S

C.L.E.A.N.The Key to Sustainable

Total Sanitation

Team 19

Kristy HackettSamantha Kearney

Theresa Lee

Nicole LipanaJulia Roy

Anjum Sultana

Can Global Sanitation 2020 Contribute to China’s Prosperity?

?

Sanitation

Improve health

Human capital

Opportunity cost

ProductivityLabor

Education

Environment

Catalyst for economic prosperity

Where to invest?

?

Where to invest?

Why South East Asia?

S Soft PowerS International reputation

S Political interest

S Regional Stability

S Need for sanitation improvement

S Economic GainsS Growing population

S Increasing purchasing power

S Geographical proximity

S Economic interdependence

S Access to natural resources

S Established infrastructure

S Similar rural urban divide to China

S Relative cultural similarity

Cambodia, Indonesia, Timor Leste

S Rural/Urban Divide

S Disproportionate access to improved sanitation

S Cambodia – 20% vs. 73%

S Indonesia – 39% vs. 73%

S Timor Leste – 37% vs. 73%

S 93 Million people in rural areas

Economic Cost :: Sanitation

Cambodia, IndonesiaTimor Leste

S US $6.2 Billion loss due to lack of sanitation [1]

S Health

S Productivity (Labor, education)

S Environment (water, land)

S Tourism

China

S China’s bilateral trade with these countries will increase by

US $240 million per year if universal sanitation coverage is

attained

[1] Water and Sanitation Program (2008)

What and how to invest?

SWhat?SHow?

Economic Technical

Cultural Scientific

Feasibility

Step 1: Community Engagement(Create Demand)

S Community-Led Total Sanitation (CLTS)

S Originated in Rajshahi, Bangladesh by Kamal Karr

S Benefits:

S Community Ownership

S Behavioral Change

S Community Empowerment

S Evidence-Based

S Decrease rates of open defecation:

S CLTS: 92%

S Non-CLTS: 28% [2]

[2] Rashid et al (2009)

Pre Triggering

• Selection

• Building Rapport

Triggering

• Participatory Sanitation Profile Analysis

• Ignition Moment

Post Triggering

• Action Planning

• Follow Up

Process of CLTS

Demand Supply

Step 2: Ecological Sanitation(Provide Supply)

Conventional ApproachEcoSan Approach

Urine diversion dehydration

(UDD) toilets

Composting toilets

Vacuum sewersSemi-

centralised biogas plants

EcoSan Options

CLTS(Demand)

EcoSan(Supply)

C.L.E.A.N.

Lessons Learned

Project RolloutFund Build Adopt Report

Introduction of EcoSan and Solution buildingDevelop plan Funding request

TriggeringParticipatory Sanitation Profile Analysis Ignition Moment

Pre-triggeringEngage community Building rapport Identify sanitation problems

C.L.E.A.N.Evaluation

Acceptability• Community-led• Participatory• Feedback loops• Equity-focused

Cost Effectiveness• DALYs avoided/

1$ spent

Health Impacts• Change in %

ODF • Diarrheal disease• <5 mortality

Environmental Impacts• Local water

quality

C.L.E.A.N. :: Monitoring & Evaluation Template

Region

CLTSEcoSan

C.L.E.A.N.

Recommended Evaluation Design

Randomized Controlled Trial (Gold Standard)

Carried out by University partners

C.L.E.A.N. :: A Multi-faceted Approach

Stakeholder Integration

Policy: Governments & Institutions

Implementation: Civil Society & NGOs

Research: Universities

Benefits

Knowledge transfer

Evidence building in the scientific community

Capacity building of community

Soft power gains for China

Project Budget

US $5 Billion per year for 3 years of full-scale implementationCambodia; 27%

Indonesia; 70%

East Timor; 3%

Additional Recommendation :: China in parallel

Vast inequities between rural and urban populations within China

Curb criticisms of not dealing with sanitation problems at home

Lessons learned in neighboring countries are transferrable

Strengthen research partnerships

Become a world leader in environmentally sustainable sanitation initiatives

Key Messages

1. C.L.E.A.N ignites the demand for and provides the supply of improved sanitation

2. Benefits of C.L.E.A.N. go beyond sanitation, addressing issues of equity and global responsibility

3. Improved sanitation in South East Asia leads to returns on investment and improves international relations and furthers economic gain

Thank You.Questions?

ReferencesReferences

Avvannavar, S. M., & Mani, M. (2008). A conceptual model of people’s approach to sanitation. Science of the Total Environment, 390, 1-12.

Cheng, J. Y. S. (2013). China-ASEAN Economic Co-operation and the Role of Provinces. Journal of Contemporary Asia, 1–24. doi:10.1080/00472336.2012.757430

Ferguson, R. J. (2012). China’s Long-Term Relations With Southeast Asia: Beyond The Pivot. Culture Mandala: The Bulletin of the Centre for East-West Cultural and Economic Studies, 10(1), 3–20.

Florini, A., Nachiappan, K., Pang, T., & Pilcavage, C. (2012). Global Health Governance: Analysing China, India and Japan as Global Health Aid Donors. Global Policy, 3(3), 336–347. doi:10.1111/j.1758-5899.2012.00173.x

Hubbard, B., Sarisky. J., Gelting, R., Baffigo, V., Seminario, R. & Centurion, C. (2011). A community demand-driven approach toward sustainable water and sanitation infrastructure development. International Journal of Hygience and Environmental Health, 214, 326-334.

ReferencesReferences

Langergraber, G., & Muellegger, E. (2005). Ecological sanitation – a way to solve global sanitation problems? Environmental International, 31, 433-444.

Montgomery, M. A. A. (2007). Water and Sanitation in Developing Countries: Including Health in the Equation (pp. 16–24).

Mosler, H-J. (2012). A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. International Journal of Environmental Health Research, 22(5), 431-449.

Murphy, H.M., McBean, E.A., & Farahbakhsh, K. (2009). Appropriate technology – a comprehensive approach for water and sanitation in the developing world. Technology in Society, 31, 158-167.

Nelson, K. L., & Murray, A. (2008). Sanitation for unserved popualtions: Technologies, implementation challenges, and opportunities. Annual review of Environment and Resources, 33 199-151.

ReferencesReferences

Rud, S. & Munch, E. V. (2008). Ecological sanitation: Selected example projects from Sub-Saharan Africa, Asia and Europe. International Conference: Pahtways towards Sustainable Sanitation in Africa. Ouagadougou, Burkina Faso.

SOIL (February 2011). Introduction to EcoSan toilets.

UNICEF, & World Health Organization. (2012). Progress on Drinking Water and Sanitation (pp. 1–66).

Water and Sanitation Program. (2007). Economic Impacts of Sanitatn in Southeast Asia Summary (pp. 1–14).

Water and Sanitation Program. (2012). Introductory Guide to Sanitation Marketing Implementation (pp. 1–14).

Water & Sanitation Rotarian Action Group (2012). Guidelines for planning sustainable sanitation projects and selecting appropriate technologies. Wasrag Technology Series.

ReferencesReferences

WaterAid. (2011). Construction Of Ecological Sanitation Latrine (pp. 1–68).

Werner, C., Panesar, A., Rud, S.B. & Olt, C.U. (2009). Ecological sanitation: Principles, technolgoies and project examples for sustainable wastewater and excreta management. Desalination, 248, 392-401.

Whittington, D., Jeuland, M., Barker, K., & Yuen, Y. (2012). Setting Priorities , Targeting Subsidies Among Water , Sanitation , and Preventive Health Interventions in Developing Countries. World Development, 40(music), 1546–1568.

World Health Organization. (2012). Global Costs And Benefits of Drinking-Water Supply And Sanitation Interventions To Reach The MDG Target And Universal Coverage (pp. 1–67).

Appendix AAdditional Recommendation ::

China in parallel

Yunnan province

Rural population: 31.375 million

46.3% in need of improved sanitation

Total cost: US $745 million

Including cost of technology, facilitators, evaluation, and overhead cost

Appendix B: Cambodia, Indonesia, Timor Leste

Government – Ministry of Health, Water & Environment, Education (multi-sectional)

NGOs

Universities and Researchers

Leading Sanitation Experts within Ministry

Regional District - Health & Environment

District

Community/Village Level

Elders, Leaders, Village Governing Council

Appendix C: Stakeholder Engagement

Appendix D: Why Not Africa?

Maintaining Current Investment Proportion

Harder to Achieve Universal Sanitation

Risky Investment

No Established Infrastructure

Strength

- Natural resources

- Large population (900M, to double)

- Emerging market

- Rising middle class

Many ODF initiatives

Weakness

- Low level of infrastructure

- Political uncertainty (Human Rights and conflict)

- Sanitation infrastructure can’t support population growth

- Low level of ODF in both urban and rural area

- Distance from China is high, meaning increased cost

- Most need

Opportunity

- Generate trade and extraction

- Increased purchasing power

- Room to improve ODF%

- Global stability and recognition

- High reward

Threat

- Uncertainty about whether resources exist

- Urbanization

- Environment

- Sanitation low in urban areas

- Unfeasible sanitation target due to many confounding issues

- Increased cost due to distance

- Soft power decreases

- High risk

Appendix E: SWOT Analysis for Investment in Africa

Total Cost to achieve universal sanitation coverageSSA: US $52 BillionSEA: US $10 Billion

Benefit:Cost RatioSSA: 2.8SEA: 5

Appendix F: Biogas

Appendix G: Composting Toilets

Appendix H: Urine Diversion Dehydration

Appendix I: Evidence of CLTS

Not Effective

Appendix J: Budget for China C.L.E.A.N. Program

Appendix K: Global Budget Calculations

Appendix L: Philanthropy

Lots of money with comparatively little economic ROI

Foreign aid can simply be aid and doesn’t have to come with strings attached

This further improves international relations, friendliness and soft power

Appendix M: Evaluation Methodology

Qualitative:

In-depth interviews with key stakeholders at community level (women, children, youth, facilitators, village government members)

Focus on equity of uptake/participation/decision making

Appendix N: Evaluation Methodology

Quantitative:

Household Surveys (pre/post) in each village

Measures of water contamination

RCT: compare changes in indicators between arms

Surveys to capture:

Health indicators

Cost effectiveness data

HH hygiene/sanitation knowledge

Attitudes towards C.L.E.A.N. approach

Appendix O: Five Year Plan :: GANTT Chart

Appendix P: Evidence for CLTS

Appendix Q: EcoSan Selection(s)