Himachal Pradesh and Madhya Pradesh, India - WSP

Enabling Environment Endline Assessment:Himachal Pradesh and Madhya Pradesh, India

Andy Robinson

April 2012

The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services.

Scaling Up Rural Sanitation

WATER AND SANITATION PROGRAM: WORKING PAPER

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By Andy Robinson

This report is based on fi eldwork and research funded by the Water and Sanitation Program (WSP). The fi eldwork and research could not have taken place without the support and assistance of the Government of Himachal Pradesh (Rural Development Department, Irrigation and Public Health Department), the Government of Madhya Pradesh (Panchayat and Rural Development Department, Public Health Engineering Department), the Government of India, and the Water and Sanitation Program—South Asia.

Special thanks are due to Ajith Kumar, K. Arokiam, Lira Suri, and Nitika Surie for their kind assistance and support in India.

Designated a core business area in 2011, WSP’s Scaling Up Rural Sanitation is working with governments and the local private sector to develop the knowledge needed to scale up rural sanitation for the poor. The programmatic approach combines Community-Led Total Sanitation (CLTS), behavior change communication, and sanitation marketing to generate sanitation demand and build up the supply of sanitation products and services at scale. In addition, WSP works with local and national governments and the local private sector to strengthen the enabling environment—including institutional, regulatory, fi nancial, service-delivery, and monitoring capacities—to achieve change that is sustainable. Starting in India, Indonesia, and Tanzania in 2006, Scaling Up Rural Sanitation is currently being implemented in over a dozen countries. For more information, please visit www.wsp.org/scalingupsanitation.

This Working Paper is one in a series of knowledge products designed to showcase program fi ndings, assessments, and lessons learned through WSP’s Scaling Up Rural Sanitation initiatives. This paper is conceived as a work in progress to encourage the exchange of ideas about development issues. For more information please email Eddy Perez at [email protected] or visit www.wsp.org.

WSP is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank.

WSP reports are published to communicate the results of WSP’s work to the development community. Some sources cited may be informal documents that are not readily available.

The fi ndings, interpretations, and conclusions expressed herein are entirely those of the author and should not be attributed to the World Bank or its affi liated organizations, or to members of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work.

The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to [email protected]. WSP encourages the dissemination of its work and will normally grant permission promptly. For more information, please visit www.wsp.org.

© 2012 Water and Sanitation Program

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Enabling Environment Endline Assessment: Himachal Pradesh and Madhya Pradesh, India


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Although TSC has been operating since 1999, it has pro-moted the elimination of open defecation and the achieve-ment of collective sanitation outcomes only since the introduction of the complementary Nirmal Gram Puras-kar (NGP) awards in 2004. In the last few years, TSC and NGP guidelines provided a well-understood framework for sanitation and hygiene improvement, with most state and district governments now actively engaged in rural sanita-tion promotion and sanitation-related activities.

Prior to the program, WSP had established a good relation-ship with the Governments of HP and MP, and during the program has supported the TSC in both states, working to enhance and broaden the level of support provided: to leverage TSC resources and sector opportunities at the na-tional level; to extend its pre-existing engagements at the state level; and to facilitate achievement of the program ob-jectives and outcomes.

MethodologyA baseline assessment of the enabling environment in Him-achal Pradesh and Madhya Pradesh was carried out in July and August 2007. An endline assessment of the enabling environment took place in mid-2010 using a similar meth-odology and interview guide to the baseline assessment.

To ensure consistency in the assessment findings, WSP de-veloped a conceptual framework for assessing the enabling environment for sanitation. This framework, developed on the basis of a literature review and discussions with key ac-tors, consists of eight dimensions considered essential to scaling up rural sanitation, including:

• Policy, strategy, and direction• Institutional arrangements• Program methodology• Implementation capacity• Availability of products, tools, and information• Financing and incentives• Cost effective implementation• Monitoring and evaluation

The Water and Sanitation Program (WSP) has been imple-menting the Scaling Up Rural Sanitation initiative since 2007. One of the central objectives of the program is to improve sanitation at a scale sufficient to meet the 2015 sanitation MDG targets in Indonesia, Tanzania, and the Indian states of Himachal Pradesh (HP) and Madhya Pradesh (MP).

Although WSP provided similar levels of support and pro-moted similar approaches and tools in both HP and MP, the starting contexts were different, with HP recognized as a small, relatively progressive, and wealthy state, and MP as one of the largest and least developed states in India. Rural sanitation coverage was higher in HP, but was still low at only 28 percent in 20011, creeping up to 34 percent by 2006; rural sanitation coverage in MP was extremely low at baseline, reaching only 10 percent in 2006. Both states faced a huge sanitation challenge, but it was clear that the larger challenge was in MP.

One of the key differences between the methodology for the program in India and that in either Tanzania or Indo-nesia is the pre-existence of a large-scale, national rural sanitation program, The Total Sanitation Campaign (TSC). TSC is a huge and ambitious program—in its current phase, the national TSC budget exceeds US$3.9 billion, with a goal in the next five-year phase (2008–2012) of providing toilets to 115 million households. It aims to achieve open defecation free status across the country by 2012.

TSC provides a broad financial, policy and institutional framework for sanitation improvement in India, but al-lows individual states and districts the freedom to de-velop local policies and interventions according to their specific needs and priorities. This freedom limits central control of program methodology, but allows more pro-gressive local governments to develop and implement new approaches and policies. As a result, there is a wide variation in the effectiveness and outcomes of TSC in dif-ferent states.

Executive Summary

1 Government of India (2001) Census of India 2001.

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Executive Summary

iv Scaling Up Rural Sanitation

FindingsTSC and NGP continue to provide excellent frameworks for rural sanitation development through the provision of adequate finance, basic technical guidelines, and institu-tional incentives. Sanitation is a state subject, allowing con-siderable latitude in how these resources and mechanisms are used by local governments, and resulting in highly vari-able outcomes across states. Therefore, despite rural sanita-tion development being guided by the TSC and NGP, the enabling environment at state level has a significant impact on sanitation activities and outcomes.

In 2010, rural sanitation coverage in HP is estimated to have passed 80 percent, an increase of around 50 percent in only four years; whereas coverage in MP is estimated at around 17 percent, barely 7 percent growth during the same four-year period. Given similar government programs and program support, it is significant that the HP program has accelerated dramatically over the last three years, while the MP program has struggled to reach the average coverage level in India.

There was a huge difference in the scale of challenge in MP, and some credit is due as both states have managed to provide sustainable sanitation to a similar number of households over the last three years, with an additional 600,000 or so households covered in each state. However, HP is a much smaller state and achieved this coverage gain with rural sanitation expenditures of around US$8 million, compared to more than US$80 million invested in MP. While there are undoubtedly higher cost factors in the huge scale of the MP program, and in the higher proportions of poor and marginalized households, this endline assessment found that the significantly better cost-effectiveness in HP reflects a much stronger enabling environment than that found in MP.

Enabling environment in Himachal PradeshSignificant improvements were apparent in the enabling environment for rural sanitation in Himachal Pradesh since baseline. Strong political support for sanitation, led by the Chief Minister, has galvanised local leaders and adminis-trators, enabling already competent local governments to use all of their capacity and resources to address sanitation deficits.

The state government stood firm on the no-subsidy policy introduced in 2005, despite concerns that HP was los-ing out by not utilizing the growing BPL latrine incentive funds available through TSC. There was a consensus that a demand-led approach, rather than a supply-driven and sub-sidized approach, was working well. This consensus was fed by widely reported open defecation free (ODF) successes and expanding evidence of the benefits of improved sanitation, which led to strengthened local government commitment to TSC implementation and rapid scaling up of progress.

Regular monitoring and benchmarking of TSC progress, including spot checks by senior state officials and weekly videoconferences with the chief minister, at which TSC progress was discussed, provided incentives for district administrators to prioritize the program, and encouraged improved coordination and cooperation between local government departments. Competition between neighbor-ing areas was also an important motivation, driven by the regular WSP benchmarking reports that the government adopted as its key performance monitoring tool.

Nirmal Gram Puraskar (NGP) awards remain an important incentive for sanitation development by local governments, but the institutionalization of the state sanitation awards in HP over the last three years has been even more effective in generating political and popular support for rural sanitation improvement. The state sanitation awards target a broader group of stakeholders, including school children and women’s self-help groups, and have deliberately involved elected repre-sentatives from local government in judging and presenting the awards. As a result, a large proportion of the population is familiar and engaged with the awards, which are seen to recog-nize and promote a Himachali vision of purity and cleanliness.

Good use was made of WSP technical support, with capac-ity building organized in advance of strategic needs, and regular demands made for WSP support in new areas as the program progressed and scaled up. Exposure visits were used to introduce and validate new approaches, and the full-time presence of the WSP state coordinator was impor-tant in maintaining momentum and interest.

Overall, a more institutional and enabling approach has been developed, with continuous sanitation development now

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household investment in latrines—which is limiting the scale and spread of improved outcomes.

WSP has undertaken similar activities to strengthen the enabling environment in both HP and MP, including ex-posure visits, capacity building, performance benchmark-ing, targeted assessments, and sharing of best practices. This approach proved successful in HP, where local government was receptive and engaged in the process but has had only limited success in MP. While some of the problems stem from the more challenging context in MP, the conclusion of this assessment is that the failure of the state government to embrace critical elements of the approaches promoted by the program—such as the need to move away from a supply-driven approach toward a demand-based total sani-tation approach—limited high-level recognition of the problems and prevented the reforms required to improve the enabling environment.

Enabling Environment at National LevelOne of the lessons from the HP and MP assessments is that high latrine subsidies can create implementation problems because of the temptation to revert to supply-driven ap-proaches and short-circuit demand creation processes. The rising BPL incentive in MP has increased the use of supply-driven approaches, which in turn has diminished efforts to generate genuine demand for latrines or to encourage user involvement in the process. In contrast, the zero hardware subsidy adopted in HP, which resulted from the decision not to use the BPL incentive funds provided by the TSC, encouraged local governments to develop cost-effective ap-proaches to demand generation and institutional support, and ensured that households who built latrines felt owner-ship, responsibility, and pride in their facilities.

The recent WSP rapid assessment of TSC processes and out-comes provided good evidence of the association between process quality and TSC project performance. Discussions with the Department of Drinking Water Supply (DDWS) revealed that support for the total sanitation approach, which was relatively low in central government at baseline, has increased substantially as evidence of the higher sus-tainability and cost-effectiveness of this approach over more supply-driven approaches has emerged. However, DDWS has little authority to impose specific approaches and tools

seen as an integral part of the government program. The vi-sion of an open defecation free Himachal Pradesh (Nirmal Himachal) by 2012, which seemed unlikely at the outset of the program in 2007, is now viewed as a realistic and achiev-able goal. At baseline, two or three exceptional districts were performing well whereas today, at endline, only two or three districts out of the twelve in Himachal Pradesh are lagging behind, and even these supposed laggards report that more than half of their villages are now ODF.

Enabling Environment in Madhya PradeshThere is little evidence that the enabling environment for rural sanitation has improved in MP since baseline, despite the relocation of TSC within the Panchayat and Rural De-velopment department (PRD). Significant implementation efforts and investments have been made in rural sanitation through the program, TSC, NGP, and NREGA programs and projects, and through substantial technical support provided by UNICEF, WaterAid, and other development partners. However, this work has translated into relatively meager benefits due to the lack of high-level engagement, commitment, or priority.

Political support for sanitation remains limited. There was little evidence that local leaders or administrators see sanita-tion improvement as a priority: the chief minister has not yet presented the 2009 NGP awards to the winning vil-lage heads, and no state sanitation awards had been made more than two years after inception. There is little involve-ment or coordination of TSC activities with those of other government departments, and there appears little recog-nition of the cross-sectoral benefits of effective sanitation improvement.

While few reliable data were available, the policies and ap-proaches adopted in MP do not appear cost-effective. Total investments in rural sanitation over the last three years are estimated to be about ten times higher than those in HP and, while TSC online monitoring data report dramatic increases in sanitation coverage, more rigorous large-scale household surveys and recent WSP assessments suggest that many of the latrines built through TSC in MP are not being used. In addition, the use of multiple program subsidies to finance latrine construction means that the leverage ratio is also low—program investments are not leveraging much

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as cost-effective as hoped. The lesson appears to be that implementation support should not be scaled up until the government is fully engaged and some minimum enabling environment conditions are met; otherwise there will be a significant opportunity cost to any investment.

Potential to Achieve Sanitation MDGThe 2015 MDG for sanitation is to halve the proportion of the population without access to basic sanitation (using a 1990 baseline). The lack of sanitation data disaggregated by state makes it difficult to estimate the 1990 baseline, but it has been assumed that 1990 rural sanitation coverage in MP was close to the national average of 7 percent, which would set the 2015 MDG for rural sanitation at 54 percent coverage; and the 1990 baseline in HP was around 15 per-cent, setting the MDG at 58 percent.

At the end of the program, it appears that HP has already surpassed its 2015 MDG target. The 2008 District Level Household and Facility Survey (DLHS) reported rural sani-tation coverage of 53 percent, while recent estimates sug-gest that coverage has passed 80 percent in 2010. In MP, the 2008 DLHS found that rural sanitation coverage had increased to only 10 percent, while recent forecasts suggest that coverage is unlikely to be much higher than 17 percent in 2010. At the current rate, which is around 2.5 percent increase in rural sanitation coverage per year, MP will not reach its MDG until 2025.

Key LessonsThe success of the HP TSC project, to which the program contributed, has shown that, under the right conditions, rapid and large-scale sanitation progress is possible in only a few years; and that ODF success rates need not be limited to the 35 percent suggested by previous implementation experiences. When the enabling environment is well devel-oped, and strong political support drives implementation, universal sanitation can become a realistic and achievable goal within a relatively short period.

This endline assessment found that political support and priority were central to the success of TSC and NGP pro-grams in HP. While the reasons for the development of this political support are complex, it seems likely that the early successes provided by a combination of progressive state

on independent state and district projects, and is thereby restricted to knowledge management and advocacy activi-ties to share best practices, highlight implementation issues, and strengthen accountability for program outcomes.

Nirmal Gram PuraskarNGP continues to be a controversial program. Recent evaluations by UNICEF and others found NGP-awarded villages with low sanitation coverage and significant levels of open defecation, raising questions about the integrity of the NGP verification process and the sustainability of sanitation outcomes generated by the NGP awards. This assessment concludes that the positive effects of NGP in generating political attention to sanitation improvement, and in galvanizing local government activity, far outweigh the problems associated with the process.

NGP fulfils its original function well, in that it creates in-centives for local governments to achieve collective sanita-tion outcomes and it draws considerable political attention to rural sanitation improvement. NGP was never meant to be a mechanism for ensuring the long-term sustainability of these outcomes. Since baseline, NGP has been strength-ened to add some emphasis to sustainability, but a com-plementary program is needed to provide the long-term institutional support and monitoring that will ensure more sustainable improvements in rural sanitation.

WSP Enabling Environment RoleThe WSP team played an important role in developing the enabling environment for rural sanitation at both the na-tional and at the state level in HP. However, it has had only limited success in influencing the enabling environment in MP, and it lacks the staff capacity to implement parallel support programs in a number of other Indian states that have asked WSP for assistance of the type provided by the program.

The WSP team acknowledged that it became apparent over the last year or so that the program in MP lacked the high level political influence required to shift the policy on la-trine subsidies and supply-driven approaches or to generate real political engagement with both TSC and NGP pro-grams. As a result, many of the lower level activities related to program implementation have not been as successful or

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improvement, and to incorporate a more public health-based framework for measuring sanitation and hygiene outcomes.

In addition, TSC guidelines, which have been evolving gradually as TSC itself changes, should be developed into a more formal rural sanitation policy—one that is relevant for all rural sanitation interventions not just those under TSC. A rural sanitation policy based on TSC guidelines would provide opportunities to involve stakeholders from other sectors and encourage an evidence-based policy devel-opment process building on the strengths of TSC, without being limited by its programming needs.

Recommendation 2: Develop More Effective High-level AdvocacyIn order to present Government with clear, consistent, and evidence-based messages that are designed to influence high-level decision makers, development partners should work to harmonize their advocacy, enabling environment, and performance assessment activities. In particular, reli-able cost-effectiveness data should be collected and used more widely to demonstrate the wasted investments and opportunity costs of some current sanitation strategies and implementation approaches, and the greater effectiveness and sustainability of alternatives.

Recommendation 3: Recognize That One Strategy Does Not Fit AllBetter information and data on latrine usage, sustainabil-ity of behavior change, and targeting accuracy (i.e. success in improving sanitation for the poorest households) are re-quired to develop strategic plans to meet the government’s sanitation targets.

In particular, efforts need to be made to identify hard-to-reach areas and groups, to examine issues that limit the cost-effectiveness and sustainability of sanitation improvements, and to recognize that different strategies, resources and tools are required in different contexts and stages of development.

Recommendation 4: Encourage a Two-stage Incentive SystemAt endline, the HP experience clearly demonstrates the ben-efits of a two-stage process, whereby the momentum and support generated by widespread ODF achievement has

sanitation policies and exceptional leadership in Mandi District were sufficient to demonstrate that new approaches worked and that rapid sanitation improvements were pos-sible. In addition, there was some convergence between the aims of TSC, Himachali cultural mores, and a growing en-vironmental movement, which made sanitation improve-ment a politically viable and attractive cause for leaders like the chief minister.

RecommendationsAs a result of this endline assessment of the enabling envi-ronment, there are specific recommendations for support to non-performing states. The experience in MP suggests that where the enabling environment is not supportive or developed, the initial focus should be on the development of model districts rather than large-scale implementation or technical assistance, so that local approaches and successes can be showcased to increase support for rural sanitation improvement.

The intention is to limit investment until the enabling environment improves, and to use program funds to re-ward improved performance and good governance (for ex-ample through scaling up in model districts) rather than spreading efforts thin before supportive conditions are in place. Wherever possible, model districts should introduce evidence-based approaches to challenge supply driven im-plementation and subsidy cultures, attempt to demonstrate that poor households can build improved sanitation facili-ties without up-front subsidies, and that more sustainable outcomes result from the generation of genuine demand and ownership for household latrines.

Recommendation 1: Reformulate the Total Sanitation CampaignTSC was designed as a framework for five-year district proj-ects. It therefore assumed an intensive, campaign-mode ap-proach suited to a short lifespan. In practice, it has already run for 10 years in some districts, and looks likely to op-erate on a long-term basis in many more. Furthermore, it was developed from the more technical and construction-oriented Central Rural Sanitation Program (CRSP), whereas the emphasis is now largely on behavior change and public health issues. As such, the program design should be refor-mulated to reflect the longer-term objectives of sanitation

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developed the comprehensive enabling environment required for rapid progress towards the harder-to-achieve environmental sanitation and hygiene improve-ment requirements of the NGP award.

It is recommended that WSP encourage other progressive states to employ a two-stage process to provide further evidence of the benefits of this approach, with a longer-term view to convincing the Department of Drinking Water Supply (DDWS) to formalize the inclusion of a two-stage approach in TSC guidelines.

Recommendation 5: Invest in Cost-effectiveness DataThe publication and dissemination of reliable evidence of wasted investments and opportunity costs remains one of the most powerful motivators for govern-ment reform and improvement, especially when those costs relate to emotive issues like children’s health, environment, and poverty. More effort is needed to collect and analyze information on sanitation program costs, outcomes, and im-pacts into simple cost-effectiveness measures and advocacy materials that can be used to encourage competition among districts and states, to identify optimal strategies, and to influence high-level decision and policy makers.

Recommendation 6: Incorporate Latrine Usage and Sustainability into Benchmarking SystemsWhile latrine usage and sustainability data are not as easy to collect as information on the number of latrines built, it is important that sanitation programs begin to work toward routine monitoring and benchmarking of sanitation outcomes. Initially, it may be necessary to undertake annual rapid assessments in order to generate latrine usage and sustainability data that can inform annual performance reviews, but eventually this data should be collected as part of routine public health monitoring systems.

Recommendation 7: Develop State Capacity for Knowledge ManagementExposure visits and horizontal learning events were identified as the most impor-tant knowledge management tools for local governments. At present, local gov-ernments are reliant on agencies like WSP and UNICEF to organize these visits and events, which often makes them dependent on external program finance and constrained development partner capacity.

The development of state capacity to organize knowledge management events should form part of the program exit strategy in both states, through the for-mulation of a phased annual knowledge management program that outlines the diminishing role to be played by WSP. Local governments will require some hand-holding during early events, but the additional value provided by these events should allow the development of sustainable mechanisms to finance and manage them, while WSP gradually builds local capacity for their planning and facilitation.

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Contents Executive Summary .................................................................. iii Abbreviations and Acronyms .................................................. xii Definitions ............................................................................... xiv I. Introduction ............................................................................... 1 II. Assessment Framework and Methodology ............................. 2 2.1 Assessment Dimensions ...................................................... 2 2.2 Methodology of Assessment ................................................ 3 2.3 Sampling Protocol ................................................................ 4 III. Context ...................................................................................... 6 3.1 General ................................................................................. 6 3.2 Health ................................................................................... 6 3.3 Sanitation and Hygiene ........................................................ 7 3.4 Legal Framework .................................................................. 7 IV. Total Sanitation Campaign ........................................................ 8 4.1 Evolution of the Total Sanitation Campaign ......................... 8 4.2 TSC Methodology ................................................................ 9 4.3 TSC Latrine Subsidies ........................................................ 10 4.4 TSC Incentive Framework .................................................. 11 V. Baseline Findings .................................................................... 12 5.1 Himachal Pradesh: Sanitation Coverage at Baseline ......... 12 5.2 Madhya Pradesh: Sanitation Coverage at Baseline ........... 12 5.3 Baseline Assessment Findings ........................................... 12 VI. Endline Findings ...................................................................... 15 6.1 Policy, Strategy, and Direction ........................................... 15 6.2 Institutional Arrangements ................................................. 20 6.3 Program Methodology ........................................................ 23 6.4 Implementation Capacity ................................................... 28 6.5 Sanitation Goods, Services, and Information ..................... 30 6.6 Financing ............................................................................ 32 6.7 Cost-Effective Implementation ........................................... 38 6.8. Monitoring and Evaluation ................................................. 41 VII. Conclusions ............................................................................. 48 7.1 Enabling Factors in HP ....................................................... 48 7.2 Disabling Factors in MP ..................................................... 49 7.3 Return to the CRSP? .......................................................... 50 7.4 Enabling Environment at the National Level ....................... 51 7.5 Nirmal Gram Puraskar ........................................................ 51

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Contents

7.6 WSP Enabling Environment Role ....................................... 52 7.7 Potential to Achieve Sanitation MDG ................................. 52 7.8 Key Lessons ....................................................................... 53 VIII. Recommendations .................................................................. 54

References ............................................................................... 57

Annexes 1: Assessment Meetings and Activities ................................. 60 2: Terms of Reference for Consultancy ................................. 62 3: Endline Interview Guide ..................................................... 67 4: Program Benchmarking Assessments by District, MP ...... 72

Figures 1: Infant Mortality Rates ........................................................... 6 2: Trend in Rural Sanitation Coverage—India .......................... 7 3: Improved Sanitation Coverage in Rural Areas, HP ............ 43 4: Improved Sanitation Coverage in Rural Areas, MP ........... 43 5: Latrine Usage in HP and MP ............................................. 44 6: Access to Improved Sanitation Since 1995 by Wealth

Quintile ............................................................................... 46

Tables 1: Program Areas and Number of Beneficiaries ..................... 2 2: TSC Components: Revised Earmarking and Funding

Pattern ............................................................................... 9 3: Comparative TSC and NGP Performance ...................... 14 4: Enabling Environment Improvements: Policy, Strategy,

and Direction .................................................................... 19 5: Enabling Environment Improvements: Institutional

Arrangements ................................................................... 22 6: Enabling Environment Improvements: Program

Methodology .................................................................... 27 7: Enabling Environment Improvements: TSC

Implementation Capacity ................................................. 30 8: National Growth in Nirmal Gram Puraskar Awards .......... 35 9: State Growth in Nirmal Gram Puraskar Awards ............... 36 10: Enabling Environment Improvements: Finance and

Incentives ......................................................................... 37 11: Enabling Environment Improvements:

Cost-Effectiveness ........................................................... 41

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Contents

12: TSC Physical Progress: Individual Household Latrines ... 42 13: TSC Physical Progress: Institutional Toilets ..................... 42 14: Enabling Environment Improvements: Monitoring and

Evaluation ........................................................................ 47 15: Geographic Areas and Beneficiaries ............................... 63

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Anganwadi Childcare centerADC Assistant District Collector (also known as Assistant District

Magistrate)APL Above Poverty LineBDO Block Development OfficerBPL Below Poverty LineBRC Block Resource CentersCBO Community-Based OrganizationCCDU Communication and Capacity Development UnitCLTS Community-Led Total SanitationCrore 10,000,000 (ten million) RupeesCRSP Central Rural Sanitation ProgramDC District Collector (or District Commissioner, or District

Magistrate)DDWS Department of Drinking Water SupplyDLHS District Level Household and Facility SurveyDLM District Level Monitoring (program of TSC)DRDA District Rural Development AgencyDWSM District Water and Sanitation MissionGoI Government of IndiaGP(s) Gram Panchayat(s), local political bodyHhd HouseholdHP Himachal PradeshIEC Information, Education and CommunicationJMP WHO-UNICEF Joint Monitoring Program for Water Supply

and SanitationLakh 100,000 (one hundred thousand)MDG Millennium Developmental Goals M&E Monitoring and evaluationMP Madhya PradeshMVSSP Maharishi Valmiki Sampoorn Swachata Puraskar (State Sanita-

tion Reward Scheme)NREGA National Rural Employment Guarantee ActNGO Non-Governmental OrganizationNGP Nirmal Gram Puraskar (Clean village award)Nirmal Watika Clean GardenNRDWP National Rural Drinking Water ProgramNRHM National Rural Health MissionODF Open Defecation FreePanchayat An elected body at village level.PHED Public Health Engineering DepartmentPRD Panchayat and Rural Development Department

Abbreviations and Acronyms

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Abbreviations and Acronyms

PRI Panchayati Raj Institutions (local government system)RDD Rural Development DepartmentRGNDWM Rajiv Ghandi National Drinking Water MissionRSM Rural Sanitary MartSSA Sarva Shiksha Abhiyan (SSA) Education for All programSDM Sub Divisional MagistrateSLWM Solid and Liquid Waste ManagementSRSP State Rural Sanitation ProgramSWSM State Water and Sanitation MissionTSC Total Sanitation CampaignUNICEF United Nations Children’s FundWHO World Health OrganizationWASH Water, Sanitation and HygieneWSP Water and Sanitation Program (South Asia)ZP Zila Parishad (district council)

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sessions, covering technology and service options based on willingness to pay, and provide insight on the service provi-sion schedule and know-how, management of funds and responsibilities, and management of services.

Program software: Activities that support and promote the provision of program services and facilities, for example: media campaigns, capacity building activities, or commu-nity hygiene promotion sessions. Note: program software must be differentiated from program hardware (infrastruc-ture), which includes tangible program products and facili-ties such as toilets, soakaways, and handwashing facilities.

Rural: That which is not urban, with urban spaces in India defined as towns (places with municipal corporations, mu-nicipal area committees, town committees, notified area committees or cantonment boards); also, all places with 5,000 or more inhabitants, a population density not less than 390 persons per square kilometer, or at least three-quarters of the adult male population employed in pursuits other than agriculture.

Sanitation: Interventions for the safe management and dis-posal of excreta, with the principal safety mechanism being the separation of excreta from all future human contact. The term improved sanitation is used in this report to de-note private facilities that provide safe management and disposal of excreta. The WHO-UNICEF Joint Monitoring Program (JMP) offers the following simple definitions3 of improved sanitation facilities that provide “sustainable ac-cess to basic sanitation”:

• Pit latrine with slab,• Ventilated improved pit latrine,• Composting toilet, and• Flush or pour-flush to latrine pit, septic tank, or

piped sewerage.

Unimproved sanitation facilities, which do not provide ad-equate access to basic sanitation, include:

To ensure a common understanding of the concepts and terms used in the report, the following definitions are provided:

CLTS: Community-Led Total Sanitation (CLTS) is the original variant of the total sanitation approach, a process to inspire and empower rural communities to stop open defecation and start using sanitary toilets, without offering external subsidies for the purchase of hardware such as toi-lets pans and pipes.2 CLTS uses a participatory analysis of community sanitation to identify key triggers to motivate a community to take collective action to improve its sanita-tion status.

Handwashing: Hands become contaminated with fecal material after anal cleansing, or after cleaning children’s bottoms or handling their feces. Rinsing with water alone is not enough to remove sticky microbe-containing particles from hands. Some form of soap is required: hands need to be rubbed with soap and water until fully covered with soapsuds, and then rinsed off with water.

Hygiene promotion: A planned approach to prevent diar-rheal disease (and other health problems) through the wide-spread adoption of safe hygiene practices, e.g. campaigns to encourage regular handwashing at appropriate times. Note: hygiene promotion is usually a much broader intervention than sanitation promotion, which focuses solely on the safe management and disposal of excreta.

Informed choice: Demand-based programming places the community in the role of decision-maker in the selec-tion, financing, and management of their water supply and sanitation system. In order to effectively implement a demand-responsive approach, the government should take the role of facilitator and provide informed choices to the community regarding the development and construction of sound infrastructure and services, taking into account local financial, technical, environmental, social, and institutional factors. Informed choices are provided in participatory

Definitions

2 Kar 2005.3 JMP 2006.

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• Pit latrine without slab (open pit),• Shared or public sanitation facilities,• Hanging latrine,• Bucket latrine, and• Flush or pour-flush to elsewhere (street, yard, ditch, open drain, or other

location).

Sanitation marketing: An approach that utilizes the power of the small- and medium-scale private sector in the provision of sanitation services and uses tech-niques of commercial marketing and behavior change communication to create demand.

Sanitation promotion: Encourages the safe management and disposal of excreta through the widespread adoption of safe sanitation facilities and practices, for example, programs promoting the construction and universal use of improved sanitation facilities.

Scheduled castes (SCs): Historically disadvantaged, low ranking, hereditary classes of Indian society, now under formal government protection.

Scheduled tribes (STs): Tribal communities now under formal government pro-tection, with key characteristics being traditional occupation of a definitive geo-graphical area, culture that includes tribal modes of life including tribal language, customs, traditions, religious beliefs, arts, and crafts.

Total sanitation approach: A community-wide approach whose main aim is universal toilet use (total sanitation) in each community covered. The total sanitation approach focuses on stopping open defecation on a community-by-community basis through recognizing the problems caused to all by open def-ecation within and around the community, and ensuring that every household uses either their own affordable toilet, or a shared toilet situated close to their home. The total sanitation approach is a broader variant of Community-Led Total Sanitation (see definition above) that may involve financial incentives (e.g. post-construction subsidies provided by the Total Sanitation Campaign in India); the promotion of broader environmental sanitation objectives such as drainage and solid waste management; and the promotion of hygiene improvement activi-ties such as handwashing.

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The Water and Sanitation Program (WSP) has implemented the Global Scaling Up Rural Sanitation (TSSM) project since 2007. One of the central objectives of the program is to improve sanitation at a scale sufficient to meet the 2015 sanita-tion Millennium Developmental Goals (MDG) targets in Indonesia, Tanzania, and the Indian states of Himachal Pradesh (HP) and Madhya Pradesh (MP).

A consultant was contracted to perform an endline assessment of programmatic and institutional conditions (referred to by the program as the enabling environ-ment) needed to scale up, sustain, and replicate the total sanitation and sanitation marketing program approaches in two Indian states, HP and MP. The Terms of Reference (TOR) are detailed in Annex 2. This report is the main output of that consultancy.

The baseline assessment of the enabling environment was completed in May and June 2007, during the start up phase of the overall program. This follow up end-line assessment was carried out three years later in mid-2010, following a one-year extension of the program from its original mid-2009 end date.

The purpose of the endline assessment is to:

• Assess the extent to which the enabling environment for scale up and sus-tainability have improved by the end of the program;

• Recommend what should be done to address any gaps identified by the assessment during the remainder of the program implementation period, or in the future if a follow-on program is undertaken; and

• Determine whether an appropriate enabling environment is in place to meet the 2015 MDG sanitation target, and assess whether these condi-tions are likely to be sustained.

The fundamental determination that the endline assessment should clarify is if, in India (and specifically these two Indian states) the enabling environment has been institutionalized to support scaling up in a sustainable manner, and whether that scale up can continue after 2010: without assistance, with less assistance, or with difference assistance from the program.

This report presents the main findings and recommendations from the endline assessment of the ability of the enabling environment to scale up, sustain, and replicate sanitation improvements in HP and MP, India.

IntroductionI.

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2 Scaling Up Rural Sanitation

In order to improve the comparability of the findings from the assessment in India with those from the assessments in Indonesia and Tanzania, a common assessment framework was developed by the WSP headquarters team and its special-ist advisors in Washington DC. The assessment framework consists of eight dimensions that are considered essential to scaling up, sustainability, and replication of the total sanita-tion and sanitation marketing approaches in rural areas:

• Policy, strategy, and direction• Institutional arrangements• Program methodology• Implementation capacity• Availability of products, tools, and information• Financing and incentives• Cost effective implementation• Monitoring and evaluation

Definition of Scale-up: Increase the scale, rate of provision, and sustainability of sanitation services to reach the three-year 2010 targets in the program and the MDG targets for 2015 (see Table 1).

2.1 Assessment DimensionsThe eight assessment dimensions4 represent a conceptual framework for assessing scalability and sustainability.

Assessment Framework and MethodologyII.2.1.1 Policy, Strategy, and DirectionEstablishing a shared vision and strategy and ensuring the political will to implement a program is the start-ing point for scale up. Developing this shared vision and strategy in a collaborative manner is also the foundation for coordination and for creating motivation all levels. Policy is defined as the set of procedures, rules, and al-location mechanisms that provide the basis for programs and services. Policies set the priorities and often allo-cate resources for implementation. Policies are reflected in laws and regulations, economic incentives, and the assignment of rights and responsibilities for program implementation.

2.1.2 Institutional ArrangementsIn order for the total sanitation and sanitation marketing approaches to be scaled up, the right institutions must be in place with all key roles and functions covered and clearly understood. These institutions must also have the resources to carry out their roles. In addition to clear roles and responsibilities, institutional arrangements in-clude the mechanisms for actors at all levels to coordi-nate their activities and establish partnerships between the public, private and non-governmental organization (NGO) sectors, and between communities and local governments.

TABLE 1: PROGRAM AREAS AND NUMBER OF BENEFICIARIES (MILLIONS)

Program Areas (population)

People without Access to San-

itation in 2006 (estimate)*

People Who Will Gain Access

to Sanitation During Three-

Year Program (estimate)

Additional Access to Sanita-

tion Needed to Meet 2015

MDG Targets**

Tanzania (26.7 million rural) 14.25 0.75 6.5

East Java, Indonesia (36.5

million)

18.60 1.40 10.0

HP, India (5.5 million rural) 4.30 0.70 1.2

MP, India (45 million rural) 43.60 1.10 20.0

Total 80.75 3.95 37.7

* Best estimates given poor status of data** Accounts for population growth estimates

4 The baseline report included nine assessment dimensions, but the Partnerships dimension was particular to the handwashing project and was therefore merged with the institutional arrangements dimension for this endline assessment.

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collected from the outset and that the capacity to collect the information is in place—that systems and procedures for collecting cost information and the capacity to use and collect the information exist.

2.1.8 Monitoring and EvaluationLarge-scale sanitation programs require regular monitoring and periodic evaluation and, perhaps more importantly, the willingness and ability to use the monitoring process to make adjustments in the program. Effective monitor-ing will identify strengths and weaknesses in the program methodology, implementation arrangements, and cost ef-ficiencies. Overall monitoring responsibility must be at the highest level of the program, but must be based on informa-tion collected at the local government or community level.

2.2 Methodology of AssessmentAn international consultant carried out the endline assess-ments in India with support from the WSP state Coordi-nator for MP5 during the fieldwork in both HP and MP, with overall direction and support from the WSP Country Task Manager for the program (Ajith Kumar) and the WSP team.

The endline assessments were conducted through a series of one-to-one interviews with key stakeholders at national, state, division, district, block, Gram Panchayat (GP), and village level. Based on the assessment framework, a generic interview guide was prepared, and was further revised and developed by the consultants and the program team in order to match the questions and language more closely to local contexts and norms. The India-specific interview guide was used in each interview, although some dimensions and questions were not considered relevant (or appropriate) to some stakeholders (e.g., asking local retailers about national strategy issues). All the dimensions of the assessment frame-work were covered, but not by every stakeholder.

The interview guide is included as Annex 3.

Primary data sources were main stakeholders and partners for the in-country program work, including but not limited

2.1.3 Program MethodologyThe program methodology consists of the program rules, specific activities, and their timing and sequence. Each coun-try will adapt and apply the program methodology making it specific and appropriate to the country context. A workable program methodology that is clear and agreed upon by all key stakeholders is a key programmatic condition.

2.1.4 Implementation CapacityAt all levels institutions must have the capacity to carry out their roles and responsibilities. Institutional capacity in-cludes adequate human resources with the full range of skills required to carry out their functions, an “organizational home” within the institution that has the assigned respon-sibility, mastery of the agreed upon program methodology, systems and procedures required for implementation, and the ability to both monitor program effectiveness and make continual adjustments.

2.1.5 Availability of Products, Tools, and InformationThe ability of target consumers to adopt the promoted behavior(s) is highly dependent on the existence and avail-ability of products, tools, and information that respond to consumer preferences and their willingness and ability to pay for them. Any and all relevant products and services need to be considered, specific to each country situation.

2.1.6 FinancingThis dimension assesses the adequacy of arrangements for financing the programmatic costs. These costs include training, staff salaries, transportation, office equipment and supplies, and the development of communication and edu-cation materials as well as programmatic line items in bud-gets for program and promotion activities.

2.1.7 Cost-effective ImplementationAlthough it will not be possible to assess the cost-effectiveness of the approach or how best to achieve economies of scale and scope until the end of the program, data must still be collected during implementation to make this determina-tion at the end of the program. Therefore, the focus in this assessment category is to ensure that information will be

5 Appointed in May 2007 for a three-year period, now working as a short-term consultant.

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In HP, the following two districts were randomly selected for assessment from each of the two middle performance quartiles of the WSP benchmarking data:

• Kullu (ranked 9th out of 12 districts = randomly se-lected “below average” district)

• Una (ranked 6th out of 12 districts = randomly se-lected “above average” district)

During the assessment, a review of the benchmarking data revealed that Kullu district had been wrongly ranked due to an error in the automatic benchmarking spreadsheet. Kullu is the highest ranked district for household latrine cover-age (104 percent of TSC target achieved in May 2010); has achieved 99.5 percent ODF coverage (203 out of 204 GPs have been declared ODF); and has the best “financial effi-ciency” with an expenditure of only Rs 0.55 lakh per ODF community (US$1,220).7 Unfortunately, no score was al-located to Kullu for its financial efficiency, and it has not yet applied for many Nirmal Gram Puraskar or clean village awards (NGP) awards,8 thus it was graded as a below aver-age performer. Following a correction to the financial ef-ficiency score, which awards an over-large 15 points to the top performer in this category, Kullu was re-ranked as the second best performing district.

In contrast, the benchmarking data suggested that Una district was an above average performer, yet it was found during the fieldwork to be one of only three “lagging districts” in HP. Again, the financial efficiency score ap-pears to be the main culprit here—Una was the second best performer on financial efficiency, achieving 193 ODF gram panchayats (GPs) despite spending only 21 percent of its TSC allocation, thereby gaining an additional ten benchmarking points that carried it into the above average category.

In MP, the following two districts were randomly selected for assessment from each of the two middle performance quartiles of the WSP benchmarking data:

to government agencies, international agencies, international non-governmental organizations (NGOs), local NGOs, private-sector businesses, and community-based organiza-tions (CBOs). These primary data sources were contacted at all appropriate levels: national, state, district, and local. Sec-ondary data sources comprised key documents, and potential influencers or secondary implementers such as media, minis-tries with no direct involvement, advocacy groups and so on.

2.3 Sampling ProtocolSampling was purposive for all primary data sources.

Criteria for selection for both interviews and self-reports included stakeholders that:

• Had participated in a sanitation program (or related program) for at least six months;

• Represented a main workforce type—a decision-maker, an implementer, or a mid-line supervisor or manager of the program; and

• Represented one of the different levels of the orga-nization that are involved in the program: national, regional, district, and local.

The stakeholders interviewed and the main assessment ac-tivities are listed in Annex 1.

District Selection ProcessDue to the limited time available, only two districts were visited in each state. Based on program performance infor-mation provided by the program team, one above-average district and one below-average district were selected in both HP and MP.6 High and low performing districts were not included in the sample frame as the exceptional contexts and institutional conditions in these districts are unlikely to be replicated in other districts. However, representatives from high-performing districts were invited to a stakeholder review and learning event held in each state at the end of the fieldwork period in order to capture learning from the innovations and successes in these areas.

6 The project team developed a performance benchmarking system that ranked district sanitation performance, and was utilized for cluster randomized sampling of one district from each of the two middle performance quartiles (excluding the best performing and lowest performing quartiles).

7 At the time of the endline assessment in September 2010, the official exchange rate was: US$1 = Indian Rupees (Rs) 458 Thirty-five percent of the benchmarking score is allocated for NGP achievements (15 percent for the number of NGPs achieved, 10 percent for the percentage NGP coverage,

and another 10 percent for the NGP success rate in the last year).

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• Jhabua (ranked 24th of 48 districts = randomly selected “above average” district)

• Chhindwara (ranked 27th of 48 districts = randomly selected “below aver-age” district)

Jhabua district reports high performance in household latrine coverage and school sanitation coverage, with TSC online monitoring data suggesting 124 percent latrine achievement (top ranked in state) and 101 percent school toilet achieve-ment (2nd ranked in state), but these apparent outputs are not matched by its outcome-based indicators. Jhabua ranks 23rd for the number of NGPs achieved; 30th for NGP coverage; 37th for NGP success rate; and 29th for financial effi-ciency. The lower outcome and financial efficiency indicators suggest either that the latrine output data have been over-stated, or that they have not translated into sustainable outcomes, both of which support the classification of this district as above-average (rather than the higher classification implied by the reported household latrine coverage data).

Chhindwara district is a lower performer than Jhabua in terms of outputs, but has similarly average to below average outcome achievements. However, Chhindwara’s performance has been unusually turbulent: a supportive and committed district collector led a successful program that achieved 21 of its current total of 27 NGP awards during 2007–08, but the district then failed to get its TSC proposal approved due to bureaucratic issues and was without fi-nancing for almost 18 months. During this time the campaign stalled and little progress was made. As a result, the number of NGP applications has declined over the last three years: 120 in 2008, 74 in 2009 (largely re-applications from failed 2008 applicants), and only 57 applications in 2010 (including 40 GPs re-applying for the third time).

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3.1 General3.1.1 Himachal Pradesh (HP)HP is a small state in the mountainous northwest section of India, bordered by Tibet to the east and Jammu and Kashmir to the north. The lowest point in the state is at an altitude of 450m above sea level, and the highest reaches 6,500m. As a result, some parts of HP experience extremely cold winter temperatures.

The state is divided into 12 districts, which contain 75 blocks and 3,243 Gram Panchayats (GPs). It is a predominately rural state, with 90 percent of the population (5.5 million people) living in rural areas. About 25 percent of the popu-lation belongs to scheduled castes. HP has one of the high-est per capita state incomes in India, deriving from a strong economy built around agriculture, hydroelectric power, and tourism. HP also receives substantial remittances, particu-larly from army personnel and other Government of India (GoI) officials. A 2005 Transparency International survey ranked HP as the second least corrupt state in India, after Kerala out of twenty states assessed in the survey.

3.1.2 Madhya Pradesh (MP)MP is often called the ‘Heart of India’ because of its land-locked location in central India. Until 2000, when the state of Chattisgarh was carved out from its bounds, MP was the largest state in India. It is now the second largest Indian state, covering 308,000 square kilometers, and is the sev-enth most populous with a total of about 60 million inhab-itants. Its huge land area means that the population density in MP is 40 percent lower than the national average.9

In 2003, MP formed three additional districts by further sub-dividing existing districts, bringing the state total to 48 districts, which contain 313 blocks and close to 23,000 GPs. There is a significant tribal population in MP: 89 blocks (28 percent) are considered ‘tribal blocks,’ and one third of all children attend residential tribal schools. Furthermore, incomes are low and MP is reported10 to have the lowest per capita expenditure on food of all Indian states, reflecting widespread poverty and lack of livelihood security.

ContextIII.The 2008 District Level Household and Facility Survey (DLHS 2008) published by the Ministry of Health and Family Welfare reported that 35.7 percent of rural house-holds in MP are in the lowest wealth quintile in India, com-pared to only 0.8 percent of rural households in HP. The same survey also found that only 8 percent of rural house-holds in MP live in pucca houses (made from permanent materials), compared with 42 percent in HP.

The previously mentioned Transparency International sur-vey rand MP as the third most corrupt state out of twenty states assessed in the survey.

3.2 HealthDespite its rural nature, HP has above average human de-velopment indicators for India, and is bettered only by Ker-ala in both infant mortality rate (36 deaths per 1,000 live births) and literacy rate (77 percent).

MP has low human development indicators: the under-five mortality rate is the highest of any state in India at 137 deaths per 1,000 live births11 (compared with an all-India average of 95 under-five deaths per 1,000), and reaches as

9 According to the 2001 Census of India, MP has a population density of 194 persons per sq. km compared with average 324 per sq. km in India.10 National Council for Applied Economic Research (NCAER), 1999 India: Human Development Report11 National Family Health Survey II (mortality rates for the five year period preceding the 1998-99 survey)

FIGURE 1: INFANT MORTALITY RATES

Infa

nt d

eath

s p

er 1

,000

bir

ths

100

1993Key

1998 2005

90

80

70

60

50

40

30

20

10

0

Himachal Pradesh All India Madhya Pradesh

56

7885

34

68

86

36

57

70

Source: NFHS I, II, III

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assessment teams in 478 districts (under the district level monitoring program) indicate that latrine usage rates are only around 80 percent nationally, with significant varia-tions across and within states.

3.4 Legal FrameworkThe Constitution of India determines that water sup-ply, sanitation and other public health services are state responsibilities. However, the 73rd and 74th Constitu-tional Amendments allow states to pass the responsibility and powers for water supply and sanitation down to local governments.

In HP, the Himachal Pradesh Panchayati Raj Act 1996 (updated 2001) states that sanitation is a local body (GP) function, but prior to TSC few GPs were aware of their responsibility or showed any interest in undertaking sanita-tion activities. Specifically, GPs are responsible for:

• Sanitation,• Clearing of roads and drains,• Organizing school health check-up programs,• Reporting the outbreak of gastroenteritis and any

other epidemic,• Construction and maintenance of village drains and

disposal of wastes, and• Prevention and control of water pollution.

In MP, the Panchayati Raj and Gram Swaraj Act 1993 del-egates responsibility for rural water supply and rural sanita-tion to the Gram Sabha,12 including:

• Sanitation,• Regulation of the construction of household latrines,

urinals, drains and water closets, and• Construction, maintenance and clearing of public

streets, latrines, drains, and other public facilities.

Despite the existence of a Model Public Health Act 1987 (revised) prepared by the Government of India, and the clear responsibility of the state for public health services, neither HP nor MP has adopted a Public Health Act. As a result, there is no legislative framework for the regulation of public health services in the state.

high as 152 deaths per 1,000 live births (15 percent) in rural areas. Infant mortality rates in Madya Pradesh have dropped by 19 percent since the 1998 National Family Health Survey (NFHS), but they remain 23 percent higher than the all-India average (see Figure 1) and almost double those in HP.

3.3 Sanitation and HygieneThe practice of open defecation has long been traditional in rural India. According to the 2001 Census data, only 22 percent of the rural population in India owned latrines (see Figure 2).

In addition, the supply-driven nature of previous sanita-tion interventions such as the 1986–1998 Central Rural Sanitation Program (CRSP), in which highly subsidized sanitation facilities were provided to rural households un-convinced of their benefits, meant that a large number of these latrines were not used.

3.3.1 Scale of ChallengeSimple linear projections of rural population growth show that in order to achieve the target of universal sanitation by 2012 accelerated progress is required. National progress has been reasonably good, with some surveys estimating that 2.8 million individual household latrines (IHLs) were con-structed annually over the 2001–2005 period. However, at that rate, universal sanitation would not be achieved until 2024. In addition, latrine usage remains a problem—sample surveys carried out by Government of India (GoI)

12 General village-level body consisting of persons registered in the electoral rolls

FIGURE 2: TREND IN RURAL SANITATION COVERAGE—INDIA

Pro

po

rtio

n o

f R

ural

Ho

useh

old

s w

ith

Latr

ines

(%)

Year

0

1975

1980

1985

1990

1995

2000

2005

51015202530

1 14 3

611 10 11

1417

1718

22

24

Source: India Assessment 2002 (PC) and Census of India 2001

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A key differences between India and either Tanzania or In-donesia is the pre-existence of a large-scale rural sanitation program. As described in more detail in the following sec-tion, the Total Sanitation Campaign (TSC) is a huge and ambitious program—in its current phase, the total TSC budget now exceeds US$3.9 billion, with US$267 million (Rs 1200 crore) budgeted for the 2009–10 financial year, with a goal in the current five-year phase (2008–2012) to provide toilets to 115 million households and achieve ODF status across India by 2012.

The program worked through TSC in both HP and MP. Prior to the start of the program, the WSP team had al-ready established a good relationship with the Government of HP by 2005, resulting in the formulation of a strategy for rural sanitation in HP, and the secondment of a senior HP government official to WSP for two years. It was hoped that the program would enable the WSP team to enhance and broaden the level of support provided in both states: to leverage TSC resources and sector opportunities at the national level, to extend its pre-existing engagements at the state level, and to facilitate achievement of THE PRO-GRAM objectives and outcomes. At national level, THE PROGRAM would also allow WSP to provide practical guidance on policy and implementation at scale, and to strengthen the analytical framework of TSC.

4.1 Evolution of the Total Sanitation CampaignIndia’s first nationwide program for sanitation was the Cen-tral Rural Sanitation Program (CRSP), which was initiated in 1986. This program focused on provision of household sanitation facilities using a hardware subsidy to “generate demand” for pour-flush toilets. In light of relatively poor national sanitation coverage, a revised CRSP (RCRSP) was launched in April 1999. The revised program advocated: a shift from a high-subsidy to a low-subsidy regime; greater household involvement and demand responsiveness; pro-motion of a range of toilet options to promote increased affordability; and strong emphasis on information, educa-tion, and communication (IEC) and social marketing. The

Total Sanitation CampaignIV.program envisaged complementary activities such as mason training and supply of materials through rural sanitary marts and production centers, and promoted school sanita-tion as an entry point for encouraging wider acceptance of sanitation by the rural population.

After pilots in selected states, the program was announced as the Total Sanitation Campaign (TSC) for roll-out on a national level in 2003. The program included assistance for construction of individual household toilets, sanitary complexes for women, school sanitation, and the setting up of alternative delivery systems such as rural sanitary marts. The recognition that water and sanitation in schools are critical to the formation of proper attitudes and habits for hygiene, sanitation, and safe water use and that schools are powerful channels for communicating hygiene messages to households and communities was reflected in the empha-sis on school sanitation programs. Likewise, measures were advocated to raise awareness levels and improve hygiene behavior, while simultaneously advocating the “capacity-building” of program delivery staff and other stakeholders through training initiatives.

The TSC is a comprehensive national program designed to improve rural sanitation coverage and latrine use, and to elim-inate the practice of open defecation. TSC was initiated in seven of the twelve districts in HP by 2005, and had expanded into every district by 2007. The program and was started in MP in 2000, expanding to all forty-five districts by 2003.

The key objectives of TSC are to:

• Improve the quality of life in the rural areas,• Accelerate sanitation coverage in rural areas, • Generate felt demand for sanitation facilities through

awareness creation and health education,• Provide rural schools and nursery schools13 with san-

itation facilities and promote hygiene education and sanitary habits among students, and

• Encourage cost-effective and appropriate technolo-gies in sanitation.

13 Nursery schools (crèches) are known as Anganwadis in India.

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4.2 TSC MethodologyThe Department of Drinking Water Supply (DDWS) is re-sponsible for the Total Sanitation Campaign, through the mission director of the Rajiv Gandhi National Drinking Water Mission and its CRSP. In most states, either the Rural Development Department (RDD) or the Public Health En-gineering Department (PHED) are given responsibility for state-level management of TSC project, with a state Water and Sanitation Mission (SWSM), which is a multi-stakeholder body including all relevant government departments and non-government stakeholders, mandated as the main body responsible for planning, supervising and monitoring the implementation of drinking water and sanitation programs in the districts. The program management arrangements also provide for suitable institutional arrangements at the district and sub-district levels. The fund flow for the centrally spon-sored programs like TSC is directly to the district, with the matching state share being released when the utilization and request is put in by the district agency.

TSC operates through district projects of three to five years in duration, each jointly financed by the GoI, the state gov-ernment, and the beneficiary households. The funding split varies according to the program component, but averages about 65 percent from the GoI, 23 percent from the state government, and 14 percent from the beneficiaries. TSC fi-nancial framework specifies exactly how the program funds are to be earmarked and divided between components and funding sources (see Table 2).

The approach adopted by the campaign aims at motivating rural households to build latrine facilities and encouraging them to use them. Thus, the emphasis is on designing strat-egies to motivate individual households so that they realize the need for good sanitation practices, and as a result, over time not only construct toilets but also have the members of the family use them. In addition, the program also aims to modify and improve personal hygiene behavior.

Following a mid-term review of TSC, a new set of revised guidelines was issued in 2004. These guidelines accorded emphasis on sanitary arrangements, not merely on the con-struction of household latrines. Two outcome-based objec-tives were highlighted:

• Eliminate open defecation to minimize risk of con-tamination of drinking water sources and food,

• Convert dry latrines to pour flush latrines, and • Eliminate manual scavenging practices.

The school sanitation and hygiene component was strengthened; with the provision of toilets extended to Anganwadi centers, all levels of schools (primary, middle, secondary, etc.) and all village government buildings. The GoI sought to re-orient the focus of the sanitation program to achieving the outcome of an open defecation free (ODF) environment. As a result, not only individual households, but also villages and panchayat governments were targeted.

TABLE 2: TSC COMPONENTS: REVISED EARMARKING AND FUNDING PATTERN

Component Amount Earmarked

Relative Contribution (%)

GoI State HHD

IEC campaigns and start-up activities Up to 15% 80 20 —

Alternate delivery mechanisms (production centers, sanitary marts) Up to 5% 80 20 —

(i) Individual latrines for BPL hhds

(ii) Community sanitary complexes Amount required for full coverage

60

60

28

30

12

10

Individual latrines for APL hhds Nil — — 100

Institutional sanitation (anganwadi, school & public facilities) Amount required for full coverage 70 30 —

Administration (training, overheads, M&E) Less than 5% 80 20 —

Solid and liquid waste management (capital costs only) Up to 10% 60 20 20

Source: DDWS (2010) Total Sanitation Campaign: Guidelines Central Rural Sanitation Programme.Note: Revised patterns per June 2010 Guidelines

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“The construction of household toilets should be under-taken by the BPL household itself, and on completion and use of the toilet by the BPL household, the cash incentive can be given to the BPL household in recognition of its achievement.”14

In addition, TSC guidelines clearly state that individual rural households should have a choice as to the type of la-trine that is built:

“The physical implementation gets oriented towards satisfying the felt needs, wherein individual households choose from a menu of options for their household la-trines. The built-in flexibility in the menu of options gives the poor and disadvantaged families opportunity for subsequent upgradation depending on their re-quirements and financial position.”15

The same text regarding the provision of the cash incen-tive to the BPL household after “completion and use of the toilet”, and households choosing from a menu of la-trine options, is retained in the June 2010 revision of TSC guidelines.

2006 TSC Guidelines Revisions: Raised SubsidyFurther revisions to TSC guidelines were issued in March 2006, stipulating that the incentive for BPL household la-trines would increase from Rs 500 to Rs 1200. This ap-parently inflation-driven revision doubled the maximum latrine cost to Rs 2000, in large part because the basic low cost unit now included the superstructure. This revision represented a substantial change for TSC, both in terms of the higher financial requirements of the campaign because the amount of the BPL latrine incentive increased by 240 percent, and an adequate superstructure must be provided before completion and usage can be verified.

In addition, the 2006 revisions state that financing for household latrine incentives should now cover the “actual amount required for full coverage [of the BPL households].” Similarly, financing for institutional toilets (including school and anganwadi toilets) includes the “actual amount

The district is required to submit a program proposal (in line with the guidelines issued by GoI) and a program im-plementation plan to the state government to receive GoI funding. Each state is required to establish appropriate in-stitutional arrangements to facilitate program implementa-tion by districts and monitor implementation. Specialist consultants from the fields of communication, human re-source development, monitoring, and school sanitation and hygiene education can be appointed as consultants at the state level, and where required at the district level.

The states remain free to devise their own specific ap-proaches within the broad framework provided by the pro-gram. Several states, notably Maharashtra and West Bengal, have modified TSC guidelines to mesh better with their existing sanitation initiatives, such as the use of part of the latrine subsidy funds in the promotion of improved sani-tation and hygiene practices. In addition, TSC guidelines provide a flexible framework for district projects, allow-ing different methodologies to be adopted depending on the different contexts, demands, and capacities within the district.

While the program delivery strategy in most states follows the overall TSC framework, the structure and institutional link-ages varies with the situation of local self-government systems and the mode of development program administration in the state. In states where the local governments system (Pan-chayati Raj Institutions or PRI) is mature, and financial and functional devolution has taken place, the fund flow contin-ues down to the sub-district (block) level for awareness cre-ation and overall program management, while in other states the program (and fund) management is centralized with the district administration and sub-district tier functionaries are directed and managed from the district level.

4.3 TSC Latrine SubsidiesUnder TSC, financial incentives were to be paid to below-poverty-line (BPL) households up to 80 percent of the cost (Rs 625) for a basic latrine unit (usually a single pit latrine without a superstructure), and 60 percent for latrine models costing up to Rs 1000. However, TSC guidelines state that:

14 GoI TSC Guidelines 2004a15 GoI TSC Guidelines 2004b

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required for full coverage.” Community contributions for school and anganwadi toilets, which were previously set at 10 percent, were no longer required.

4.4 TSC Incentive FrameworkFollowing the success of state incentive schemes like the Sant Gadge Baba Gram Swachayata Abhiyan scheme in Maharashtra, which is an annual competition for the cleanest village, the GoI introduced the Nirmal Gram Puraskar (Clean Village Award or NGP) in October 2003. Local governments are eligible to apply for the NGP award on achieving the following collective outcomes across their entire jurisdiction:

• One hundred percent sanitation coverage of individual households,• One hundred percent school sanitation coverage (with separate facilities

for boys and girls),• Being free from open defecation, and • Maintenance of a “clean environment.”

GPs, blocks, and districts are eligible for the award, as are individuals and orga-nizations that contributed significantly to achieving the goals within a particular area. The cash award16 ranges (depending on population size) from Rs 0.5 to 5 Lakh17 (for GPs); Rs 10 to 20 Lakh (for blocks with all their GPs being covered); to Rs 30 to 50 Lakh (for districts, with 100 percent blocks and GPs covered). Individuals and organizations can win cash awards of Rs 10,000 to Rs 50,000. The cash incentive provided to local governments is to be used for improving and maintaining sanitation facilities in their respective areas, with a focus on safe disposal of solid and liquid wastes and maintenance of sanitation standards.

16 The amounts mentioned are according to the revised incentive provision as of 2007. In the earlier two years, the incentives for panchayat ranged from Rs 2–4 Lakh.

17 Note: One lakh rupees = one hundred thousand rupees (US$2500).

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The baseline assessments of the enabling environment for rural sanitation improvement in HP and MP were con-ducted in mid-2007. The following section summarizes the key findings from these baseline assessments in order to set the scene for the endline findings.

5.1 Himachal Pradesh: Sanitation Coverage at BaselineAccess to improved sanitation in HP was marginally above average prior to the program, with 28 percent sanitation coverage reported in 2001. About 380,000 toilets were built through subsidy-based programs in the 1990s: the CRSP and state Rural Sanitation Program (SRSP) provided up-front hardware subsidies of Rs 1,700–2,000 per household toilet, but a 2003 rapid assessment in six districts18 found that these supply-driven programs resulted in toilet usage of only 20-30 percent, with some surveys reporting usage as low as 15 percent,19 indicating that there was little sustain-able impact on sanitation coverage during this period.

The 2003 rapid assessment also found that, despite per-ceptions that latrines were expensive to construct, more than 60 percent of the household latrines surveyed were constructed by private individuals without any external assistance, and that usage levels were close to 100 percent among private latrine owners. Stakeholder interviews sug-gested that the people of HP perceive themselves to have a relatively unpolluted environment and a healthy lifestyle. However, despite a cultural affinity with the mountains and forests, this perception is not supported by conditions in the wider communal environment; unsafe excreta disposal and indiscriminate waste disposal were widespread out-side the immediate domestic sphere. Another assessment20 found that 90 percent of the population still practiced open defecation, with nearby forests, nalas,21 and riverbanks re-ported as common defecation sites.

TSC online monitoring data suggest that sanitation cover-age began to rise fairly rapidly from 2005 onwards, reaching

Baseline FindingsV.around 39 percent in mid-2007. While little large-scale la-trine usage data were available at baseline, TSC district level monitoring surveys from early 2007 suggested that latrine usage was above 90 percent in HP; it was therefore assumed that most of these new latrines provided sustainable access to improved sanitation.

5.2 Madhya Pradesh: Sanitation Coverage at BaselineAccess to improved sanitation in MP was particularly low prior to the program. The 2001 Census reported 8.9 per-cent rural sanitation coverage in MP, while other surveys suggested that this figure may have been an over-estimate. A number of districts in MP face water scarcity problems, which further inhibits sustainable use of sanitation facilities and improved hygiene behavior, as reliable water supply is often required for anal cleansing, toilet flushing, and hand-washing. In addition, the social and cultural challenges faced in the tribal belts have led to dependence on handouts and supply driven approaches that tend to be ineffective in generating sustainable sanitation behavior change.

TSC online monitoring data suggest that sanitation cov-erage began to rise from 2002 onward, reaching around 30 percent in mid-2007. Although little large-scale la-trine usage data were available at baseline, TSC district level monitoring surveys found that latrine usage was only around 50 percent in MP, thus the effective increase in sus-tainable access to improved sanitation was probably much lower than that indicated by TSC online monitoring data.

5.3 Baseline Assessment FindingsIn general, the enabling environment for rural sanitation improvement in India was already strong at baseline. TSC provided a solid financial and policy framework for the na-tional goal of universal sanitation by 2012, which exceeds the 2015 MDG sanitation goal pursued by TSSM, TSC is further supported by the NGP sanitation incentive pro-gram, which rewards local governments and individuals

18 Strategy for Total Rural Sanitation in HP 2005, 2.19 Ibid, 1.20 Knowledge Links 2005. 21 Natural drainage channels (which are often dry in northern and central India).

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UNICEF has been a significant development partner in MP, working closely with the government on a number of water, sanitation, and hygiene (WASH) activities over several years through a state program office staffed by an international UNICEF WASH specialist. As a result, the introduction of program activities in this state has been against the backdrop of the slightly different policies and interventions previously promoted by UNICEF. Efforts to harmonize the WSP and UNICEF sanitation support ac-tivities, and to align better with the government’s planning and priorities, were ongoing at the time of the assessment. No other development partners were working on rural sani-tation in HP at the time of the baseline assessment.

Sanitation marketing had been limited to the promotion of production centers and rural sanitary marts that sup-ply components for government-designed latrine models, based entirely around the BPL cash incentive provided by TSC with almost no allowance for variations in household taste, willingness to pay, or local constraints.

The baseline assessment found that TSC and NGP pro-grams focus on the achievement of the NGP award, but lack any active mechanisms to extend, sustain, and monitor sanitation development after this achievement. In addition, the wider environmental sanitation requirements of the NGP award appeared too difficult for many local govern-ments to achieve, thus some become disenchanted after the initial process is completed.

The District Level Monitoring (DLM) process conducted by the Department of Drinking Water and Sanitation (DDWS) sampled community sanitation coverage and latrine usage among BPL households in 478 districts in early 2007, providing useful sanitation outcome data for comparison against the detailed supply-side data from TSC on-line monitoring system, and the less frequent nation-ally-representative household surveys. While some reserva-tions were expressed about the quality of the DLM data, the baseline assessment found that this large-scale system was an important component of the enabling environment.

The baseline performance data indicated differences in san-itation outcomes in HP and MP. The TSC was doing rela-tively well in HP, despite the late start in several districts,

that achieve well-defined collective sanitation outcomes. In addition, India has an extensive local government system that reaches most rural communities, and has long experi-ence of implementing large rural development programs.

Although TSC has operated since 1999, it is only since 2004 that the elimination of open defecation and the achievement of collective sanitation outcomes have been promoted. Nonetheless, TSC at baseline was broadly in keeping with the total sanitation approach, and TSC and NGP guidelines provided a well understood framework for sanitation and hygiene improvement, with the result that most state and district governments were actively engaged in sanitation promotion, implementation and monitoring.

The budget allocated to TSC almost doubled in the two years prior to TSSM program implementation, indicating growing political awareness and support for the rapid sani-tation improvements achieved by TSC and NGP programs. However, the growing management requirements of TSC have not been matched with sufficient state or district level personnel, and there remains a shortage of implementation partners with adequate experience of rural sanitation and community development.

Nevertheless, the broad financial and policy framework provided by TSC allowed individual states and districts significant latitude to develop local approaches and inter-ventions according to their specific needs, priorities, and preferences. While this freedom limits central control of program implementation, it allows more progressive local governments to innovate and develop effective approaches, policies, and practices. As a result, there is also a wide varia-tion in TSC effectiveness and in household outcomes in different states: for instance, the total sanitation approach had been embraced in HP, but support for this approach remained low in MP.

The institutional arrangements in MP were due to change at the time of the baseline assessment, with responsibility for TSC planned to shift from the PHED to the RDD. It was anticipated that this shift would increase focus on the achievement of collective sanitation outcomes by local governments, and lessen the supply and technology-driven approaches favored by the engineers from the PHED.

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with the DLM survey reporting almost universal toilet usage among poor house-holds compared to 81 percent toilet usage by poor households in the rest of India. In contrast, despite higher progress the TSC did not appear to be performing as well in MP: only 65 percent of poor households were using their toilets, and the expenditure per NGP award is almost three times that in HP (see Table 3).

Although the performance data might reflect, at least to some extent, the dif-ferent implementation paths taken by the two states, the baseline assessments suggested that the limited political commitment, weaker governance, and greater poverty in MP undermined the strong national enabling environment.

TABLE 3: COMPARATIVE TSC AND NGP PERFORMANCE

TSC Expenditure

(Rs million)

Household Toilets

(number) TSC Progress (%) BPL Toilet Usage (%)

2007 NGP Awards

(number)

HP 86 102,428 16 100 28

MP 1,639 1,748,874 23 65 191

Maharashtra 2,132 3,127,223 34 87 1,974

All India 30,353 33,261,001 29 81 4, 959

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TSSM supported rural sanitation improvement through TSC in all twelve districts of HP, whereas in MP the pro-gram team decided to concentrate the majority of its activi-ties in districts that expressed demand for support, and took part in capacity building, coordination, and strategy devel-opment activities. In all, the program supported twenty-two out of the fifty districts in MP, of which about fourteen districts were active and benefited from direct WSP support over the three-year program period.

6.1 Policy, Strategy, and Direction

Key Findings:• Political support for TSC had improved and was highly

evident in HP, whereas little change in political priority for rural sanitation was apparent in MP

• Despite significant increases in the BPL latrine incen-tive provided by TSC, HP has not provided subsidies for latrine construction by poor households; in contrast, MP has increased the size of the BPL incentive, and provided some subsidy to non-poor households, using resources from other rural development programs.

• HP has developed a clear strategy and direction for the achievement of universal sanitation, supported by effective policies and incentives; MP sets ambitious annual sanitation targets, but has made few real im-provements in policy, strategic planning, performance monitoring, or program support.

At national level, TSC remains significantly less important than flagship rural development programs such as the Na-tional Rural Employment Guarantee Act (NREGA), the Indira Awaas Yojna housing program, Swarnjayanti Gram Swarozgar Yojana income-generation program, and the Na-tional Watershed Development Program. However, despite this relatively low national priority, a large budget has been allocated to TSC, and the central program targets, guide-lines, and implementation models continue to dominate rural sanitation programming and policy across India.

TSC was originally seen as a five-year campaign22 imple-mented through district projects. While some states were

Endline FindingsVI.slow to become involved in the campaign, by 2003 MP had five-year TSC projects operating in all of its 45 districts.23 Seven years later and still far short of the government’s sani-tation targets, it is clear that TSC operates as a long-term national program rather than as a short-term campaign of fixed duration. Despite this recognition, there has been only limited discussion of the need for revisions to the for-mat or design of TSC to reflect the different handling and objectives of the current program.

WSP is currently assisting the GoI to develop a long-term rural sanitation strategy as part of wider efforts to formulate the 2012–2022 National Development Strategy. The future roles and objectives of both TSC and NGP are among the issues under discussion, although it seems likely that TSC and NGP will remain the main vehicles for the Govern-ment of India’s Nirmal Bharat (Clean India) vision of access to toilets for all by 2012.

DDWS organized a state minister’s sanitation conference in late September 2010 to present some of the more recent TSC and NGP evaluation and assessment findings to the states, with the intention of highlighting the higher perfor-mance found in states using better policies and processes, and encouraging reforms in those states with low perfor-mance. This conference would have been the first high-level sanitation-related conference for almost a decade, and was generating some excitement and interest among development partners that have been pushing for reforms for some time, but it was postponed due to a clash with another event.

6.1.1 Direction at State LevelIn HP, the state government had set itself the ambitious goal of making the state open defecation free by the end of 2009, some three years ahead of the national target; then extended this deadline to the end of 2010 when it became clear that the 2009 deadline would not be met. The Gov-ernment of MP has declared its intention for Nirmal MP (Clean MP) by 2012, in line with the GoI goal for universal sanitation by that date.

22 2010 TSC guidelines state that “TSC project cycle in the project districts is expected to take about 4 years or less for implementation”.23 Due to the sub-division of several large districts, there are now 50 districts in MP.

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chief minister and other high-level state officials. As a re-sult, there is widespread awareness of the raised priority for sanitation throughout the local government system, which in turn has led to strong coordination and collaboration between stakeholders, more effective implementation pro-cesses, and increased monitoring and attention to sanita-tion outcomes like latrine usage and sustainability.

Senior government officials, including the chief secretary of HP (who was formerly the union secretary for rural develop-ment responsible for TSC nationally, and therefore has a par-ticular interest) and the secretary of rural development, took time out of their busy schedules to discuss TSC and NGP progress with the assessment team, demonstrating a good un-derstanding of the issues, a realistic stance on the challenges involved in reaching the 2012 state sanitation target, and considerable interest in the initial findings of this assessment.

The improvements in political support and program lead-ership since baseline appear to reflect a form of virtuous circle in which increased political attention strengthened commitment and accelerated progress, which further raised the program profile and broadened its appeal, resulting in wider improvements to inter-sectoral support, implementa-tion and progress monitoring, thereby generating dramatic and extensive recent progress.

Direction in MPMP was the first state to implement TSC in every district, but rural sanitation still remains a low priority when com-pared to NREGA, road building, watershed development and rural water supply. Despite comments that senior state politicians were committed to sanitation improvement, there was little hard evidence that political commitment had in-creased greatly at either state or district level since baseline. A few district exceptions were reported, with good performance in a handful of the 50 districts, but this appeared to reflect the commitment and application of specific local governments and individuals rather than a wider enabling environment.

The focus in MP remains on toilet building and target-driven NGP activities, which results in a more supply driven approach than that in HP. TSC guidelines state that “the

The varying urgencies of the state targets reflect both the different initial conditions and the differing political sup-port for sanitation. HP had 28 percent sanitation coverage in 2001, whereas MP had only 9 percent coverage, and HP has higher levels of human development than MP. How-ever, perhaps more important to the success and ambition of the program has been the way in which the states decided to use TSC resources and the priority attached to the pro-gram by state politicians.

Direction in HPThe Government of HP has continued to follow the prin-ciples of its progressive 2005 Strategy for Rural Sanitation in HP, which stated that no latrine subsidies would be paid to below poverty line households. This radical decision, first taken when the BPL latrine incentive was only Rs 500 (US$11), has meant that a significant proportion of TSC funds were not used, and that district governments have had to develop highly cost-effective approaches to creating demand for sanitation without the incentive of hardware subsidies for latrine construction.

Interestingly, the main focus in HP over the last three years has been on achieving ODF communities rather than on the higher profile and more difficult goal of NGP awards.24 As a result, a more phased approach to sanitation devel-opment has been followed: more than 85 percent of GPs have been declared ODF, but only 16 percent have won the NGP award. Now that the primary challenge of eliminat-ing open defecation is largely overcome, the government is turning its attention to the higher order problems of ad-dressing the sustainability of institutional sanitation facili-ties and the safe management of solid and liquid wastes.

It seems remarkable that the government and people of HP have achieved so much in such a short time, until notice is taken of the high level political support for sanitation im-provement. Every stakeholder remarked that the chief min-ister mentioned sanitation in every speech. Government officials stated that, where TSC was rated as the fourth (or lower) priority rural development program at baseline, it has now become the second most important rural develop-ment program in the state, with regular monitoring by the

24 The NGP criteria include broader environmental sanitation outcomes such as the safe management and disposal of household solid and liquid wastes.

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dry latrines. The new guideline recognizes the utility of dry latrines in cold and water-scarce zones, and allows the use of ecological sanitation facilities.

A new objective was also added to “develop community managed environmental sanitation systems focusing on solid and liquid waste management.” Up to 10 percent of the program cost can now be used to provide infrastructure for solid and liquid waste management. This revision reflects the inclusion of the solid and liquid waste management cri-teria in the NGP without any finance mechanisms being in-cluded under TSC or through other development programs.

The October 2007 guidelines also included for provision of a revolving fund in the district program, with up to Rs 50 Lakhs (US$109,000) funds to be taken from the five percent allocated to rural sanitary marts and production centers, for the provision of toilet loans to BPL and above poverty line (APL) households.

A further revision to TSC guidelines was issued in June 2010, immediately prior to this endline assessment. The new guide-lines revised the deadline for the full coverage of sanitation facilities in schools and anganwadis to March 2012, but oth-erwise retained the same objectives as the previous guidelines. A new section was introduced to promote and detail the use of ecological sanitation facilities, including urine-diverting toilets and waterless urinals, with these new concepts to be promoted alongside existing total sanitation approaches.

Another major change in the 2010 TSC guidelines is that TSC funds are now released to the SWSMs rather than di-rectly to districts, with the SWSM now responsible for veri-fying that the districts have met the criteria for the release of funds.

2008 Increase to TSC Incentive to BPL HouseholdsThe DDWS issued a government order25 in October 2008 to increase the unit cost of individual household latrines provided under TSC from Rs 1,500 to Rs 2,500, with the BPL incentive increased from Rs 1,200 to Rs 2,200, while the household contribution was kept at Rs 300. This pol-icy revision amounts to an 83 percent increase in the BPL

construction of household toilets should be undertaken by the BPL household itself, and on completion and use of the toilet by the BPL household, the cash incentive can be given to the BPL household in recognition of its achievement.” Despite this clear central guideline, common practice in MP is to use the BPL incentive funds to purchase latrine materi-als and hire contractors or masons to build household toilets, with little household involvement and rare instances when cash payments are made to individual BPL households.

It proved very difficult to meet senior state government of-ficials in MP. Neither the secretary of rural development nor the director responsible for TSC were able to make time available for a formal meeting to discuss TSC progress and TSSM support, although both did attend one hour of the Bhopal workshop organized to discuss and ground truth the initial findings of this assessment. While the limited access to senior officials undoubtedly reflects their busy schedules, it contrasted strongly with the experience in HP where high-ranking officials went out of their way to assist and inform the assessment. The implications are that TSC has a lower priority within the state government of MP, and that WSP has not managed to establish as close and produc-tive a partnership with government in MP as in HP.

6.1.2 TSC Policy Changes Since BaselineSeveral significant changes have been made to TSC guide-lines since the baseline assessment of the enabling environ-ment for rural sanitation improvement was completed in mid-2007.

A revised set of guidelines was issued in October 2007, which included the explicit objective to “accelerate sani-tation coverage in rural areas to access to toilets by all by 2012” and to provide sanitation facilities in all rural schools and anganwadis by March 2009. In addition, the objective to “convert dry latrines to pour flush latrines and eliminate manual scavenging” was dropped, with the more detailed wording of the guidelines revised to state that “construc-tion of bucket latrines is not permitted in the rural areas” and that “existing bucket latrines, if any, should be con-verted to sanitary latrines” where previously these policy statements referred to the prohibition and conversion of all

25 No. W-11037/6/2205-CRSP

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6.1.3 Comparative Analysis of Policies and OutcomesThe strategy and policies adopted in MP at endline con-trast markedly with those in HP, where the majority of TSC expenditures have been for sanitation promotion and com-munity mobilization, and where poor households reported that improved sanitation facilities could be built for as little as Rs 1,200 (US$26).

The significant government subsidies available for toilet con-struction in MP have enabled the government to accelerate toilet provision in areas where progress was previously slow, as the large subsidy facilitates a contractor-based approach and means that little or no contribution is required from the household. Unfortunately, this additional construction finance reduces the need for community participation in the sanitation development process as household contributions are no longer needed, which tends to decrease attention to the important areas of demand creation, sanitation promo-tion, and behavior change communication—with a conse-quent detrimental effect on latrine usage and sustainability.

A comparison of the supply-side data from TSC online monitoring system with household survey data from the 2001 Census, DLHS-2 and DLHS-3 surveys confirms the sustainability problems in MP: TSC online monitor-ing data show rapid coverage gains since 2006, whereas the demand-side household survey data show that sanitation coverage has barely changed since 2001. The household survey data suggest that few—perhaps only one in four—of the new latrines reported by TSC monitoring system are in use. In HP, the household survey data confirm the high latrine usage and sustainability rates suggested by the evalu-ation data, with around 90 percent of new latrines reported by TSC system found to be in use.

Strategic PlanningSignificant changes have occurred in the strategy followed in HP. At baseline, a few districts had adopted progressive and strategic approaches but the majority continued to use a conventional toilet building approach with little interfer-ence from the state level. In the last three years, high-level interest in the program and visible success in the more

incentive in the 2.5 years since the previous March 2006 revision. The inclusion of finance for the latrine superstruc-ture explains part of the large increase, while DDWS offi-cials also noted that the price of construction materials had risen dramatically in the last few years.

The June 2010 revision to TSC guidelines retained the Rs 2,500 unit cost and the Rs 2,200 BPL incentive, mean-ing that the BPL incentive has more than quadrupled from Rs 500 (US$12) at baseline to Rs 2,200 at endline (US$48). There were also suggestions that the DDWS plans to increase the BPL incentive further in the near fu-ture, perhaps by as much as Rs 1,000, due to continuing pressure from states that already provide large discretionary additions to the minimum TSC incentive for below pov-erty line households.

TSC Incentive Policy in MPIn 2008, when TSC latrine incentive rose to Rs 2,200 (US$48) per BPL household, many local governments in MP continued to complain that this amount was insuffi-cient for the construction of a hygienic toilet with an ad-equate superstructure. As a result, the state government decided to allow some of the NREGA cash-for-work funds to be used for the construction of brick-lined latrine pits. The Nirmal Watika (Clean Garden) scheme uses NREGA cash-for-work funds to provide Rs 2,700 to Rs 5,000 (US$59–109) per household for the construction of two brick-lined latrine pits and the planting of five fruit trees,26 with the intention that the latrine pits will provide addi-tional nutrients for fruit production.

As a result, local governments in MP now have as much as Rs 7,200 (US$157) per BPL household available for the construction of toilets, and can spend up to Rs 5,000 on toilet construction for APL households that have job cards.27 This additional financing has increased the supply-driven nature of the program, with every household (both APL and BPL) in some poor communities now qualifying for hardware subsidies of Rs 3,000–7,000, which enables these village government to finance entirely free, contractor-built toilets for all.

26 Strictly, NREGA funds pay Rs 100 per person per day (for up to 100 days work), thus a Rs 5,000 Nirmal Watika investment should be payment for 50 days’ work, representing 50 percent of the total annual NREGA income available to a poor individual.

27 In some of the tribal areas of MP visited during the assessment, every single household qualified for Nirmal Watika assistance through their job cards.

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for assistance in these areas, WSP recently arranged expo-sure visits to solid and liquid waste management (SLWM) schemes in Maharashtra and Kerala, and organized SLWM training courses in Nainital.

In contrast, there was little evidence of strategic planning in MP (see Table 4). Implementation appears to be driven by the number of villages to be covered each year in order to reach universal coverage by 2012, with little adjustment for the available resources, strategic challenges, sustainability losses, or the likelihood that coverage will become harder to achieve towards the end of the process.

In the two districts visited during the assessment, the state-determined targets for each district dictated the annual number of NGP applications rather than the number of villages that met the NGP criteria and were ready to apply. This target-driven planning has encouraged coercive and short-term approaches, with a fixed number of village gov-ernments—usually those with the highest baseline sanita-tion coverage—being told that they must achieve NGP status each year. As a result, local implementation teams often over report progress and conceal problems as they struggle to meet these externally imposed targets.

strategic districts have been sufficient to persuade the state government to promote the more cost-effective approaches used by the successful districts, to encourage a phased strat-egy to sanitation development, to identify poor performing districts and areas, and to develop effective solutions for lag-ging, difficult, and remote communities.

The strategy has been successful. In nine out of the twelve districts in HP, more than 80 percent of GPs are now ODF, and five districts are close to achieving 100 percent ODF status. The other three districts (Lahaul and Spiti, Chamba, and Sirmaur) have reached 50–65 percent ODF coverage and are now receiving additional support and attention from the Government of HP. In several cases, government officials from districts with more successful sanitation programs have been transferred to the lagging areas to introduce more effec-tive approaches, mobilize resources, and accelerate progress.

Furthermore, the state government’s attention has shifted from achieving sanitation coverage and ODF targets to the higher level objectives of improving latrine usage, addressing the sustainable operation and maintenance of institutional sanitation facilities, and strengthening capacity for solid and liquid waste management. Following explicit demands

TABLE 4: ENABLING ENVIRONMENT IMPROVEMENTS: POLICY, STRATEGY, AND DIRECTION

Indicator 2007 Baseline 2009 Target 2010 Achieved

Strategic planning

HP: District strategies implemented

MP: District strategies implemented

1

0

12 (100%)

10 (25%)

9 (75%)*

4 (8%)**

Political support

HP: expenditure on state awards

MP: expenditure on state awards

0

0

US$163,000

US$435,000

US$600,000 (368%)

US$ 0 (0%)***

Effective policy

HP: BPL subsidy paid to household

MP: BPL subsidy paid to household

HP: % investment by BPL household

MP: % investment by BPL household

US$0

US$13

100%

10%

US$0

US$0

100%

50%

US$0

US$60–110

100%

0%

Policy alignment: total sanitation

UNICEF

WaterAid

DDWS

No

No

No

Yes

Yes

Yes

Yes

Partial

Partial

* Nine of 12 districts were reported to have implemented district sanitation strategies (compared to target of all 12 districts).**Four of 50 districts were reported to have implemented district sanitation strategies (compared to target of 10 districts)***The Government of MP allocated funds allocated to a sanitation award, but no awards have yet been made, therefore there has been no expenditure to date.

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6.2.1 State-level ArrangementsThe baseline assessment found that insufficient resources were attached to state-level management of TSC. Since then, the Government of HP has strengthened TSC units at both state and district levels. TSC funds have been used to finance the activities of both government officials and contracted consultants, providing considerably increased capacity to monitor and support TSC activities across the state.

State-level monitoring in HP confirmed better performance among districts that had employed local NGOs with large community-based networks to strengthen and expand TSC implementation. While not every district has a local non-governmental organization (NGO) with sufficient experi-ence and outreach, the state sanitation unit has encouraged lagging districts to seek out alternative solutions through employing successful NGOs from neighboring districts or convincing good local NGOs from other sectors to under-take sanitation and hygiene activities.

Where NGO support has been successful, the district gov-ernments worked closely with the NGOs and encouraged all levels of PRIs to provide active support to the NGO activities. Several NGOs commented that the level of pay-ment made by the district government was inadequate, par-ticularly given the scale and intensity of activities, but that the campaign’s public health focus and the visible support of local leaders allowed their grass roots networks of com-mitted volunteers and activists to mobilize communities ef-fectively. Women’s self-help groups (Mahila Mandal) were reported to be particularly effective channels for sanitation promotion.

In contrast, NGO involvement has been relatively limited in MP. As a result, the state government made the deci-sion to strengthen TSC coordination by adding a layer of contracted block coordinators below the existing district coordinators. Thirty-six TSC district coordinators (72 per-cent coverage) and 249 TSC block coordinators (80 per-cent coverage28) were working at the time of the assessment,

6.2 Institutional Arrangements

Key Findings• The Government of HP has strengthened TSC units at

both state and district levels, providing considerably improved capacity to monitor and support program activities.

• TSC’s institutional home and arrangements within the state government make little difference if there is no high-level pressure for improved performance, and no monitoring of the sustainability and quality of program outcomes.

• Improved coordination of all government and sanitation stakeholders has been an important success factor in HP.

• Because NGO involvement is limited in MP, the state government decided to strengthen TSC coordination by recruiting block coordinators below the existing dis-trict coordinators.

There have been no significant changes in the institutional arrangements set out by TSC guidelines, although a new sector institution was proposed in September 2010 when guidelines were issued for the establishment of Block Re-source Centers (BRCs) to support both the National Rural Drinking Water Program (NRDWP) and TSC. BRCs will contain between two and four paid government function-aries, and are intended to provide sub-district support for training, surveys, construction supervision, coordination, and promotional activities relating to rural water supply and sanitation.

BRC expenditures will be financed from the NRDWP allocation for support activities rather than from TSC, and the job description for the BRC block coordinators confirms that water supply services are likely to be the main focus of BRC activities. It is currently uncertain how significant or effective this new institution will be, but it should provide additional block-level resources for sanitation activities and thus may strengthen TSC imple-mentation and provide a sustainable support mechanism to improve the long-term monitoring of sanitation and public health outcomes.

28 There are 313 development blocks in MP.

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This finding suggests that the institutional home and ar-rangements make little difference if there is no political pressure for improved performance, and no monitoring of the sustainability and quality of program outcomes. Where elected representatives and senior administrators are committed to making TSC a success, the full gov-ernment machinery is utilized to implement the cam-paign, with regular monitoring and evaluation to ensure that activities are well coordinated and that resources are used cost effectively. Where TSC remains a low prior-ity and TSC online monitoring system shows reasonable progress, there is little incentive for those involved in implementation to follow up with the more comprehen-sive monitoring and evaluation that might expose any shortcomings.

6.2.3 CoordinationOne of the key findings in HP was that successful imple-mentation was due to impressive coordination between the different levels of government and the different depart-ments at each of these levels.

Effective government coordination remains an unrealized goal in many development arenas, despite the myriad co-ordination mechanisms available and concerted efforts by interested stakeholders. It is not easy to align the different agendas, motivations and preferences of numerous govern-ment departments and officials across large areas. Once again, the key factor here appears to be strong political commitment at state level. District commissioners and pro-gram officers reported that the chief minister of HP used a weekly video conference with the district heads to follow up on TSC progress, putting heavy pressure on any lag-ging areas. They reported that the importance of sanitation was now mentioned in every political speech and that local political leaders had become involved in the presentation of sanitation awards. As a result, all elected and administrative officials were aware that TSC was a priority and that any shortcomings would be noted at the highest level.

The state governments also noted that the WSP state coordinators had played an important role in support-ing TSC management at both state and district levels.

all financed from the administration budget in the district TSC projects.

The block coordinators cover large areas and are therefore unable to provide detailed support to implementation activi-ties, but they have improved monitoring at the GP level and provide regular feedback to the district coordinators. Unfor-tunately, much of the pressure for rapid progress falls on the district and block coordinators. Given that they are also re-sponsible for TSC monitoring, this top-down pressure creates a conflict of interest and encourages over-optimistic reporting of results.

6.2.2 TSC Institutional Home The baseline enabling environment assessment found that the PHED in Madhya Pradesh favored supply-driven and more technical approaches to sanitation development, and lacked the manpower or skills to undertake the behavior change based approach advocated by most stakeholders. As a result, both WSP and UNICEF encouraged the MP government to shift control of TSC from the PHED to the Panchayat & Rural Development Department (PRD). This transition had not yet happened at the time of the baseline assessment, but it was hoped that the PRD man-agement of TSC would ensure stronger participation by village governments and allow the introduction of more progressive and cost-effective approaches to sanitation improvement.

The PRD was given responsibility for TSC in MP in late 2007, shortly after the baseline assessment. Disappoint-ingly, three years later this endline assessment found that the reallocation has had little impact on policy, ap-proaches, activities undertaken, or outcomes. In practice, PHED delegated much of the work to the same district and village officials that are now responsible for pro-gram implementation, and there has been little pressure from above to change the way in which TSC funds are used. As a result, most districts have continued with the contractor-based and supply-driven approach, and use the same standard latrine designs, favored by the PHED, with little recognition that latrine usage and sustainabil-ity remain low.

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presenting the state government with different sanita-tion policies and strategies at the outset of the program, and both promoting slightly different implementation ap-proaches and institutional arrangements.

UNICEF has had a longer presence in MP, and has sig-nificant influence with the state government through a permanent office staffed by an international UNICEF WASH specialist and a significant budget for state activi-ties. As a result, some of the early WSP initiatives were undermined by parallel UNICEF activities and vice versa, which led to only limited cooperation and collaboration between the two agencies during the early phases of the program.

Over the last three years, inter-agency coordination has im-proved substantially. The arrival of a new UNICEF WASH specialist in early 2010, who had favorable experiences with Community-Led Total Sanitation (CLTS) in a previ-ous position, has galvanized joint activities and encouraged convergence on many key issues. Nevertheless, it was ap-parent that the state government has been able to play the two agencies off against each other for some time, for in-stance by preferring the UNICEF TSC performance rank-ing system over the program benchmarking system, and by adopting the consultant-based UNICEF approaches to institutional support ahead of the more sustainable arrange-ments promoted by WSP.

In addition to hands-on assistance in arranging capac-ity building and other support activities, the presence of a full-time coordinator prevented the state governments from letting TSC slip down the list of priorities, and encouraged more regular meetings and performance re-views. In HP, the state government noted that the recent lack of a state coordinator had allowed focus to drift from important strategic issues to more pressing local matters, and suggested that the state coordinator had been good at providing guidance and regular reminders to keep things on track.

The endline assessment found that the state and district missions were meeting more frequently than at baseline, with all but the MP State WASH Mission now meeting at least every two months (see Table 5). While it is hard to assess whether the regular coordination meetings have any significant impact on performance, the greater frequency provides solid evidence that busy government officials at-tach sufficient priority to rural sanitation improvement to organize and attend the meetings. It was also apparent that most rural development officials were aware of TSC status and progress

6.2.4 Sector Coordination in MPThe baseline assessment of enabling environment noted that there was an element of competition between WSP and UNICEF in MP, with both development partners

TABLE 5: ENABLING ENVIRONMENT IMPROVEMENTS: INSTITUTIONAL ARRANGEMENTS


Sector coordination Last meeting29: Last meeting: Last meeting:

National sanitation group — — —

HP: State WASH Mission 12 months 3 months 2 months

MP: State WASH Mission 15 months 3 months 8 months

HP: District WASH Missions 14 months 6 months 1 month

MP: District WASH Missions 14 months 6 months 2 months

29 Number of months since last meeting took place.

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updates to TSC guidelines, perhaps to reflect the increased emphasis on a broader concept of sanitation including solid and liquid waste management, institutional toilets, and personal hygiene.

The 2010 TSC guidelines focus more on toilet build-ing than on stopping open defecation and, despite the name, include no explicit total sanitation objectives or approaches other than “to cover all rural families” by 2012. However, the 2010 update to the NGP guidelines gives one of the four primary objectives as the develop-ment of “open defecation free and clean villages that will act as models for others to emulate.” In addition, the eli-gibility criteria for the award include “complete elimina-tion of open defecation within the boundaries of the PRI. Nobody, including floating population, defecates in the open and child feces are disposed of in toilets” and the guidelines now include a section on disincentives in case of a relapse from ODF status.

As at the beginning of the program, TSC guidelines focused on incremental increases in sanitation coverage, with the below poverty line (BPL) household latrine incentive pay-able on completion and use of an individual latrine rather than on achievement of a collective sanitation outcome in a village or GP. However, the NGP awards promote collective sanitation outcomes and encourage local governments to aim for community-wide improvements. In combination, TSC and NGP schemes provide a strong framework for sanitation improvement, with TSC ensuring that resources and mechanisms are available for effective implementation and the NGP encouraging comprehensive and community-wide sanitation improvements.

These policy adaptations have an important impact on the program methodologies adopted by state and district TSC projects, as they define the objectives and rules of the pro-gram, and therefore influence efforts to improve and refine program methodologies.

6.3.2 Support for Total Sanitation ApproachSupport for the CLTS approach, which aims to trigger sani-tation behavior changes that eliminate open defecation, has

6.3 Program Methodology

Key Findings• The 2010 update to the TSC guidelines focused on

building toilets, rather than stopping open defecation, and lacked any explicit total sanitation objectives or approaches.

• Despite the strong policy and financing framework pro-vided by the TSC and NGP, there remains limited con-sensus on program methodology among national and state stakeholders.

• Program methodologies differ widely by state, with HP using a demand-driven approach, and MP using a supply-driven approach.

TSC and NGP guidelines do not specify detailed program methodology, but instead provide a general policy and fi-nancing framework for the district projects. As a result, the methodologies used for critical components of the pro-gram, for instance how to stimulate household demand, promote sanitation improvement, and ensure sustainable behavior change, must be determined by individual states and district projects. The intention behind the broad TSC and NGP guidelines is to focus attention on achieving sani-tation outcomes rather than just counting outputs (which may or may not lead to positive outcomes, depending on how appropriate, useful, and sustainable the inputs and outputs turn out to be).

The program has three components that require detailed methodologies:

• Creating demand (using CLTS and BCC approaches),• Strengthening supply (using sanitation marketing

and BCC approaches), and• Improving the enabling environment for rural

sanitation.

6.3.1 Policy Impact on Methodology: Total SanitationThe 2004 update to TSC guidelines stated that the elimina-tion of “open defecation to minimize risk of contamination of drinking water sources and food” was one of the program’s primary objectives. However, this objective was not in-cluded in the six objectives listed in either the 2007 or 2010

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with the total sanitation approach. Originally the state gov-ernment intended to use BPL household incentive funds to reward communities that achieve ODF status but this pol-icy was blocked by the central government due to concerns that these funds, which were allocated to BPL households, might benefit APL households if provided in the form of a community grant. Fortunately, since the use of BPL in-centives has been shown to be counterproductive, the state government had already noticed the impressive progress being made in Mandi District without hardware subsidies, and so decided that the significant finance available for BPL household incentives would not be used.

The lower poverty levels in HP, where less than one per-cent of rural households are reported to be in the bottom wealth quintile nationally, was, and remains, an important factor in the success of the program methodology without payment of BPL latrine incentives. The elimination of the BPL incentive from the implementation process greatly simplifies the approach, removing the temptation to speed up progress using supply-driven interventions, and making outcomes dependent on the creation of genuine demand and commitment to rural sanitation improvement by local households, communities and governments.

In addition, the districts in HP have followed a two-stage process, focusing first on achieving ODF status, and then on meeting the NGP criteria. This longer process allows a narrower and more targeted approach during the initial stages, and does not attempt to tackle the difficult areas of solid and liquid waste management until some capacity, ex-perience, and confidence have been developed in achieving an easier collective sanitation outcome.

This two-stage approach has led to relatively slow progress in the NGP awards, with only 16 percent of GPs in HP having won an NGP award despite the state achievement of meeting 93 percent of its TSC household latrine target; but it has been highly successful in achieving self-declared ODF communities, with 85 percent of GPs now reported to be ODF. As districts approach 100 percent ODF cover-age, the focus is shifting to NGP progress and the number

grown since the start of the program. There is now wide-spread recognition among government and development partners that CLTS is an effective approach to demand-gen-eration and is a useful behavior change tool. In HP, CLTS techniques have been combined with more traditional IEC approaches, such as kala jattar street theatre, to develop a methodology that is considered appropriate and effective by both local implementers and local communities.

WSP-organized exposure visits to areas where CLTS has been successfully used were instrumental in persuading practitioners and decision-makers to adopt the CLTS ap-proach in the face of considerable misgivings by senior officials. In particular, the March 2009 exposure visit to Bangladesh triggered a significant scaling up of efforts in HP, including recognition that more widespread and effec-tive training in the total sanitation approach would be re-quired in order to achieve statewide sanitation targets.

6.3.3 Achievement of the Desired OutcomesThe program efforts to develop performance-benchmark-ing systems have been important in developing support for the total sanitation approach in HP. At baseline, several dis-tricts had expended their entire IEC budget, either through external support organizations or through their own efforts, with little to show for their expenditures other than a list of outputs (brochures distributed, posters printed, camps completed). However, there was little measure of effective-ness available other than the number of NGP awards gar-nered by each district.

The HP benchmarking system incorporates eight different performance indicators, including a 20 percent weight-ing for the number of ODF GPs declared in the previous six months and a financial efficiency indicator that exam-ines TSC expenditure per ODF GP. These measures have highlighted areas where TSC expenditures have been inef-fective,30 and have convinced both state and district stake-holders that a CLTS-based approach is highly cost-effective.

It is important to note that the methodology adopted in HP does not rely on hardware subsidies and is in keeping

30 A drawback to the current cost-effectiveness indicator is that it penalizes districts that have progressed to higher-level activities such as solid and liquid waste management. Since these expenditures are not deducted. As a result, their higher total TSC expenditures suggest a higher cost per ODF GP.

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using the BPL incentive as intended, since the amount pro-vided is more than enough to finance (or reimburse) the construction of a durable and improved sanitation facility; or towards developing tools and techniques capable of trig-gering sanitation development in previously disinterested and resistant groups. In addition, TSC technical require-ments have now been lowered so that dry latrines and eco-san facilities are now acceptable, which should allow the promotion of more appropriate options in water-scarce and chronically poor areas.

The lower emphasis on the total sanitation approach in MP is also reflected in the monitoring system, which does not collect data on the number of ODF communities. As a result, the performance benchmarking in MP is based on the number of latrines built, NGP progress and TSC expenditures. While NGP success suggests a higher sanita-tion standard than ODF status, only 7 percent of GPs have been awarded the NGP which means that progress in the remaining 93 percent of communities is assessed only on incremental and self-reported latrine coverage without any information on collective outcomes.

The differences between the program methodologies ad-opted in HP and MP illustrate the broad scope provided by TSC framework. The methodology utilized in HP broadly follows a total sanitation approach. In contrast, the meth-odology in most areas of MP is based on a supply-driven approach, through which local governments employ private contractors to build standard toilets. There are variations across districts, with the more successful districts in MP adopting elements of the total sanitation approach, includ-ing sanitation promotion and behavior change activities, but most prefer the easier supply-driven approach despite the best efforts of WSP to promote and spread the total sanitation approach within MP.

The endline assessment found that the number of districts using the total sanitation approach in HP had increased from five to nine (75 percent of all districts), but the scale of adoption had not changed in MP from the original five districts (10 percent of all districts) found using total sanita-tion approaches at baseline (see Table 6).

of applications is increasing rapidly. In 2010, 1258 NGP applications were submitted by GPs (39 percent of all GPs) as well as 10 Block NGP applications. Given an NGP ap-plication success rate of 48 percent in 2009, compared to only 24 percent application success in MP, the state govern-ment is confident that NGP progress will accelerate rapidly over the next year or two.

6.3.4 Remaining Resistance to the Total Sanitation ApproachDespite increased central support for the total sanitation ap-proach, there remain several states that argue that the current BPL latrine incentive is inadequate, and provide significant additions to this household incentive from state funds. TSC guidelines make it clear that the BPL incentive should be paid to the household on completion and use of the facility. However, in many states, including MP, local governments use the increased incentive amount for up-front purchase of latrine materials and direct payments to private latrine con-tractors. In these cases, the beneficiary household does not receive any of the incentive amount since the local govern-ment spends the entire sum on the bulk purchase of materi-als and latrine construction activities.

In MP, the state government obtained permission to use payments made under NREGA to supplement the funds available for household latrine construction. In practice, NREGA and TSC funds31 are usually combined to pay contractors to build twin pit latrines and plant fruit trees, with little or no involvement from the user household. The enhanced hardware subsidy provided by the Nirmal Watika scheme makes it easier for the GP to build the sort of fa-miliar brick-built latrines that are favored by many govern-ment officials, and enables latrines to be built for all BPL and some APL households without the need to generate genuine demand.

The higher poverty levels in MP, where 36 percent of rural households are reported to be in the bottom wealth quin-tile nationally, have undoubtedly made it harder to mo-bilize communities to build household latrines that meet TSC requirements. Nevertheless, insufficient effort has been directed towards more creative and effective ways of

31 Only BPL households with job cards qualify for both TSC latrine incentives and the Nirmal Watika NREGA payment.

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In 2010, WSP developed a behavior change communi-cations strategy that aimed to reduce open defecation, increase knowledge of low-cost latrine products, and mo-tivate people to seek information, products, and services at local sanitation suppliers. This strategy may have helped in the development of a sanitation marketing methodology, but the Government of HP reported that this communi-cations strategy arrived too late. By the time the strategy was completed, the government’s main challenges were no longer stopping open defecation and building latrines, as significant progress had already been made in these areas, but rather tackling institutional sanitation, solid and liquid waste management, and improvements to the sustainability of sanitation outcomes.

6.3.6 Methodology: Enabling EnvironmentWSP has used a broad spectrum of approaches to improve the enabling environment for rural sanitation. In each of the two states, WSP has undertaken performance bench-marking based on the routine monitoring data collected by the district and state governments, organized exposure visits to introduce and spread new ideas and approaches, ar-ranged capacity building to develop and improve skills and capabilities, conducted rapid assessments and evaluations to provide detailed information on performance, outcome and impact, and produced knowledge products to dissemi-nate the learning from these various activities. WSP has also undertaken wider assessments to demonstrate the impor-tance of process on TSC performance, such as the 21-state study Rapid assessment of processes and outcomes: a Decade of the Total Sanitation Campaign completed in August 2010.

The program methodology for improving the enabling en-vironment has been effective in increasing support for the total sanitation approach, and in generating pressure for state governments to improve the program methodologies and monitoring used in their TSC and NGP programs.

However, one of the central elements of the enabling en-vironment efforts has been to demonstrate that increased hardware subsidies are not necessary to build hygienic la-trines, and in some cases can hinder cost-effective rural san-itation improvement. In particular, efforts have been made to highlight the problems caused by the supply-driven use of BPL incentive funds to finance latrine construction by

6.3.5 Methodology: Sanitation MarketingAs at baseline, there was little evidence of any explicit meth-odology for sanitation marketing. This gap reflects the good availability and affordability of sanitation products and ser-vices in most rural parts of India, and the supply-driven nature of TSC in places like MP, which together limit the need for formal sanitation marketing interventions.

Masons have been trained to construct latrines in both states, including more than 150 master masons in MP, but few have emerged as entrepreneurs willing to market their services or to innovate new products. In part, this reflects the application of fairly rigid standards regarding latrine type and quality. TSC technical guidelines and training courses in MP were reported to define the number and spacing of bricks in a honeycomb brick lining, the exact size and composition of concrete slabs, and to state that only steeply sloping low-flush latrine pans, known as “rural pans,” should be installed.

The more supply-driven approach used in MP involves bulk purchases by local governments and mass contracts for local building firms to build latrines. As a result, user households have little choice in the design or quality of the latrine and all of the latrines built in a particular area tend to be the same. Those responsible for TSC project in MP argue that large contracts and bulk purchases remove transport problems and reduce costs, but the lack of user involvement in the design or construction process appears to result in low ownership, limited latrine usage, and the development of program-based supply chains for latrine construction that leave little scope for sanitation marketing by the private sector.

In HP, where total sanitation approaches have been used more extensively to develop demand for sanitation im-provement, a combination of existing local services and self-supply has been sufficient to enable most households to build adequate latrines. A range of different latrine designs was found, although many households favored a variation on a pour-flush latrine connected to a large, stone-lined la-trine pit or septic tank. The main latrine components, such as the ceramic latrine pan, are bought from local markets, and local masons are usually employed to construct the slab, pipework, and pit lining.

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period. There was also no evidence of any performance dividend in program-supported districts, and no reports of any substantial strengthening of the enabling environment in the fourteen districts in MP that received direct support for the duration of the program.

UNICEF supported six “integrated districts” through its program in MP, and three of these are among the six high-est performing districts ranked by the program benchmark-ing assessment. While this high performance may reflect the comprehensive support provided by UNICEF, several stakeholders noted that support to these districts was pro-vided because of their progressive approaches and effective programs, and that the other three integrated districts are ranked 21st, 39th and 40th and that there is no suggestion that the UNICEF support has provided any more consis-tent benefits than the WSP program.

The benchmarking assessment does not directly measure any of the components of the enabling environment, but it suggests that there is currently little difference between the sanitation outcomes in districts supported directly by the program or UNICEF programs and those implementing without external assistance. This finding indicates that the wider enabling systems, mechanisms, and incentives that should drive rural sanitation improvement have not been sufficiently institutionalized for consistent or large-scale progress.

contractors, in contravention of TSC guidelines on the pay-ment of BPL incentives after the household has built its latrine. The evidence from successful programs like that in HP appears convincing but, while the technical nature of this evidence has been well received and understood by ad-ministrators, it has proved insufficient to counter concerns that poor households cannot afford to build hygienic toilets under the current program, which has generated strong po-litical pressure from state and union ministers for further increases to the BPL latrine incentive.

The enabling environment methodology has been effective in developing conditions for the acceleration of rural sanita-tion progress in HP, but has failed to generate the same sup-portive conditions or positive progress in MP despite the use of similar techniques, activities, and advocacy channels.

This point is illustrated by the wide variation in perfor-mance and enabling environment found in the twenty-two WSP assisted districts in MP (see Annex 4: Program Benchmarking Assessments). Only nine of the program-supported districts are in the top half of the benchmarking ranking, with the remaining thirteen program supported districts all ranked below average, including seven of the ten worst performers. These low performing districts all re-quested assistance from the program, but did not engage with or follow up on any of the program activities. As a result, no further support was provided after the initial

TABLE 6: ENABLING ENVIRONMENT IMPROVEMENTS: PROGRAM METHODOLOGY


Total sanitation at scale

HP: use of TS approach

MP: use of TS approach

5 districts (25%)

5 districts (10%)

12 districts (100%)

24 districts (48%)

9 districts (75%)

5 districts (10%)

Sanitation marketing at scale

HP: use of SM approach

MP: use of SM approach

0 districts (0%)

0 districts (0%)

6 districts (50%)

12 districts (24%)

0 districts (0%)

0 districts (0%)

Knowledge management

HP: Exposure visits (people/year)

MP: Exposure visits (people/year)

HP: Best practice seminars

MP: Best practice seminars

WSP field & learning notes

44

20

0

0

0

50

200

12

4

2

20 (40%)

0 (0%)

4 (33%)

3 (75%)

1 (50%)

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including three consultants from CCDU and two admin-istrative staff. While this is a rather small team to manage such a dynamic and extensive program, the establishment of a dedicated unit has greatly increased the regular moni-toring and support provided by the state government (see Table 7).

Capacity-building mechanisms appeared effective in HP, with most districts reporting that they had been given effective training in key areas, and few reports of capac-ity shortages. Most recently, capacity had been built in SLWM, with a large team from Kullu District sent to Nainital for a one-week course, and representatives from across the state sent to visit successful SLWM projects in Southern India.

The TSC unit in MP has also increased in size, and now has seven technical staff and 20 administrative staff. A team of state quality monitors tasked with reviewing district level TSC progress further supports the state TSC unit. The ad-ditional review capacity provided by these monitors should be a useful supplement to the state TSC unit capacity, but there is little accountability for their activities, and there was little evidence that they were either well-used or add-ing any value to the state sanitation activities.

Huge numbers of local stakeholders have been trained in MP through the three state resource centers (State Insti-tute of Rural Development, Water and Land Management Institute, and the Administration Academy) and twenty NGOs that operate regional training centers, but several stakeholders noted that much of the trained capacity is not utilized effectively at district level or below. In particular, 150 master masons were trained to provide cascade train-ing to masons at district level, but few of the districts were reported to have used these training resources consistently or effectively.

No mechanisms were apparent for evaluating the effective-ness or use of the capacity building activities, or for pro-viding the reliable feedback and data needed to improve selection processes and course content. As a result, there is limited awareness of the value added by capacity-building activities, and little recognition of the need to reform and improve approaches to capacity building.

6.4 Implementation Capacity

Key Findings• Both HP and MP state governments have developed

increased capacity for TSC management at state level.• Large amounts of local capacity building have been un-

dertaken, but no systems are in place to check whether capacity building is appropriate or effectively utilized.

• HP government has identified three areas in which greater capacity is needed: strategies to reach dif-ficult areas and groups (remote, disadvantaged, and excluded households and communities); improving the sustainability of household and institutional sanitation facilities; and solid and liquid waste management.

Few countries can claim to have rural sanitation programs that match the scale and scope of either TSC or the NGP. As a result of the massive investments associated with TSC and NGP programs and the extensive local government system, there are few resource constraints for rural sanita-tion improvement. However, each state and district uses the available resources in different ways. The implementation capacity of local governments varies dramatically depend-ing on the institutional support and training provided to the main implementers as well as on the implementation approaches adopted by each local government.

6.4.1 State-level CapacitySince the baseline, both HP and MP state governments have recognized the need for increased management capacity at state level. In part, this change reflects increased monitoring and evaluation requirements imposed by central govern-ment to improve the quality of the NGP application and verification system, and increased financial requirements since the central TSC funds are now released to the SWSM for payment to the appropriate district or other beneficiary. The SWSM is also responsible for compiling individual dis-trict TSC plans into a state annual implementation plan that is submitted to the central DDWS for approval. These administrative requirements impose a heavy workload on the state TSC unit, which most state governments have ad-dressed by using consultants from the Communication and Capacity Development Unit (CCDU).

In HP, there is now an assistant director in the RDD as-signed to manage the state TSC project, with five staff

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the way of resources to support or strengthen implementa-tion at the village level. In the absence of any other local sup-port, only exceptionally motivated village governments find time to undertake genuine demand generation and behavior change activities that might improve latrine usage and the sustainability of sanitation outcomes. In practice, the village governments rarely face the challenge of motivating house-holds to build or use toilets because the capacity to build the toilets is provided by local contractors financed with TSC funds. Furthermore, TSC’s online monitoring system does not require any post-construction assessment of latrine usage or sustainability, so there is little incentive to invest scarce capacity and resources in social mobilization and follow up.

Selective examples were found of district projects in MP engaging local NGOs to provide community mobilization and social intermediation services, but few positive experi-ences were reported. One district collector stated that he had contracted a number of small NGOs on identical per-formance contracts that would reward the achievement of specified rural sanitation targets, but that the NGOs were so unsure about their ability to achieve the targets that none of them did any further work or applied for any further payments after receiving the initial mobilization payment.

The frequent transfer of district administrators and local officials noted during the baseline assessment remains a sig-nificant problem. Many of the senior district officials in the areas visited during the assessment had been in position for less than one year. The lack of continuity limits the potential to implement any medium-term or long-term strategy, and requires regular retraining and re-orientation. Frequently, it was the support NGO or contracted consultants who held institutional memory, rather than the government officials responsible for the program.

6.4.3 WSP CapacityWSP has strengthened its program team further since the baseline assessment. The Delhi-based team has extensive ex-perience in rural sanitation development in India, and remains responsive to state and local government demands. WSP state coordinators have played an important role in supporting state TSC implementation, and it is clear from the assessment that this sort of close and long-term support builds trust with the state government and adds value to program interventions.

6.4.2 District-level CapacitySimilarly to the state level, TSC administrative require-ments have increased significantly at the district level. TSC reporting systems now require that detailed progress data to be entered for each GP in order to verify its progress before accepting NGP applications, and to allow more thorough auditing of the use of TSC funds such as the BPL incen-tive payments. These requirements have led most districts to employ one or two TSC administrative staff in addition to the normal rural development staffing.

In HP, most districts use an NGO “support organization” to manage TSC activities and provide support at block and GP levels. Many GP officials lack the soft skills, temperament and time required to undertake intensive social mobilization and behavior change activities. This means that the support organizations play a vital role in providing capacity and ex-perience in these areas, and in playing a social intermediary role between the local government and the community.

As the program moves to tackle higher-level goals in HP, the state government has identified three areas in which greater capacity is needed:

• Strategies to reach difficult areas and groups (re-mote, disadvantaged, and excluded households and communities),

• Improving the sustainability of household and insti-tutional sanitation facilities, and

• Solid and liquid waste management.

A different approach has been used in MP, with a network of TSC coordinators contracted to strengthen capacity at district and block levels. In addition, each district has been asked to identify and employ “reform champions” from the outstanding natural leaders that emerge during community sanitation development processes, and select “brand ambas-sadors” from the village heads in NGP-winning communi-ties. While a promising concept, there is little evidence that either the reform champions or brand ambassadors have yet had any significant impact on capacity to implement activi-ties or improve outcomes.

TSC district and block coordinators spend much of their time and energy on administrative tasks, and are provided little in

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6.5.2 Sanitation Goods, Services, and Information in HPThe HP sanitation strategy is based on allowing freedom of technology options and avoiding interference with market supply. Most stakeholders agree that market supply is working well. Products remain reasonably priced at about Rs 150–250 (US$4–6) for a ceramic latrine pan, and widely available de-spite the large distance from the major ceramic goods manu-facturers in Gujarat. Retailers and other service providers report few government restrictions on their business activities.

Cold conditions, and generally higher standards of living, mean that the typical latrine in HP is some way up the ‘sanitation ladder.’ Most self-provided household latrines in HP have ceramic pans, large lined latrine pits, and solid superstructures (often a combined bathroom and latrine). Many latrines appear over-designed, often due to techni-cal misconceptions regarding the need to line latrine pits (e.g., in rocky ground where the risk of collapse is low), the provision of impermeable linings in leach pits (which should be permeable), the provision of vent pipes (in water-sealed latrines), and over-sizing of the latrine pit. However, the solid designs favored in HP perhaps reflect the harsh climatic conditions and the traditional building techniques used in most local housing.

Despite the presence of many expensive latrines, poor households in HP reported that they had been able to build a hygienic and durable pour-flush latrine for as little as Rs 1,200 (US$26). The cost estimated by the household ignored the opportunity cost of the labor supplied by the household and the value of any self-supplied materials, which were considerable in many cases due to the construc-tion of stone-lined latrine pits and stone-walled superstruc-tures. The household cost estimates tended to be lower in more remote rural areas where traditional building materi-als were easier to obtain, and where a lower value was at-tached to time spent constructing the facility.

6.5 Sanitation Goods, Services, and Information

Key Findings• In recognition of the utility of dry latrines in cold and

water-scarce areas, the 2007 and 2010 revisions of TSC guidelines dropped the prohibition of dry latrines.

• The HP sanitation strategy is based on allowing free-dom of technology options and avoiding interference with market supply.

• Local governments in MP continue to promote the construction of standard latrines that meet technical specifications set by the PRD, which may not be as technically advanced as reported.

• The differences between supply chains in HP and MP are marked, with those in HP gaining strength and divergence, and those in MP are temporary and program-driven.

6.5.1 Policy: Conversion of Dry Latrines into Pour-Flush LatrinesThe 2004 TSC guidelines stated that one of the main objec-tives of TSC was “to convert dry latrines to pour flush latrines, and eliminate manual scavenging practice, wherever in exis-tence in rural areas.” This policy statement was significant as it set the minimum level of service in India higher than that recommended by the UNICEF-WHO Joint Monitor-ing Program for Water Supply and Sanitation (JMP) by ex-cluding dry latrines from the options promoted by the Total Sanitation Campaign.

In recognition of the utility of dry latrines in cold and water-scarce areas, the 2007 and 2010 revisions of TSC guidelines dropped the prohibition of dry latrines. A revised guideline stated that existing bucket latrines should be converted to sanitary latrines, and the 2010 guidelines include a section detailing the benefits of ecological sanitation facilities such as urine-diversion composting toilets and waterless urinals.

TABLE 7: ENABLING ENVIRONMENT IMPROVEMENTS: TSC IMPLEMENTATION CAPACITY


HP Districts/state technical staff 0 12/3 = 4 12/4 = 3 (133%)

MP Districts/state technical staff 0 50/3 = 17 50/7 = 7 (233%)

HP District TSC staff (total) 3 24 28 (117%)

HP District TSC staff (total) 0 48 36 (75%)

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footrests, which cost an additional Rs 30 to supply with the rural pan). Suppliers also noted that the deeper rural pan was more difficult and expensive to install due to the larger vol-ume of excavation and enclosing materials required.

Most significantly, suppliers noted that they have no private customers for the rural pans, which are only bought by gov-ernment officials and NGOs supplying materials to TSC projects. When asked why private customers always preferred the supposedly inferior conventional pans, the suppliers noted that these pans are available in many colors (whereas the rural pans are only available in white), are bigger and come with built-in footrests, are considered more beautiful (perhaps be-cause they are the model favored by non-poor households), and are widely available for a similar price. Few suppliers stocked the rural pans, and even these suppliers stated that the rural pans were “difficult to sell” and that they would not stock them if TSC officials stopped asking for them.

It is argued that only low-flush rural pans should be in-stalled in water-scarce areas, hence that this is the best tech-nology to promote in states like MP. However, the water saving provided by the rural pan pour-flush is not nearly as significant as that provided by a dry latrine, such as the dry composting latrines promoted in the 2010 version of TSC guidelines. Given the wide variations in physical condi-tions, prices, willingness to pay, and preferences across any state, the optimal solution would be to provide GPs and individual households with information on all of the latrine options available and let them make their own decisions based on individual requirements.

Another factor affecting demand for rural latrine pans is the NGP verification process. Pressure from the state gov-ernment for NGP performance means that district govern-ments respond rapidly to any comments or signals from NGP verification teams. When asked about the strong preference for rural latrine pans, several district and block officials noted that some NGP verification teams had ques-tioned or rejected household toilets with conventional la-trine pans due to concerns that these might use more water and be unsuitable for rural use. While this concern is not supported by any of TSC or NGP guidelines, the suggestion

A technical manual detailing the advantages and disadvan-tages of the different sanitation technologies was produced32 and circulated by the HP RDD, but does not appear to have been widely used at district level.

No significant changes were apparent in the availability and affordability of goods and services for rural sanitation im-provement in HP since baseline. However, local government officials, service providers, and rural households were far better informed on the range of possible latrine options and prices. An absence of information on low-cost latrine options in rural communities, which leads poor households to conclude that they cannot afford a latrine, can be a critical constraint in de-veloping countries. The widespread latrine development in HP has resulted in almost universal awareness of latrine prices and options, with most stakeholders in agreement that poor households face few constraints in building simple latrines.

6.5.3 Sanitation Goods, Services, and Information in MPLocal governments in MP continue to promote the construc-tion of standard latrines that meet technical specifications set by the PRD. While the standard design varies slightly from district to district depending on local costs and mate-rial availability, in most areas latrines constructed with TSC support are easily identifiable by their roof-less brick super-structures, low-cost metal doors and steeply-sloping “rural latrine pans.” This technical standardization has been fur-ther reinforced by the recently published DDWS-UNICEF Technology Options for Household Sanitation, which states: “rural [pour-flush] pans having higher gradient with less water consumption for flushing are technologically superior to flat pans which require more water for flushing.”

A brief review of the “rural pans” available in MP questioned whether these advantages are as significant as suggested in the technology option document. The rural pour-flush latrine pan is reported to require a lower quantity of water for flush-ing due to the steeper slope of the pan, but flushing volumes are often more heavily influenced by the size of the water container than by the slope of the pan. Price differences be-tween rural and conventional pans were also nominal in MP, with imported rural pans costing Rs 150–180 whereas con-ventional pans were available from Rs 200 (including built-in

32 Knowledge Links (2005) Discussion of technologies for sanitation in rural HP.

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6.6 Financing

Key Findings• Twenty-five percent of the total TSC budget is ear-

marked for total sanitation, sanitation marketing, and the enabling environment. The balance of funds are ear-marked for cash incentives and facility constructions.

• Because of its demand-driven approach HP has used only a small percentage of the funds available from TSC. MP, with its supply-driven approach has used a much higher percentage.

• The unprecedented success of the NGP award has had unexpected side effects, resulting in changes in the way the program is administered.

• State reward schemes have seen varied success.• Financing for public facilities is only available for pub-

licly owned facilities.

Approximately 25 percent of the total TSC budget is earmarked for investment in the three main areas of the program:

• Total sanitation (up to 15 percent on IEC and start-up activities);

• Sanitation marketing (up to 5 percent on alternate delivery mechanisms); and

• Enabling environment (up to 5 percent on raising awareness, capacity building, and administration)

Substantial sums are available for creating sanitation de-mand, increasing the supply of appropriate sanitation goods and services, and improving the enabling environ-ment. At present, many districts have been under-utilizing the software elements of their TSC budgets. Therefore, given the additional support from WSP and the five-year duration of TSC, there is unlikely to be a shortage of funds for implementation.

The remaining 75 percent of TSC budget is earmarked for cash incentives to BPL households, and for facility construction (community sanitary complexes, institu-tional toilets, and solid and liquid waste management facilities).33 This substantial hardware investment should stimulate private sector supply and strengthen supply chains.

that NGP status might be endangered by the installation of non-rural pans has been sufficient for district teams to be rigid in their preference for rural latrine pans.

The systematic preference for government-determined latrine components and designs, which is reinforced by the technical manuals, training courses, and program criteria adopted in MP, makes it extremely difficult to encourage innovation, or promote household responsibility and ownership for facili-ties, or implement demand-led sanitation development.

6.5.4 Sustainable Supply ChainsThe HP sanitation strategy has helped to strengthen sus-tainable local supply chains, and to ensure that most local governments and rural households are aware of appropriate latrine options, prices and availability. Some longer-term is-sues, such as safe emptying or replacement of full latrine pits and septic tanks, have not yet been tackled, but the market-based approach has ensured that households and communities feel strong ownership for their sanitation fa-cilities, and are likely to seek out practical and affordable solutions to maintain and upgrade these facilities.

In contrast, the approach adopted in MP has resulted in entirely temporary and program-driven supply chains that run parallel to, and thus undermine, market supply. In most parts of MP, the GP orders latrine materials (pans, bricks, cement, sand, pipework, doors) in bulk from local suppli-ers, and then pays a local contractor to build the facilities. There is little innovation or variation in the standard la-trines built, and the beneficiary households have little or no control over the facilities that are built for them.

There is little transparency, participation, or account-ability in the process. As a result, many latrines are built using cheap materials and poor workmanship. Few of the recipients are sufficiently engaged in or aware enough of the process to complain that the latrines are not worth the large amount invested by the government on their behalf. This opaque process provides enormous scope for corrup-tion and profit, so those involved in procuring, managing, or monitoring these latrine programs have little interest in changing implementation practices, assessing value-for-money, or improving household outcomes.

33 The proportion of each component varies depending on the local context and requirements.

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have been lower than anticipated, thus the program funds account for about 10 percent of the total rural sanitation ex-penditures in HP over the last three years. While it is hard to separate out the contribution made by the program to TSC activities and outcomes, the majority of the program funds have been used for capacity building, evaluation, strategy development, and knowledge management, which are areas not well covered by the conventional TSC expenditures.

The higher TSC expenditures in MP, where combined central and state TSC expenditures totaled US$79.4 million since 2007; and the larger NGP contribution, which has reached at least US$3.3 million, mean that the US$1 mil-lion invested by the program in MP amounts to only 1.2 percent of the government’s spending. Although pro-gram funds have clearly played a small part in the overall MP program, WSP decided to concentrate the majority of its activities in districts that expressed demand for support, and took part in capacity building, coordination, and strat-egy development activities. In all, twenty-two out of the fifty districts were supported by the WSP program, of which about fourteen districts were active and benefited from di-rect WSP support over the three-year program period.

6.6.2 Sanitation Subsidy Policy in HPThe 2005 “Strategy for total rural sanitation in HP” pro-posed that the funds allocated to BPL latrine incentives should be used to finance collective incentive payments for villages that achieve ODF status, with the lump sum pay-ment then used by the GPs to achieve other sanitation im-provements such as solid and liquid waste management, or improvements to institutional sanitation.

The GoI subsequently ruled that the BPL incentive funds could not be used for the finance of community sanitation infrastructure or services because these services would also benefit APL households and therefore would not meet the pro-poor objective of the original incentive design. As a re-sult, the BPL incentive funds have been unused during the last three years of the program.

The Government of HP has now applied to the GoI for the release of the currently unused BPL incentive funds, with

The endline assessment confirms that TSC financing is more than sufficient for the improvement of household sanitation facilities. Indeed, states like HP have used the IEC funds to mobilize household investment so effectively that they have not had to use almost Rs 22 crore (US$5 million) in TSC funds allocated for BPL household incen-tives. However, it was clear that program assistance played an important role in developing the strategies, approaches, capacity, and systems that enable the state government to manage the program, and enable district governments to use their TSC project funds effectively.

TSC funds available for the provision of institutional sani-tation facilities and for solid and liquid waste management are less generous, and as local governments grapple with the challenge of providing these facilities in order to meet the onerous NGP requirements, it is clear that more cost-effective approaches are required for these components, and that more flexibility in the use of TSC funds is needed to allow for the variable needs and priorities in different areas.

In the areas where TSC has not been performing well, the GoI has encouraged its development partners to provide additional support to improve policies, approaches and practice. Recently the Global Sanitation Fund approved US$5 million for a program to support TSC in Assam and Jharkhand using approaches that will build on the learning from the program in India.

6.6.1 Program Influence on TSC OutcomesOver the last three years, the combined central and state TSC expenditures in HP total around Rs 3.0 crore (US$6.5 million).34 This total is 80 percent lower than the US$32.7 million TSC allocation originally approved for HP, largely because of the non-utilization of the BPL incentive funds. Another US$0.5 million or so has been provided through first installment payments of the NGP awards.35

At the outset of the program in HP, the planned program investment of around US$0.6 million over three years ap-peared small in comparison to the US$12 million likely to be spent on rural sanitation by the government during the program period. In practice, TSC and NGP expenditures

34 US$1.6 million in TSC funds was spent in HP prior to the 2007 baseline assessment.35 Fifty percent of the NGP award is paid initially. It remains unclear whether the second installments of the NGP awards have been paid.

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In the districts visited, local government officials reported that the use of NREGA funds for latrine construction had made their work easier. Funds are now available to con-struct latrines for most APL and BPL households, which allows latrine construction to move faster and output-based district targets to be met more easily. It was not possible to do a rigorous assessment of the impact of the additional NREGA funds on sanitation improvement, but there were widespread reports that the funds are being used ineffi-ciently to build latrines that are unnecessarily expensive, over-priced, and poor quality, and that latrine usage rates are very low because of the supply-driven nature of the pro-gram. Consequently, a huge amount of TSC and NREGA investment in latrine building in MP is going to waste.

6.6.4 Nirmal Gram PuraskarBecause the NGP is an open and one-time only award, the GoI hopes that every GP in India will qualify and apply for the NGP before 2012. Therefore, the 11th Five Year Plan (2008–2012) budget included Rs 6,000 crore (US$1.48 billion) for the separately financed NGP, which is Rs 300 crore (US$74 million) higher than TSC budget over the same period.

In addition to the financial incentive attached to the award, the NGP benefited from an early decision to add some prestige and profile to the NGP awards by asking the Presi-dent of India to make the awards in person. As a result, the initial winners of the NGP awards, who were largely elected village leaders, were honored by the president at a ceremony in Delhi attended by ministers and high-ranking officials from all over India. The prestige and positive publicity gen-erated by this high-profile ceremony was far greater than anticipated, giving considerable impetus to local govern-ment involvement in TSC, and resulting in strong inter-est and competition for the NGP awards at all levels of government.

The unprecedented success of the NGP award has had un-expected side effects. The number of awards has increased dramatically from 38 NGP GPs at the first ceremony in 2005 to 12,144 NGP GPs in 2008, with a commensurate increase in the number and spread of NGP applications, and in the finances and resources required to process, vali-date, and verify these applications (see Table 8).

the intention of distributing the funds to BPL households that are using toilets built since TSC began. However, the Government of HP noted that the steadily rising BPL in-centive amount would penalize early adopters if distributed according to the date of first latrine use and, therefore, it now plans to average the incentive amount across all BPL beneficiaries.

6.6.3 Sanitation Subsidy Policy in MPAs noted earlier, the BPL incentive funds have been central to the implementation of TSC in MP. These funds have been used to purchase latrine materials and hire contractors to build toilets for BPL households, but have rarely been paid directly to the BPL households as stipulated in TSC guidelines.

In September 2009, the MP SWSM issued a circular to all district collectors to confirm that there is provision within TSC for payment of the Rs 2,200 latrine incentive to BPL households “after the completion of [the] toilet,” and that this incentive payment could be made through the respective bank or post office accounts opened for these households under the NREGA. This circular was issued to counter claims that local governments were not allowed to pay the incentive directly to BPL households, but there re-mains little evidence that local governments in MP have been making cash payments to BPL households that build their own latrines.

As noted earlier, the BPL incentive in MP has been aug-mented by the Nirmal Watika scheme, which uses NREGA funds to finance the construction of twin latrine pits and plant fruit trees. In HP, eligible households can earn up to Rs 11,000 (US$239) for 100 days of NREGA work, and some BPL households have chosen to use Rs 1,000–1,200 of their NREGA cash, the equivalent of around 11 days’ work, to finance latrine construction. In MP, up to Rs 5,000 of the NREGA funds are being used to construct toilets for qualifying APL households, or to supplement the Rs 2,200 incentive available to BPL households. As a result, up to half of the NREGA wages available to qualify-ing households are being used for latrine construction, and these households have little choice in how this money is used since it is controlled by the local government and paid directly to local contractors.

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effects on the wider support for, and involvement in, TSC implementation program.

NGP PerformanceThe NGP remains one of the biggest drivers of sanitation im-provement in India. In the two states visited, NGP awards have considerable political capital and NGP targets remain among the most closely followed indicators of sanitation success.

However, the NGP awards continue to attract strong criti-cism,36 with the DDWS poised to publish a joint GoI-UNICEF study entitled “NGP at risk” at the time of the endline assessment. In part, the problems relate to the wide-spread success and scale of the NGP program, which peaked at more than 12,000 Gram Panchayat awards in 2008 (see Table 9). The annual application and verification process has become so large that it is difficult to find enough veri-fication teams with the experience, capacity, and integrity needed to make independent assessments of community sanitation outcomes. In addition, there have been sugges-tions that the one-time only NGP award combined with a single verification process can encourage short-term, inten-sive, and coercive efforts to win awards rather than create the more sustainable development intended.

As a result of these practical problems and concerns, the NGP process and guidelines have been revised and im-proved since baseline. The scale of the awards mean that it is no longer practical for the President of India to present each award in Delhi, so it was decided that the awards should be presented by the respective chief ministers in the state capitals. Improvements to the verification process include the requirement that the applicant GP shows 100 percent latrine coverage in the online monitoring system before the

This rapid expansion has stretched the resources available to provide independent assessments of the applications, ne-cessitated a reduction in the amounts awarded to smaller GPs (from Rs 200,000 down to Rs 50,000), and made it impossible for the President to congratulate each recipi-ent personally. As a result, the NGP awards were delayed in 2007 (from January to May), and several stakeholders complained that the positive impact of the awards had been diminished by the reductions in financial rewards and prestige.

Increased efforts are being made to improve the sustainabil-ity of the NGP achievements. In order to limit last minute efforts to meet the NGP criteria NGP applications are now only allowed from local governments whose online moni-toring data show that they have achieved their household latrine targets before March 31st of the application year, Furthermore, the payment of the NGP cash incentive is now split into two equal installments: the first released im-mediately upon award, and the second contingent on the sustainability of the ODF and Nirmal Gram status as veri-fied by random checks carried out by the SWSM at least six months after the award. In addition, the right to declare ODF and Nirmal Gram status will be withdrawn from a GP, and any related NGP blocks and districts, if an awarded GP is persistently fails in its efforts to retain this status.

Despite concerns about the sustainability of the NGP outcomes, the number of states proffering applications in-creased from only six (West Bengal, Maharashtra, Tamil Nadu, Tripura, Kerala and Gujarat) at the outset to twenty-seven states by 2008. The ever-widening pool of NGP ap-plicants reflects the growing political and popular interest in the awards, which in turn have important incidental

TABLE 8: NATIONAL GROWTH IN NIRMAL GRAM PURASKAR AWARDS

2005 2006 2007 2008 2009 Total

NGP applications (nr) 481 1,421 9,745 — — —

NGP GP awards (nr) 38 760 4,945 12,144 4,556 22,443

NGP Block awards (nr) 2 9 14 112 28 165

States involved (nr) 6 16 22 27 25 27

36 TARU, 2008; WaterAid, 2008; Bhaskar, 2009; Snehalatha et al, 2010; Alok K, 2010.

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Satna) with 42 percent of all NGP awards in the state found within these few districts. However, the success in these five dis-tricts appears to reflect the particular approaches adopted and the exceptional committed individuals managing the district projects rather than a more institutional statewide approach or more supportive conditions for sanitation improvement.

It was also reported that NGP award payments had been de-layed in MP, that recent winners had not been presented to the chief minister in MP, and that there had been no second verification or payment of the second NGP installment. Con-sequently, the NGP winners and TSC stakeholders in MP were starting to lose some of their enthusiasm for the NGP.

There was less evidence of these problems in HP, where more attention has been given to achieving Open Defeca-tion Free (ODF) status before moving on to the higher NGP criteria. As a result of this two-stage process, and the demand-led approach that requires households to finance their own latrines, the NGP application success rate has been almost twice as high in HP as in MP. In addition, the rapid assessment of NGP GPs in HP indicated much bet-ter long-term outcomes as 90 percent of households were found to own functional toilets, and 97 percent of these toilets were in use at the time of the assessment.

6.6.5 State Reward SchemeSeveral stakeholders in HP commented that the state re-ward scheme has now become a more powerful incentive than the NGP. Over the last three years, the Government of HP has invested considerable effort and finance in develop-ing a comprehensive incentive framework, with awards now given for local government sanitation (Maharishi Valmiki

application can be accepted; more spot checks have been added to the verification system; and the award has been divided into two installments of 50 percent of the award, the second of which cannot be paid until the sustainability of the achievements has been confirmed by checks made at least six months after the initial award.

While these changes have tightened and improved the pro-cess, the assessment found that some district coordinators in MP were reporting 100 percent latrine coverage in NGP applicant communities well before actual achievement of this objective. Discussions with block and GP officials re-vealed that, despite showing 100 percent coverage in the online system, some applicant GPs had less than 60 percent latrine coverage at the time of NGP application.

The premature or false reporting of achievements reflects state and district pressure for NGP success, which encourages those lower down the monitoring chain to exaggerate progress in order to ease the pressure. It also results in extreme pressure on verification teams, as there is a lot at stake for TSC coordina-tors and local government officials if NGP applications fail. A visit by the assessment team to a previous NGP winner in MP supported the findings37 of the recent rapid assessment of 15 NGP GPs in MP, which found that 23 percent of house-holds had no toilet; 26 percent had non-functioning toilets; six percent were not using functional toilets; and only 44 percent were using hygienic toilets. These data suggest not only that NGP status is not being sustained by some NGP winning vil-lages, but that—in some cases—it was never achieved.

The WSP benchmarking suggests that five districts in MP are performing relatively well (Jabalpur, Dhar, Indore, Rewa and

TABLE 9: STATE GROWTH IN NIRMAL GRAM PURASKAR AWARDS

2007–08 2008–09 2009–10 2010–11 Total

NGP applications (nr):

HP

MP

—

—

—

—

526

2,663

1,258

4,280

NGP awards (nr):

HP

MP

India

22

190

4,945

245

682

12,144

253

639

4,556

—

—

—

520 (16%)

1,512 (7%)

22,443

37 The assessment team found that 25 percent of poor households visited during a transect walk in an NGP GP in MP had never owned a latrine (despite long-term residence in the village and awareness of TSC and NGP campaigns).

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started well, with 27 NGPs awarded in 2007, but the num-ber of NGP winners has declined every year since, down to only 6 NGP winners in 2009. The lack of funds after the first year was given as one of the major reasons for the slowdown of progress, although the district collector also changed and it has since proved difficult to regenerate the initial enthusiasm. Despite these problems, the WSP benchmarking assessment ranked this district as an average performer, with overall per-formance better than some twenty other districts.

A major factor in the early problems with financial flows was the limited state-level capacity and engagement, which meant that insufficient attention was given to the district plans before passing them to central government for ap-proval. The state TSC unit in MP is now more familiar and engaged with the process, as a result there have been few recent problems with the approval of district plans or the financial flows.

6.6.7 Financing: Institutional SanitationDespite TSC financing framework stating that district pro-posals should include the “actual amount required for full coverage” of institutional toilets (including school and an-ganwadi facilities), it is only possible to obtain funding for improvements to public owned facilities. In practice, a sig-nificant proportion of institutional sanitation facilities are privately owned due to rented accommodation or entirely private educational establishments.

This proved a serious stumbling block during early imple-mentation, but local governments are now finding ways to mobilize funds from other sources, such as the Sarva Shik-sha Abhiyan (SSA) Education for All program, and have been more successful in leveraging private investments now that local politicians are involved and the profile of the sani-tation program has been raised.

Sampoorn Swachata Puraskar), school sanitation and sani-tation achievements by women’s self-help groups (Mahila Mandal).

Applications for the MVSSP State Sanitation Reward scheme were received from only 4 GPs in 2007, but had expanded to 1,033 GPs in 2010 with applications received from all 77 blocks. The combined budget for the MVSSP and school sanitation awards in 2010 has reached Rs 2.285 crore (US$500,000), all of which is provided by the state government (see Table 10). One of the successful features of the state sanitation award scheme has been the involvement of local leaders in the pre-sentation of the awards, which has galvanized political interest and considerably raised the profile of sanitation.

In contrast, the state sanitation award scheme in MP (Ujmal) has not been successful. Despite starting at a similar time to the HP awards, just 40 applications were received in 2009 and all of them were rejected. No awards have been made to date, and the state government suggested that perhaps the award criteria were too stringent, but there is little evi-dence that the state award scheme has received any priority or attention, nor that it is providing any incentive for local governments to improve their sanitation performance.

6.6.6 Funding FlowsMost stakeholders report that the transfer of TSC funds to the SWSM has improved both financial flows to the districts and general financial management. Prior to this change in financial arrangements, several districts in MP experienced long delays in payments due to incomplete or incorrect program implementation plans being rejected by the DDWS.

One of the MP districts visited during the assessment had no funds for 18 months of the program period. The program

TABLE 10: ENABLING ENVIRONMENT IMPROVEMENTS: FINANCE AND INCENTIVES


Sanitation finance

HP: State award expenditure

MP: State award expenditure

US$187,000

US$0

US$163,000

US$435,000

US$500,000

US$0

Sanitation incentives

HP: NGP GP awards

MP: NGP GP awards

28

191

300

600

253 (84%)

639 (107%)

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has a dramatic effect on overall performance. Furthermore, the cost element is based on “total TSC expenditure,” which includes expenditures on both institutional sanitation and on solid and liquid waste management, thereby unfairly rewarding low-spending districts that have not progressed beyond ODF achievement (i.e. have not incurred addi-tional expenditures for broader environmental sanitation improvements).

Nevertheless, despite these shortcomings, the benchmark-ing system has been adopted by the HP state government and, due to regular sharing and broadcasting of the bench-marking results, has a significant influence on district performance.

No data on ODF status were available in MP, in which case the WSP benchmarking system uses the cost per NGP award as the main measure of cost-effectiveness. Unfortu-nately, the state government in MP has not adopted WSP-supported benchmarking, choosing instead to adopt the simpler district grading system developed by UNICEF. As a result, no cost-effectiveness measures are being regularly monitored in MP.

6.7.1 ODF Success RateThe program’s design in HP assumed that 300 GPs would be verified as ODF by the end of the program. In practice, TSC achievement has far surpassed this target, with 2,694 GPs declaring ODF status during the three-year program period. Approximately 85 percent of all GPs in HP have now declared themselves to be ODF.

Due to concerns about the reliability of self-declared ODF status, the state government introduced an improved moni-toring system, linked to the state sanitation award system, to verify ODF status. In the two districts visited during the fieldwork for this assessment, it was clear that there was some variation in the reliability of self-declarations. Sanita-tion outcomes were universally impressive in Kullu District where only one community is yet to declare ODF status, but in Una district about 20 percent of households in one of the self-declared ODF communities were found to have no toilet and to practice open defecation. The GP declared

6.7 Cost-Effective Implementation

Key Findings• Outcome-based goals are increasingly being used to

assess effectiveness.• Despite its shortcomings, HP has adopted the pro-

gram benchmarking assessments. MP uses the less-stringent assessments of cost effectiveness provided by UNICEF.

• ODF success rates seem to be over-reported in MP, but less so in HP.

• Cost effectiveness calculations show that cost-per-outcome is lower in HP than in MP.

• There are currently no mechanisms for assessing the cost of government involvement in sanitation interventions.

In India, the outcome-based goals promoted by the national TSC and NGP programs are increasingly being used to as-sess effectiveness. In the past, state governments wanted to know how many latrines had been built, and how this affected state sanitation coverage; but, increasingly, state ministers and secretaries are asking about the number of ODF communities, and the number of NGP awards. These indicators represent an important step forward from simple output indicators, but provide only a one-time snapshot of sanitation outcomes, rather than the more regular measures needed for reliable monitoring and evaluation of effective-ness and sustainability.

Few state and district governments have managed to spend the full TSC funds approved for their programs, so there are few financial constraints, and cost effectiveness remains a low priority. WSP introduced a cost-effectiveness indica-tor into the benchmarking system supported in each state, but it has proved difficult to attract much interest in this measure.

In HP, the cost-effectiveness indicator used was the cost per ODF community, with 15 percent of the total benchmark-ing score allocated to this measure. However, it was decided to score only the top three performers in this category38 which, given a 30 point spread between the total scores from the other seven indicators, meant that this indicator

38 Benchmarking scores are increased by 15 percent for the highest “financial efficiency,” 10 percent for second, 5 percent for third and 0 percent for all other districts.

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online monitoring system, WSP program finance data, and the rapid assessments conducted by Wilbur Smith Associ-ates suggest the following averages for the HP TSC project (see Table 11 for summary of improvements):39

• Cost per ODF community: decreased from US$27,400 to US$3,075 (11 percent)

• Cost per NGP community:40 decreased from US$58,700 to US$16,800 (29 percent)

• Cost per latrine in use: decreased from US$22 to US$13

• Leverage ratio (household latrine investment: pro-gram investment):41 increased from 18:1 to 30:1

These cost-effectiveness estimates suggest dramatic im-provements as the HP program has scaled up and become more effective. In particular, the leverage ratio, although an under-estimate because TSC costs include all institutional sanitation and SLWM expenditures, is remarkably high: each dollar invested by TSC and the program has leveraged US$30 investment by the household. These data confirm previous reports that households in HP have made large investments in their latrines, and suggest that the program investments have been highly cost-effective in encouraging them to build these latrines.

The same calculations for the TSC in MP suggest:

• Program cost per ODF community;42 no data available

• Program cost per NGP community: decreased from US$141,700 to US$60,800 (43 percent)

• Program cost per latrine in use: decreased from US$57 to US$51

• Leverage ratio (household latrine investment: pro-gram investment);43 increased marginally from 6.6:1 to 7.4:1

ODF status at the Gram Sabha six weeks previously, but noted that this was a declaration of its intention to become ODF within three months. Una is rated as one of the three low performing districts by the state government, despite a relatively high ranking in the WSP benchmarking, and a brief review of implementation in two sub-districts sug-gested that self-declared ODF status in less committed dis-tricts may be unreliable.

No data on ODF success rate were available from MP, and the findings of the recent WSP rapid assessment cast some doubt over ODF status in even NGP winning villages. Seven percent of GPs in MP have been awarded the NGP, com-pared to 16 percent in HP, and there was some suggestion in the two MP districts visited that few interventions were taking place outside of the 2010 NGP applicant villages. The NGP success rate was 24 percent in 2009, but it was appar-ent that a significant number of these were re-applications from GPs that had previously failed to win the award. As a result of this trend for multiple re-applications by failed ap-plicants, the 2010 NGP guidelines include a clause that pro-hibits re-application by local governments that “have applied and disqualified for NGP thrice during the previous years.”

6.7.2 Cost per Sanitation OutcomeThe program encouraged the two state governments to de-velop detailed systems to monitor performance and cost-effectiveness. Performance monitoring has been greatly improved by the benchmarking system adopted in HP, but even this system includes only one coarse measure of cost-effectiveness. Therefore, as at the baseline assessment, some endline estimates of cost-effectiveness have been pro-duced in order to examine whether cost-effectiveness has improved over the three years of the TSSM.

Simple calculations based on cost and effectiveness data taken from the WSP benchmarking assessments, TSC

39 Endline estimates calculated by the author based on cost and effectiveness data provided by the TSSM team and by the Government of India TSC online monitoring reports; baseline estimates taken from the 2008 TSSM baseline assessments of enabling environment.

40 Average GP size in HP estimated at 338 households (1.097 million rural households in 3,243 GPs in 2008).41 Household latrine investments based on the latrine cost survey data from the rapid assessments (Wilbur Smith Associates, 2010) and the number of latrines recorded in TSC

physical reports. The household latrine cost estimates prepared by Wilbur Smith Associates included imputed labor costs (Rs 100 per day) based on the days of self-supplied labor estimated by the household.

42 Average GP size in MP estimated at 364 households (8.125 million rural households in 22,341 GPs in 2008).43 Household latrine investments based on the latrine cost survey data from the rapid assessments (Wilbur Smith Associates, 2010) and the number of latrines recorded in TSC

physical reports.

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intended to illustrate the value gained from better employ-ment of the available data.

6.7.3 Impact of Cost-effectiveness EstimatesThe estimates provided above were presented to both state governments and to the GoI during feedback sessions on the enabling environment assessments. In all cases, there was considerable interest in the estimates (and in the data from which they were derived), which illustrates the poten-tial power of efforts to improve the regular monitoring and benchmarking of cost-effectiveness.

The WSP team noted that there is considerable sensitiv-ity regarding any comparisons across states, with represen-tatives from MP quick to point out their lower starting conditions and more difficult context whenever there is any suggestion of low performance. In addition, the sec-retary of rural development in MP noted that WSP has a tendency to be too negative in its assessments, which was thought to be demotivating for those responsible for TSC implementation.

Nevertheless, comparisons like those above should help the DDWS and other national stakeholders to better under-stand the factors that influence cost-effectiveness, and per-suade them to influence TSC and state policy in order to make the best use of the government’s resources.

6.7.4 Unmeasured CostsThere are currently no mechanisms for assessing the cost of government involvement in sanitation interventions. Sig-nificant RDD and PRI time and resources are required to implement TSC effectively, but their routine costs (salaries, training, overheads) are rarely included in cost assessments. Several stakeholders commented that the resource-intensive campaign mode required by TSC could not be sustained for longer than a year or two in each area without having a detrimental impact on other activities. These comments highlight the currently unmeasured direct and opportunity costs of diverting valuable government staff and resources from other duties. Future cost-effectiveness assessments should attempt to quantify these costs.

While there has been some improvement in the cost-effectiveness estimates for MP, it is striking that both the cost per latrine in use and the leverage ratio have changed by barely 10 percent over the three years of the program (compared to roughly 50 percent improvements in HP). Furthermore, these cost estimates do not include recent large latrine investments through the NREGA program (as insufficient data were available on the extent of these investments), which were as high as US$1 million per dis-trict per year in the two districts visited during the field-work. The inclusion of these data would have a significant negative impact on the program cost per latrine and the leverage ratio.

The leverage ratios are based on estimated household latrine costs, but the survey only collected these costs from house-holds with functioning latrines. In MP, where a significant proportion of subsidized latrines have collapsed or been abandoned, most of the functioning latrines are owned by non-poor households, meaning that these costs are likely to be over-estimates. The assessment fieldwork suggested that very few poor households had invested any cash or labor in their government-provided latrines, or were using these la-trines. On this basis, the leverage ratio for BPL households in MP would be lower than 1:1.

There are dramatic differences between the cost-effectiveness estimates for HP and those for MP. Some of these dif-ferences reflect the better economic and social context in HP, which makes implementation easier and allows higher household investments, but much of the differ-ence relates to policy decisions, such as not to use the BPL incentive funds, and to the higher effectiveness represented by the significantly better latrine usage rates found in HP.

The cost per NGP community is more than three times higher in MP than in HP; the cost per latrine in use is al-most four times higher, at US$51 compared to only US$13 in HP; and the leverage ratio is less than a quarter of that in HP, at 7:1 compared to 30:1. These rough estimates need further work before being used more widely, but are

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from only 16 percent physical progress in 2007 to 96 per-cent in 2010; whereas progress in MP has mirrored the na-tional average, improving from 23 percent in 2007 to 59 percent in 2010. These figures represent progress compared to TSC household latrine targets, which were based on an estimate of the number of households without improved sanitation facilities at the outset of TSC project. Therefore, these figures do not include the baseline sanitation cover-age, or allow for population growth since TSC began, and therefore need to be re-calibrated in order to provide the actual rural sanitation coverage in each area.

The major shortcoming remains the lack of any reliable sys-tem to monitor sanitation outcomes such as latrine usage. The current TSC online monitoring system is an impressive achievement, in that it records the number of toilets built in each GP, with recent refinements requiring that each house-hold has a unique identifier to record its sanitation status. However, it does not require follow-up visits to find out whether the beneficiary households started using the new latrines, nor is there any incentive for local governments

6.8 Monitoring and Evaluation

Key Findings• TSC on-line monitoring system now records latrine pro-

vision data by village.• TSC district level monitoring survey (DLM) was stopped

in 2007, thus no demand-side or time series sanitation data are available through the TSC on-line system.

• Household survey data demonstrate that the current TSC monitoring and NGP verification processes are not adequately capturing the latrine usage and sustainabil-ity outcomes that are central to effective monitoring of sanitation progress.

The GoI operates an online monitoring system for TSC, which requires that each district provide monthly updates on its physical and financial progress. Tables 12 and 13 summarize reported progress since mid-2007 (as at mid-September 2010).

TSC online monitoring data suggest that HP has shown dramatic progress since the baseline assessment, improving

TABLE 11: ENABLING ENVIRONMENT IMPROVEMENTS: COST-EFFECTIVENESS


Effectiveness

HP: Nr. ODF communities

MP: Nr. ODF communities

HP: ODF success rate

MP: ODF success rate44

60

557

15%

15%

600

1,200

40%

35%

2,754 (460%)

1,512 (126%)

85%

7%

Cost-effectiveness (TSC + WSP Program)45

HP: Cost per ODF community

MP: Cost per ODF community

US$27,400

—

—

—

US$3,075

—

HP: Cost per NGP community

MP: Cost per NGP community

US$58,700

US$141,700

US$17,400

US$43,500

US$16,800

US$60,800

HP: Cost per latrine in use

MP: Cost per latrine in use46

US$22

US$57

US$10

US$15

US$13

US$51

HP: Leverage ratio (hhd: program)

MP: Leverage ratio (hhd: program)

18:1

6:1

4:1

4:1

30:1

7:1

44 Based on verified NGP awards as no data is available on ODF achievement.45 Based on estimated costs from TSC financial records and from the project.46 Includes latrines built by APL households, which comprise 57 percent of all new latrines built in MP during the TSSM project period.

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yet all of them were financed by TSC, and entered as com-pleted latrines in TSC online monitoring system.

6.8.1 Alignment with JMPAnother issue is the lack of alignment with the JMP, the body tasked by the UN with monitoring MDG progress for water supply and sanitation. The JMP MDG indicator for basic sanitation is the “proportion of population using an improved sanitation facility,” and this category does not include use of shared sanitation facilities of any type.

The latest JMP progress report states that only 21 percent of the rural population in India used improved sanitation facilities in 2008, whereas the Government of India re-ported that 50 percent rural sanitation coverage had been achieved in 2008. The vast difference is largely due to the

to monitor subsequent collapse, abandonment, or dysfunc-tion of these latrines. As a result, the detailed TSC reports tend to ignore sustainability losses and over-estimate latrine coverage, with the degree of accuracy determined by the effectiveness of the state or district TSC project in creating genuine demand and ownership for the latrine facilities.

TSC monitoring system in HP is well used and provides a reasonable picture of progress, with evaluations suggesting that 90 percent of the latrines recorded in TSC online system are functional and in use. The self-reported system works less well in MP. In one tribal community, abandoned and collapsed latrines built only three years ago by the PHED were observed alongside brand new latrines built recently for the same households by the PRD. None of the latrines, either old or new, had been used by these tribal households,

TABLE 12: TSC PHYSICAL PROGRESS: INDIVIDUAL HOUSEHOLD LATRINES

Target (no. latrines) Achieved (no. latrines)

BPL APL Total BPL Percent APL Percent Total Percent

HP

2007

2010

108,017

218,154

543,032

632,583

651,049

850,737

32,549

197,335

30

90

69,879

619,987

13

98

102,428

817,322

16

96

MP

2007

2010

3,368,972

3,614,346

4,273,749

4,852,847

7,642,721

8,467,193

963,563

2,334,194

29

65

785,311

2,662,372

18

55

1,748,874

4,996,566

23

59

All India

2007

2010

56.3m

61.8m

58.7m

63.9m

114.9m

125.7m

19.7m

37.8m

35

61

13.6m

32.2m

23

50

33.3m

70.0m

29

56

TABLE 13: TSC PHYSICAL PROGRESS: INSTITUTIONAL TOILETS

Target (no. institutional toilets) Achieved (no. institutional toilets)

School Anganwadi School Anganwadi

HP

2007

2010

6,926

17,863

1,090

10,408

1,162 (17%)

10,320 (58%)

210 (19%)

4,256 (41%)

MP

2007

2010

76,128

137,730

10,592

27,595

36,760 (48%)

88,385 (64%)

2,626 (25%)

19,182 (69%)

All India

2007

2010

1,009,814

1,314,636

362,926

506,968

383,787 (38%)

1,026,929 (78%)

117,096 (32%)

345,062 (68%)

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These charts suggest that the sustainability loss, which is the difference between the sanitation coverage reported by the supply-side program monitoring data and that from the de-mand-side household usage data, is relatively small in HP, that is, the gains in latrine usage (marked in blue) mirror the increased coverage reported by TSC online system. In contrast, TSC on-line monitoring system reports a rapid growth in the number of sanitation facilities built in MP, whereas the household survey data show that latrine usage has barely changed since 2001, ris-ing only 1 percent over seven years of TSC activity.

Given the huge government investment in TSC and NGP programs, it is important that these investments gener-ate sustainable benefits. WSP and other stakeholders, in-cluding UNICEF, have conducted rapid assessments and evaluations of sanitation improvement that suggest a strong correlation between the quality of the processes used to cre-ate demand, build supply chains, and improve the enabling environment, and the performance of TSC projects.

The Government of India recognizes that some states are slipping behind on TSC progress, both in terms of reported

Government’s use of supply-side TSC monitoring data whereas the household surveys provide data on household latrine usage.47 In addition, the JMP do not count the four percent of the rural population estimated to use shared sanitation facilities. It is reported that the GoI is awaiting the results of the 2010 Census before providing a definitive policy statement on this issue. The DDWS is hoping that the census will reflect the rapid progress made in the two or three years since the last household survey, and that the smaller gap will make this issue easier to resolve.

6.8.2 Household Survey Data on Sanitation UsageThe household survey data (see Figures 3 and 4) demonstrate clearly that the current TSC monitoring and NGP verifica-tion processes are not adequately capturing the latrine usage and sustainability outcomes that are central to sanitation improvement. These data imply that there are significant differences between the quality and cost-effectiveness of the implementation processes in the two states, with very little benefit (in terms of improved access to basic sanitation) ap-parent in MP despite the theoretical progress reported by TSC and NGP systems.

47 The core sanitation survey question for the DHS, MICS and related surveys is “What kind of toilet facility do members of your household usually use?”

FIGURE 3: IMPROVED SANITATION COVERAGE IN RURAL AREAS, HIMACHAL PRADESH

100

2001 2002 2003 2004 2005 2006 2007 2008 2009

TSC sanitation coverageKey

Household survey sanitation coverageForecast

Per

cent

age

90

80

70

60

50

40

30

20

10

0

28%

53%

Source: TSC online reports; census 2001; DLHS 2004; DLHS 2008

FIGURE 4: IMPROVED SANITATION COVERAGE IN RURAL AREAS, MADHYA PRADESH

100

2001 2002 2003 2004 2005 2006 2007 2008 2009

TSC sanitation coverageKey

Household survey sanitation coverageP

erce

ntag

e

90

80

70

60

50

40

30

20

10

010%9%

Source: TSC online reports; census 2001. DLHS 2004; DLHS 2008

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coverage) found to be using latrines, compared to 87 per-cent latrine usage in NGP-winning villages in HP. Unfor-tunately, these findings have not been well accepted by the Government of MP, with several senior officials suggesting that the sample size and assessment methodology were in-adequate, or that the assessors had deliberately looked for problems in order to contradict broader TSC monitoring and NGP verification results.

Limited political or bureaucratic recognition of the prob-lems in MP reflects superficial engagement with sanitation improvement, and low accountability for program out-comes. At present, the success of TSC projects is measured largely by self-reported progress in TSC online monitoring system and by the number of NGP awards each year.

MP is doing reasonably well by these measures, with 59 per-cent of the unserved households identified by TSC now re-ported to have toilets49 and more than 1,500 NGP awarded GPs. However, district stakeholders reported that data in-dicating 100 percent latrine coverage are routinely entered into TSC online monitoring system before achievement in order to allow applications for the NGP awards (which now require 100 percent coverage before applications are accepted). TSC’s online monitoring system also fails to cap-ture non-usage or abandonment of latrines. Both the field-work for this assessment and the WSP rapid assessments indicate that the sustainability of sanitation outcomes is low in some NGP GPs, and suggest that the variable quality and integrity of the NGP verification process may have resulted in some undeserved awards.

A 2008 NGP impact assessment financed by UNICEF50 found similar problems. In the 162 NGP GPs assessed, 36 percent had less than 80 percent latrine coverage. Ten NGP communities from Chhattisgarh state, which used to be part of MP, were included in the assessment. La-trine coverage was reported to be very high in the Chhat-tisgarh communities, but only 39 percent of households in these NGP winning communities were using func-tional toilets. The main reasons given for the high rates

progress through the online monitoring system and through more reliable data from rapid assessments and evaluations. In particular, the DDWS has identified five states—Assam, Bihar, Jharkhand, Rajasthan and Uttar Pradesh—as priori-ties for future program support.

6.8.3 WSP Rapid AssessmentsIn early 2010, the lack of reliable or regular data on sanita-tion outcomes (see Table 14) led WSP to contract an inde-pendent rapid assessment of the usage rates and quality of recently constructed latrines in HP and MP (see Figure 5). The assessment methodology involved randomly selecting48 15 NGP GPs and 15 non-NGP GPs in each state, with 20 randomly selected households surveyed in each GP.

The rapid assessments found significant latrine usage and sustainability problems in MP, with only 44 percent of households in the 15 NGP-winning MP villages (verified through the NGP process as having 100 percent latrine

FIGURE 5: LATRINE USAGE IN HIMACHAL PRADESH AND MADHYA PRADESH

100

NGPvillages

Himachal Pradesh Madhya Pradesh

Non-NGPvillages

NGPvillages

Non-NGPvillages

Per

cent

age

80

60

40

20

0

Source: Rapid Assessments of Global Scaling Up Rural Sanitation Project: MP and HP, 2010

48 Stratified random sampling was utilized to ensure a representative sample across each state.49 A baseline of 9 percent coverage plus 59 percent progress in the unserved 91 percent = 63 percent total rural sanitation coverage.50 TARU (2008).

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The MP Government has suggested that the DLHS 2008 data is now three years old, and that both sanitation cover-age and program effectiveness have accelerated rapidly in the last three years. However, the 2008 household survey data imply that only one in four (26 percent) of the latrines reported by TSC monitoring system at that time were func-tioning and in use. While it is possible that latrine usage rates have improved since 2008 as more effective approaches have been introduced, the latrine usage rate implied by the household surveys is remarkably similar to the latrine usage rates found by recent WSP-supported rapid assessments. Therefore, it seems likely that the 2010 Census data will show only limited growth in sanitation coverage in MP.

In HP, the same analysis implies a latrine usage rate of 87 percent, which corresponds closely with the rate reported by the recent rapid assessment. It is significant that this rate is more than three times higher than that estimated in MP.

6.8.5 Evaluation by Sanitation Incentive SystemsThe NGP and state award systems provide limited annual evaluation systems, but both systems have weaknesses. The NGP is a stand-alone process: once the award has been made to a GP, it is no longer eligible, and therefore no lon-ger features in the process—every community can apply for the NGP but there is no guarantee that the sanitation out-comes will be sustained once the award is gained. The state clean village competitions have a different problem—these awards are made only to an elite group, the cleanest vil-lages in each area, and subsequently are unlikely to reach the much larger and more critical group of averagely clean and below-average communities.

The challenges faced by the NGP verification process, which has become increasingly difficult as the scale of the award scheme has increased, suggest that the most practical solution to large-scale monitoring or evaluation of sanitation outcomes is some form of sampled annual household sanitation survey that provides more regular and detailed data than the national household surveys undertaken every three or four years.

Both WaterAid and UNICEF were planning large-scale sanitation surveys in 2007, but have subsequently

of non-use and non-functionality were the low quality of the facilities (34 percent), lack of behavior change (23 percent), no superstructure (16 percent), and wrong lo-cation (12 percent).

As noted earlier, the WSP rapid assessment findings con-firmed those from the limited fieldwork for this enabling environment assessment, and from the large-scale house-hold surveys discussed previously. These findings suggest that sustainable use of improved sanitation facilities in MP may have improved from the 10 percent found by the DLHS in 2008 to around 17 percent in 2010,51 and con-firm that total sanitation coverage in HP lies somewhere between 44 percent and 87 percent.

6.8.4 Household SurveysThe baseline assessment noted that the DDWS-managed DLM survey was last undertaken in the second quarter of 2007. At the time, the DLM survey sampled 500 house-holds from each of 478 out of the 602 districts in India. The intention was to provide a randomized check on the achievements claimed by the districts through TSC online monitoring database, focusing on two indicators: overall sanitation coverage and latrine usage by BPL households.

Although there were some questions regarding the quality and reliability of the initial DLM survey findings, it was expected that these would improve as the DLM survey ma-tured. Unfortunately, the DDWS officials responsible for developing and managing the DLM survey left in 2007, and no further surveys were completed.

At present, the only reliable measure of household sanita-tion coverage is from large-scale household surveys such as the nationally-representative District Level Household and Facility Survey (DLHS-3) undertaken in 2008, the DHS-compliant National Family Health Survey (NFHS-3) un-dertaken in 2005-06, and the 2001 Census. While these large-scale surveys provide a reliable and demand-side as-sessment of sanitation practices, they are not undertaken frequently enough to provide the regular progress monitor-ing data required by program managers and government planners.

51 Only 7 percent of GPs in MP are NGP winners, which increases average sanitation coverage from 15 percent to 17 percent.

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6.8.7 Impact EvaluationImpact evaluation remains a major area of weakness. Few national or local institutions have the specialized knowledge and expertise required to design and conduct rigorous im-pact evaluations. As a result, few reliable impact evaluations are conducted, the findings are rarely shared or dissemi-nated (especially if they demonstrate lower impacts than anticipated), and therefore, program design rarely includes the lessons learned from previous programs and impact evaluations.

Unfortunately, the program impact evaluation will not be completed in HP because progress accelerated so fast that the state government decided not to wait for the endline impact evaluation before allowing interventions in the control sites. As a result, complete impact evaluation data will only be available from the less successful interventions in MP.

WSP also attempted to conduct a shorter-term evaluation that examined the impact of improved sanitation on clini-cal data from rural health centers and primary health data

abandoned these surveys due to the logistical challenges involved. While these organizations could provide techni-cal support for subsequent surveys, it seems likely that the government will have to take the initiative to develop an annual survey process along the lines of the DLHS termi-nated in 2007.

6.8.6 Equity IssuesOne of the critical policy and program issues for TSC is the effectiveness of the BPL latrine incentive. TSC guide-lines are posited on the assumption that the BPL incen-tive encourages poor households to build toilets, and then reimburses them for this achievement, thus ensuring that sanitation improvement is not an economic burden. Evolv-ing TSC guidelines, which include dramatic increases in the BPL latrine incentive, are driven by a sense that poor households are not building toilets because they are too ex-pensive, and that higher subsidies or incentives will enable even the poorest to benefit from improved sanitation.

The social protection literature supports this approach, sug-gesting that optimal benefits derive from transfers that tar-get the poorest first, and that societal benefits will accrue from the lower health, social, environmental, and economic costs resulting from the use of improved sanitation by those with the highest disease and other burdens.

A huge investment has been made in this approach. In the last three years, approximately 18 million BPL households have been provided with some form of latrine subsidy or incentive, at a cost approaching US$500 million.

A recent UNICEF analysis of the disaggregated wealth quintile data from nationally representative household sur-veys in India found that while the use of improved sani-tation facilities had increased dramatically in the middle and fourth wealth quintiles, only 13 percent of the second wealth quintile used improved sanitation facilities and, re-markably, improved latrine use was only 3 percent in the poorest wealth quintile (see Figure 6). These data suggest that, while latrine use in India is increasing, few of the poorest 20 percent, who include those with the highest dis-ease burdens, are being reached by the BPL latrine incentive provided through TSC.

FIGURE 6: ACCESS TO IMPROVED SANITATION SINCE 1995 BY WEALTH QUINTILE

100

Per

cent

age

80

6095

23

99

01

83

413

94

06

64

4

32

83

0

17

5

20

75

56

0

44

42

94

60

9440

20

1995

2008

0

1st

Improved and shared facilitiesUnimproved facilitiesOpen defecation

1995

2008

2nd19

9520

08

3rd

Wealth Quintile

1995

2008

4th19

9520

08

5th

Key

Source: Trend analysis based on three or more DHS, AIS, and/or MICS.

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from NGP villages in Haryana, Maharashtra and Andhra Pradesh, but the limited availability of disaggregated data restricted the analysis, and the primary research found evidence of open defecation in the supposedly NGP villages, effectively minimizing any differences between these villages and the control villages. These examples highlight the difficulty of conducting rigorous impact evaluation stud-ies, even with the resources and expertise available to the WSP team.

TABLE 14: ENABLING ENVIRONMENT IMPROVEMENTS: MONITORING AND EVALUATION


Monitoring systems

National outcome monitoring

Harmonization with JMP indicators

HP: ODF monitoring

MP: ODF monitoring

No

No

Yes

No

Yes

Yes

Yes

Yes

No

No

Yes

No

Sanitation evaluations

WSP financed (rapid assessments)

Govt. financed (national)

0

0

2

2

3

0

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TSC and NGP programs continue to provide excellent platforms for rural sanitation development, through the provision of adequate finance, basic technical guidelines, and institutional incentives. Yet there remains considerable latitude in how these resources and mechanisms are used by local governments, and outcomes are highly variable across states. Sanitation is a state subject. Therefore, despite rural sanitation development being guided by central TSC and NGP programs, the enabling environment at state level has a significant impact on sanitation activities and outcomes.

WSP provided similar levels of support and promoted simi-lar approaches and tools in both HP and MP. The start-ing contexts were different, with HP recognized as a small, relatively progressive and wealthy state, and MP as one of the largest and least developed states in India. Rural sanita-tion coverage was higher in HP, but was still low at only 28 percent in 2001, creeping up to 34 percent by 2006. Rural sanitation coverage in MP was extremely low at baseline, reaching only 10 percent in 2006. Both states faced a huge sanitation challenge, but it was clear that the larger chal-lenge was in MP.

In 2010, rural sanitation coverage in HP is estimated to have passed 80 percent, an increase of around 50 percent in only four years; whereas coverage in MP is estimated at around 17 percent, barely 7 percent growth during the same four-year period. Given similar government programs and program support, it is significant that the HP program has accelerated so dramatically over the last three years, while the MP program has struggled to reach even average national coverage levels.

There was a huge difference in the scale of challenge in MP, and some credit is due as both states have managed to provide sustainable sanitation to a similar number of households over the last three years, with an additional 600,000 or so households covered in each state. However, HP achieved this with rural sanitation expenditures of around US$8 million, compared to more than US$80 mil-lion invested in MP. While there are undoubtedly higher cost factors in the huge scale of the MP program, and in the higher proportions of poor and marginalized households,

ConclusionsVII.this endline assessment found that the significantly better cost-effectiveness in HP reflects a much stronger enabling environment than that found in MP.

7.1 Enabling Factors in HPSignificant improvements were apparent in the enabling en-vironment for rural sanitation in HP since baseline. Strong political support for sanitation, led by the chief minister, has galvanized local leaders and administrators, enabling al-ready competent local governments to use all of their capac-ity and resources to address sanitation deficits.

The state government stood firm on the no-subsidy policy introduced in 2005, despite concerns that HP was losing out by not utilizing the BPL latrine incentive funds avail-able through TSC. There was a growing consensus that a demand-led approach was working well. This consensus was fed by widely reported ODF successes, and expanding evidence of the benefits of improved sanitation, which led to strengthened local government commitment to program implementation and rapid scaling up of progress.

Regular monitoring and benchmarking of TSC progress, including spot checks by senior state officials, and weekly video conferences with the chief minister at which TSC progress was discussed, provided incentives for district administrators to prioritize the program, and encouraged improved coordination and cooperation between local gov-ernment departments. Competition between neighboring areas was also an important motivation, driven by the regu-lar WSP benchmarking reports.

The state government encouraged the spread of the success-ful institutional arrangements piloted in Mandi District, including the use of an NGO support organization and a district sanitation mission. Many districts introduced more strategic planning as coverage rose, in order to tackle the different community contexts and problems encountered when implementation is no longer targeted at only progres-sive, dynamic, and cooperative communities, as well as to ensure that optimal use was made of district resources to keep on track for long-term targets. Similar strategic pro-cesses are now being used to address solid and liquid waste

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laggards report that more than half of their villages are now open defecation free.

7.2 Disabling Factors in MPThere is little evidence that the enabling environment for rural sanitation has improved in MP since baseline, de-spite the relocation of TSC within the PRD. Significant implementation efforts and investments have been made in rural sanitation through the program and TSC, NGP, and NREGA programs and projects, and through substantial technical support provided by UNICEF, WaterAid, and other development partners. All of this work, however, has translated into relatively meager benefits due to the lack of high-level engagement, commitment, or priority.

Political support for sanitation remains limited. There was little evidence that local leaders or administrators see sanita-tion improvement as a priority: the chief minister has not yet presented the 2009 NGP awards to the winning village heads, and no state sanitation awards were yet been made more than two years after inception. There is little involve-ment or coordination of TSC activities with those of other departments, and there appears little recognition of the cross-sectoral benefits of effective sanitation improvement.

At baseline, it was hoped that shifting responsibility for TSC from the PHED to the PRD would increase the en-gagement of local governments, and decrease the overly technical and supply-driven approach favored by govern-ment engineers. In practice, little improvement was ap-parent in the implementation approaches used, or in the institutional arrangements. The new institutional home has made little difference because the same Gram Panchayat of-ficials are being tasked to implement the same approaches as at baseline, without any noticeable increase in priority or attention from above.

Most government officials in MP see TSC as a subsidy-driven latrine-building program. Sanitation activities are largely target-driven with little strategic planning, little evaluation of effectiveness, and little allowance for the dif-ferent ways in which communities and households respond to interventions. There was no evidence that either total sanitation or sanitation marketing approaches were being employed consistently or at any scale: standard PHED

management, and higher level issues like the long-term sus-tainability of outcomes.

Although the availability and affordability of sanitation goods and services has not changed greatly over the life of the program, information about goods and services has be-come widely available through the scaling up of sanitation promotion activities by local governments. Latrine con-struction is not difficult, but many rural households previ-ously perceived hygienic latrines as unattainable luxuries. Many stakeholders now have in-depth knowledge of low-cost latrine options, with the result that thousands of poor households have been assisted in finding affordable and ap-propriate sanitation facilities.

NGP awards remain an important incentive for sanitation development by local governments, but the institutionaliza-tion of the state sanitation awards in HP over the last three years has been even more effective in generating political and popular support for rural sanitation improvement. The state sanitation awards target a broader group of stakehold-ers, including school children and women’s self-help groups, and have deliberately involved elected representatives from local government in judging and presenting the awards. As a result, a large proportion of the population is familiar and engaged with the awards, which are seen to recognize and promote a Himachali vision of purity and cleanliness.

Good use was made of WSP technical support, with capac-ity building organized in advance of strategic needs, and regular demands made for WSP support in new areas as the program progressed and scaled up. Exposure visits were used to introduce and validate new approaches, and the full-time presence of the WSP state coordinator was impor-tant in maintaining momentum and interest.

Overall, a more institutional and enabling approach has been developed, with continuous sanitation development now seen as an integral part of the government program. The vision of an ODF HP (Nirmal Himachal) by 2012, which seemed unlikely at the outset of the program in 2007, is now viewed as a realistic and achievable goal. At baseline, two or three exceptional districts were performing well, whereas at endline, only two or three districts out of the twelve in HP are lagging behind, and even these supposed

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WSP has undertaken similar activities to strengthen the enabling environment in both HP and MP, including ex-posure visits, capacity building, performance benchmark-ing, targeted assessments, and sharing of best practices. This approach proved successful in HP, where local government was receptive and engaged in the process, but has had only limited success in MP. While some of the problems stem from the more challenging context in MP, the conclusion of this assessment is that the failure of the state government to embrace critical elements of the approaches promoted by the program—such as the need to move away from a supply-driven approach toward a demand-based total sani-tation approach—limited high-level recognition of the problems, and prevented the reforms required to improve the enabling environment.

7.3 Return to the CRSP?In many ways, TSC in MP has come full circle back to the CRSP paradigm of the 1990s. At the outset of TSC, the relatively small amount provided for the BPL latrine incen-tive, Rs 500 (US$12) per household, forced local govern-ments to generate demand for sanitation facilities, utilize cost-efficient approaches, and encourage households to in-vest some of their own time and resources to build facilities. As the BPL incentive amount has risen, and as additional sources of subsidy have become available through programs like NREGA, local governments have been able to return to the entirely supply-driven approach and standard technical designs favored under CRSP.

CRSP ended when low latrine usage rates and sustainability of facilities, along with the massive waste of government in-vestment that these entailed, became apparent. At present, the Government of MP appears reluctant to accept that the current subsidy policy, and the implementation approaches that this policy encourages, are resulting in low ODF and NGP success rates, low latrine usage rates, little sustainable behavior change, and low cost-effectiveness. As a result, there is little recognition of the need for any reform in im-plementation approaches, or for any improvements in the enabling environment for rural sanitation improvement.

The pro-poor arguments being used to support an increase in the BPL incentive assume that the reason for low latrine uptake and usage is that the latrines currently promoted

latrine designs were promoted and installed in most areas, with little or no allowance for household variations in pref-erence or needs, and little attempt to build sustainable pri-vate supply chains.

The district projects have recruited district and block TSC coordinators, but these coordinators currently lack the capacity, experience, or resources for effective support to community level implementation by the GPs. The GPs are asked to mobilize households, organize activities, purchase materials, and supervise contractors, but have few incen-tives to perform well or to sanction poor performance by service providers. In a context of poor governance and high poverty, the large sums of money involved in program im-plementation, when combined with limited independent monitoring or accountability for expenditures, mean that TSC is often an opportunity for additional income genera-tion by local officials.

Although few reliable data were available, the policies and approaches adopted in MP do not appear cost-effective. Total investments in rural sanitation over the last three years are estimated to be about ten times higher than those in HP and, while TSC online monitoring data report dramatic increases in sanitation coverage, more rigorous large-scale household surveys and recent WSP assessments suggest that a similar number of households have gained sustainable access to improved sanitation facilities in both states. Many of the latrines built through TSC in MP are not being used, while the use of multiple program subsi-dies to finance latrine construction means that the leverage ratio is also low—program investments are not leveraging much household investment—which is limiting the scale and spread of improved outcomes.

WSP benchmarking suggests that five districts are per-forming relatively well (Jabalpur, Dhar, Indore, Rewa, and Satna) with 42 percent of all NGP awards in the state found within these few districts. However, there is little evidence of any large-scale improvements in enabling environment that have changed practices or lifted performance across the entire state. The five successful districts are driven by exceptional, committed individuals rather than by a more institutional approach or more supportive conditions for sanitation improvement.

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build consensus on what works best. As a result, influential union and state politicians are able to present any increase in the BPL latrine incentive as a pro-poor measure needed to tackle the long-running sanitation deficit, with little resistance from vested interests that benefit from higher subsidies, and little accountability for the ineffective use of government funds due to the limited reporting of past or present program outcomes.

The recent WSP rapid assessment of TSC processes and outcomes52 provided good evidence of the association be-tween process quality and TSC project performance. Dis-cussions with the DDWS revealed that support for the total sanitation approach, which was relatively low in cen-tral government at baseline, has increased substantially as evidence of the higher sustainability and cost-effectiveness of this approach over more supply-driven approaches has emerged. However, the DDWS has little authority to im-pose specific approaches and tools on independent state and district projects, and is thereby restricted to knowledge management and advocacy activities to share best practices, highlight implementation issues, and strengthen account-ability for program outcomes.

Another important national constraint identified was the lack of flexibility in the TSC financing model. TSC guidelines earmark fairly rigid proportions of each district TSC project to specific implementation components, but these earmarks fail to recognize the massive variation in requirements and approaches across rural India. Several districts in HP had de-veloped cost-effective approaches to latrine development, and only used a fraction of the allocated budget in achieving the program targets for this component, but then found them-selves short of TSC funds for the development of institutional sanitation facilities and communal drainage and solid waste infrastructure despite large amounts of their original TSC project budget remaining unused. More flexibility in the use of these district TSC funds would encourage innovation and greatly enhance the effectiveness of implementation.

7.5 Nirmal Gram PuraskarNGP continues to be a controversial program. Recent evaluations by UNICEF and others found NGP-awarded

by TSC are unattractive and inadequate, and that a larger incentive will afford more durable and attractive latrines. However, the HP assessment suggests that demand creation and ownership are critical ingredients of large-scale rural sanitation improvement, and that rural households and communities often find far more cost-efficient solutions to latrine construction than supply-driven government projects.

India has some of the lowest cost factors—materials, trans-port, labor, and skilled services—in the world. The current BPL incentive of US$49 per BPL household should be suf-ficient to build a durable and hygienic latrine in even in the most remote and difficult contexts of MP, provided that more effective and sustainable approaches to promotion and implementation are widely adopted.

7.4 Enabling Environment at the National LevelOne of the lessons from the HP and MP assessments is that high latrine subsidies often create implementation prob-lems because of the temptation to revert to supply-driven approaches and short-circuit demand creation processes. The rising BPL incentive in MP has increased the use of supply-driven approaches, which in turn has diminished ef-forts to generate genuine demand for latrines or to encour-age user involvement in the process. In contrast, the zero hardware subsidy adopted in HP, which resulted from the decision not to use the BPL incentive funds, encouraged local governments to develop cost-effective approaches to demand generation and institutional support, and ensured that households who built latrines felt ownership, responsi-bility, and pride in their facilities.

The absence of any reliable or regular measure of the use of improved sanitation facilities, and the relationship be-tween these outcomes and the state policies and processes, has limited understanding of this lesson in central gov-ernment. The DDWS remains vulnerable to charges that the BPL incentive is insufficient to create demand in poor areas, and does not allow the construction of the durable and attractive facilities needed to encourage sustainable use, because it lacks a convincing evidence base with which to

52 WSP 2010.

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500 to Rs 2,200, and the GoI has indicated that it is likely to be increased to Rs 3,200 (US$70) in the near future. The significant increases to the latrine incentive indicate that influential stakeholders remain unconvinced that India’s ambitious sanitation goals can be met without higher sub-sidies. This assessment concludes that the main constraint is not the level of the BPL latrine subsidy, but the way in which these subsidy funds have been used to strengthen supply-driven approaches to latrine construction that are not the most cost-effective or sustainable use of govern-ment resources. Unfortunately, WSP has not yet been able to develop sufficiently compelling evidence, or present it well enough to the right people, to convince key decision makers of the huge opportunity costs associated with some current practices.

7.7 Potential to Achieve Sanitation MDGThe 2015 MDG for sanitation is to halve the proportion of the population without access to basic sanitation using a 1990 baseline. The lack of sanitation data disaggregated by state makes it difficult to estimate the 1990 baseline, but it has been assumed that rural sanitation coverage in MP was close to the national average of 7 percent, and in HP was around 15 percent.

These baseline estimates set the 2015 sanitation MDGs at 54 percent in MP and 58 percent in HP. Differential sani-tation progress up to 2006 meant that the MDG challenge was substantially harder in MP at program baseline since it needed to increase rural sanitation coverage from 10 per-cent in 2006 up to 54 percent in 2015: a gain of 44 percent in only 9 years, which required more than 4 million new la-trines; compared to the HP challenge to raise coverage from 34 percent in 2006 up to 58 percent in 2015: 24 percent in 9 years, which required 0.5 million new latrines.

At the end of the program, it appears that HP has already surpassed its MDG target. The 2008 DLHS reported rural sanitation coverage of 53 percent, while recent estimates suggest that coverage has now passed 80 percent. As noted earlier, the 2008 DLHS found that rural sanitation cover-age in MP had only increased to 10 percent, and recent forecasts suggest that coverage is unlikely to be much higher

villages with low sanitation coverage and significant levels of open defecation,53 raising serious questions about the in-tegrity of the NGP verification process and the sustainabil-ity of sanitation outcomes generated by the NGP awards. This assessment concludes that the positive effects of NGP in generating political attention to sanitation improvement and in galvanizing local government activity far outweigh the problems associated with the process.

NGP fulfils its original function well, in that it creates in-centives for local governments to achieve collective sanita-tion outcomes and it draws considerable political attention to rural sanitation improvement in the process. It was never meant to be a mechanism for ensuring the long-term sus-tainability of these outcomes. NGP has been strengthened to add some emphasis to sustainability, but a comple-mentary program is needed to provide the long-term in-stitutional support and monitoring that will ensure more sustainable improvements in rural sanitation.

7.6 WSP Enabling Environment RoleThe program team has played an important role in devel-oping the enabling environment for rural sanitation at na-tional level, and at state level in HP. However, it has had only limited success in influencing the enabling environ-ment in MP and it lacks the staff capacity to implement parallel support programs in the three or four other Indian states that have asked WSP for project-type assistance.

The WSP team acknowledged that it became apparent over the last year or so that the program in MP lacked the high level political influence required to shift the policy on latrine subsidies and supply-driven approaches or to generate real political engagement with both TSC and NGP programs. As a result, many of the lower-level project implementation-re-lated activities have not been as successful or as cost-effective as hoped. The lesson appears to be that implementation sup-port should not be scaled up until some minimum enabling environment conditions are met; otherwise there will be a significant opportunity cost to any investment.

In the three years since the baseline assessment in mid 2007, the BPL latrine incentive has quadrupled from Rs

53 TARU, 2008; WaterAid, 2008; Bhaskar, 2009; Snehalatha et al, 2010; Alok K, 2010.

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than 17 percent in 2010. At the current progress rate, which is around 2.5 per-cent increase in rural sanitation coverage per year, MP will not reach its MDG until 2025.

7.8 Key LessonsThe success of the HP TSC project, to which the program contributed, has shown that, under the right conditions, rapid and large-scale sanitation prog-ress is possible in only a few years; and that ODF success rates are not limited to the 35 percent suggested by previous implementation experiences. When the enabling environment framework is well developed, and strong political support is available to drive implementation, universal sanitation becomes a realistic and achievable goal within a relatively short period.

This endline assessment found that political support and priority were central to the success of TSC and NGP programs in HP. While the reasons for the develop-ment of this political support are complex, it seems likely that the early successes provided by a combination of progressive state sanitation policies and exceptional leadership in Mandi District were sufficient to demonstrate that new approaches worked and that rapid sanitation improvements were possible. In addition, there was sufficient convergence between the aims of TSC, Himachali cultural mores, and a growing environmental movement, to make sanitation improvement a po-litically viable and attractive cause for influential figures like the chief minister.

Given the importance of context, timing, and culture to this process, the chal-lenge for any other program will be to generate a similar level of political support and priority, particularly in states with less supportive starting conditions.

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As a result of this endline assessment of the enabling envi-ronment, there are specific recommendations for support for non-performing states. The experience in MP suggests that where the enabling environment is not supportive or developed, the initial focus should be on the development of model districts rather than large-scale implementation or technical assistance, so that local approaches and successes can be showcased to increase support for rural sanitation improvement.

The intention is to limit investment until the enabling environment improves, as well as to use program funds to reward improved performance and good governance (e.g., through scaling up in model districts) rather than spreading efforts thin before supportive conditions are in place. Wherever possible, model districts should introduce evidence-based approaches to challenge supply-driven im-plementation and subsidy cultures, attempt to demonstrate that poor households can build improved sanitation facili-ties without up-front subsidies, and that more sustainable outcomes result from the generation of genuine demand and ownership for household latrines.

It is also important to strengthen the enabling environ-ment at state level through building the evidence base and undertaking high-level advocacy activities. Wherever pos-sible, senior development partner staff should be employed to access and influence decision-makers. Explicit enabling environment targets should be negotiated with state gov-ernments, with the agreement that the scaling up of imple-mentation support will not take place until these targets have been met.

The experience in HP provides useful lessons on scaling up towards universal sanitation. In particular, it is important to identify the specific problems faced by lagging districts, areas and groups, and to develop appropriately tailored strategies to tackle these problems. Given the capacity shortages and incentive problems often found in poor per-forming areas, it is recommended that additional resources are provided by state government and its development partners to any lagging districts that agree to implement tailored sanitation strategies and accept more intensive

RecommendationsVIII.monitoring and evaluation of progress. The intention is to focus attention on the different challenges faced by outliers, to develop specific approaches and arrangements to tackle these challenges, and to provide sufficient resources and ex-pertise to develop the capacity needed to implement and sustain improvements.

The following sections contain generic recommendations arising from the assessment and from subsequent discus-sions of the assessment findings with in-country stakehold-ers and WSP staff:

Recommendation 1: Reformulate the Total Sanitation CampaignTSC was designed as a framework for five-year district proj-ects. It therefore assumed an intensive, campaign-mode ap-proach suite to a short lifespan. In practice, it has already run for 10 years in some districts, and looks likely to op-erate on a long-term basis in many more. Furthermore, it was developed from the more technical and construction-oriented CRSP, whereas the emphasis is now largely on be-havior change and public health issues. As such, the pro-gram design should be reformulated to reflect the longer term objectives of sanitation improvement, and to incorpo-rate a more public health-based framework for measuring sanitation and hygiene outcomes.

There is a need for longer-term institutional support and monitoring of sanitation outcomes, which is not currently filled by TSC or NGP. This sort of public health moni-toring and regulation is usually the responsibility of local health services; it is recommended that efforts should be made to develop a sustainable system for sanitation out-come monitoring through local health services (rather than through the rural development department or public health engineering department). This approach will have the advantage of using existing networks of health exten-sion workers and volunteers, and of encouraging stronger linkages and collaboration with other initiatives aiming to reduce diarrheal disease and lower child mortality.

In addition, TSC guidelines, which have been evolv-ing gradually as TSC itself charges, should be developed

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Recommendation 4: Encourage a Two-stage Incentive SystemThe HP assessment confirms the value in a two-stage in-centive system, whereby ODF achievement by local gov-ernments is monitored separately from NGP applications and awards. The two-stage process is more palatable for less dynamic and able village governments, and results in a more focused and less rushed process that allows activities to develop in scale and complexity as community capacity and experience builds and improves. The two-stage process also provides finer-grained information for district and state governments, informing better planning, resource alloca-tion, and capacity building.

WSP has long championed a two-stage process at national level, but met with resistance from central and state stake-holders who questioned the utility of ODF achievement without wider environmental sanitation and hygiene im-provements. At endline, the HP experience clearly dem-onstrates the benefits of a two-stage process, whereby the momentum and support generated by widespread ODF achievement has developed the comprehensive enabling environment required for rapid progress towards the harder-to-achieve environmental sanitation and hygiene improvement requirements of the NGP award.

It is recommended that WSP encourage other progressive states to employ a two-stage process in order to provide further evidence of the benefits of this approach, with a longer-term view to convincing the DDWS to formalize the inclusion of a two-stage approach in TSC guidelines.

Recommendation 5: Invest in Cost-effectiveness DataThe publication and dissemination of reliable evidence of wasted investments and opportunity costs remains one of the most powerful motivators for government reform and improvement, especially when those costs relate to emo-tive issues like children’s health, environment, and poverty. More effort is needed to collect and analyze information on sanitation program costs, outcomes, and impacts into simple cost-effectiveness measures and advocacy materials that can be used to encourage competition among districts and states, to identify optimal strategies, and to influence high-level decision and policy makers.

into a more formal rural sanitation policy—one that is relevant for all rural sanitation interventions not just those under TSC. A rural sanitation policy based on TSC guidelines would provide opportunities to involve stakeholders from other sectors and encourage a more evidence-based policy development process that builds on the strengths of TSC, without being hamstrung by its programming needs.

Recommendation 2: Develop More Effective High-level Advocacy Improving political support and priority for sanitation im-provement is one of the central challenges of strengthen-ing the enabling environment. The MP assessment suggests that advocacy and enabling environment activities were not at a sufficiently high level to influence key decision makers, and that key development partners promoted different and conflicting support strategies, implementation approaches, and monitoring tools.

In order to present Government with clear, consistent and evidence-based messages that are designed to influence high-level decision makers, development partners should work to harmonize their advocacy, enabling environment, and performance assessment activities. In particular, it is recommended that reliable cost-effectiveness data should be collected and used more widely to demonstrate the wasted investments and opportunity costs of some current strate-gies and approaches, and the greater effectiveness and sus-tainability of the alternatives.

Recommendation 3: Recognize That One Strategy Does Not Fit AllBetter information and data on latrine usage, sustainabil-ity of behavior change, and targeting accuracy (i.e. success in improving sanitation for the poorest households) are re-quired to develop strategic plans to meet the government’s sanitation targets.

In particular, efforts need to be made to identify hard-to-reach areas and groups, to examine issues that limit the cost-effectiveness and sustainability of sanitation improve-ments, and to recognize that different strategies, resources and tools are required in different contexts and stages of development.

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Recommendation 6: Incorporate Latrine Usage and Sustainability into Benchmarking SystemsWhile latrine usage and sustainability data are not as easy to collect as information on the number of latrines built, it is important that sanitation programs begin to work towards routine monitoring and benchmarking of sanitation outcomes. Initially, it may be necessary to undertake annual rapid assessments in order to generate latrine usage and sustainability data that can inform annual performance reviews, but eventually this data should be collected as part of routine public health monitoring systems.

Recommendation 7: Develop State Capacity for Knowledge ManagementExposure visits and horizontal learning events were identified as the most impor-tant knowledge management tools for local governments. At present, local gov-ernments are reliant on agencies like WSP and UNICEF to organize these visits and events, which often makes them dependent on external program finance and constrained development partner capacity.

Given the significant government budget available, efforts should be made to convince decision makers to allocate budget to organize and implement periodic exposure visits and multi-level horizontal learning events. WSP can continue to provide technical assistance to these events but it is important that the direction and finance should come from sustainable government sources.

The development of state capacity to organize knowledge management events should form part of the program exit strategy in both states, through the for-mulation of a phased annual knowledge management program that outlines the diminishing role to be played by WSP. Local governments will require some hand holding during the early events, but the additional value provided by these events should allow the development of sustainable mechanisms to finance and manage them, while WSP gradually builds local capacity for their planning and facilitation.

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Alok, K. 2010. Squatting with dignity: Lessons from India. New Delhi: Sage Publications. India.

Bhaskar, T. 2009. Sustaining the sanitation revolution: India country sanitation status. ADB-DMC Sanitation Dia-logue, Ministry of Rural Development. Government of India.

DDWS (2010a) Guidelines Central Rural Sanitation Pro-gram: Total Sanitation Campaign. New Delhi: Gov-ernment of India, Ministry of Rural Development. Department of Drinking Water Supply.

DDWS (2010b) Nirmal Gram Puraskar: Guidelines New Delhi: Government of India, Ministry of Rural Devel-opment. Department of Drinking Water Supply.

DDWS (2010c) Technology options for household sanitation New Delhi: Government of India, Ministry of Rural Development, Department of Drinking Water Supply.

Government of Himachal Pradesh (2004) Strategy for Total Rural Sanitation in Himachal Pradesh.

Government of India (1999) National Family Health Survey (NFHS-1) Mumbai: Ministry of Health and Family Welfare, International Institute for Population Sciences.

Government of India (2001) Census of India 2001 http://www.censusindia.gov.in/Census_Data_2001/States_at_glance/state_profile.aspx


Government of India. (2004a) Guidelines on Central Rural Sanitation Program: Total Sanitation Campaign New Delhi: 9, paragraph 9(d). Ministry of Rural Develop-ment. Department of Drinking Water Supply.

Government of India. (2004b) Guidelines on Central Rural Sanitation Program: Total Sanitation Campaign New Delhi: 7, paragraph 7. Ministry of Rural Develop-ment. Department of Drinking Water Supply.


Government of India (2006) Modification in TSC guidelines: Increase in unit cost of household toilets. New Delhi: Ministry of Rural Development. De-partment of Drinking Water Supply. Memo No. W-11013/4/2000-CRSP (Pt. III).

Government of India (2008) District level household and facility survey: fact sheet—Himachal Pradesh. New Delhi: Government of India. Ministry of Health and Family Welfare.

Government of India (2008) District level household and facility survey: fact sheet—Madhya Pradesh. New Delhi: Government of India. Ministry of Health and Family Welfare.

JMP (2006) Meeting the MDG drinking water and sanita-tion target: the urban and rural challenge of the decade Geneva: World Health Organization and United Na-tions Children’s Fund Joint Monitoring Programme for Water Supply and Sanitation, progress report.

Kar, K. (2005) Subsidy or self-respect? Community led total sanitation. An update on recent developments Brighton: University of Sussex, Institute of Development Studies.

Knowledge Links (2005) Formative research: development of sanitation IEC manual for HP

NCAER (1999) India: Human Development Report New Delhi: National Council of Applied Economic Research

RGNDWM (2005) Nirmal Gram Puraskar: a national award under Total Sanitation Campaign. New Delhi: Rajiv Gandhi National Drinking Water Mission. Gov-ernment of India website: www.ddws.nic.in

Robinson, A. (2005) Scaling up rural sanitation in South Asia: Lessons learned from Bangladesh, India and Paki-stan New Delhi: The World Bank. Water and Sanita-tion Program South Asia.

Snehalatha M, V. Ratna Reddy, and N. Jayakumar (2010) Assessing sanitation costs and services in Andhra Pradesh, India. IRC Symposium 2010: Pumps, pipes and promises.

TARU (2008) Impact assessment of Nirmal Gram Puraskar awarded Panchayats: final report. UNICEF.

References

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment References


WaterAid (2006) Total sanitation in South Asia: the challenges ahead. Discussion Paper. London: WaterAid.

WaterAid (2008) Feeling the pulse: a study of the Total Sanitation Campaign in five states. Report. New Delhi: WaterAid India.

WHO-UNICEF (2010) Progress on sanitation and drinking water: 2010 update. Geneva: World Health Organization.

Wilbur Smith Associates (2010) Rapid assessment of total sanitation and sanita-tion marketing (Global Scaling Up Rural Sanitation) project: Madhya Pradesh and Himachal Pradesh. WSP report. Unpublished.

WSP (2007) An approach that works: Community Led Total Sanitation in rural areas. New Delhi: The World Bank. Water and Sanitation Program South Asia.

WSP (2010) A decade of the Total Sanitation Campaign: Rapid assessment of proc-esses and outcomes. Study report. Water and Sanitation Program South Asia.

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Annex 1: Assessment Meetings and Activities


Activities in Himachal PradeshThe following list details the stakeholders interviewed by the assessment team in HP during 01–09 September 2010:

1. Jasywant, PO RDD Kullu, Kullu 02 Sept.2. Journalists (Ajay Kumar, Sumeet Johan & Ashish

Sharman), Kullu 02 Sept3. Retailers, Kullu 02 Sept4. Indar Dev, ZSS (NGO) Kullu 03 Sept5. Chairman, Zila Parishad, Kullu 03 Sept6. District Health Officer, Kullu 03 Sept7. BM Nanta, District Commissioner, Kullu 03 Sept8. Block Development Officer, Banjar Block, Kullu 04

Sept9. LSEO, Banjar Block, Kullu 04 Sept

10. Block Coordinator, ZSS (NGO), Banjar Block, Kullu 04 Sept

11. Gram Panchayat, Balaghad, Kullu 04 Sept12. District Commissioner, Una 06 Sept13. ADC, Una 06 Sept14. Ravinder Sharma, PO RDD, Una 06 Sept15. Media representatives, Una 06 Sept16. Chief Medical Officer, Una 06 Sept17. Gautam Sharma, ICDS, Una 06 Sept18. Utri (NGO), Block Coordinator, Una 06 Sept19. BDO, Una Block, Una 06 Sept20. Pradhan, Bedhala GP, Una 07 Sept21. Panchayat Secretary, Bedhala GP, Una 07 Sept22. Pradhan, Dehlan GP, Una 07 Sept23. Panchayat Secretary, Dehlan GP, Una 07 Sept24. RD Dhiman, State Secretary RDD, Shimla 08 Sept25. Robin George, Assistant Director TSC-RDD,

Shimla 08 Sept26. Ravinder Kumar, CCDU consultant, Shimla 08

Sept27. RN Bhatta, Director RDD, Shimla 08 Sept

Following the main interview schedule and fieldwork, a short feedback meeting was held in Shimla on Wednes-day 08 September 2010 (14:00–17:00). At this feedback

meeting, the assessment team presented their initial find-ings to a small group of key stakeholders (including the PRD Secretary, Assistant Director TSC, and assorted State and District officials) for verification, discussion and fur-ther clarifications.

Activities in Madhya PradeshThe following list details the stakeholders interviewed by the assessment team in Madhya Pradesh during 10–17 Sep-tember 2010:

1. Dr Puranik, Assoc. Professor WALMI, Bhopal 10 Sept

2. Engineer-in-Chief, PHED, Bhopal 10 Sept3. SC Jaiswal, Technical Officer, WaterAid MP, Bhopal

10 Sept4. Ravindra Pra, CCDU consultant, Bhopal 10 Sept5. District Collector, Bhopal District, Bhopal 10 Sept6. Gajendra Rathod, Block Coordinator, Rama Block,

Jhabua 12 Sept7. Gram Panchayat, Gundipara GP, Jhabua 12 Sept8. Amit Dubey, District Coordinator, Jhabua 12 Sept9. Kalawati Buria, President Zila Panchayat, Jhabua 12

Sept10. Deputy Director, Branch Office NCHSE (NGO),

Jhabua 12 Sept11. Shobhit Jain, District Collector, Jhabua 12 Sept12. SDO, Rural Engineering Services PHED, Jhabua

12 Sept13. Ahed Khan, Sub-Editor, Hindi Daily (Rajasthan

Patekha), Jhabua 12 Sept14. Retailer, Jhabua bazaar, Jhabua 12 Sept15. GP Secretary, Temaria GP, Petlawad Block, Jhabua

13 Sept16. TSC District Coordinator, Chhindwara 15 Sept17. District Collector, Chhindwara 15 Sept18. Retailer, Chhindwara bazaar, Chhindwara 15 Sept19. Chief Medical Officer, Chhindwara 15 Sept20. Superintending Engineer, PHED, Chhindwara 15

Sept

Annex 1: Assessment Meetings and Activities

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21. Sanjay Goutam, Editor Dhanik Bhaskhar, Chhindwara 15 Sept22. Gram Panchayat, Ridhora GP, Parasia Block, Chhindwara 16 Sept23. Block Development Officer, Parasia Block, Chhindwara 16 Sept24. Block Coordinator, Parasia Block, Chhindwara 16 Sept25. Gregor von Medeazza, WASH specialist, UNICEF, Bhopal 17 Sept26. MR Soni, Deputy Commissioner TSC, PRD, Bhopal 17 Sept27. Secretary, PRD, Bhopal 17 Sept

Following the main interview schedule and fieldwork, a short feedback meeting was held in Bhopal on Friday 17 September 2010. At this feedback meeting, the assessment team presented their initial findings to a small group of key stake-holders (including the Secretary of Rural Development, Director PRD, Deputy Commissioner TSC, and assorted state and district officials) for verification, dis-cussion and further clarifications.

Activities in New DelhiThe following list details the national stakeholders interviewed by the assessment team in New Delhi during 30 August–24 September 2010:

1. Ajith Kumar, WSP Country Task Manager for the program, 30 August2. Manu Prakash, WSP consultant, 30 August3. Aruvindar Satiawada, WSP consultant, 30 August4. Arokiam Kakumanu, WSP MP State Coordinator, 30 August5. Juan Costain, Regional Team Leader, WSP South Asia, 31 August6. JS Mahur, Joint Secretary DDWS, 20 Sept7. Lourdes Baptista, CEO, WaterAid India, 20 Sept8. Ashufta Aslam, DFID India, 20 Sept9. Moni Sagar, BCC and Marketing specialist, USAID, 22 Sept

10. Jeremy Gustafson, Director CLEEO, USAID 22 Sept11. RVV Raghava, Senior Infrastructure Specialist, World Bank India, 22 Sept12. Sumita Ganguly, UNICEF India, 22 Sept

A learning event was held in New Delhi on Tuesday 21 September to present the initial findings of the enabling environment assessments in Himachal Pradesh and Madhya Pradesh, and to brainstorm on enabling environment issues with a group of engaged and active stakeholders. Key participants included: Lizette Burgers (Chief of Child Development and Environment, UNICEF India); Vijay Mittal, Director TSC DDWS, Dirk Walther, GTZ adviser).

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Annex 2: Terms of Reference for Consultancy


2. Background/General DescriptionThe Water and Sanitation Program (WSP) is an interna-tional partnership to help the poor gain sustained access to water supply and sanitation services. Administered by the World Bank with financial support from several bi-lateral, multi-lateral, and private donors, WSP is a decentralized partnership and operates through offices in Africa, East Asia, Latin America and South Asia. A major thrust of the programs is to help its clients prepare for and implement actions towards meeting the water supply and sanitation (WSS) Millennium Development Goals (MDGs). In pur-suing their mission, WSP staff provides advisory support to projects and policies to help identify and disseminate best practices and lessons from experience across countries, as-sist clients in the implementation of pilot projects to test out new ideas, and facilitate informal networks of practitio-ners and sector stakeholders. Additional information about WSP can be found on the program website (www.wsp.org).

The Water and Sanitation Program is implementing the “Total Sanitation and Sanitation Marketing (TSSM): New Approaches to Stimulate and Scale Up Sanitation Demand and Supply Project.” This program has the primary goal of learning about scaling up and about effective and efficient sanitation interventions that improve health. The TSSM pro-gram is a large-scale effort to meet the basic sanitation needs of the rural poor who do not currently have access to safe and hygienic sanitation. That aim will be accomplished by developing the practical knowledge for designing sanitation and hygiene programs that are effective at improving health and are sustainable at large scale for rural areas. The program will test proven and promising approaches to create demand for sanitation, and to use marketing techniques to improve the supply of sanitation-related products and services.

The program is designed to achieve key milestones in each country at the end of four years of program implementation (including the start up period that will facilitate the achieve-ment of the MDG 2015 sanitation targets. These milestones

Endline Assessments of the Enabling Environment to Scale up, Sustain, and Replicate Sanitation Approaches in the Global Scaling Up Rural Sanitation Program

In Indonesia, India, and TanzaniaDRAFT Revised: 25 February 2010

1. Overview of TOR The Water and Sanitation Program (WSP) is in the final phase of a project entitled “Total Sanitation and Sanita-tion Marketing: New Approaches to Stimulate and Scale up Sanitation Demand and Supply.” The program has as one of its central objectives to improve sanitation at a scale sufficient to meet the sanitation MDG targets by 2015 in Indonesia, Tanzania, and the Indian states of Himachal Pradesh and Madhya Pradesh.

The purpose of this consultancy is to carry out an endline assessment of the programmatic conditions needed to scale up, sustain and replicate the total sanitation and market-ing approaches. The programmatic conditions are the eight dimensions that are defined in the conceptual framework in Section 3 of this TOR. Scale up is defined as meeting the 2015 MDG targets in each country. Sustainability is defined as the ability to maintain programs after external funding has ended. Replication is the eventual application of the TSSM approach in other countries at scale.

The endline assessments will be carried out during the final phase of the overall program during late 2010 and early 2011. The endline assessments in each country will be carried out by two-person team consisting of an inter-national specialists and a local consultant of country WSP staff member. The consultant teams will be hired as inde-pendent consultants but will function as one overall team under the direction of the WSP Country Task Manager for the TSSM program with support from the Global Task Team Leader.

Annex 2: Terms of Referencefor Consultancy

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scalability, approaches for demand creation, sanitation mar-keting, and the baseline for the impact evaluation will be carried out during this period. Phase II is the three-year im-plementation period and Phase III is the three to six month wrap-up phase that will include the final evaluation and dissemination of lessons learned. This final programmatic assessment will take place during Phase III.

In the larger sense, the assessment will answer the question whether there is an enabling environment in place in each country that can continue after the end of this program and meet the MDG targets by 2015.

3. Conceptual FrameworkIn order to ensure consistency in the assessment findings, WSP developed a conceptual framework for assessing scalability. This framework was developed based on a review of relevant literature and discussions with key individuals. The framework consists of eight dimensions that are considered essential to scaling up the total sanitation and sanitation marketing ap-proaches in rural areas using on-site sanitation facilities.

• Policy, strategy, and direction• Institutional arrangements• Program methodology• Implementation capacity• Availability of products, tools and information• Financing and incentives• Cost effective implementation

should indicate if the key program elements are in place by mid-2010 to meet the 2015 MDG targets. The specific tar-gets for scaling up in each country are in Table 15.

The purposes of this terms of reference are to 1) assess to ex-tent to which the programmatic conditions for scale up and sustainability have improved by the end of the TSSM pro-gram and, 2) on the basis of the endline assessment findings and learnings, recommend what should be done to address the gaps during the remainder of the TSSM program im-plementation period or for the future if a follow on project is undertaken. Determine if the programmatic conditions are in place to meet the 2015 MDG targets and are likely to be sustained over time. The fundamental question that the assessment is intended to answer is whether the country can continue to scale up after 2010 without assistance, with less assistance or with different assistance, from the TSSM program and whether the TSSM program conditions are institutionalized to support scaling up in a sustainable man-ner. Strengthening the enabling environment is integral to increasing demand at the household and community lev-els and improving the supply of affordable and appropriate sanitation products and services.

The overall TSSM program is four years in duration with three distinct phases. Phase I—December 2006 to August 2007—is the initial six to nine month start-up period for detailed studies, planning, and procurement at the global and country level. Several assessments including the one for

TABLE 15: GEOGRAPHIC AREAS AND BENEFICIARIES

Geographic Areas Where the Program

Will Take Place/Population

Estimated Number of

People without Access

to Sanitation in 2006*

Estimated Number of

People Who Will Gain

Access to Sanitation

during Two-year Pilot

Phase

Vision of Number of

Additional People Who

Will Get Access to

Sanitation by 2015 to

Meet MDG Targets**

Tanzania (rural)/26.7 million in 2006 14.25 million 750,000 6.5 million

Indonesia (East Java province)/36.5 million 18.6 million 1.4 million 10 million

Indian state of Himacahal Pradesh (rural)/5.5 million

rural population 4.3 million 700,000 1.2 million

Indian state of Madhya Pradesh (rural)/45 million rural

population 43.6 million 1.1 million 20 million

Total 80.75 million 3.75 million 37.7 million

* Best estimates given poor status of data.** Accounts for population growth estimates

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administrative or travel related logistics for the field assignment.

4.4. Finalize the interview protocols for the respective coun-tries based on the baseline documents and any new in-formation or revised analytical framework provided by WSP-WDC or WSP-Countries either before or during the initial planning meeting ( as per 4.3 above). For ex-ample, while the original concept and related baseline focused on the enabling environment at the national or state government level, WSP countries have in many cases extended the concept to local government levels. The conceptual framework is intended to provide a common approach to the assessment so that the results are comparable across countries. Each dimension has a set of questions to be answered during the assessment. The consultant will be responsible for determining what information needs to be collected to answer these questions, how the information will be collected, and for developing interview protocols.

4.5. Carry out the endline assessment of the program-matic elements required for scale up of the total san-itation and sanitation marketing approaches. While the specific activities for each assessment will be de-termined by the consultant team, the assessment is expected to include the following aspects:• Review of key documents (assessment reports, prog-

ress reports, sector strategies, laws, regulations, etc.)• Meetings with key stakeholders including govern-

ment officials at the national, provincial, and local government levels; private sector providers of sani-tation products and supplies; NGOs; and donors.

• Debriefing State, Provincial National governments as appropriate to test the validity of key findings

4.6. Based on the results of the endline assessments, for-mulate recommendations for improved implemen-tation and for creation of the enabling environment necessary to meet the 2015 MDG targets.

4.7. Debrief the WSP Country TSSM Task Manager, and as appropriate, other WSP country staff and key gov-ernment officials responsible for the program. The consultant should discuss the recommendations and actions needed to strengthen those elements that were found to be blockages to scaling up rural sanitation.

4.8. Write a report with findings, recommendations for moving forward and filling remaining gaps in the en-abling environment and, lessons learned by the WSP

• Monitoring and evaluation

[NB: the detailed descriptions of the framework dimen-sions have been omitted to shorten the TOR].

4. Scope of Work International Specialist ConsultantThe tasks in the scope of work are divided into three over-all phases: preparation, endline assessment in the field and, capturing and documenting learnings. The international consultant will carry out all of the tasks in these three phases, with assistance from the WSP country teams dur-ing the main periods of fieldwork.

4.1. Review key background and program documents provided by WSP. Participate in a planning meet-ing with the Global TSSM Task Team Leader. This may take place in WDC or in a mutually convenient meeting place in Europe. The objectives of the plan-ning meeting will be to ensure that the international consultant understands the background and objec-tives of the assessment; what expectations are in terms of deliverables, etc.

4.2. Work with the respective WSP Country TSSM Task Managers via email and phone as needed to develop a work plan and schedule for the endline assessments, including agreement and arrangement of preliminary meetings (in order to reduce the time spent in the capital on arrival).

4.3. Travel to each country and participate in a planning meeting in each of the countries with the TSSM country task manager, the WSP coordinator or STC consultant assignment to be part of the endline as-sessment team in support of the international special-ist, and other TSSM team members as appropriate. The purpose of the meeting will include providing the international consultant with an update on work done and related accomplishments in the enabling environment and also to include a review and dis-cussion of the self-assessed “spider diagram” progress reports showing progress in strengthening the en-abling environment. This initial meeting should also allow the country team to share learnings about the process of strengthening the enabling environment since the baseline with the consultant. Finally, as needed, the meeting should also confirm any related

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Endline Assessment• Participate in team planning meeting• Participate in finalizing (and translating if needed)

interview protocols and questionnaires• Participate with international consultant in all field

work related to the endline assessment • Assist with translation (if needed), processing and

analysis of information from assessment• Assist with debrief of WSP and government officials

5. Expected Products/Outcomes 5.1. The international consultant will be responsible for

the following deliverables An Enabling Environment Endline Assessment Re-

port for each country (India report to include both HP and MP in separate sections). As a starting point, the outline for the report should be as below. Final revision of the outline should be carried out during the initial global planning meeting. • Introduction. This section should explain the

context and purpose of the assessment, summa-rize the TOR, and explain the methodology of the assessment.

• Summary of conceptual framework and assess-ment dimensions that guided the assessment

• Summary of findings – Policy, strategy, and direction – Institutional arrangements – Program methodology – Implementation capacity – Availability of products and tools – Financing – Cost effective implementation – Monitoring and evaluation

• Conclusions. Based on the specific findings, this section should summarize the overall conclusions of the assessment team, especially those that are cross-cutting and not captured in the findings for each assessment dimension.

• Recommendations. These are specific recom-mendations that may still be needed to fill any remaining gaps in the conditions necessary for scale up and sustainability.

• Action plan directly based on the recommen-dations in the assessment report. This section should include the following:

team, government partners and other stakeholders as appropriate using the format that is agreed upon in the team planning meeting. As a starting point, the basic report will look like the baseline reports (see WSP website to review each of the reports) and revise and improve as appropriate and agreed to with the Global TSSM Task Team leader.

4.9. When all the country reports are completed, the consultant will then prepare a global report that syn-thesizes the findings and recommendations from all three countries. Among other things, the synthesis report should identify and discuss common cross-global findings and recommendation. The starting point for the format of the approach should be the synthesis report prepared on the baselines assess-ments (report can be found on WSP website).

4.10. Based on this assignment, prepare a guidance docu-ment for carrying out enabling environment assess-ments for rural sanitation programs. This document will be similar to the guidance note developed for carrying out a Handwashing enabling environment assessment that can be found of the WSP website.

4.11. Based on the lessons from this assignment and the overall TSSM Global program experience, prepare a WSP Learning Note on the challenges and oppor-tunities for strengthening the enabling environment for large scale rural sanitation programs.

WSP CoordinatorWSP should provide one experienced staff member (prefer-ably one of the TSSM program field coordinators) to assist with the implementation of the endline assessments.

Preparation• Develop list of stakeholders (at central, provincial

and district levels)• Collect local policies, strategies, and other back-

ground documents• Collect and organize all enabling environment spi-

der diagrams and related documentation• Assist in review of background documents (arrange

translation where appropriate)• Set up meetings and plan field visits for assessment

(with WSP assistance)• Plan feedback/debrief sessions • Organize logistics for assessment

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• Understanding What is Meant by Scalability and Sustainability

• Assessment Methodology including description of conceptual framework and related dimensions

• Annexes ( Resources and tools to be used by as-sessment team):

– Sample TOR – Sample Study protocol – Sources by Dimensions Table (BLANK

TABLE FOR USE TO IDENTIFY THE DIMENSIONS RELEVANT TO AND COVERED IN INTERVIEWS WITH DIFFERENT STAKEHOLDER ORGANIZATIONS)

• Proposed Report Outline• Interview Guide

5.4. A WSP Learning Note on the, experience, challenges and opportunities for strengthening the enabling en-vironment for large scale rural sanitation programs. Learning Notes are 2–4 pages long and designed to be accessible for a wide audience. Therefore, they should be written in a non-technical language and can incorporate graphics (maps, photographs, charts, etc). Each Note includes the following sections: In-troduction, Problem Statement, Action, Key Learn-ings and What Else do We Need to Know?

6. Personnel and Estimated Level of EffortThe assessment in each country will be carried out by a two-person team consisting of an international consultant and a WSP coordinator.

The international consultant should have the following qualifications:

• 15 years of experience in the water supply and sani-tation sector, especially in project design and imple-mentation and sector reform

• Extensive consulting experience• Significant and in-depth experience in institutional

development • Knowledge of sanitation and the related institutional

and programmatic issues • Excellent communication and report writing skills

in English

a. Actions that need to be taken. Where possi-ble, these actions should be linked to existing programs that are seeking similar reforms.

b. Sequence in which they should be addressed and a timeline

c. Skills and expertise and estimated LOE needed to implement the actions

d. Expected implementation challenges, risks, and assumptions

• A final section in the report with Lessons learned by the WSP team and government partners in strengthening the enabling environment for a large scale rural sanitation program.

5.2. A global synthesis report. This should be a short (no more than 30 pages) synthesis of the findings, con-clusions and recommendations from the enabling environment endline assessments in all three coun-tries. The suggested draft outline is based on the syn-thesis report for the baseline enabling environments and can be revised based on an agreement with the global task team leader:• Executive summary• Introduction with relevant background and context• Summary of Country Projects• Analysis by dimension

1. Policy, strategy and direction2. Institutional Arrangements3. Program Methodology4. Implementation Capacity5. Availability and Knowledge of sanitation

products and services6. Financing and incentives7. Cost-Effective implementation8. Monitoring and evaluation

• Overall Conclusions 5.3. A guidance document for carrying out enabling en-

vironment assessments for rural sanitation programs that are large scale and sustainable. The following draft outline is based on a similar guideline devel-oped for handwashing and should be considered as a starting point:• Purpose of the Guideline• Background

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Annex 3: Endline Interview Guide

www.wsp.org 67

1. Policy, Strategy, and DirectionEstablishing a shared vision and strategy and ensuring the po-litical will to implement a program is the starting point for scale up. Developing this shared vision and strategy in a col-laborative manner is also the foundation for coordination and for creating motivation at all levels.

1. To what extent is there political will and support to expand access to and use of sanitation facili-ties, and at what levels (national, state, district, local)?*

2. If not, what is needed to generate stronger political will and support? Who are the key decision-makers whose political support is needed?

3. What are the best channels for influencing policy relevant to a state program?* How are sanitation pol-icy and decision-makers held accountable by rural households?

4. If there is a political will for sanitation in general, to what extent is there political will to use:• the total sanitation approach (focused on ODF)?• the sanitation marketing (SM) approach?

5. Evidence: what policy changes, budget allocations, or program activities have people or organizations already made to follow up on that political will? Are more changes needed for the sanitation program to be successful?

6. What are the key policy barriers to scaling up the program and how are they being addressed? (e.g. related to policy alignment, subsidies, availability of products, policy on dry toilets etc.)*

7. Are the overall goal and specific objectives of the program clear and understood? Is there a shared vi-sion and direction among key stakeholders (at all levels)? What is this shared vision?

8. Has a detailed strategy (and investment plan) to meet these objectives been developed? Is there co-ordinated implementation by key stakeholders

Introductions (5 minutes)• Introductions• Appreciation for time• Purpose of interview • Confidential, won’t use name or other identifying

information• Have series of questions, but not exclusive of other

questions

NB—For TSSM, it will be essential to define “rural sanita-tion” and what is being promoted in the national/state context (in the purpose of interview).

Opening (10 minutes)• Tell me something about the importance of

Sanitation• Tell me something about your organization and

briefly what your organization does to support TSSM/sanitation work. And what you plan to do.

Dimensions Interview (50–60 minutes)Use attached interview guide.

Closing (5 minutes)• What do you see as the single most important suc-

cess factor in the TSSM program?*• And what would you recommend be done to im-

prove the environment in which this sort of project will be successful and sustainable?*

• Thanks for his/her time.

Notes: 1. Questions highlighted in bold type are con-

sidered “core questions” that should always be asked (if that dimension is relevant to the interviewee).

2. Questions marked with an asterisk “*” are consid-ered suitable for use in FGDs

Annex 3: Endline Interview Guide

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defined? Are existing institutional arrangements adequate for effective large-scale implementation (to meet program objectives)?

4. Have reforms been required to support large-scale implementation? What implementation mecha-nisms are already in place? If still being put in place, then what is the process?

5. What mechanisms have been established for coor-dination among relevant partners (at national, state and district levels)? How many ‘coordination points’ are active?

6. How well are coordination mechanisms working (when was the last meeting)? Have any coordina-tion bodies collapsed or proved redundant? How might they be improved?*

7. Has the program fully explored potential strate-gic alliances with public, private, and NGO sec-tor organizations? What has been done to explore these potential strategic alliances? What/who has been considered (or excluded)?

8. Are partners fully aware of the overall goal and ob-jectives of the program? Do partners participate actively in planning decisions and discussions?

9. How would you describe the quality of the part-nerships between district/municipal governments and implementing NGOs? How might they be improved?*

10. How would you describe the working relationships between the partners (e.g. NGOs) and the commu-nities with which they work? How might they be improved?

11. To what extent (and how) have partners integrated the program into their ongoing activities and/or budgets? To what extent do they plan to do so?*

3. Program MethodologyThe program methodology consists of the program rules, specific activities and their timing and sequence. Each country will adapt and apply the program methodology making it specific and appropriate to the country context. A workable program methodology that is clear and agreed upon by all key stakehold-ers is a key programmatic condition.

(at all levels)? What are the key elements of the strategy? Have targets been set to support the achievement of strategic objectives?

9. What are the strengths and weaknesses of this strat-egy? What recommendations would you make to overcome these weaknesses? Who needs to act and how?

10. What are the institutional incentives, e.g. finan-cial, recognition, training, at the national, state, and local government levels that support program implementation? What additional incentives might be needed?

11. Which organizations, individuals, or agencies could act as champions or catalysts for the program? What would it take to mobilize them successfully? Note: these might include government units and programs, NGOs, CBOs, and for-profit companies.

2. Institutional ArrangementsInstitutions at all levels must clearly understand their roles, responsibilities, and authorities. They must also have the resources to carry out their roles. In addition to clear roles and responsibilities, institutional arrangements must include the mechanisms for actors at all levels to coordinate their activities.

1. What process has been/is being used to plan this program? Who is involved?

2. How has the program been organized? Please de-scribe the institutional set-up for the TSSM program in terms of the following institutional functions:

a. setting policyb. developing program methodologyc. implementation (start-up, IEC, latrine con-

struction, institutional sanitation)d. program coordinatione. trainingf. monitoring and evaluation (ODF status,

NGP awards, progress towards objectives, im-pact assessment)

3. To what extent are there these implementation arrangements (roles and responsibilities) clearly

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2. What resources are in place to build, strengthen and support the required capacity? What is lacking?

a. Financialb. In-kindc. Human resourcesd. Capacity building/training (skills development)e. Technology

3. Are capacity building mechanisms effective? How is this effectiveness monitored?

4. Where/what are the biggest capacity constraints (barriers to progress)? What is/will be needed to implement this program at larger scale (hiring staff, training, increased financial resources, in-centives etc.)?

5. To what extent is there adequate capacity to plan and implement behaviour change activities in the government sector? What about among NGOs? Among other major stakeholder groups (e.g. pri-vate sector)?*

6. Describe a behaviour change program you consider successful (at national or state level). What made it successful?*

7. To what extent is there adequate capacity in the pri-vate sector to provide affordable goods and services and respond to consumer preferences? Will the pri-vate sector be able to respond to increased demand as the program scales up? If not, what mechanisms are in place to build private sector capacity and local markets?

5. TSSM—Availability of Sanitation Products, Services and InformationTarget consumers ability to adopt improved behaviors is highly dependent on the availability and affordability of appropri-ate products, services and information. Any and all products, services and information need to be considered, specific to each country situation.

1. How would you rank the availability and consistent supply of the following Sanitation product and ser-vices? [1 lowest to 5 highest]

1. To what extent is there a defined and detailed meth-odology for implementing the program?*

2. Is the methodology achieving the desired out-comes and objectives? Is it being implemented at large scale? If not, does the methodology need to be modified for large-scale implementation?

3. To what extent is the program methodology widely understood and accepted by program partners and implementers? Who has the main responsibility for implementation of the program methodology?*

4. How fully/effectively has this program methodology been applied? What challenges have been experi-enced? What improvements would you recommend?*

5. What kind of evaluation (if any) has there been of this methodology?

6. How has the methodology been documented? How complete is it? How useful and operational is the documentation?

7. How easy would it be for someone else (e.g. another agency) to implement the program methodology in another location (e.g. another State)? Would the methodology achieve similar outcomes in another location, or are the methodology and outcomes par-ticular to Himachal Pradesh/Madhya Pradesh?

4. Implementation CapacityInstitutions at all levels must have the institutional capacity to carry out their roles and responsibilities. Institutional capacity includes adequate human resources with the full range of skills required to carry out their functions, an “organizational home” within the institution that has the assigned responsibility, mas-tery of the agreed upon program methodology, systems and pro-cedures required for implementation, and the ability to monitor program effectiveness and make continual adjustments.

1. How would you rank capacity (financial, human resources, training, technology, transport) to imple-ment and monitor the main program components at different levels: national/state, district, GP/com-munity (1 lowest–5 highest):• Total sanitation;• Sanitation marketing; and• Enabling environment improvements.

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1. Are you aware of the costs of implementing the pro-gram? Which costs (breakdown)?

2. To what extent is sustainable financing available to meet the costs of implementing the program? (costs such as staff salaries, training, transport, etc.)*

3. Do current arrangements for program financ-ing ensure adequate, timely and predictable pay-ments to: • Districts• Program partners (e.g. NGOs)• GPs

4. Who is responsible for financial planning? Could this process be improved?

5. What are the financing opportunities and willing-ness to finance among public (or other) agencies at national, state, and local levels?*

6. To what extent have promotional activities been included in state-, district-, and GP-level bud-gets? Are these budgets adequate for the required promotional activities?

7. How are households mobilized to invest in sani-tation facilities? What schemes or mechanisms are in place to mobilize households? Are any of these mechanisms aimed at the poorest households?

8. To what extent are there local opportunities to fund community and/or household investments (such as micro-financing, group savings/credit schemes, capital for initial investments)? Is credit available for toilet upgrades?

9. Is credit available to local entrepreneurs/producers? If so, who provides the credit and on what terms? If not, does this lack of credit affect the availabil-ity, affordability or quality of sanitation goods and services?

10. To what extent will the national government (or other agencies) be able to sustain the costs of imple-menting the TSSM approach after the program is over? What needs to be done to ensure continued financial support (and ongoing monitoring and fol-low-up) from the national government?

11. Are there any incentives/rewards/benefits avail-able to high performers? Anything to encourage people to become actively involved in sanitation programs?

• Direct sanitation services (i.e. sanitation masonry and construction)

• Related sanitation services (i.e. provider financ-ing and transportation)

• Key sanitary products (i.e. ceramic pans and plas-tic slabs)

2. Have there been any improvements in the avail-ability, affordability or quality of sanitation goods and services since 2007? If so, what enabled these improvements?

3. Are products/services reasonably priced for the poor and of dependable quality? Is there a range of op-tions for other unserved groups (APL, tribal etc)?

4. Is information readily available on the quality and price of different product/service options? How can rural households access this information?

5. Do existing policies and guidelines influence or limit the range of sanitation goods and ser-vices available to households (e.g. fixed ideas on technology)?

6. What should the government start doing (or stop doing) to facilitate increased availability and con-sistent supply of sanitation products and services?

7. What should the government start doing (or stop doing) to ensure affordability and depend-

able quality of the above sanitation product and services?

8. Are there any local institutions (government agen-cies or civil organizations—i.e. associations) in place to facilitate the availability, affordability or qual-

ity of the above sanitation product and services? If so, can you name them and detail their function and responsibilities? How would you rank the ef-forts made by these institutions [1 lowest/worst to 5 highest/best]?

6. Financing and IncentivesThis dimension assesses the adequacy of arrangements for fi-nancing the programmatic costs. These costs include training, staff salaries, transportation, office equipment and supplies, and the development of communication and education materi-als as well as programmatic line items in budgets for program and promotion activities. It also examines incentives for scaling up, improving quality and meeting program targets.

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www.wsp.org 71

Effective monitoring will identify strengths and weaknesses in the program methodology, implementation arrangements, and cost efficiencies. Overall monitoring responsibility must be at the highest level of the program, but must be based on informa-tion collected at the local government or district-level.

1. What are the most important program monitor-ing indicators? What is the main use of the moni-toring data?

2. Is there sufficient monitoring capacity at the national/state/district levels?

3. Is there a national (or state) monitoring process that measures program effectiveness and out-comes (or collects this data from the program)?

4. Is there any performance benchmarking across program units (e.g. districts)? Has this bench-marking had any impact on policies, activities or investments?*

5. How will the monitoring (local and national) be sustained once the main program activities are complete?

6. What other sectors (whoever you are not interview-ing) have strong M&E components and which or-ganizations facilitate the process at different levels? What other monitoring processes provide informa-tion to the program (e.g. health data)?

7. To what extent is the (current or planned) pro-cess sufficient to monitor quality of services, outcomes, identify gaps and weaknesses, and de-termine lessons learned and best practices?*

8. What is the most effective M&E tool for learn-ing, identifying weaknesses and driving improved performance?

9. What would be required to replicate the program M&E systems/processes in another location (e.g. state)?

10. What technical, administrative or financial im-provements or support are needed to ensure that the existing monitoring systems are adequate to support an expanded program?

11. What incentives exist to engage in and apply the re-sults of monitoring activities? What might encour-age programs to value monitor?

7. Cost-Effective ImplementationWhile it will not be possible to assess the cost-effectiveness of the approach and how best to achieve economies of scale until the end of the program, data must still be collected during imple-mentation to make this determination at the end of the pro-gram. Therefore, the focus in this assessment is to ensure that information will be collected from the outset and that the ca-pacity to collect the information is in place—systems and pro-cedures for collecting cost information and capacity to use and collect it exist.

1. How is “effective implementation” measured? Is there any distinction between program outputs (e.g. nr. toilets) and program outcomes (e.g. toi-lets in use, improved sanitation behaviours and health indicators)?

2. What information do you collect on program costs (e.g. hardware, software, program, partner costs etc)?

3. What assessments are made of cost-effectiveness?* What factors influence cost-effectiveness? Has anything been done to improve cost-effectiveness?

Note: may be necessary to explain difference between cost efficiency (cost per output) and cost effectiveness (cost per outcome/impact).

4. How is the size of the targeted and affected (benefi-ciary) program population assessed?* (give example if possible)

5. Does the program depend on other non-permanent, supporting programs or resources (e.g., use of sala-ried local government staff )? Is any information col-lected in order to measure these supporting costs?

6. To what extent does the capacity exist at the local government and state level to produce cost-effective-ness data?* What needs to be done to ensure that this information is collected and reported?

8. Monitoring and EvaluationLarge-scale sanitation programs require regular monitoring and perhaps more importantly, the willingness and ability to use the monitoring process to make adjustments in the program.

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Scaling Up Rural Sanitation in India: Enabling Environment Endline Assessment Annex 4: Program Benchmarking Assessments by District, MP


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8241-CH10.pdf 728241-CH10.pdf 72 3/30/12 11:25 AM3/30/12 11:25 AM

By Andy Robinson

This report is based on fi eldwork and research funded by the Water and Sanitation Program (WSP). The fi eldwork and research could not have taken place without the support and assistance of the Government of Himachal Pradesh (Rural Development Department, Irrigation and Public Health Department), the Government of Madhya Pradesh (Panchayat and Rural Development Department, Public Health Engineering Department), the Government of India, and the Water and Sanitation Program—South Asia.

Special thanks are due to Ajith Kumar, K. Arokiam, Lira Suri, and Nitika Surie for their kind assistance and support in India.

Designated a core business area in 2011, WSP’s Scaling Up Rural Sanitation is working with governments and the local private sector to develop the knowledge needed to scale up rural sanitation for the poor. The programmatic approach combines Community-Led Total Sanitation (CLTS), behavior change communication, and sanitation marketing to generate sanitation demand and build up the supply of sanitation products and services at scale. In addition, WSP works with local and national governments and the local private sector to strengthen the enabling environment—including institutional, regulatory, fi nancial, service-delivery, and monitoring capacities—to achieve change that is sustainable. Starting in India, Indonesia, and Tanzania in 2006, Scaling Up Rural Sanitation is currently being implemented in over a dozen countries. For more information, please visit www.wsp.org/scalingupsanitation.

This Working Paper is one in a series of knowledge products designed to showcase program fi ndings, assessments, and lessons learned through WSP’s Scaling Up Rural Sanitation initiatives. This paper is conceived as a work in progress to encourage the exchange of ideas about development issues. For more information please email Eddy Perez at [email protected] or visit www.wsp.org.

WSP is a multi-donor partnership created in 1978 and administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, Switzerland, United Kingdom, United States, and the World Bank.

WSP reports are published to communicate the results of WSP’s work to the development community. Some sources cited may be informal documents that are not readily available.

The fi ndings, interpretations, and conclusions expressed herein are entirely those of the author and should not be attributed to the World Bank or its affi liated organizations, or to members of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work.

The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to [email protected]. WSP encourages the dissemination of its work and will normally grant permission promptly. For more information, please visit www.wsp.org.

© 2012 Water and Sanitation Program

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Enabling Environment Endline Assessment:Himachal Pradesh and Madhya Pradesh, India

Andy Robinson

April 2012

The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services.


WATER AND SANITATION PROGRAM: WORKING PAPER

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Documents

Himachal Pradesh and Madhya Pradesh, India - WSP