Editorial Perspectives: we need innovation for water, sanitation, and hygiene (WASH) in developing communities

When I started in my faculty position in December 2011, the talk was of the Millennium Development Goals (MDGs), which sought to halve by 2015 the proportion of the population without sustainable access to safe drinking water and basic sanitation (relative to 1990 levels).¹ The MDG for water was met (if you accept “improved” drinking water source as a meaningful step toward “safe” water) but the goal for sanitation was not.² The numbers are still staggering: over 890 million people open defecate, 2.3 billion people lack access to basic sanitation, the bodily waste of 4.5 billion people is not safely managed, and 2.1 billion lack access to safely managed water.³

Despite the failure to achieve the sanitation MDG, renewed optimism could be found in the 2015 Sustainable Development Goals (SDGs), which set even more ambitious targets for water, sanitation, and hygiene (WASH) through SDG 6: ensure safe and sustainable access to water and sanitation for all by the year 2030.⁴ Now, less than 3.5 years into the endeavor, the most recent synthesis report aggregates past data to conclude that the world is not on track to achieve SDG 6, and that we are facing headwinds.³ Now as much as ever, we need all hands on deck and a diversity of approaches to attack this global challenge.

As we consider how best to advance WASH in developing communities (which can be in both least developed and high-income countries), I would first like to establish that everyone everywhere should have access to clean water, sanitation with dignity, and reliable resources for hygiene. These are basic rights, and any discussion about their impact on health, economic development, environmental sustainability, or any other indicators does not in any way influence their intrinsic importance and the absolute necessity of achieving complete access. It must be done. Now, as we set our minds and hearts to overcoming this massive challenge, there are four assertions I offer for consideration to anyone seeking to contribute.

1. We need to stop looking for donors and start looking for investors. Using existing models to advance sanitation and water is tremendously expensive. The World Bank estimates that hitting SDG 6.1 (safe water) and 6.2 (sanitation and hygiene) targets with current approaches would require $114 billion a year, but greater than 80% of participating countries have reported insufficient financing to achieve national WASH targets.³ It is common to rely on donors (including aid agencies) to help address WASH funding gaps, but the shortfall is still dramatic. We need to fundamentally change the way we think about development financing, and shift to a model that targets financial sustainability of interventions. If we can develop WASH solutions that have a strong business case and a manageable risk profile (e.g., energy recovery from fecal sludge⁵), there is no limit on the available capital for development. However, to access these financial resources, we need to revisit our core assumptions about WASH in developing communities, including our expectations for interventions and the decision-making processes used to develop and deploy them.⁶

2. We need to redefine what “works” in development. It has been observed that more than half of water and sanitation projects fail within a year or two of installation.⁷ Undoubtedly, many of these projects are conventional approaches, including the installation of boreholes and protected wells for drinking water and the installation of pit latrines for sanitation. Despite pervasive failure of established technologies, it is not uncommon to hear (for example) “latrines work” given that they provide a low-cost mechanism to help manage bodily waste. However, I would argue our definition of what “works” should be more ambitious and should include financial sustainability and sustained adoption by end users. By this definition, there are no technologies that consistently, across all contexts and subject to all constraints, “work”.

3. We need to remove artificial constraints that impede innovation. For instance, the basic idea that WASH interventions need to be made with local materials is, in many cases, a fabricated constraint that unnecessarily limits the landscape of possible solutions. I could offer cell phones as an example of a technology that has achieved tremendous penetration in developing communities despite being imported, but others would argue a cell phone is nothing like WASH interventions. Similarly, proponents of local materials could point to WASH failures with imported products or components, but I would argue the design process itself was flawed and did not appropriately consider life cycle costs. Regardless of the type of innovation – technology, service delivery, finance, capacity building, education, etc. – locally tailored, multidisciplinary planning and design processes should play a central role.^6,8 When it comes to constraints specifically, the local context should govern which are appropriate.

4. We need to focus on creating perceived value and understanding what that means in a given context. To achieve sustained adoption, we must align the intended value proposition of the WASH intervention with the perceived value according to end users. There is always the danger that experts may place greater weight on their own judgment over the perspectives of local stakeholders, which may exacerbate inequalities and lead to imposed solutions that have a mismatch in intended vs. perceived value. For instance, if a family is provided with a new latrine, the perceived value may be as a dry, secure (lockable) space to store grain rather than the intended use as a place to defecate. As we seek to develop new solutions, it is critical that multidisciplinary teams (leveraging engineering, marketing, sociology, natural resources, governance, etc.) come together to achieve co-creation of innovations with stakeholders while addressing pervasive inequalities and navigating power dynamics.

I expect we can agree that we are not making adequate progress on WASH. Our current pace will still leave people without these basic services in 2030 and beyond, and more of the same approach is accepting failure. We must change our trajectory, and we must change it now. We must work with local stakeholders to re-envision what is possible in WASH and collaboratively develop transformative solutions – interventions that fundamentally change the nature of how communities manage and deliver safe water, manage and treat bodily waste, provide equitable and reliable access to handwashing, menstrual hygiene management, and food hygiene, and monitor progress toward development targets. If we can get behind this vision, then perhaps we can also agree to learn from the past, but not let it define our future.

Acknowledgements

I am grateful for thoughtful discussions on re-envisioning WASH with John Trimmer, Diana Byrne, Hannah Lohman, Eberhard Morgenroth, Dani Barrington, Sherri Cook, Paige Novak, Michael Templeton, and many others whose passion and commitment keep me optimistic about the future.

References

1. UN General Assembly, United Nations Millennium Declaration, New York, NY.
2. UN Department of Economic and Social Affairs, The Millennium Development Goals Report 2015, 2016.
3. UN General Assembly, Sustainable Development Goal 6: Synthesis Report on Water and Sanitation, New York, NY, 2018.
4. UN General Assembly, Transforming our world: The 2030 agenda for sustainable development, New York, NY, 2015.
5. C. Wald, Nature, 2017, 549, 146.
6. M. R. Templeton, Environ. Sci.: Water Res. Technol., 2015, 1, 17–21.
7. M. Starkl, N. Brunner and T.-A. Stenström, Environ. Sci. Technol., 2013, 47, 6102–6110.
8. J. S. Guest, S. J. Skerlos, J. L. Barnard, M. B. Beck, G. T. Daigger, H. Hilger, S. J. Jackson, K. Karvazy, L. Kelly, L. Macpherson, J. R. Mihelcic, A. Pramanik, L. Raskin, M. C. M. Van Loosdrecht, D. Yeh and N. G. Love, Environ. Sci. Technol., 2009, 43, 6126–6130.

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