Rural water supply is a priority of many donors and most, if not all countries for which evaluations are available, notably because specific targets were included in the Millennium Development Goals and significant challenges persist especially in rural areas. Hence, availability of funds does not seem to be a major constraint for scaling up.
As mentioned above, WASH programmes that have taken the opportunity of a punctual or recurrent emergency situation to support regular programming have been the ones able to raise the greater amount of funds for the longest period of time. For example, the Sudan country office has had an on-going WASH programme since 1975. Its budget has quadrupled between 2002 and 2010, reaching more than 18 million USD in 2010 with the largest share being for water supply interventions. UNICEF Sudan has successfully leveraged a contribution from the government, which doubled during this period (2.3 million USD in 2010, according to the 2012 evaluation report). In DRC, since the WASH programme resumed in 2006, funding steadily increased every year from one million USD (2006) to 35 million USD in 2014 with an important part being dedicated to water supply intervention. Zimbabwe and Kenya water supply interventions have also attracted large funding for many years.
Other large but more stable countries such as Ethiopia, Nigeria and Bangladesh have regularly mobilised sufficient funding (between 15 and 40 million USD annually) from multiple donors to extend the scale of their WASH programme, to allow for long-term planning and engagement of a number of implementing partners with strong government leadership and decentralised management arrangements. The 2012 evaluation found that the WASH programme in Ethiopia extended to all regions and 78 woredas (districts), providing almost two million people with improved water supply systems between 2006 and 2011. Between 2007 and 2013, the Bangladesh WASH programme operated on a total budget of over 110 million USD and claims to have provided improved water supply to more than two million people in half of the districts of the country. In Nigeria, four million people have been documented as having gained access to improved water supply between 2009 and 2013, supported by an annual budget of 10 to 30 million USD.
A few middle-income countries have advocated for increased public investment in water supply. In Bolivia, the government more than doubled its investment between 2005 and 2010. In Ghana, the government’s financial contribution to the Guinea Worm eradication programme multiplied by ten during the same period. In Bosnia-Herzegovina, UNICEF successfully advocated for municipalities to provide considerable co-funding for the infrastructure component of the UNICEF-UNDP joint water supply and governance programme. No other instances of significant fund leveraging are documented in evaluation reports.
In other countries, water supply interventions may have stayed at the ‘project status’. They are heavily dependent on a small number of modest funding sources. Long-term planning is impossible, the number of implementing partners and of beneficiaries is limited, and government’s leadership role is minor.
Globally, the number of beneficiaries of water supply interventions directly supported by UNICEF remained stable between 2007 and 2013 at around six to eight million per year, with an increase to 13.8 million in 2014 (excluding emergency response)18, some of which benefited from a rehabilitated water point rather than a new one. This is due to the issue of functionality of water points installed. In the various evaluation and sustainability check reports, the rate of broken down systems in rural areas is found to be high in some countries (see section 6.4). Quality and sustainability of water supply interventions pose a problem for scaling up. Rehabilitation works divert available funds from actual expansion of the water coverage.
While it is clear that the ability of WASH sections to raise funds is variable, it is also obvious that unit cost of rural water supply systems require a lot of resource mobilisation efforts if results are to be achieved at scale. This is particularly the case in rural areas in Sub Saharan Africa characterised by low population density, which typically rely on boreholes or small piped water schemes with a unit cost ranging from 20 to 50 USD per person served according to the various evaluations. Such water supply interventions lack cost-effective and scalable approaches with simple steps and practical guidelines that would compare with CLTS. It should be highlighted that recent developments in low cost, self-supply approaches such as manual drilling, which uses local skills, workforce and resources to build shallow boreholes in favourable areas, have not been evaluated by UNICEF during the 2007-2015 period.
Some initiatives related to water point inventories and mapping have been rolled out nationally with the aim of strengthening the planning and monitoring system (Malawi 2011, Ethiopia 2012). In Indonesia, slow sand filters have been replicated at district level only (2013 evaluation). In Vietnam, water safety plans have been replicated at province level only (2009 report). The required critical mass has not been reached yet.
An innovative approach related to water supply delivery model was tested in Somalia. It consisted of the expansion of existing urban utility perimeter to low-density rural areas through a public-private partnership arrangement. The 2012 evaluation demonstrated its failure, mainly due to weaknesses in the design of the initiative. The pilot involved existing and profitable utilities, which had limited interest in the operation of less profitable rural water supplies. Furthermore, the provision of initial investment and the possibility to introduce cross-subsidies in water tariff across urban and rural areas were not foreseen in the project. As a result, the pilot could not been validated and scaled up as planned.
The example of Somalia illustrates the lack of UNICEF expertise in engaging with and supporting the private sector in order to meet the demand for rural water supply. UNICEF could have taken advantage of the expertise of other development agencies, but weak sectoral coordination mechanisms and learning platforms may be a constraint in a number of countries.
Sanitation and Hygiene (45 reports from 32 countries)
During the period of the current WASH strategy, CLTS has progressively replaced PHAST (Participatory Hygiene and Sanitation Transformation) as an approach to community mobilisation and planning for rural sanitation and hygiene improvements in the majority of UNICEF WASH programmes. CLTS, as opposed to PHAST, is a recent approach that gained considerable momentum since its introduction in the early 2000s in Bangladesh by Kamal Kar. While scale up is more recent in sub-Saharan Africa, CLTS programmes there have been spreading quickly. UNICEF played a critical role in their roll out in Asia and Africa (and Bolivia in Latin America). The global CATS evaluation completed by UNICEF in 2014 states that UNICEF is implementing CLTS in 53 countries; that is to say that CLTS is being implemented in more than half of the countries where UNICEF engages in WASH programming and two thirds of countries where UNICEF engages in regular WASH programming (as opposed to humanitarian). Geographical coverage of CLTS is therefore very significant.
This scaling up is reflected in evaluation reports. Ten evaluations refer to PHAST and all of them date back from before the end of 2012: Kenya 2009, Indonesia 2009, Ghana 2009, Mozambique 2010, Ethiopia 2010, Djibouti 2010, Malawi 2011, South-Sudan 2011, and DRC 2009 and 2012. All evaluated WASH programmes but one have subsequently abandoned PHAST and engaged in the CLTS approach. The only exception is DRC where the ‘Healthy Schools and Villages’ programme still uses an approach inspired by PHAST. In both DRC evaluation reports, scalability issues are not discussed in depth. It is only noted that the programme has reached a significant scale, unlike other countries. However, more funds are needed from both donors and the government to maintain this dynamic, and the capacity of partners to implement PHAST in the field is still considered limited considered the relative complexity of the approach.
In countries where UNICEF has engaged in CLTS, it effectively contributed to the rapid reduction of open defecation and encouraged the large-scale construction of latrines. As of June 2013, some 37,000 communities supported by UNICEF had reached the ODF status, representing an estimated total population of 24 million (global CATS evaluation 2014). In 2014, an additional 9.3 million people gained access to sanitation facilities through CLTS. More than 19,000 communities were newly certified ODF, an increase of 4,000 compared to the previous year. These figures have increased every year in all countries since 2007. By comparison, the number of sanitation beneficiaries (in development setting) was 4.4 million in 2007.19 CLTS has therefore demonstrated results at scale.
Top countries with more than one million people living in ODF communities are Pakistan, India, Ethiopia, Nepal, Nigeria and Sierra Leone. They represent more than 16 million beneficiaries, which clearly indicate the level of uptake of CLTS within these six countries. The global CATS evaluation and other country-led evaluations also underline the rapid uptake in Mozambique, India, Zambia, Mali, Kenya, Mauritania, Madagascar, Nepal and Malawi.
CLTS has overcome the scaling up challenge by moving away from the traditional approach where development agencies were trying to address scattered, private sanitation investments with a donor-funded top-down strategy. CLTS recognises that household sanitation in general, and associated investment and action in particular, remain the primary responsibility of households and of the community they belong to. The role of development agencies is therefore limited to provoking awareness at the community level and facilitating the leveraging of local resources. This approach seems to have lifted the following three bottlenecks: availability of external and national financing; channelling funds to dispersed rural households; and latrine ownership.
A strong advantage of CLTS compared to other types of WASH interventions and other approaches to rural sanitation is its cost-effectiveness. The cost of the intervention has drastically reduced as the cost of constructing latrines is now borne by households – except in programmes using targeted household subsidies or rewards. According to the evaluations, the monetary cost for them is close to zero. Indeed, the approach invites communities to use locally available materials and their own skills and creativity. It is estimated that only around 10-30% of households decide to purchase construction material or hire a mason (Mali 2015, Ethiopia 2012, Zambia 2011 and Cambodia 2009). The survey conducted during the global CATS evaluation found that for 75% of respondents the cost of CLTS for households is considered either as a moderate or not an obstacle at all for scaling up.
The cost of CLTS is also reduced due to the fact that the community mobilisation strategy is time-effective. Additionally, it does not require any visual materials such as posters and flashcards that are costly to print in large quantities and get lost or not used at all after a while (Kenya, Ghana).
The cost borne by governments and development partners only covers capacity building, community mobilisation and field monitoring. The global CATS evaluation estimates that the unit cost of the intervention per person living in a CLTS village ranges from five to 15 USD. More recent country-led evaluations indicate that this figure may be slightly overestimated, suggesting an average unit cost of 7 USD per person: less than 5 USD in Madagascar, Zambia and several West African countries, 7 USD in Mali, 9 USD in Mauritania, and 11 USD in Pakistan. The cost per person obviously varies depending on the size of the community, but CLTS primarily and mostly targets small rural communities. This cost moderately increases when new components are added such as post-certification follow-up and sanitation marketing. Upscaling would have been extremely costly with the previous approach based on household subsidies for latrine construction – if not impossible, as suggested by past experience and highlighted in many evaluations.
Although far more latrines are built and used under the CLTS approach for much less government and external investment, scaling up could only be achieved thanks to governments’ and donors’ support.
UNICEF provided most of the funding, including the cost associated with the mobilisation of regional and local technical departments involved in the (pre-)triggering, follow up and certification process. This represented 70 million USD globally in 2014 (almost the same investment level as for rural water supply).20
In some countries, UNICEF has been successful in convincing the government to include part of the cost of CATS in the national budget. The Mauritanian government included a sanitation line in the national budget for the first time and committed in the Sustainability Compact signed with UNICEF to increase its financial allocations. In Mozambique, the Ministry of Water and Public Works assigned a dedicated water and sanitation budget to the districts. In Nigeria, Pakistan, Nepal, Ghana and Bolivia, the government or subnational authorities contributes financially to the roll out of the programme. In several other reports, evaluators encourage UNICEF to leverage more funds from national governments (Kenya 2013, Pakistan 2014, Timor Leste 2015).
UNICEF also played a critical role in almost all countries in creating an enabling environment for scale up. Key areas of success in this regard are global and national advocacy, mainstreaming in national policies and strategies, and long-term, country-wide planning. As a result, governments, donors and NGOs became aware of the CLTS approach and relevant policies have been progressively re-oriented accordingly since 2008. Six evaluation reports mention that CLTS now constitutes the basis for rural sanitation planning: Ghana 2009, Mauritania 2013, Mozambique 2013, Nepal 2013, Sierra Leone 2013, and Madagascar 2014. In Pakistan, UNICEF and other development partners such as WSP, WSSCC and WaterAid, are advocating CLTS adoption at varied levels across the country, with some success, notably in Punjab (2014 report). In other countries, national campaigns have been launched by UNICEF with significant funding and ambitious targets: Open Defecation Free Rural Kenya 2013 (budget of 49 million USD and over 13 million Kenyans targeted) and Madagascar Sans DAL 2018 (99% ODF country by 2018). In Ethiopia, UNICEF worked with Plan International and Kamal Kar to explain and demonstrate CLTS to senior decision makers, overcome initial misunderstanding and resistance, before paving the way to scaling up through national guidelines (2012 report). The same progressive approach was adopted in other countries like Mauritania and Mali. Nowadays, most governments are fully engaged and demonstrate leadership on rural sanitation. This is a major shift from the past. In Madagascar, a National Sanitation and Hygiene Directorate did not exist before 2012.
In several countries, UNICEF and national governments have mobilised other partners, aligned respective initiatives and put in place effective coordination mechanisms or informal working groups. In Sierra-Leone, the coverage of CLTS is now nationwide: UNICEF’s CLTS and SLTS programme extends to six out of the 12 districts, while the African Development Bank covers four further districts and a Dutch funded programme operates in the remaining two districts (2013 report). In Mauritania, donors (Agence Française de Développement, European Union, African Development Bank) as well as most NGOs adopted CLTS and engaged in joint planning (2013 report). In Madagascar (2014 report) and Ethiopia (2012), UNICEF coordinated with the Global Sanitation Fund and USAID under the government’s leadership. Nepal has launched the ‘Aligning-for-Action’ initiative to breed a culture of coordination (2013 report). In all these countries and others, the government organised workshops to reconcile the approaches of the various development agencies: terminology, implementation modalities, technical standards for latrines, certification criteria, monitoring indicators. Harmonised step-by-step implementation manuals have been developed or are underway in many countries (Mali, Madagascar etc.). Collective progress towards targets is regularly monitored. The Health and Education ministries have been often engaged where sanitation is not part of their direct responsibilities. Health extension workers are involved in triggering and follow up. CLTS is implemented in schools (SLTS in Nepal, Mali, Ethiopia…). UNICEF has also entered into new partnerships with local authorities, community-based organisations, and traditional and religious associations. These proved key in ensuring local buy-in while scaling up. In conclusion, in most countries CLTS is not managed as a UNICEF-project but is becoming a national programme.
The main concern in terms of coordination and scalability is the persistence of diverse forms of household subsidies, demonstration latrines and result-based rewards. As pointed out above, some evaluations highlight that these are (Pakistan 2014) or were (Ghana 2009, Mozambique 2013) used by UNICEF in direct contradiction to the spirit of CLTS. They reveal various levels of understanding of CLTS even within UNICEF WASH staff. Other evaluations point out that this practice results from the non-alignment of some other development agencies partners coupled with deficient government leadership (Cambodia 2009, Sierra Leone 2014, Madagascar 2014, Pakistan 2014, Mali 2015). It is usually justified on equity grounds when targeted to the poorest, in terms of sustainability when meant to improve the standard of latrines, or as an incentive or compensation when provided after the ODF certification. This practice remains the major departure from the CLTS essential elements as originally established by Kamal Kar and subsequently enshrined and promoted by UNICEF HQ. The Pakistan 2014 evaluation documents that the pro-poor subsidy resulted in greater dependency among beneficiaries no matter what economic strata they belong to. It countermined the principle of self-help and overlooked the objective of community empowerment. It discouraged even the well-off from building their own latrines. The proportion of people asking for external assistance / cost sharing arrangements actually increased during the CLTS intervention. It also created frictions within some communities. The Mozambique evaluation report from 2014 further states that subsidies “influence communities to move towards immediate quantitative results rather than adopting more durable, embedded behaviour change”. Another reported consequence is that communities aware of subsidised projects in neighbouring areas will not want to engage in CLTS, negatively affecting upscaling efforts.
Evaluations uncover different implementation arrangements between UNICEF WASH programmes. Some countries with a higher level of decentralisation such as Ethiopia, Nepal and Cambodia used existing local authorities, technical departments or health workers to mobilise communities and carry out post-triggering activities. This is an asset to ensure both scalability and sustainability. In most other countries UNICEF signed multiple partnership agreements with NGOs and community-based organisations intervening in separate areas of the country. Technical departments then typically participate in the triggering and certification phases. The limited number of available and skilled NGOs or community-based organisations may be a constraint for scaling up, as well as the capacity of the UNICEF WASH team to manage numerous partnership agreements. However, implementation at scale through government partners can also be constrained by their limited capacity. The Mauritania 2013 evaluation report describes a third arrangement where national and local authorities led the implementation process but recruit one coordinator, a couple of supervisors and several facilitators among local NGOs to carry out daily field activities. Regional monitoring committees chaired by the governors are made up of several technical departments, radios and religious associations. This institutional arrangement reportedly reinforced local ownership, coordination and uptake.
Regardless of the implementation arrangement, there is a lot to do to raise the profile of sanitation at the decentralised level and build partners’ capacity. Sanitation is usually not in the top priorities of communes although they are now in charge of sanitation issues. Their capacities as well as those of the other implementing partners are notoriously weak. This can affect the potential for further upscaling of CLTS. For this reason UNICEF organised extensive partners’ training at national and subnational levels as consistently recognised in all evaluation reports. Many of them emphasise the specific role played by Kamal Kar in assisting UNICEF WASH teams and training key stakeholders in many countries. Then, within each country, several hundreds of decision makers, trainers of trainers, technical staff, local leaders, NGO staff, religious and traditional associations, and community facilitators have been trained. Pools of skilled trainers and CLTS champions have been established in some countries. This critical mass of resource persons can be utilised in scaling up CLTS in the country. The global CATS evaluation found that UNICEF’s investment in capacity building went “well beyond what was needed to implement the specific UNICEF funded intervention; this reflects an approach to national capacity development rather than just project delivery”.
Multiple techniques are used: theoretical workshops, simulations, and learning by doing with feedback sessions. Most capacity building efforts focus on the explanation of the overall approach and the triggering session. Subsequent steps including monitoring, certification and post-certification activities benefit from less attention. Moreover, facilitators and focal points require periodic re-training or additional expertise such as: strengthening of facilitation skills, shifts in community empowerment methods, monitoring of and being pro-active to conditions and changes in ODF communities, and sustainability issues (most notably the Cambodia 2009 report).
As a support for large-scale capacity building and implementation, the CLTS manual developed by Kamal Kar and Robert Chambers was used in many countries before being adapted to the local context. The extent to which existing guidelines and manuals are used by all stakeholders is unclear. The 2010 regional evaluation of CLTS roll out in the WCA region recommended to compile all guidance and tools, to compare them and extract lessons learnt and good practices. Four years later, the global CATS evaluation does not indicate that this useful exercise has been done.
The Sierra Leone 2014 evaluation report rightly points out that “for the government, the high level of logistics involved for the required monitoring of CATS progress and achievements, especially beyond the life of the programme, is viewed by the district officers in particular as a significant constraint to the sustainability and scalability of CLTS/SLTS initiatives.” The Mauritania 2013 report adds that the weak human resources and logistical capacities at regional and local levels hinder the scaling up of CLTS. It is difficult for them to reach the most isolated communities, to participate in key activities in all communities, and carry out frequent monitoring visits. Homogeneity and rigour in the implementation process may be lacking as a result, which can jeopardise the sustainability of ODF status and therefore the upscaling of CLTS. The lack of resources to trigger more areas also poses a threat to the scale up of the programme. According to some evaluations, it is recommended to not trigger too many communities at the same time, or to trigger communities that are close to each other (Ghana 2009 and WCARO 2010 evaluations).
CLTS has proven effective in creating a demand for sanitation in most areas where it has been applied. Exceptions have been noted by evaluators: peri-urban settings, areas with difficult geographical / environmental conditions, and specific cultural context such as in the South of Madagascar. UNICEF would need to better understand the local social dynamics and cultural barriers in order to adapt the approach in these areas.
On the supply side, local service providers respond to market conditions, which are not wholly favourable in rural, often poor and remote areas. The global CATS evaluation states that “engagement with the private sector is far from systematic”. The level of support provided to the private sector actually varies from one country to another. This aspect is further discussed in the sustainability section below.
Diffusion and organised replication of sanitation and hygiene interventions other than CLTS are not extensively discussed in evaluations. Sanitation interventions in peri-urban North Korea (2010) and Liberia (2012 and 2013) have been evaluated with no evidence of – and limited prospect for – scaling up. Several water treatment and safe storage and handwashing with soap campaigns have been evaluated in Malawi where it was implemented through antenatal health care facilities, in Guinea Conakry and Guinea Bissau as part of a country-wide mass media cholera prevention campaign and in Vietnam as part of water safety planning programme. These evaluations carried out in 2009 found high uptake and dissemination, and a good potential for upscaling. WaterGuard and Sur’Eau products have been found to be adopted widely and rapidly by friends and relatives of targeted families and in non-beneficiary communities through word of mouth. The specific effect of word of mouth in the diffusion of the technology requires further investigation. Since then Malawi converted to CLTS and sanitation marketing. Subsequent developments have not been documented in the other three countries.
The use of mass media as an organised diffusion strategy for hygiene behaviour change has also been found effective in Bangladesh (2014). By contrast, the Malawi 2011 and Kenya 2012 reports found no significant effect on behaviours in the targeted population. In 2010-2012, Kenya launched the ‘SOPO’ hygiene programme based on an entertaining, participatory approach and using a mascot of a bar of soap (called SOPO) to promote good behaviours in communities, schools and through mass media. The evaluation did not find positive results on children’s and caregivers’ handwashing practices. The Public-Private Partnership for Handwashing with Soap was rolled out in several countries (Ghana, Indonesia…) with World Bank funds. It also developed mass media campaigns. However, no evaluation of the programme is available. Handwashing with soap is now integrated in most if not all CLTS interventions.
The extent to which other UNICEF WASH programmes made use of mass media besides on the occasion of the Global Handwashing Day and other global events is unclear from evaluation reports. It is interesting that no evaluation of Global Handwashing Day activities has been found despite the existence of an impact assessment toolkit published in 2010. This kind of evaluative activity might not be considered as a corporate priority and be difficult to execute without strong external expertise. The lack of a Communication for Development (C4D) section or the weak level of collaboration between the WASH and C4D sections in some country offices might be an additional obstacle.
Common lessons learnt from the evaluations of programmes using mass media to change behaviour at scale are that WASH messages should not be too numerous, must be tailored to a well identified intended audience, must be continuous or repeated over time, and use various communication channels to reinforce each other and reach different categories of population – which has been rarely the case in evaluated programmes.
WASH in schools (and health centres) (15 reports from 12 countries)
WASH in schools has been confronted with the problem of the lack of effective and easily scalable approach in rural, low-income settings. Particularly, many of the evaluated WASH in schools interventions faced the issue of high unit costs. As a matter of fact, schools need a sustainable water point on-site for drinking, handwashing and cleaning the school. In rural areas especially in Sub Saharan Africa where piped schemes are rare, boreholes (or wells) are drilled to capture groundwater. The unit cost of a borehole is typically between 10,000 and 20,000 USD depending on hydrogeological and market conditions. When a piped system already exists in the village, standpipes or taps can be installed in the school compound at a lower cost. Protected springs can be used in favourable contexts only (some areas in DRC, Ethiopia…). Rainwater harvesting systems never provide sufficient water throughout the school year. In addition, pupils need latrines in or near the school. They must be of sufficient quantity and good quality to ensure children’s (and teachers’) privacy and safety, as well as sustainability. This comes at a significant cost.
Reducing the cost of the intervention has been an attempt in few countries. Several evaluation reports discuss the issue of self-construction. Concerns with the construction quality and the complexity of managing such an arrangement are raised (see below in the sustainability section). Targeting schools that already have WASH facilities, or carrying out capacity building and awareness raising (software) activities only in countries where all schools do not yet have those facilities poses an obvious equity problem. It is to be noted that during the period under review, no evaluation has been commissioned on manual drilling or the ‘3 star approach’ for WASH in schools as these innovative approaches are recent.
Despite the challenge of costs of school WASH facilities, two evaluated programmes have been able to cover a large number of schools with a full WASH package: the DRC ‘Healthy Schools and Villages’ programme (more than 1,000 schools since 2008) and the Mali WASH in schools programme (almost 2,000 schools since 2011, “one of the largest and most comprehensive school WASH programs undertaken to date” according to the 2015 impact evaluation). Both programmes have evolved as national programmes rather than projects limited in scope and time. They have a global planning and implementation process and a unified monitoring and evaluation system. They follow a standardised implementation process supported by accompanying guidelines and training materials that are applied by the multiples implementing partners involved in the programme and other not directly involved in the programme (informed through WASH cluster meetings notably). There is no significant difference by donor.
The other, past or current, large WASH in schools programmes in Bangladesh, Nepal, Sierra Leone, India, Lao or Philippines either focus mainly on the software component with limited or no construction of WASH facilities, or are limited in time, or have not been evaluated. Sudan, Egypt, Rwanda, Burundi, Haiti, Indonesia, Bolivia, Kenya and Nigeria WASH in schools programmes have been included in WASH evaluations but they have not yet been taken to scale. They typically cover a few dozens to a few hundred schools.
In Mali and DRC, scaling up was possible thanks to strong donor commitment. In both countries, UNICEF is using funds from multiple donors and continuously raising more funds to keep the programme going. The DRC WASH programme created a donor pool fund.
In many countries UNICEF has been very active in advocacy and mainstreaming. It has helped raise the profile of WASH in schools in national development agendas, complementing the advocacy efforts of UNICEF HQ. The objective is to embed WASH in policies, budget, administrative procedures and routine work of the education system and therefore ensure that WASH reaches all schools. Some of these efforts have been documented in country-led evaluations. In Indonesia, UNICEF has successfully advocated for increased budgeting for WASH in schools at provincial level. A roadmap was developed for financing and scaling up of WASH in schools. In Mali and DRC, a national strategy for WASH in schools has been validated and rolled out with strong UNICEF support. In Bosnia Herzegovina, Lao and Indonesia, WASH has been incorporated or reinforced in the school curriculum (‘Blue Box’ programme in Lao). In Mali, WASH and menstrual hygiene management have been integrated in the national teacher training curriculum. In many countries UNICEF helped the government define technical guidelines for WASH facilities (Nigeria, Mali, Kenya, Haiti etc.). In Indonesia and Mali, UNICEF has worked with the government to improve the administrative monitoring and information system, with various levels of success. Some countries have tried to address the issue of lack of administrative incentives. Haiti has advocated for the recruitment of WASH inspectors by the Education Ministry. DRC and Mali have created a system of certification or reward similar to the ODF certification process. In DRC, schools must comply with pre-defined standards to receive the ‘healthy schools’ certification. In Mali, a competition is organised between beneficiary schools and the ones that receive the best final score receive a prize.
All these initiatives have an advantage of addressing systemic issues of WASH in schools and have the potential of benefitting all schools in the country. However, their actual application and roll out remains unclear or limited to UNICEF’s intervention areas. As a matter of fact, political willingness, leadership and institutional arrangements appear to be bottlenecks. Despite international and national advocacy efforts from UNICEF, WASH in schools is often not a priority at national and local levels. Responsibilities are scattered and poorly defined. The Education ministry is responsible for the schools but internal expertise in WASH is often weak. School WASH requires a good collaboration between the multiple ministries in charge of Education, Water, Sanitation and Health. Within the Ministry of Education, numerous departments are involved such as those in charge of primary and secondary education, infrastructure, school health and environment, teacher training, girls enrolment etc. Within each of these departments, communication and coordination between the national and subnational levels are reportedly erratic. Turnover of decision makers and technical staff and absorption capacity again are major issues. These various bottlenecks are cited in reports from Mali, Indonesia, DRC, Kenya, Egypt, Burundi, Bangladesh etc.
In many of these countries however, UNICEF has facilitated the creation of coordination platforms between the government and its development partners: a WASH in Schools Alliance in Haiti; national, provincial and local ‘AMPL’ commissions in Indonesia; a Programme Steering Committee in DRC and Mali. UNICEF Indonesia complemented coordination efforts at national levels with additional efforts at provincial and district levels. The evaluation found that its collaboration with AMPLs and the organisation of inter-district and school cluster meetings have been very effective in raising awareness, leveraging funds and disseminating guidelines to other, non-beneficiary schools. UNICEF Mali supported the creation of the National Network of NGOs for WASH in schools, with more than 20 members. Since 2011, it has been providing several trainings every year to the member NGOs and their staff (including on programme design and management and fund raising), discuss and collaboratively improve the implementation strategy of the programme, and carry out advocacy campaigns to the line ministries. Other national and international NGOs have been trained or provided with technical advice and guidelines that have been used in other projects and areas of the country. Evidence has been found that education departments require other development partners to align with the approach supported by UNICEF. The evaluation also highlights that the Mali WASH in schools programme has disseminated guidelines, manuals, IEC tools and training material to other UNICEF country offices: Guinea, DRC, Sierra Leone, Indonesia, Nigeria, Central African Republic, Haiti, Egypt and Sudan. They have been translated into English and disseminated through the washinschoolsmapping.org website. In most other countries, it was not reported that capacity building and technical assistance included stakeholders other than UNICEF’s implementing partners in country.
Engagement of schools and especially teachers (more than pupils) is an issue. WASH related activities are sometimes seen as an additional burden in their already very busy schedules. Many of the tasks that are required from them are difficult to perform without a sufficient budget transferred from the Ministry of Education or the local authority. Motivation may be low as a result. Both the DRC and Mali programmes have developed an innovative approach to overcome this obstacle and enrol more schools. In DRC, the ‘Healthy Schools and Villages‘ programme is publicly advertised. Schools (and villages) that are interested to participate are invited to send an application. Schools are then selected based on eligibility and prioritisation criteria. This procedure is interesting as it makes the programme visible and ensures a level of motivation and ownership. However, evaluations show that it is not systematically applied locally. In Mali, a similar procedure was introduced more recently in 2014 based on the DRC experience. The WASH in schools programme is also advertised publicly through local radio campaigns. It is presented as a competition with a significant prize for the winners. Individual letters are sent to schools that meet eligibility criteria. Interested schools must fill out a form and write a cover letter describing their WASH status and their motivations. They must be signed by the school head, all teachers, the president of the school management committee and the village chief, and sent back to the local education department within two weeks. As a result, the programme is well known and many schools want to participate. During programme implementation, teachers in selected schools are generally more engaged. The competitive spirit, the lure of gain and pride are strong motivating factors, as demonstrated by CLTS. In addition, the school benefits from strong support from the village leaders and population.
Scalability and scaling up of WASH interventions in health centres have not been discussed or documented in any evaluation reports.
Performance related to scalability by type of WASH intervention is summarized as follows:
