marketing (SM) approach?
5. Evidence: what policy changes, budget allocations,
or program activities have people or organizations
already made to follow up on that political will? Are
more changes needed for the sanitation program to
be successful?
6. What are the key policy barriers to scaling up the
program and how are they being addressed? (e.g.
related to policy alignment, subsidies, availability
of products, policy on dry toilets etc.)*
7. Are the overall goal and specific objectives of the
program clear and understood? Is there a shared vision and direction among key stakeholders (at all
levels)? What is this shared vision?
8. Has a detailed strategy (and investment plan) to
meet these objectives been developed? Is there coordinated implementation by key stakeholders
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(at all levels)? What are the key elements of the
strategy? Have targets been set to support the
achievement of strategic objectives?
9. What are the strengths and weaknesses of this strategy? What recommendations would you make to
overcome these weaknesses? Who needs to act and
how?
10. What are the institutional incentives, e.g. financial, recognition, training, at the national, state,
and local government levels that support program
implementation? What additional incentives might
be needed?
11. Which organizations, individuals, or agencies could
act as champions or catalysts for the program? What
would it take to mobilize them successfully? Note:
these might include government units and programs,
NGOs, CBOs, and for-profit companies.
2. Institutional Arrangements
Institutions at all levels must clearly understand their roles,
responsibilities, and authorities. They must also have the
resources to carry out their roles. In addition to clear roles
and responsibilities, institutional arrangements must include
the mechanisms for actors at all levels to coordinate their
activities.
1. What process has been/is being used to plan this
program? Who is involved?
2. How has the program been organized? Please describe the institutional set-up for the TSSM program
in terms of the following institutional functions:
a. setting policy
b. developing program methodology
c. implementation (start-up, IEC, latrine construction, institutional sanitation)
d. program coordination
e. training
f. monitoring and evaluation (ODF status,
NGP awards, progress towards objectives, impact assessment)
3. To what extent are there these implementation
arrangements (roles and responsibilities) clearly
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Annex 3: Endline Interview Guide
4.
5.
6.
7.
8.
9.
10.
11.
defined? Are existing institutional arrangements
adequate for effective large-scale implementation
(to meet program objectives)?
Have reforms been required to support large-scale
implementation? What implementation mechanisms are already in place? If still being put in place,
then what is the process?
What mechanisms have been established for coordination among relevant partners (at national, state
and district levels)? How many ‘coordination points’
are active?
How well are coordination mechanisms working
(when was the last meeting)? Have any coordination bodies collapsed or proved redundant? How
might they be improved?*
Has the program fully explored potential strategic alliances with public, private, and NGO sector organizations? What has been done to explore
these potential strategic alliances? What/who has
been considered (or excluded)?
Are partners fully aware of the overall goal and objectives of the program? Do partners participate
actively in planning decisions and discussions?
How would you describe the quality of the partnerships between district/municipal governments
and implementing NGOs? How might they be
improved?*
How would you describe the working relationships
between the partners (e.g. NGOs) and the communities with which they work? How might they be
improved?
To what extent (and how) have partners integrated
the program into their ongoing activities and/or
budgets? To what extent do they plan to do so?*
3. Program Methodology
The program methodology consists of the program rules, specific
activities and their timing and sequence. Each country will
adapt and apply the program methodology making it specific
and appropriate to the country context. A workable program
methodology that is clear and agreed upon by all key stakeholders is a key programmatic condition.
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1. To what extent is there a defined and detailed methodology for implementing the program?*
2. Is the methodology achieving the desired outcomes and objectives? Is it being implemented at
large scale? If not, does the methodology need to
be modified for large-scale implementation?
3. To what extent is the program methodology widely
understood and accepted by program partners and
implementers? Who has the main responsibility
for implementation of the program methodology?*
4. How fully/effectively has this program methodology
been applied? What challenges have been experienced? What improvements would you recommend?*
5. What kind of evaluation (if any) has there been of
this methodology?
6. How has the methodology been documented? How
complete is it? How useful and operational is the
documentation?
7. How easy would it be for someone else (e.g. another
agency) to implement the program methodology
in another location (e.g. another State)? Would the
methodology achieve similar outcomes in another
location, or are the methodology and outcomes particular to Himachal Pradesh/Madhya Pradesh?
4. Implementation Capacity
Institutions at all levels must have the institutional capacity to
carry out their roles and responsibilities. Institutional capacity
includes adequate human resources with the full range of skills
required to carry out their functions, an “organizational home”
within the institution that has the assigned responsibility, mastery of the agreed upon program methodology, systems and procedures required for implementation, and the ability to monitor
program effectiveness and make continual adjustments.
1. How would you rank capacity (financial, human
resources, training, technology, transport) to implement and monitor the main program components
at different levels: national/state, district, GP/community (1 lowest–5 highest):
• Total sanitation;
• Sanitation marketing; and
• Enabling environment improvements.
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Annex 3: Endline Interview Guide
2. What resources are in place to build, strengthen and
support the required capacity? What is lacking?
a. Financial
b. In-kind
c. Human resources
d. Capacity building/training (skills development)
e. Technology
3. Are capacity building mechanisms effective? How is
this effectiveness monitored?
4. Where/what are the biggest capacity constraints
(barriers to progress)? What is/will be needed to
implement this program at larger scale (hiring
staff, training, increased financial resources, incentives etc.)?
5. To what extent is there adequate capacity to plan
and implement behaviour change activities in the
government sector? What about among NGOs?
Among other major stakeholder groups (e.g. private sector)?*
6. Describe a behaviour change program you consider
successful (at national or state level). What made it
successful?*
7. To what extent is there adequate capacity in the private sector to provide affordable goods and services
and respond to consumer preferences? Will the private sector be able to respond to increased demand
as the program scales up? If not, what mechanisms
are in place to build private sector capacity and local
markets?
5. TSSM—Availability of Sanitation Products,
Services and Information
Target consumers ability to adopt improved behaviors is highly
dependent on the availability and affordability of appropriate products, services and information. Any and all products,
services and information need to be considered, specific to each
country situation.
1. How would you rank the availability and consistent
supply of the following Sanitation product and services? [1 lowest to 5 highest]
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2.
3.
4.
5.
6.
7.
8.
• Direct sanitation services (i.e. sanitation masonry
and construction)
• Related sanitation services (i.e. provider financing and transportation)
• Key sanitary products (i.e. ceramic pans and plastic slabs)
Have there been any improvements in the availability, affordability or quality of sanitation goods
and services since 2007? If so, what enabled these
improvements?
Are products/services reasonably priced for the poor
and of dependable quality? Is there a range of options for other unserved groups (APL, tribal etc)?
Is information readily available on the quality and
price of different product/service options? How can
rural households access this information?
Do existing policies and guidelines influence
or limit the range of sanitation goods and services available to households (e.g. fixed ideas on
technology)?
What should the government start doing (or stop
doing) to facilitate increased availability and consistent supply of sanitation products and services?
What should the government start doing (or
stop doing) to ensure affordability and dependable quality of the above sanitation product and
services?
Are there any local institutions (government agencies or civil organizations—i.e. associations) in place
to facilitate the availability, affordability or quality of the above sanitation product and services? If
so, can you name them and detail their function
and responsibilities? How would you rank the efforts made by these institutions [1 lowest/worst to
5 highest/best]?
6. Financing and Incentives
This dimension assesses the adequacy of arrangements for financing the programmatic costs. These costs include training,
staff salaries, transportation, office equipment and supplies,
and the development of communication and education materials as well as programmatic line items in budgets for program
and promotion activities. It also examines incentives for scaling
up, improving quality and meeting program targets.
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1. Are you aware of the costs of implementing the program? Which costs (breakdown)?
2. To what extent is sustainable financing available to
meet the costs of implementing the program? (costs
such as staff salaries, training, transport, etc.)*
3. Do current arrangements for program financing ensure adequate, timely and predictable payments to:
• Districts
• Program partners (e.g. NGOs)
• GPs
4. Who is responsible for financial planning? Could
this process be improved?
5. What are the financing opportunities and willingness to finance among public (or other) agencies at
national, state, and local levels?*
6. To what extent have promotional activities been
included in state-, district-, and GP-level budgets? Are these budgets adequate for the required
promotional activities?
7. How are households mobilized to invest in sanitation facilities? What schemes or mechanisms are
in place to mobilize households? Are any of these
mechanisms aimed at the poorest households?
8. To what extent are there local opportunities to fund
community and/or household investments (such
as micro-financing, group savings/credit schemes,
capital for initial investments)? Is credit available for
toilet upgrades?
9. Is credit available to local entrepreneurs/producers?
If so, who provides the credit and on what terms?
If not, does this lack of credit affect the availability, affordability or quality of sanitation goods and
services?
10. To what extent will the national government (or
other agencies) be able to sustain the costs of implementing the TSSM approach after the program is
over? What needs to be done to ensure continued
financial support (and ongoing monitoring and follow-up) from the national government?
11. Are there any incentives/rewards/benefits available to high performers? Anything to encourage
people to become actively involved in sanitation
programs?
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7. Cost-Effective Implementation
While it will not be possible to assess the cost-effectiveness of the
approach and how best to achieve economies of scale until the
end of the program, data must still be collected during implementation to make this determination at the end of the program. Therefore, the focus in this assessment is to ensure that
information will be collected from the outset and that the capacity to collect the information is in place—systems and procedures for collecting cost information and capacity to use and
collect it exist.
1. How is “effective implementation” measured? Is
there any distinction between program outputs
(e.g. nr. toilets) and program outcomes (e.g. toilets in use, improved sanitation behaviours and
health indicators)?
2. What information do you collect on program
costs (e.g. hardware, software, program, partner
costs etc)?
3. What assessments are made of cost-effectiveness?*
What factors influence cost-effectiveness? Has
anything been done to improve cost-effectiveness?
Note: may be necessary to explain difference between cost
efficiency (cost per output) and cost effectiveness (cost per
outcome/impact).
4. How is the size of the targeted and affected (beneficiary) program population assessed?* (give example
if possible)
5. Does the program depend on other non-permanent,
supporting programs or resources (e.g., use of salaried local government staff )? Is any information collected in order to measure these supporting costs?
6. To what extent does the capacity exist at the local
government and state level to produce cost-effectiveness data?* What needs to be done to ensure that
this information is collected and reported?
8. Monitoring and Evaluation
Large-scale sanitation programs require regular monitoring
and perhaps more importantly, the willingness and ability to
use the monitoring process to make adjustments in the program.
www.wsp.org
8241-CH10.pdf 71
Annex 3: Endline Interview Guide
Effective monitoring will identify strengths and weaknesses in
the program methodology, implementation arrangements, and
cost efficiencies. Overall monitoring responsibility must be at
the highest level of the program, but must be based on information collected at the local government or district-level.
1. What are the most important program monitoring indicators? What is the main use of the monitoring data?
2. Is there sufficient monitoring capacity at the
national/state/district levels?
3. Is there a national (or state) monitoring process
that measures program effectiveness and outcomes (or collects this data from the program)?
4. Is there any performance benchmarking across
program units (e.g. districts)? Has this benchmarking had any impact on policies, activities or
investments?*
5. How will the monitoring (local and national) be
sustained once the main program activities are
complete?
6. What other sectors (whoever you are not interviewing) have strong M&E components and which organizations facilitate the process at different levels?
What other monitoring processes provide information to the program (e.g. health data)?
7. To what extent is the (current or planned) process sufficient to monitor quality of services,
outcomes, identify gaps and weaknesses, and determine lessons learned and best practices?*
8. What is the most effective M&E tool for learning, identifying weaknesses and driving improved
performance?
9. What would be required to replicate the program
M&E systems/processes in another location (e.g.
state)?
10. What technical, administrative or financial improvements or support are needed to ensure that the
existing monitoring systems are adequate to support
an expanded program?
11. What incentives exist to engage in and apply the results of monitoring activities? What might encourage programs to value monitor?
71
3/30/12 11:25 AM
Key
72 70
68 67 66
55
Districts not supported
by either WSP or UNICEF
Districts receiving support
from WSP and UNICEF
Districts receiving support
from UNICEF
Districts receiving support
from WSP
0
10
20
30
40
50
60
70
80
(> 50%)
Top Performing
MAY 2010
Below Average (25–39%)
(> 25%)
17 15
Low Performing
50 50 50 49 48 48
47 46 45 44 44
43 43 43 41 41 41 40 40
40 39 38
36 34
33 33 32 32 32 32 31 30
27 25
24 21 21
20 20 19
Above Average (40–50%)
Annex 4: Program Benchmarking Assessments
by District, MP
Percentage
8241-CH10.pdf 72
Jabalpur
Dhar
Indore
Rewa
Satna
Hoshangabad
Khandwa
Khargone
Seoni
Harda
72
0 0
5
TSC expenditure
100
10
Financial efficiency
Total Score Possible
10
10
School sanitation target
Average Gram Panchayat size
10
Proportion of NGP Gram Panchayats
10
15
2009 success rate in NGP applications
30
Latrine coverage
Percentage
Number of NGP Gram Panchayats
Indicator
Scoring System
District
5% if 50% of the TSC budget is spent
10% for lowest cost per NGP GP
10% if 80% of schools meet the TSC coverage target
10% if the GP population is greater than 15,000
10% if the success rate is over 75%
10% if more than 50% of GPs have received an NGP
15% if 90% of households meet the TSC coverage target
30% if more than 100 GPs have been awarded an NGP
Detail
Dewas
Shahdol
Raisen
Ratlam
Narsinghpur
Mandsaur
Rajgarh
Balaghat
Umaria
Vidisha
Jhabua
Mandla
Sagar
Bhopal
Sehore
Ujjain
Chhindwara
Barwani
Dindori
Datia
Kaini
Morena
Betul
Gwalior
Neemuch
Shajapur
Anuppur
Burhanpur
Guna
Shivpuri
Damoh
Chhatarpur
Sidhi
Ashoknagar
Tikamgarh
Sheopur
Panna
Bhind
Singrauli
Alirajpur
Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment
Annex 4: Program Benchmarking Assessments by District, MP
Scaling Up Rural Sanitation
3/30/12 11:25 AM
By Andy Robinson
This report is based on fieldwork and research funded by the Water and
Sanitation Program (WSP). The fieldwork and research could not have taken place
without the support and assistance of the Government of Himachal Pradesh
(Rural Development Department, Irrigation and Public Health Department), the
Government of Madhya Pradesh (Panchayat and Rural Development Department,
Public Health Engineering Department), the Government of India, and the Water
and Sanitation Program—South Asia.
Special thanks are due to Ajith Kumar, K. Arokiam, Lira Suri, and Nitika Surie for
their kind assistance and support in India.
Designated a core business area in 2011, WSP’s Scaling Up Rural Sanitation
is working with governments and the local private sector to develop the
knowledge needed to scale up rural sanitation for the poor. The programmatic
approach combines Community-Led Total Sanitation (CLTS), behavior change
communication, and sanitation marketing to generate sanitation demand and
build up the supply of sanitation products and services at scale. In addition,
WSP works with local and national governments and the local private sector
to strengthen the enabling environment—including institutional, regulatory,
financial, service-delivery, and monitoring capacities—to achieve change that is
sustainable. Starting in India, Indonesia, and Tanzania in 2006, Scaling Up Rural
Sanitation is currently being implemented in over a dozen countries. For more
information, please visit www.wsp.org/scalingupsanitation.
This Working Paper is one in a series of knowledge products designed to showcase
program findings, assessments, and lessons learned through WSP’s Scaling Up Rural
Sanitation initiatives. This paper is conceived as a work in progress to encourage the
exchange of ideas about development issues. For more information please email
Eddy Perez at wsp@worldbank.org or visit www.wsp.org.
WSP is a multi-donor partnership created in 1978 and administered by the World Bank to
support poor people in obtaining affordable, safe, and sustainable access to water and sanitation
services. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill &
Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland,
United Kingdom, United States, and the World Bank.
WSP reports are published to communicate the results of WSP’s work to the development
community. Some sources cited may be informal documents that are not readily available.
The findings, interpretations, and conclusions expressed herein are entirely those of the author
and should not be attributed to the World Bank or its affiliated organizations, or to members
of the Board of Executive Directors of the World Bank or the governments they represent. The
World Bank does not guarantee the accuracy of the data included in this work.
The material in this publication is copyrighted. Requests for permission to reproduce portions of
it should be sent to wsp@worldbank.org. WSP encourages the dissemination of its work and will
normally grant permission promptly. For more information, please visit www.wsp.org.
© 2012 Water and Sanitation Program
8241-COVR.pdf ii
3/30/12 11:25 AM
WATER AND SANITATION PROGRAM: WORKING PAPER
Scaling Up Rural Sanitation
Enabling Environment
Endline Assessment:
Himachal Pradesh and
Madhya Pradesh, India
Andy Robinson
April 2012
The Water and Sanitation Program is a multi-donor partnership administered
by the World Bank to support poor people in obtaining affordable, safe, and
sustainable access to water and sanitation services.
8241-COVR.pdf i
3/30/12 11:25 AM