Inclusive Sanitation: Bringing Services to all People in Cities


In the current sanitation landscape, public funding is heavily skewed toward sewerage and centralized treatment plants even though this excludes many, if not most, city residents in low- and middle-income countries. Most of a city’s poor residents rely on onsite sanitation, such as septic tanks and pit latrines, if they have access to any at all.

As cities start to invest in improved sanitation, there is typically a strong preference for sewerage over other types of sanitation solutions, including onsite options. But too often, sewer coverage prioritizes high-income areas, and there is no plan or remaining funds to provide services to a large portion of the population, including low income areas, slums, and informal settlements.

This puts a greater burden on areas excluded from sewer coverage to purchase their own sanitation infrastructure. Even in model cities for sanitation service delivery, like Manila—which, in addition to expanding sewerage networks, also offers free septic tank desludging services—this is a barrier, as households must still pay to install their own onsite sanitation system in the first place.

However, “the future is onsite sanitation.”

That’s according to Roshan Shretsha, from the Bill and Melinda Gates Foundation, at a recent Citywide Inclusive Sanitation (CWIS) convening in Manila. A global mix of city government officials and regulators, university, nonprofit and research/advisory partners, as well as major players including the Asian Development Bank and the World Health Organization, are all working to bring inclusive sanitation services to cities around the world.

CWIS principles—developed by BMGF, Emory University, Plan International, The University of Leeds, WaterAid, and the World Bank—outline a vision to bring sanitation services to all people living in a city—regardless of residence type, location, income, gender, religion, disability, or social status.

CWIS presents a strong framework for cities to use in delivering inclusive sanitation services, but many cities are still figuring out how best to implement it. Cities have a lot to learn from each other along their path to achieving CWIS, and events like this are critical outlets for knowledge-sharing and to collectively drive the sector forward.

Through field trips to visit the local utilities in Manila as well as many lively small group breakout sessions to work through key questions, the group of more than 100 participants generated several factors that should be widely embraced by cities and partners working to bring CWIS to their residents.

  1. Regulation is key to financial sustainability because it helps strengthen the market for operators. Regulators are trusted to benefit the consumer; they focus on quality, accessibility, affordability, sustainability, and importantly, they have a timeline longer than the next election.
  2. There is a need for pro-poor incentives and associated metrics of success imposed upon the private sector. Privatization can achieve great things. But without incentives like KPIs, or language built into the concession or contract, the private sector has no incentive to reach the poor, deal with gender or other social barriers, or achieve higher coverage rates than they’re contractually bound to do. Fees paid to private sector operators should be tied to service delivery metrics, such as the number of septic tanks emptied. Before you can set metrics and monitor coverage of poor areas, these areas must be clearly defined. Similarly, the private sector needs incentives to scale and to do more community engagement (see below).
  3. To scale, you must put people and communities at the center. Several represented cities emphasized that community engagement is key, starting with awareness and moving upstream to policy at the local and national levels. Once you have awareness, you can build capacity and knowledge; once you have institutions, you can secure investment. Contracts with private sector operators should include KPIs designed around community engagement.
  4. Have an eye for conflicts of interest. These must be avoided to prevent collusion. Some cities have experienced this in the form of a regulator having partial ownership in a concession, and treatment and trucking operators being the same entity or having the same owner (and thus an opportunity for colluding on reported metrics).
  5. Applying a gender lens is critical. Last but certainly not least, gender is the centerpiece of every city’s approach to CWIS. Emory University is developing a measure of women’s empowerment related to sanitation that includes indicators for household sanitation decision-making and policy sanitation decision-making—critical elements of successful sanitation programs. In addition to including and considering women in decision-making, there is a need to look at how well women decision-makers actually represent the needs of all women, considering class/caste, religion, and other social intersections. There is also a need to consider what issues women may want to raise while not in the presence of men; including men and women together at the decision-making table may not be enough.

After learning from exemplar cities and discussing the many challenges and success factors related to CWIS, what can other cities take away from this and what can sector leaders look to do next to move CWIS forward?

To improve a city’s likelihood of success in achieving CWIS, city leaders and supporting organizations must first (1) generate political will at every level; (2) create an operating environment that includes strong legal and administrative institutions; (3) integrate sanitation into urban planning; and (4) build infrastructure and enablers including financial, human capital, technical, and social.

To improve outcomes and increase investment, sector leaders must come together to design common indicators that are harmonized across donors and other institutions. There is also a need for intermediate outcomes for impact investing—it’s not feasible to link sanitation services directly to health and environmental impacts, especially on a near-term basis. What’s better is tracking intermediate outcomes such as volume of fecal sludge collected and quality of treated fecal sludge.

To meet the goal of providing sanitation services to everyone in a city, including the poorest and hardest to reach, city and sector leaders must embrace onsite sanitation solutions. A new generation of technology solutions, including Reinvented Toilets, Omni Processors, and Omni Ingestors—part of the Reinvented Toilet portfolio—offer cities new options to help achieve their CWIS goals.  

Finally, knowledge-sharing of successes, failures, lessons learned and best practices, whether from pilot testing a new technology, implementing a new policy or metric, or trying a completely new approach to finance or regulation, will continue to be critical to the success and scale-up of CWIS across our cities worldwide.

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