USAID Global Waters – May 2017

USAID Global Waters – May 2017

Articles in this issue include:

Where WASH Saves Lives: Creating New Traditions in Nepal: Safe WASH II is trying a new approach to chhaupadi to ensure sustained behavior change with the hope that traditional healers and religious leaders can harness community energy to transform the meaning of menstrual taboos globalwaters

Doubling Access to Safe Drinking Water: How Four African Countries Did It – The WALIS project identified four common elements applied to local systems in Ethiopia, Rwanda, Senegal, and South Africa that contributed to meeting the Millennium Development Goal for clean water access to help other countries learn how to replicate their success.

Tackling Water Issues Lightens the Load for Garment Workers: On World Water Day 2017, USAID and Gap Inc. announced the formation of the Women + Water Global Development Alliance to advance the health and well-being of women, families, and communities touched by the apparel industry.

Real Impact: Water Security for Resilient Economic Growth and Stability: Working in six sites in the Philippines, Be Secure has spent the past five years increasing sustainable access to water and wastewater treatment services and resilience to water stress and extreme weather.

With Water Pours Out Hope: One Village in Tajikistan Builds a Better Future: USAID is working with local governments to improve their capacity to deliver municipal services and providing support to install inexpensive water systems to improve citizens’ access to clean drinking water.

Developing Markets for Sanitation: A Blog Series

In response to the growing prevalence of market-based approaches to sanitation, the Bill & Melinda Gates Foundation convened a meeting between three leading sanitation development practitioners—iDE, PSI, and Water for People—to discuss their experiences in building supply capacity and demand for sanitation products and services, and possibly develop a joint understanding of the process. The result of those discussions are presented in this four-part blog series.

PART 4 of 4: For the Future: Making Markets Work for Everybody

Read Part 1 of 4: The Basics: Terminology, Organization, and Process
Read Part 2 of 4: Selling Sanitation: Who Does What?
Read Part 3 of 4: Achieving Sustainability and Measuring Results

When Do Markets Work?

Markets are not the silver bullet solution to all aspects of the sanitation crisis, and there is a limit to what markets can and cannot do. A market-based approach will only work under promising market conditions, which are determined by:

  • The market opportunity and consumer demand.
  • The level of consumer dissatisfaction with existing practices, designs, and/or pricing.
  • Sufficient market size for business owners to consider investing.
  • Sufficient market density to make it cost effective to promote and deliver the products / services.
  • Existing physical infrastructure for production and transportation.
  • Familiarity with market-based transactions within the community.
  • If the society is organized more around bartering or gifting, then a system based on buying and selling may pose challenges for adoption.
  • The priority given to spending on latrines within the household and whether there is sufficient disposable income. Households who are focused on covering basic needs, such as shelter, school fees, and food will likely not make latrine purchases a high priority.
  • The regulatory environment, including the government’s ability to enforce existing rules and improve regulations based on changing market conditions.

Even under ideal market conditions, market actors are driven to maximize profit, which provides little incentive to target the poorest of the poor. With this in mind, the group (and the sector as a whole) discussed two solutions—sanitation financing and smart subsidies—for ensuring that sanitation markets expand their reach to whole populations.

Photo by iDE / 2016

Finance Options

Research and experience (for example, the iDE-commissioned Willingness-To-Pay study)⁠ show that access to financing can significantly increase demand for sanitation at market price. Bottom of the pyramid customers may not be able to pay the full retail price of a latrine in one large single transaction, but they may be willing and able to pay in installments by taking out a loan to finance the purchase of a latrine. Financing can be an accelerator of demand. Repayment rates in iDE’s experience have been 100%, indicating the low-risk nature of sanitation loans in the Cambodian context.

PSI and Water for People are also experimenting with consumer financing for sanitation. The main results show that there is strong demand for consumer financing, but the sector is still working to develop a model that allows for financial sustainability and operational compatibility for the financial institution partners.

PSI has also demonstrated that there is demand for supply side financing, which can serve as a “carrot” of sorts to motivate businesses to cooperate with the NGO on matters such as record keeping.

Photo by Water For People

Smart Subsidies

A market-based approach does not mean the total absence of subsidies. In fact, everything we do as market-based NGOs is a form of subsidy, including R&D, capacity building, and demand creation activities. But practitioners should think about how subsidies can be used in a more strategic and targeted manner. In doing so, it is useful to think about subsidies in two categories. The first comprises subsidies for “behind the scenes” market development activities, while the second category is more closely aligned with traditional “direct” subsidies to consumers and businesses.

The group agreed that subsidies should be focused primarily on the first category, “behind the scenes,” which often include functions such as those listed above: R&D, capacity building, and demand creation. Product design is often a critical component of developing a healthy market, especially in cases where no affordable, desirable products or services exist. From the group members’ experiences, demand creation is also an area that often needs to be subsidized, particularly in the initial stages when trying to introduce a new form of service that users are not strongly “pulling” for on their own. In no instances have we seen businesses investing sufficient resources in actively generating demand to rapidly increase uptake. In fact, it is a common business practice in these markets to passively wait for customers to show up and sell only when a product is requested. As such, practitioners should be prepared to invest heavily in demand generation activities as a means of building the market. With that in mind, any demand creation program should be aware of customer acquisition costs and make an intentional decision about who should bear that cost and for what period: the NGO or the business.

Group members also agreed in their skepticism of the second category of subsidies, which comprises traditional, direct subsidies to consumers and businesses. This type of subsidy has the potential to create demand, crowd in other investments, and provide a one-time incentive for adopting a particular behavior (buying a toilet, in this case). However, direct subsidies to the customer-business transaction also have the potential to distort incentives on both the consumer and supply chain side, and to erode market health over the long term. Given the potential for these subsidies to undercut market development, the group agreed that they should be limited to those customers who genuinely cannot afford to pay at market price. In these cases, value-added services like loan financing can play a crucial role. The group members encourage other organizations to consider developing “smart” subsidies that precisely target poor customers through existing channels and market mechanisms, minimizing distortions in the rest of the market.

Photo by Kiran Thejaswi / PSI

Main Ideas for Building Markets

  • A market-based approach implies scale – we don’t do things one village at a time; you can’t tell a business where to sell and where not to sell. They will sell wherever they identify a profitable business opportunity, and this allows the impact to be district and country-wide.
  • Developing sanitation markets is not an add-on accessory effort to your existing sanitation approach. You need competent staff and you need to invest in quality. You need to have a team dedicated to sanitation, not someone who’s doing sanitation AND water supply AND business development, etc.
  • The market-based approach is also not a silver bullet. It does not work in EVERY circumstance, just like any other approach.
  • Market facilitation does not mean a lack of subsidies or incentives. Everything we do is subsidy. It’s just a matter of where you inject the subsidy. Use subsidy in a way that minimizes market distortion while maximizing impact.
  • You need to be nimble, iterative, and responsive to what you’re learning real-time from the market.
  • In order to do market development effectively, your organizational culture needs to be business-minded. It needs to be a part of your DNA. A handful of trainings and a set of guidelines will not be sufficient to respond to real-time problems. Product innovation alone is not enough. You need to get the product right, but the innovation really happens in the business model.

Read Part 1 of 4: The Basics: Terminology, Organization, and Process
Read Part 2 of 4: Selling Sanitation: Who Does What?
Read Part 3 of 4: Achieving Sustainability and Measuring Results

iDE creates income and livelihood opportunities for poor rural households. In the WASH sector, we design and build markets for products that have the potential to transform people’s health by preventing diarrheal-related disease. Yi Wei

Population Services International (PSI) is a global nonprofit organization focused on the encouragement of healthy behavior and affordability of health products. PSI uses a market development approach to deliver sanitation and fecal sludge management products and services in a sustainable manner.  Genevieve Kelly

Water For People exists to promote the development of high-quality drinking water and sanitation services, accessible to all, and sustained by strong communities, businesses, and governments. Steve Sugden

Recent WASH research


The science behind One Health: at the interface of humans, animals, and the environment. Annals NY Academy of Sciences, May 15, 2017.

According to the One Health Commission, nearly 75% of emerging human infectious diseases in the past three decades originated in animals. Poor environmental health brought on by contamination, pollution, and degradation of air, water, and land creates disturbances that foment cross-species infectious disease transmission, as well as noninfectious disease spread across entire populations of humans and animals.

The threat of antimicrobial resistance in developing countries: causes and control strategies. Antimicrobial Resistance & Infection Control, May 15, 2017.

Apart from the irrational use of antimicrobials, unique environmental conditions such as crowding and poor sanitation also contribute in the circulation and spread of resistant microorganisms.

Sustainability of community-led total sanitation outcomes: Evidence from Ethiopia and Ghana. International Journal of Hygiene and Environmental Health, May 2017.

This study provides new evidence that CLTS outcomes can be sustained in the presence of training provided to local actors, and strengthens previous recommendations that CLTS is not appropriate in all settings and should be combined with efforts to address barriers households face to building higher quality latrines.

Assessing patterns and determinants of latrine use in rural settings: A longitudinal study in Odisha, India. International Journal of Hygiene and Environmental Health, May 2017.

Results highlight the low and inconsistent use of subsidized latrines built under the TSC in rural Odisha. This study identifies individual and household levels factors that may be used to target behavior change campaigns to drive consistent use of sanitation facilities by all.

Processes and challenges of community mobilisation for latrine promotion under Nirmal Bharat Abhiyan in rural Odisha, India. BMC Public Health, May 16, 2017.

Agencies or organizations implementing sanitation campaigns and conducting sanitation promotions need to enhance their staff’s knowledge and build capacity in order to address important social heterogeneity within villages.


This Brief looks at lessons learned by a local small and medium sized enterprise which operates a new fecal sludge emptying service – SWEEP.


Predictors of drinking water boiling and bottled water consumption in rural China: A hierarchical modeling approach. Environ. Sci. Technol, May 20, 2017.

Our findings show that boiling is not an undifferentiated practice, but one with different methods of varying effectiveness, environmental impact, and adoption across socioeconomic strata.

Environmentally sustainable WASH? Current discourse, planetary boundaries and future directions. Jnl of WASH for Development, March 2017.

This paper reviews recent literature at the intersection of WASH and environmental sustainability to identify current themes and future directions. Findings point to both opportunities and gaps within current sector thinking, which can drive leadership from knowledge and research institutions towards better integration of access and environmental sustainability imperatives.


John Oldfield- Water Is Global (In)Security. Forbes, May 23, 2017.

Agencies Launch Water Monitoring Tools and Processes for SDG 6 Reporting. IISD, May 23, 2017.

Using Waste Cloth and Towels, 4 Rajkot Schoolkids Created Reusable Sanitary Pads for Women

Using Waste Cloth and Towels, 4 Rajkot Schoolkids Created Reusable Sanitary Pads for Women. The Better India, May 24, 2017.

To shatter taboos surrounding periods and promote menstrual hygiene, a group of friends in Rajkot designed an affordable DIY pad using waste cloth and taught women in nearby slums and villages how to make them. The project won the Disney Innovation Award in the ‘Large Impact’ category at the ‘I CAN Awards 2014’ organised by Design for Change. 


Waste cloth and towels collected through a donation rally.

A group of boys and girls at the Galaxy School in Rajkot, Gujarat realised that, even within their close circle, they were uncomfortable discussing the topic of periods openly.

On probing this deep-seated issue, they stumbled across a report by AC Nielsen stating that a mere 12 % of Indian women use pads, while an overwhelming 88 % use unhygienic materials like ash, sand, and husk during their menstruation.

Poor menstrual hygiene leads to the spread of infections and risk of cervical cancer, with 70 % of reproductive diseases in India originating from this. This worrying situation bothered the students.

Digging deeper to understand why this is such an issue, the students spoke to 70 women in their community and discovered that many cannot afford to buy pads at all.

Read the complete article.

In Nepal, women are still banished to ‘menstrual huts’ during their periods. It’s time to end this dangerous tradition

In Nepal, women are still banished to ‘menstrual huts’ during their periods. It’s time to end this dangerous tradition. Independent, May 24, 2017.

After seeing the practice of seclusion and the plight of these women, I believe that taboos around periods are not a cultural issue, they are a human rights issue 


An example of a menstrual hut in remote areas of Nepal (Anjana Saud/Tatapani)

As a journalist and development professional living and working in Katmandu, I have had the chance to see menstruating women’s situation across Nepal from close quarters.

I found that the practice of isolating women during their period exists across the country in differing forms. The situation of women living at the rural areas is terrible.

In some places, women cannot be in their own homes during their period; in others women can be in the house, but not in the kitchen and worship room.

They are also forbidden from touching other people (especially male members of the family or neighbours) or cattle and from growing fruit and vegetables.

Read the complete article.

PMA2020 Menstrual Hygiene Management Briefs

PMA2020 Menstrual Hygiene Management Briefs

PMA2020 MHM Briefs are a one-page snapshot of select MHM indicators. PMA2020-horizontal-web-tagline

PMA2020 looks at how menstrual hygiene is managed across age groups and across wealth categories, including the types of materials used to collect menstrual blood, the main environments where MHM is practiced, and the safety, privacy, and cleanliness of these environments, among other metrics.

Briefs are available on Ghana, Kenya, Indonesia and other countries on the PMA2020 website.

IRC – Menstrual Hygiene Day – everybody’s business

Menstrual Hygiene Day – everybody’s business. IRC, May 18, 2017.

This is 2017 and still menstrual health is a taboo topic around the globe.

We need to be more open about it, because it is a normal biological process.

Taboos on menstruation have a severe impact on the lives of women and girls. It can lead to unhygienic situations, missing out on school and work.

Progress is slow, but things are starting to change. Raising awareness during Menstrual Hygiene Day is hugely important.

Gaining some knowledge via the Menstrual Hygiene Day Quiz is a small but relevant contribution.

Take the Quiz and share it with friends and colleagues.