Well said Mr Mughal. What then can we do? I share the same opinion from my experience in Southern Africa. What about SDG6? Is it realistic given this unfavorable scenario? We cannot achieve scale by piloting? Now we are talking about innovative financing using the 4Ts (Tariffs, taxes, transfers and Trade). How much scale is achievable this way? Who can be engaged to make the pilot projects that never fail scale up? My opinion is that financing is a must but it can work where there is a favourable enabling environment. How do we create such an environment in a developing country which is heavily laden with debt and has an alarming poverty rate? A lot of effort and thinking need to be put to this. We have to deal with the problems in scaling up if we are going to achieve SDG6 target.

Scale up of software programs also fails at a lower level: sufficiently skilled "field" personnel that simply does not exist in most places.
For these kind of behaviour change interventions targeting the poorest part of the population there is a special profession: social workers. These are usually highly trained persons, but good luck finding those even for a few supervising positions in developing countries.
Not only do software interventions usually end up working with more or less randomly skilled staff, it is also not paid well enough to attract motivated persons with some personal interest in what is expected to be done by them.
In the end managers try to compensate with extremely formulaic approaches and some hardware subsidy to attract participants.

If you hit a fertile ground with a certain approach as was the case with CLTS in parts of Bangladesh (and a few other places) so that it works more or less by itself with limited intervention necessary, great!
But usually that isn't the case, and then your great software approach will not scale beyond the pilot due to the HR issues outlined above. And let's not always blame local governments here, who usually have the same issues but even less budget than NGOs trying (and failing) to do similar things.

Generally, the documents and reports that one come across, tend to suggest that the scaling-up of the sanitation programs and approaches is possible. The views of Jan Willem Rosenboom of the Bill & Melinda Gates Foundation seems to suggest somewhat otherwise, though he has aired a way-out strategy: (www.devex.com/news/sanitation-for-all-sc...-is-hard-to-do-87881)

Experience has shown that a major, well-established constraint in developing countries, whether it pertains to scaling-up, or just developing some pioneering projects, is the lack of technical expertise, motivation, lack of accountability, and poor monitoring and evaluation, in the local municipal government departments.

Rosenboom, more or less, do emphasize these points. He has, however, limited his discussion to CLTS (community-led total sanitation). People have different views about CLTS, ranging from: less effective, context-specific, to part of an overall sanitation strategy. Perhaps, Rosenboom, may like to speak in terms of other initiatives and programs like a regional initiative, Sustainable Water and Sanitation in Africa (SUWASA), Community Approaches to Total Sanitation (CATS), and WHO’s Participatory Hygiene and Sanitation Transformation (PHAST) approach.

Having said that, Rosenboom has drawn attention to many interesting points. Some are briefly mentioned here.

Pilot projects never fail, and they never scale: Many would have different views on this.

The following contention does make some sense, and would apply in some projects:

“Intuitively, this makes some sense. For pilot (or demonstration) projects, we select the most responsive communities, with the most supportive leadership. We use the best front line workers we can find, and there is frequent follow up from the (international) organization supporting the pilot. This is a recipe for success.”

Perhaps, most would agree on this statement:

“Making the transition from pilot to scale, however, changes everything. This requires political buy-in first of all, supplemented by — often limited — program funds. Limited budgets, front line workers with less training and experience, less follow-up, average motivation and support: over time, the conditions for success move from “outstanding” to “average,” and so do the results.”

The above point appears to be valid in the context of developing countries. Yes, political-will, especially for sanitation projects, is low; there are limited funds; operation and maintenance allocation is low, and, as I said earlier, the municipal government departments lack technical know-how.

Talking about CLTS, Rosenboom says: The results mentioned above demonstrate this to some degree, and the Learning Series report supports this also: “CLTS was widely perceived as being universally applicable … even though outcomes varied depending on community characteristics. Rather than viewing it as a comprehensive solution … CLTS should be considered as one component of a sanitation strategy.”


“Research from other countries and other organizations shows similar variations based on context, ranging from UNICEF in Mali reporting very positive CLTS outcomes (in terms of access, use and even stunting of children), to IPA in Bangladesh reporting mediocre results from CLTS (or sanitation marketing) alone, but much better results from CLTS combined with a subsidy. Recent research in India shows enduring issues with the use of sanitation facilities, and mixed results in terms of an increase in coverage.”

“Research from other countries and other organizations shows similar variations based on context, ranging from UNICEF in Mali reporting very positive CLTS outcomes (in terms of access, use and even stunting of children), to IPA in Bangladesh reporting mediocre results from CLTS (or sanitation marketing) alone, but much better results from CLTS combined with a subsidy. Recent research in India shows enduring issues with the use of sanitation facilities, and mixed results in terms of an increase in coverage.”


While Rosenboom rightly advocates for “change behavior,” as a way-out, I think the important point would be that of capacity building of the municipal governments, may be in the shape of continuing education (as government officials are transferred, typically after 3 years' of posting). Municipal officials also need to be sensitized about sanitation. This strategy should then be directed towards to decision-makers, key government functionaries and, the politicians handling the municipal departments.

F H Mughal