Reza
The issues you have highlighted are ground realities and fragmentation is necessary
developing countries.Dealing with ULB representative local political representative with very little or no knowledge is most difficult task during implementation

Summary of discussion week 1, theme 1: Holistic Comprehensive Systemic Change or Piecemeal Solutions?

The discussion on the SuSanA forum was organised from 13 to 23 October 2015. During the first week we had a total of 13 contributions. For those who have missed it, the discussion will run for one more week concurrently with the discussion on the theme for the second week. Note that the introduction to the first week’s theme can be found on the SuSanA website. forum.susana.org/forum/categories?func=v...&id=15395&limit=1000

The guiding questions of last week were:

1. What are your views on using the systemic change approach for addressing the (urban) sanitation challenges?
2. Is it justifiable to continue focusing on onsite containment of human faeces and thereby ignoring all the other links of the sanitation chain?
3. How can we balance the need for systemic long-time change with addressing some of the immediate urgent needs?

Dorothee Sphuler kicked of the discussion by saying that she agreed “that a for a strategic planning level, a systematic view and planning approach is required in order to support more integrated and potentially more unstainable sanitation plans. This was followed by a but, after which a number of challenges were listed:

1. Systematic approaches are often larger projects and it is difficult to implement such approaches incremental. Institutional arrangements for systematic planning, cross-sectoral dialogue and human and financial resources need to be in place.
2. Change has to take place simultaneously at different levels from the individual to the organisation. As it is not easy to break down systematic approaches to the impact level of an individual this may lead to piecemeal solutions.
3. A systematic approach must be linked to the communities in order to ensure participation of all stakeholders leading to ownership and uptake. This requires flexibility so that the approach can be adapted to the needs of the communities.

cmaredkar agreed with Dorothee’s third point by saying that a systematic approach needs to be flexible as per the demand of the community as well as for other stakeholders whose roles keep changing. He further mentioned that it requires good leadership “who can create a revolution within the existing system.”

David Crosweller agreed that a systemic holistic approach may be necessary “I think systematic is great... but it has to be done properly so we have to take as much time as we need”. “It is important to engage the relevant authorities from stage one, but we need to start somewhere and to try and solve everything from day one could be very daunting.”

Avanagthoven fully agreed “with the fact that systemic change is needed to fully solve the issues. However, I don't think it is realistic to get such programmes off the ground as "a systemic whole" due to the way things work in practice. He suggested breaking up the work in “managable pieces of work” and prioritise where to start. There has to be a common view (a clear vision) on what the final situation should look like so that different actors can work at different parts of the same big puzzle. This vision and the leadership for others to buy into that vision is often missing.

Muchie wrote that adopting a systemic change approach is the way to go. While referring to a study by UNC Water Institute (2013) he explained that focussing on toilets will not bring lasting solutions to the sanitation crisis. The entire sanitation chain needs to be investigated to avoid that untreated wastewater and faecal sludge end up into the environment. It must be recognized however that the problem is complex and challenging. Countries which have made good progress in improving sanitation coverage have high prevalence of diarrhoeal diseases largely attributed to poor sanitation. Piecemeal solutions that do not address all the parts of the sanitation chain therefore do not work.

Giacomo Gali wrote that if we are to talk about 'systemic change' rather than 'piecemeal solutions', we should move away from the idea of 'projects' how difficult it may be. Urban sanitation is not the problem of NGOs, consultancy companies etc. instead it should be the problem of the local authorities. They should be the ‘drivers’ of the change process. There is a need for an urban masterplan, with different approaches for different neighbourhoods, to be able to address sanitation throughout the city. The challenge is to see systemic change not just as a 'larger project', but as different way of working. The challenge is to change what is actually 'being done', while changing 'how we do it'. This may include changing our own organisations. Any change process can be broken down in different phases. Establishing a vision and clearly moving away from fragmented project based interventions is a first step.

Responding to Gali’s contribution, David Crosweller wrote that progress can be made in a city “that joins up the dots and works as a cohesive whole.” It is up to us to prove the authorities that the system can work by showing a working, sustainable and a profit making system or model. Once that is done you can think about citywide schemes and upscaling.

Reza Patwary ended his contribution by saying that a carefully designed chosen number of piecemeal solutions can contribute to fixing the sanitation chain. The term 'holistic' is a visionary one but that it often lacks operational level understanding. Reza seems to agree with David when he writes that piecemeal solutions are in actually fact micro demonstrations which over time may lead to a holistic solution. The timespan of 10 years to go through all the three phases was seen as too optimistic. Reza provided the context by introducing the programme he is working in (south Bangladesh) with a strong emphasis on faecal sludge management. Our programme reality is that we are working in every phase simultaneously but with different speed. An example he gave concerned the fixing of human waste containment versus collection and transportation of faecal sludge. Whereas the first intervention is expected to take the longest time, they were able to make greater and bolder steps when developing business models for small entrepreneurs.

Marielle Snel started as follows: “clearly there are astronomical WASH challenges especially in the mega cities around the world in terms of coping with their sanitation issues.” She argued that only through a whole systemic change approach will we able to address the sanitation challenges. Current efforts have mainly targeted at providing access to basic sanitation facilities. Referring to the first guiding question, Marielle invited experts working in the ‘south’ to reflect on the systemic change process with some pragmatic examples. Her second issue concerned the, what seems like, “everlasting fragmentation in partnerships” to deal with the sanitation challenges. She was of the impression that WASH partners are not truly working together to create sustainable sanitation services that last.

The final contribution to date came from Moritz Gold. From his experience, holistic change needs to come from those who have the mandate for urban sanitation. The “sanitation sector” (development organizations, NGOs, consultancy companies etc.) can facilitate this process through different types of support. Good examples are the National Water and Sanitation Utility (ONAS) in Dakar or GIZ/SNV who (among others) sit in ministries, municipalities for many years to facilitate change. According to Moritz the discussion about “systemic change” vs. “piecemeal change” is as misleading as discussions about sewer/wastewater treatment vs. FSM. Only both will do the job. As there are no successful cases, we have to investigate what works best through piecemeal solutions which can be integrated into long-term systematic solutions. Systematic change will only come through work of the above mentioned “local” authorities.

Erick Baetings, IRC

I agree with both sides that systemic change is necessary to achieve sustainable service delivery and the clear need to incorporate all aspects (FSM/off-site), reach everyone and encompass the entire service chain. However I feel that the piecemeal programs are also needed to trial options and work through the gaps and barriers and create a working platform that is ready to implement the holistic approach.

While Indonesia already has some of the components of systemic change (thanks to the work of a number of organizations over many years which has led to Government support, domestic financing, some institutions and existing infrastructure), many programs focusing on the city strategy, overall planning or funding major infrastructure appear to get stuck on the various gaps in institution and service delivery. During a recent study by WSP World Bank on improving on-site sanitation and increasing connections to sewers, it was found that although the DFAT out-put based grants for connecting low income households to sewerage had a piecemeal approach, they provided a means and incentive to bridge some important gaps in governance and service delivery and a step towards systemic change.

In summary: DFAT provide grants to local government for an agreed number of low income household connections to sewer (around 500 connections in a year), but only after the local government has financed and built them and they have been verified. While it relies on local government ability to finance up-front and requires existing planning documents, institutions and originally in areas with existing treatment, the benefits seen from this approach include: improved planning, the mechanisms and technical skills to build and manage a system, established marketing methods to create demand, and leveraged additional local government investment (to connect more households or cover the gap between cost and grant). Once the city had proven its implementation ability they often received additional national government and donor financing to expand their coverage. Additionally the DFAT program expanded scope to include building decentralised treatment and sewerage where no treatment plant exist, and the National Government is considering setting up its own similar funding program and potentially applying this approach to improve on-site systems and FSM.

While I appreciate each country is different, when some of the sector support and governance aspects already exist, such as in Indonesia, to achieve the huge improvements needed (currently 1% wastewater and 4% sludge safely managed), this small project scope with a focus on actually achieving service delivery appears to be a beneficial step towards systemic change. Leveraging from this successes and a functioning service provider, there is now an opportunity to increase momentum from the other end with sector support (coordination, collaboration, institutional development) and governance, to systematically expand the scope to ensure that the entire area and non-sewered households are included.


Freya Mills
Independent consultant (the above comments are my own and do not represent those of WSP World Bank)
Background: I was the lead researcher on the above mentioned WSP World Bank study “Improving On-site Sanitation and Connections to Sewers in Southeast Asia – Insights from Indonesia and Vietnam” and have worked on various urban sanitation programs in Asia Pacific.

Dear all,

I found Giacomo`s post very inspiring.

From what I experienced, holistic change needs to come through work by city councils, municipalities, national sanitation utilities, ministries, regulations, etc. who have the mandate for urban sanitation. The “sanitation sector” (development organizations, NGOs, consultancy companies etc.) can facilitate this process (not project) (e.g. awareness raising, capacity building, technical support, business development). Good examples are the National Water and Sanitation Utility (ONAS) in Dakar or GIZ/SNV who (among others) sit in ministries, municipalities for many years to facilitate change (in polices, regulations, market development, and implementation of sanitation systems).

However, I feel the discussion about “systemic change” vs. “piecemeal change” is as misleading as discussions about sewer/wastewater treatment vs. FSM, only both will do the job. We have no successful case of a fully functioning sewer/wastewater treatment and FSM system in urban areas of cities in development. This means we have to investigate what works best through piecemeal solutions which can be integrated into long-term systematic solutions. However, I feel that systematic change will only come through work of the above mentioned “local” authorities.

Cheers,
Moritz

Dear all,
Interesting reading and reflections… Clearly there are astronomical WASH challenges especially in the mega cities around the world in terms of coping with their sanitation issues. We, at IRC, believe that to ensure sustainable sanitation for all, there is a need to look at sanitation beyond simply the interventions or programs. Unfortunately today we still see too many one/two dimensional projects focusing on sanitation (e.g. just the collection, transportation, etc stage), let alone reflecting on the systematic change approach. Our, as well as my own, argument is that only through a whole systemic change approach will we seriously be able to address the sanitation challenges and thereby have a more potential likelihood for success. Currently, efforts have to a large extent been targeted at providing simply access to a basic sanitation facility, which is a necessary starting point, but not focusing on the whole sanitation delivery chain picture. On this first point, I would actually really like to get some pragmatic examples for colleagues, especially those in the south, who have possibly done some work on the whole systemaic change approach (or some form of it) and reflect with us on how this worked (or not) and why.
My second concern/issue is that there is an (or what seems like) everlasting fragmentation in partnerships to deal with the systemic change approach for addressing the sanitation challenges. By this I mean fragmentation of different partners and therefore systems in place. As a result WASH partners are not truly working together in a more harmonious manner towards creating sustainable sanitation services that last. My question here is how at the most basic/pragmatic level can we start to overcome? Would love to hear from some of the colleagues on this issue too.

Great discussion started!

The term 'holistic' is a visionary one but it often shows lack of operational level understanding. People like to see immediate visibility and benefits.

The debate of holistic or piecemeal solution: Even in the diagram presented in the discussion, we see so many different phases and layers of activities involving multiple stakeholders. What we are referring here as piecemeal is actually micro-demonstration, leading to a implementation of a micro-module which may later lead to a holistic solution the duration of which may take, as the research shows, upto 10 years that again, in my understanding, coming from a developing economy, is optimistic!

Programme Context: We are part of a SNV-managed FSM programme in three southern cities in Bangladesh. At the beginning of the programme, we were happier to include a clause on the importance and implementation of FSM in national water and sanitation policy. Holistically perhaps a great achievement. Challenges came when we started interacting with the local authorities. We had to deal with the classic problem of addressing the capacity issues of those municipalities. Municipalities are run by elected representatives who now have to see the FSM issue as one of the top priorities putting them sometimes even ahead of city garbage collection - a greater compelling problem in the daily city life than discharge of fecal waste that finds it ways through storm-drains, water-bodies and canals escaping most our attention. And then how soon we can convince the local authorities and leaders (elected by the people who are living cheap / afford to support other necessities at the cost of health and environment) to introduce taxes and charges to the people at once to take care of the chain-wide FSM.

Market Solution vs. Holistic Approach: If we believe in market, we need to believe in research and evidence. When we use the term holistic, much of it indicates planning, interestingly someone has already said, rather a dream. For our working solution, its great that we came up with different phases of the FSM value chain: containment (which needs to be upgraded), collection and transportation (price of services to be readjusted), processing (construction of treatment plant is costly and funding and operation is an issue) and then disposal and reuse. Our programme reality is that we are working in every phases simultaneously but with different speed. When we look at the containment - we feel time needed to fix the containment will be the longest. However, we are working there more on awareness level. But in the area of sludge collection and transportation we are able to make greater and longer bold step - developing business models to encourage small entrepreneurs. Now when we see the possibility of city-dwellers paying a more realistic price for sludge-emptying, we realize that its about time to start full-fledged treatment plant when we can cover the O&M expenses by taxing the households and institutions even more.

Thus I clearly see that carefully designed chosen a number of piecemeal solutions can contribute to the solution to the chain wide FSM.

This message is intended to all of you that are interested in the urban sanitation dialogue but who may not have the time so far to contribute to the ongoing discussion.

The debate on urban sanitation has unfortunately not been that lively to date. Knowing how busy we all are in getting our own job done and the fact that we were somewhat late in informing you about this debate, we would like to invite all of you to continue this e-debate during the coming week concurrently with the discussion on the second topic dealing with government leadership.

Wishing you all the very best and looking forward to your contributions.

Erick Baetings
IRC | Senior Sanitation Specialist
Also on behalf of Marielle Snel and Cor van Dietvorst

Giacomo said in the post above:

Well for one, I don't agree with Alan's view. I'm sure you're doing a fantastic project, but sanitation is an issue for the entire city. If one puts the focus on slums only, it becomes reduced to a 'poverty' issue; most likely leading to less interest amongst wealthier citizens. I think it would be better to have an urban masterplan, with different approaches for different neighbourhoods. I realise that this is an enormous challenge and that it is tempting to improve directly the situation for those living in the slums, but such an approach will never be ongoing without external support.

And I don't take it personally. But find the city that joins up the dots and works as a cohesive whole. At present we are in the process of proving to the Corporation that the system works. Once that is done then you can start thinking about city-wide schemes. This is not a solution that WE will solve, but we can show corporations and municipalities the basic model and let them scale up. However, in order to do that you have to show a working, sustainable and, likely, a profit making system. This can only be done in a small way before scaling up.

Dear all,

Thank you for this interesting discussion; thanks to those who took this up and to all those reacting so far.

My two cents:
If we are to talk about 'systemic change' rather than 'piecemeal solutions', I think we should move away from the idea of 'projects'. I know that this is difficult as we all depend on project money and time-lines. In fact, most people me included, are unable to move beyond this mindset, call it a paradigm if you want. I just came back from a city in Northwest Congo where I have seen how this project-based thinking can be dominating all processes within a society, from politics to churches and small local NOGs. Sad enough, everybody is consciously caught in this trap of moving from one project to the next without any change being realised.

What we need to realise is that urban sanitation is not the problem of those working in NGOs, consultancy companies etc. We are only there to facilitate. Urban sanitation is, or should be, the problem of the local political-administrative authorities (city councils, ULBs (urban local bodies) etc.). This is an ongoing responsibility, not a concern related to project funds, expertise and time-frames. External facilitation can certainly help, but these should not be the 'drivers' of this process.

What does this mean? (names are not intended as personal attacks)
Well for one, I don't agree with Alan's view. I'm sure you're doing a fantastic project, but sanitation is an issue for the entire city. If one puts the focus on slums only, it becomes reduced to a 'poverty' issue; most likely leading to less interest amongst wealthier citizens. I think it would be better to have an urban masterplan, with different approaches for different neighbourhoods. I realise that this is an enormous challenge and that it is tempting to improve directly the situation for those living in the slums, but such an approach will never be ongoing without external support.

Second, and this is also a reaction Dorothee, the challenge is to see systemic change not just as a 'larger project', but as different way of working. Of course, this leads to the problem of how to implement this within existing funding timeframes, electoral calenders etc. It also indeed means working with the existing institutions, organisations and communities; this is indeed challenging as it can lead to fragmentation. In fact, the challenge is to change what is actually 'being done', while changing 'how we do it' and en passant also changing our own organisations and institutions (international actors very much included here).

Frankly, this seems like a far-fetched dream more than a plan. However, as Erick mentioned such a process can be broken down in different phases. Establishing a vision and clearly moving away from fragmented project-based interventions is a first step. I've seen in DRC how difficult this can be if the political-economic incentives are all aligned to keep this mentality ongoing.

Cheers,
Giacomo

Dear contributors many thanks for your valuable contributions to this discussion.

What I read between the lines and something I fully agree with is the fact that resolving the urban sanitation challenge(s) is a daunting task. Something that is not resolved over night but unless we start tackling it whole heartedly not much is likely to change drastically for the urban citizens all over world. If we would have had all the answers then there would have been no need for this e-debate on the SuSanA forum. I am therefore happy to see that the discussion has started as it will help (all of) us to better frame our mind.

Let me try to react to some of the reactions brought up so far.

Dorothee Spuhler mentioned that she was missing part of the links of the sanitation chain (e.g. containment, collection and transportation) in the figure provided in the introductory text. We should have mentioned in the text that the figure is still work in progress and I hope that we will be able to improve it on the basis of this and other discussions. I do agree that the figure is not clear and not complete. The red inner circle called "sustainable service delivery" is the interface between the service providers and users. All the services relevant to assure that the urban population have access to and use sustainable and environmentally safe sanitation facilities (or services) should be captured in this circle. That includes all the different links of the sanitation chain from containment all the way to safe disposal and or safe reuse but also interventions necessary to change the behaviour and practices of the population (through HP and or BCC interventions). More needs to be done to better capture all these elements in the figure.

Is systemic change (some call it systematic approaches) possible? The first four reactions basically agree that it will be difficult and may be not realistic "to get such programmes of the ground". "Trying to solve everything from day one could be very daunting as the scale of the problem is so large." I would tend to agree with these observations if indeed we would want to change the whole world in one 'project'. That is indeed not realistic but that is also not what we were thinking of. Simply said systemic change means that you need to look at and address all the weak elements or links within a system but not necessarily all at once. In IRC's theory of change we would break up the entire process in three 'manageable' phases where the first phase "Initiating the change" is may be the most crucial with the following four interconnected elements:
- Managing partnerships and building trust;
- Carrying out a rapid assessment;
- Building consensus around a shared vision; and
- Developing a comprehensive city-level sanitation strategy and plan

The actual implementation of the city sanitation strategy through phase 2 "Learning and testing"and phase 3 "Replicating and scaling" could then be carried out incrementally and could possibly even include piecemeal solutions as long as they fit within the shared vision for the desired end situation. However there could possibly be challenges that need to addressed at scale, for example improving faecal sludge management services and practices may need to be carried out city-wide to create economies of scale for potential commercial businesses.

Thank you for launching such an interesting discussion....a subject very close to my heart. I think adopting a Systemic change approach is the way to go especially if we want to improve the health outcomes of the majority of the people especially in Africa. It is now widely acknowledged that just focussing on the toilet will not bring lasting solutions to the sanitation crisis. Study by UNC Water Institute (2013) and WSP (2014) underscores the need to redefine the way sanitation is approached. Firstly considering that quite a number of improved sanitation facilities are inadequate as they release untreated wastewater and facaecal sludge into the environment, it is crucial that these other parts of the sanitation chain (e.g transport,treatemt) are also investigated and proper policies put in place to ensure that they perform functionally. it must be recognized however that the problem is complex and challenging because for example some countries in Africa which have water-borne sewerage systems adopted these during the colonial era and because of their economic situation among other factors they have failed to maintain or upgrade the existing infrastructure and thus have fallen into disrepair. Secondly, a look at some of the Sub-Saharan countries which have made some good progress in improving sanitation coverage, have high prevalence of diarrhoeal diseases largely attributed to poor sanitation. This means even though sanitation coverage maybe high, the sanitation is not adequate as the other parts of the sanitation chain are ignored. Piecemeal solutions therefore do not work.

Thanks for organising this discussion and the interesting opening/ introduction.
I fully agree with the fact that systemic change is needed to fully solve the issues. However, I don't think it is realistic to get such programmes off the ground as "a systemic whole" due to the way things work in practice: planning cycles, budgets, limitations to the number of organisations you can work with efficiently etc. You will need to break things into managable pieces of work and it should be possible to prioritise where to start. A crucial factor is that there is a common view on what the final situation should look like (in big strokes! leaving flexibility on details). I see it as a big, complicated jigsaw puzzle that will only be fully solved if all pieces fall into place, but it is possible for different actors to work at different parts of the puzzle at the same time OR at different times. But that requires a clear VISION (from (local) government?) of what to work towards, so all will be working on the same big puzzle and you won't get a lot of unfinished, different puzzles at the end. So this vision and the leadership for others to buy into/ stick to that vision is the key and often missing.