Enormous progress has been made in reducing open defecation in Ethiopia. Nevertheless, the quality of sanitation facilities remains a big challenge and a serious health concern.
Sanitation marketing is used by the Government of Ethiopia to strengthen the private sanitation service sector, and to help households 'move up the sanitation ladder'.
IRC's shortly to be published Learning Note describes successes and challenges of creating demand for sanitation products and services under the USAID Transform WASH project in Ethiopia. Transform WASH supports the development of the private sector sanitation market in 41 intervention districts (Woredas) throughout the country. The results of IRC's action research reveal that there is no one-size-fits-all business model for rural Ethiopia due to local conditions such as topography, socioeconomic status, population density, and the interests and capabilities of District Health Offices and individual entrepreneurs. The Learning Note highlights two business models that, if implemented according to the design, enable private sector providers to substantially contribute to increases of improved sanitation coverage.
In both business models, government-employed Health Extension Workers (HEWs) raise public awareness of locally available sanitation products and services, as part of their routine work of providing primary health care services at village (Kebele) level, and ensure that all households in their village know where and how to purchase them. HEWs do not take part in the business side of the effort – they don't handle any household funds, nor do they receive any commission from suppliers. When households express interest in a sanitation product or service, HEWs refer them to a local sales agent or supplier.
In the first of the two successful models, a mason or farmer takes on part-time work as a toilet slab manufacturer. These manufacturers produce concrete slabs in a decentralised manner for several nearby villages, sometimes basing themselves at the village administration office compound. Customers are acquired through a team of sales agents hired by the slab manufacturer. The sales agents work part-time, and receive commissions from the manufacturer for each completed sale. They focus on households in their own or nearby villages (within walking distance), contacting them through door-to-door visits and community gatherings, often moving together with the local HEW. Sales agents collect advance payments for larger products like the concrete slabs but may also deliver easily transportable products, such as molded plastic toilet pans (i.e., SATO pans) and AIM slabs, directly to customers. The study found that Community Health Promoters (volunteers) seem to make very good sales agents.
In the second successful business model, local masons are trained as manufacturers, but also become their own sales agent. Since the masons are locally known and trusted, they can easily approach households to offer this additional product for existing and new clients. In this model, the customer purchases the needed materials and supplies in advance. When all is ready, the mason comes to the customer's house and manufactures their toilet slab on site. One advantage of this model is that any changes in material costs are covered directly by the customer, so there are no explanations required by the manufacturer if the price of the product increases. Another advantage is that the manufacturers generally don't need to take out loans to purchase the materials, such as cement and iron reinforcing bar.
Despite these successes, several key challenges remain. One is to ensure that the main actors driving demand creation - HEWs and sales agents, are able to effectively play their respective roles. The research revealed not all HEWs or sales agents are sufficiently motivated to reach all of the potential customers in their areas. To improve their performance, it is recommended that sanitation marketing approaches be formally integrated into Ethiopia's Health Extension Program, and that HEWs are provided training on delivery of short but concise messages in order to maximize the number of households they can reach. Also, it is recommended to ensure that all available sales materials, such as fliers and leaflets, are available to (and used by) the HEWs. It also would be useful to provide District Health Office managers with a sanitation marketing checklist, so that they can review and support HEWs more effectively on this aspect of their work.
To enhance sales agent effectiveness, one recommendation is to ensure that a sufficient number of sales agents are engaged to cover the geographic target area. Ideally, one or (at most) two sales agents should be recruited per village to ensure they are locally known - while leaving a sufficiently large number of households per sales agent to ensure a reasonable income from sales commissions. Also, sales agents should be made aware from the outset that this work is part-time, and therefore offers only modest income potential. This is why Volunteer Community Health Promoters may be well-suited for the role of sales agent – as they are already involved in delivering health messages to the community and they appreciate receiving sales commissions as an outcome of work they would otherwise have done for free. Similarly, masons who are already in operation can increase their income by adding sanitation products to their existing offerings, but they don't need to fully rely upon such sales for their revenue.
The Transform WASH project provides a good platform upon which to test and improve sanitation business models in Ethiopia. This research demonstrated that it is possible to create demand for sanitation products and services at the local level, using existing health system staff (HEWs) and by enlisting sales agents to help drive and close sales. Future work should include a focus on expanding the most effective approaches, such as the two business models discussed above, so that the reach and scope of the sanitation market will continue to expand. Innovative solutions like this will be needed throughout the country if Ethiopia is to reach the Sustainable Development Goal of achieving universal access to improved sanitation by 2030.
USAID TRANSFORM WASH sets out to improve water, sanitation and hygiene (WASH) outcomes in Ethiopia by increasing access to and sustained use of a wide spectrum of affordable WASH products and services, with a focus on sanitation. It does so by transforming the market for low-cost, high quality WASH products and services: stimulating demand at community level, strengthening supply chains, and building the enabling environment for a vibrant private market.
USAID TRANSFORM WASH is a USAID-funded project implemented by PSI in collaboration with SNV, Plan International, and IRC. The consortium is working closely with government agencies including the Ministry of Health, the Ministry of Water, Irrigation and Electricity, the National WASH Coordination Office and regional governments.