Scaling-up rural sanitation in South Asia : lessons learned from Bangladesh, India and Pakistan

In South Asia, despite significant investments, rural sanitation coverage in the region is barely keeping pace with population growth. Current approaches to the development and provision of rural sanitation services in the region are either not effective, or are not at sufficient scale to make an impact on the enormous population that lacks adequate sanitation.

The main objectives of this study were: 1) to develop case studies of innovative approaches to rural sanitation; 2) to analyze the factors of success and constraints in these case studies; 3) to assess potential strategies to scaling-up the approaches used; and 4) to draw up policy recommendations for large-scale rural sanitation programs in the region.

Seven of the cases used a ‘total sanitation’ approach to promote behavior change, including low-cost toilets in India and Bangladesh. The eighth case implemented simplified rural sewerage schemes in Pakistan using a ‘component sharing’ approach. The programs ranged in size from a small-scale NGO program covering 12 villages in one district to a large-scale government program that provided more than 1.5 million toilets in Andhra Pradesh last year.

Based on the findings, 10 performance indicators were used to rate the overall performance of each program. A detailed analysis was carried out, identifying key ‘factors of success’: The study suggests that the focus of large-scale sanitation programs should be on stopping open defecation and on improving hygiene behavior on a community-by-community basis, with success measured not by the number of toilets built, but by long-term improvements in public health and well-being.