Intersting discussion...

I think another important aspect is to offer low cost options that a) are affordable to the great majority of the population, that b) people can identify with, and c) for environmental reasons don't pollute the groundwater. Products derived from human waste, be it in the form of fertilizer products, be it as produce of some kind (cashing in on the added value) will help to make the servicing affordable.

In my view, understanding the benefits of sanitation and costs are the crucial factors to get a population involved. Where the benefits of sanitation are marginal (like in very rural areas), there is no need to make a big effort.

Cheers, H-A

Dear all,

Without having any real answers, here some considerations from my side.

I fully agree that extra effort should be made to reach those that have less, or no, access to resources as a result of gender, poverty, cast, ethnicity, disability, etc. However, I am not sure that the track record on for example gender in development makes me very hopeful this will be done in a good way.

In my view, to reach scale in sanitation, supply and service chains need to be set-up. For the supply chain, probably the private sector can do much. For service (fecal sludge management, etc.), I tend to think (semi) public providers are probably a good idea.

It seems to me that building a private sector based supply chain would initially rely on customers who are able to pay. Once a market exists, pro-poor subsidy programs can work through the same supply chain. The problem of this approach is that initially those who cannot afford services are left out.

If we have a very strong focus on reaching those most in need, I see the following potential dangers:

-If we assist, financially or otherwise, the people we classify as “most in need”. We probably end up excluding a large amount of people who are “much, but not most, in need”. This may create tensions in communities.
-Also, if you look at the poverty line in South Asia, the group of people who are just above the line is enormous. If, for example, you would take the poverty line as a cut-of for an assistance program, you risk disheartening a very large sector of society who feel that they don’t have the resources to built toilets, but who still are “too well off” to fall under your program.
-Building a supply chain for hardware around subsidies for the poor may result in a “private sector” that cannot live without these subsidies.

Some starting points I could see for inclusiveness:

-Make sure that service chains (FS management, sewers, roads, etc.) do reach everyone As I consider these to be (semi) public functions, I feel that governments (and those who support them) can make a difference here.
-For promotion and awareness campaigns:
-Make sure the same information is available in all languages spoken in your target area.
-Make sure the gender and ethical/cast composition of your teams reflects that of the target populations.
-Make sure “good examples, posters, etc.” also depict the same variety of people as your target area.

Make sure that the goals for inclusiveness in your programs are reflected in the indicators for success.

Regards

Marijn

Thanks very much for the interesting contributions.

It is definitely not easy to reach the hard to reach, but the SDGs represent a global commitment to reach everyone, so the challenges must be met by practitioners, governments, development partners, and all involved in the delivery of safe services to all.

I would like to take this opportunity to share some work being led through the Rural Water Supply Network (RWSN) on reducing inequalities in water, sanitation and hygiene (WASH). Although the focus here is on water supply rather than sanitation, a similar approach would be required for Sanitation. We are inviting people to share inspiring examples of inclusive ways of working and infrastructure designs that you have applied to reduce inequalities in WASH access and use (see ‘call for presentations’ below). This will reach professionals and practitioners across the globe and your work could also be included in a RWSN publication.

Aims, activities and timings
The aims of the Reducing Inequalities in WASH work stream are to:

1. Find out what information, guidance, and support is available on practical ways of working and designs of infrastructure that can be applied to reduce inequalities in WASH.
2. Generate shared learning and discussions on approaches and solutions with RWSN members with the intention of assisting members to ‘do inclusion better’.

We will be holding e-discussions and webinars on 1) Practical ways of working for more inclusive WASH; 2) Design of infrastructure that can be applied to reduce inequalities in WASH access and use; 3) Information, guidance and support for inclusive ways of working and infrastructure design.





Call for presentations
We are looking for people to give a 7-minute presentations on of inspiring examples of inclusive ways of working and infrastructure designs applied to reduce inequalities in WASH access and use. We are particularly interested in attempts to reduce inequalities in WASH related to ethnicity, race, nationality, language, religion, caste, sex / gender, age (children and older people) and health conditions. But please don’t feel constrained by this list.

If you would like to present or want more information please email Jane Wilbur, Equity, Inclusion and Rights Advisor, WaterAid This email address is being protected from spambots. You need JavaScript enabled to view it.

A controversial view several experts have said to me in private: Open Defecation is not always that bad, so blanket assumptions that "public health benefits of sanitation can only be realised when nobody is still defecating in the open" may not hold in some rural communities.

Given that these communities might well be the most isolated and most expensive to reach with sanitation interventions, is there not an argument that "leaving nobody behind" might give incentives to address problems which are not so serious, perhaps reducing the money to address problems where they are serious (for example OD in dense urban areas) and prioritising interventions that those communities do not see as the most urgent?

Who, actually, is deciding who the most needy are?

It also seems to me that there is an inevitable conflict between addressing the needs of the majority and the conflicting needs of a minority. In terms of water security, there are clearly issues with regard to supply of urban clean waters which could impact on land tenure rights. How is it possible to find a way through these complex needs - because clearly saying that a majority cannot have clean water because of the needs of a minority is unlikely to be much of a local vote winner.

If we multiply this up to all possible contradictory claims of the 17 goals, it seems like we are only heading for masses of red-tape, and prioritising the "most in need" in most cases will be impossible to deliver.

Louisa Gosling wrote: The point about prioritising basic access is based on the principle of non-discrimination and equality, recognising the reality that for people who have nothing there has to be a step to something, along with a plan to incentivise and support progress towards improved services for all. States have an obligation to progressively realise human rights to water and sanitation, which means having a plan to move forward and not to slip backwards.

"Prioritizing those most in need" is however a form of positive discrimination, and I think many democratic states do not see it as their mandate to prioritize a minority over the majority for the provision of sanitation services.

Even though the SDGs are an joint goal of governments and civil society (and somewhat also the private sector, but they don't seem to be really aware of that..), each of these actors has different mandates and focus. Therefore there is little point in trying to get a lip-service about "prioritizing those most in need" from stakeholders that do not consider this as their mandate.

I personally think that this ultimately comes down to a division of labor: where service provision for the (not so poor) majority is making progress through state driven programs (or private sector initiatives), civil society & international donors can focus on those most in need.
But in countries or areas where this clearly isn't the case, it would be a waste of funds and effort to try and focus on service provision for the hardest to reach minority, while the majority still doesn't have access to these services either.

Thank you to all the contributors to this thread who have raised very pertinent questions.

I think that this is a critical area where the SDGs are different to the MDGs, aspiring to universal access, leaving no-one behind. The public health benefits of sanitation can only be realised when nobody is still defecating in the open. Even if I have a toilet my health is at risk if my neighbours do not. The MDGs could be achieved without reaching everyone but the SDGs require us to think how to reach even those who face the most challenging barriers, including physical, economic, social, political and attitudinal barriers.
This means we have to find ways of overcoming those barriers in the ways services are designed. Of course it does not mean ignoring those who are not "most in need" but developing a range of different approaches that recognise the chronic lack of services and social exclusion faced by those who are hardest to reach precisely in order to make services accessible to all.

The human rights to water and sanitation require that services should be available, accessible, acceptable, affordable and safe. To pick up on Joe's comment about safety - there are many examples where toilets are made available but are not accessible for many people in the population including children or older people or those with disabilities, are not safe for women to use, especially at night, are not culturally acceptable because of social norms around sanitation and hygiene practice, or are not affordable.

There is a growing body of experience in taking more nuanced approaches to behaviour change, and the complex range of triggers - different in different contexts - that can be used to incentivise demand for and uptake of sanitation services. Social norms, dignity, status, privacy and health are all important; different drivers work for different people in different social and cultural contexts. The most successful sanitation marketing is based on working with these triggers to increase demand for sanitation.

As Krischan points out those who are not the poorest are most able to respond to these triggers, which is critical for progress. But unless there is a focus on the most marginalised they will continue to be left further and further behind.

To achieve universal access the way services are designed should take into consideration the barriers that people face. As Graham pointed out there is a danger that market based approaches exclude those living on $1 a day or less. In that case how can they be reached? What different ways of financing services will enable them to get on the first rung of the sanitation ladder? What combination of support and incentive will work in different situations? What is the role of the state in making sure services are affordable for all?

In order to address physical barriers what design features can help people make toilets safer, easier to use, with more dignity? What communication methods are most effective in reaching people with different languages, literacy levels, and cultural practices? How can those with least power be enabled to participate in decisions about design and services and to understand that benefits of sanitation? How can people and providers be supported to treat sanitation as a human right?

The point about prioritising basic access is based on the principle of non-discrimination and equality, recognising the reality that for people who have nothing there has to be a step to something, along with a plan to incentivise and support progress towards improved services for all. States have an obligation to progressively realise human rights to water and sanitation, which means having a plan to move forward and not to slip backwards.

I am sure that many in this network have experience in innovative approaches that address these challenges. I look forward to more thoughts on this topic.

Dear all,

Thank you for sharing your ideas and thoughts on the topic of SDG indicators. For those of you who have joined the discussion late, I would like to provide a brief summary of the issues addressed so far and point to some of the questions that have been raised to facilitate further discussion:

(I) ISSUES ADDRESSED SO FAR:

(1) Linking the goal to address those most in need with the issue of basic v. safe sanitation
As Joe asks (#14730): how good do the systems have to be to be? What are we actually trying to do: supply something, which is still clearly inadequate, to those who have nothing, or supply safe water and sanitation?

(2) Should reaching those most in need be a priority?
As Krischan wonders (#14744): Does it make sense to focus on the hardest to reach (assuming they need it most), when easier to reach parts of the population who might even be partially able to pay for the services are not yet reached? Aiming for those first, might make reaching the remaining later on much easier too.

(3) Are we really prioritising those most in need? (i.e. those living on $1 or less/day)
As Graham criticizes, help does no longer seem to be given to those who cannot afford to buy 'products’. Projects to improve latrines become abandoned when it is realised that no one is going to pay for such improvements.

(II) FURTHER QUESTIONS:

How can the reduction of inequalities be adequately measured? What problems exist?

What should be done to address inequalities with regard to various factors?
- gender
- rural areas, slums, peri-urban areas, informal settlements…
- disability
- age
…

What is your experience with regard to enabling access to WASH for these groups?

I look forward to your thoughts and opinions on the matter!

Best,
Katrin

I would like to raise a fundamental question regarding sanitation though, it seems, applicable to most efforts to help “those most in need”.
What does “Prioritising those most in need” really mean?

For me we should be talkng about helping those on $1 a day or less but that does not seem to be the case – not really! So far as I can see help is no longer given to those who cannot afford to buy 'products'!!
Am I wrong? Really? It seems to be USA and UK government policy
Otherwise projects on, for example, improving latrines would be a top priority but what happens is that such projects get abandoned when it is realised that no-one if going to pay for such improvements.

In 2012 two projects were being developed to modify existing latrines and convert the manure into protein.
Just what is needed, you might think, for millions across the rural world but what happened next?
It was deemed that they had to “create a product that’s commercially viable” !
How crazy and how typical of many projects creating a device only needed by the very poor and then expecting them to buy it – with what?
Visit
blogs.lshtm.ac.uk/sanitationventures/inn...let-design-workshop/

OK, but what do some of those things mean? What does it mean to "prioritize basic access"? Is that to say access is more important than safety? What if many have access but then don't use them?

National governments have the obligation to ensure the progressive realisation of human rights, including rights to water and sanitation for all. The SDGs also reinforce this responsibility for government and monitoring will be critical to ensure national focus is on reaching those who are most likely to be left behind.

The checklist developed by the Equality and non discrimination (END) working group of the Joint Monitoring Programme provides a useful starting point for this discussion, by highlighting who to focus on in the SDGs. The checklist sets out the following questions:

When examined as a whole, do the goals, targets, and indicators:
• prioritize basic access and focus on progressive realization toward safe and sustainable water, sanitation and hygiene for all, while reducing inequalities?
• address spatial inequalities, such as those experienced by communities in remote and inaccessible rural areas and slum-dwellers in (peri-)urban areas?
• focus on inequities, shining the light on the poorest of the poor?
• address group-related inequalities that vary across countries, such as those based on ethnicity, race, nationality, language, religion, and caste?
• attend to the impacts of individual-related inequalities that are relevant in every country of the globe, such as those based on sex/gender, age, disability, and health conditions imposing access constraints—as they are experienced both inside and beyond the household? Do they address menstrual hygiene management?

The checklist was established precisely to show how many different factors interact to result in exclusion from basic rights to water and sanitation. While the MDG monitoring process highlighted disparities between urban and rural populations and between wealth quintiles, this list requires a far more comprehensive approach.

Addressing these inequalities brings in many challenges precisely because so many aspects of lives affected by marginalisation, poverty and social exclusion are under-reported and even invisible in official data.

For example people in informal settlements often work in informal economies, are reliant on unofficial services, lack land rights and often even the most basic documentation. Some are particularly invisible, such as homeless people, refugees, travellers and migrants.
Gathering information about individual factors that affect access to WASH (age, gender, disability, health conditions) is difficult for many reasons: Social stigma and taboo makes it very difficult to get any accurate information about disability or other illnesses that increase peoples’ need for WASH whilst at the same time making it difficult to use standard services that are provided. Menstrual hygiene is a topic that cannot easily be discussed, in spite of recent progress in “breaking the silence”.

Even if specific questions are asked about such issues data collectors and enumerators may not be comfortable asking questions associated with stigma, and where the respondent is the head of household they are often simply unaware of the experience of their more vulnerable household members.

Information about inequalities related to specific population groups in different countries are also extremely sensitive and often very politically charged, especially where specific castes, religious or ethnic groups are systematically disadvantaged.

The END working group produced a simple information sheet about measuring the reduction of inequalities, but this is the tip of the iceberg.

We need to work together and creatively to understand more about the barriers to WASH experienced by those who need it most and what can be done to monitor change in the real experience of access. The SDGs provide a huge opportunity to focus efforts on the hardest to reach and there are many promising openings to explore further.

For example the content and principles of the human rights to water and sanitation provide a set of commonly agreed criteria for water and sanitation services that are acceptable in human rights terms: summarised as availability, affordability, accessibility, acceptability and safety. The principles of equality and non-discrimination, participation and access to information apply to service provision as well as to the monitoring process. The Handbook on the human rights to water and sanitation provides more practical information on all aspects of service provision and there is a specific section on monitoring .

We are also learning more about individual related inequalities. Research into access to WASH for disabled and older people, (such as the Undoing Inequity project ), is producing more evidence about issues of access to WASH for people in vulnerable situations as well as producing some tools and methodologies that can be used to monitor inclusion and access.

A much bigger focus on gender and menstrual hygiene management is bringing attention to the availability of MHM facilities in school WASH as well as the existence of separate, safe, accessible and private facilities for in public places and institutions.

Critical to this discussion is the importance of placing WASH firmly into the arena of inequalities and joining with those who fight for the wider human rights of the most marginalised.

I look forward to this discussion and hope it will generate more ways in which we can focus efforts on achieving the SDGs for those most in need of safe sanitation.

Another food for thought question:
Does it make sense to focus on the hardest to reach (assuming those need it most), when easier to reach parts of the population who might even partially able to pay for the services are not yet reached? Aiming for those first, might make reaching the remaining later on much easier too.

I'm looking forward to this discussion as I think it is one of the most important ones to address.

I think, though, that some of these things are actually very closely related together. For example: "prioritising those most in need" is a tricky thing to determine if you haven't first determined what you mean by "safe".

The UN has said that "safe" water is water that is "free from micro-organisms, chemical
substances and radiological hazards that constitute a threat to health" and that sanitation should be "hygienic; wastewater and excreta safely disposed."

The trouble is that it is very hard to get water which is absolutely free from microbes and the "safe disposal of excreta" is a matter of opinion.

If we are going to say that those "most in need" are those who do not have access to clean potable water or any form of sanitation system, how good do the systems have to be to be?

This matters because targeting Open Defecation could lead to a large number of people being given low quality (but cheap) sanitation facilities which they must empty themselves (which is a high risk activity).

What actually are we trying to do: supply something, which is still clearly inadequate, to those who have nothing, or supply safe water and sanitation? Those are not the same thing.