A WORLD BANK TECHNICAL PAPER

Appropriate Technologyfor Water Supply and Sanitation

Meeting the Needs of the Poorfor Water Supply and Waste Disposal

Fredrick L. Golladay

1000

4P~~~~~~~~~~~~~~~

- -r

TDA:3532 I~ _____ 5t

.W67 .... -1 - -nv 13 ***TD353 .W67 v.13 c.2

c.~ ~ ~ 2 Meeting the need h ororwatir suppliy and waste dis _~~

SLCO501 56osel *99 A Contribution to the International Drinking Water Supply and Sanitation Decade 13

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

Pub

lic D

iscl

osur

e A

utho

rized

A WORLD BANK TECHNICAL PAPER

Meeting the Needs of the Poorfor Water Supply and Waste Disposal

Fredrick L. Golladay

SER NpL LIBRA RY

R.INTETILO~NA BANK

RECNsR FOR

REONSTRUC'ioN" A-ND DEVELOPMENTr

OCT 2 3 1984

The World BankWashington, D.C., U.S.A.

Copyright © 1983The International Bank for Reconstructionand Development / THE WORLD BANK1818 H Street, N.W.Washington, D.C. 20433, U.S.A.

First printing December 1983All rights reservedManufactured in the United States of America

This is a working document published informally by the World Bank. Topresent the results of research with the least possible delay, the typescripthas not been prepared in accordance with the procedures appropriate toformal printed texts, and the World Bank accepts no responsibility for errors.The publication is supplied at a token charge to defray part of the cost ofmanufacture and distribution.

The views and interpretations in this document are those of the author(s)and should not be attributed to the World Bank, to its affiliatedorganizations, or to any individual acting on their behalf. Any maps usedhave been prepared solely for the convenience of the readers; thedenominations used and the boundaries shown do not imply, on the part ofthe World Bank and its affiliates, any judgment on the legal status of anyterritory or any endorsement or acceptance of such boundaries.

The full range of World Bank publications is described in the Catalog ofWorld Bank Publications; the continuing research program of the Bank isoutlined in World Bank Research Program: Abstracts of Current Studies. Bothbooklets are updated annually; the most recent edition of each is availablewithout charge from the Publications Sales Unit of the Bank in Washingtonor from the European Office of the Bank, 66, avenue d'Iena, 75116 Paris,France.

Fredrick L. Golladay is a senior economist with the Water Supply andUrban Developrnent Department of the World Bank.

Library of Congress Cataloging in Publication Data

Golladay, Fredrick L.Meeting the needs of the poor for water supply and

waste disposal.

(World Bank technical paper. Appropriate technologyfor water supply and sanitation ; v. 13)

"A contribution to the International Drinking WaterSupply and Sanitation Decade."

"August 1983. " IDBibliography: p.1. Water-supply--Developing countries. 2. Sewage

disposal--Developing countries. I. World Bank.II. Title. III. Series.TD353.G58 1983 363.6'1'091724 83-14636

ISBN 0-8213-0238-8

- iii -

ABSTUCT

This paper examines economic, political, social andcultural obstacles to meeting the needs of low-income people forwater supply and waste disposal and it proposes steps to reducethese obstacles. Households are often poorly informed aboutavailable options and are unable to allocate resources efficientlyamong their members. The paper suggests ways in whichcommunications, peer and family support for innovators andincentives can be strengthened. Communities organize and manageresources in order to carry out activities that cannot beprofitably undertaken by households, encourage constructive changeand sanction undesirable behavior. The paper proposes methods forfacilitating the formation and operation of communityorganizations to carry out these functions. Formal bureaucraciesprovide professionalized technical and administrative services,and supply pol:Lcy guidance, goods and financial resources tooperating agencies and communities. Largely because of theirinherent conservatism, formal bureaucracies often fail to satisfythese needs, especially for innovative activities. Governmentsmust revise legal codes to permit adoption of affordabletechnologies, aiid must assist community organizations in dealingwith legal, financial, technical and administrative problems andin recruiting and retaining competent technical staff. Thesedemands must be met within the constraints of both practicalpolitics and bureaucratic behavior.

Persons who wish only a summary of the paper's mainarguments should consult the conclusions (pages 46-51). The textof the paper, in addition to providing a more complete statementof the paper's ideas, is illustrated by examples drawn from theexperiences of t:he Bank and others, and should be read in order tofully grasp the arguments.

APPROPRIATE TECHNOLOGY FOR WATER SUPPLY AND SANITATIONVolume 14

In 1976 the World Bank undertook a research project onappropriate technology for water supply and waste disposal in developingcountries. Emphasis was directed toward sanitation and reclamationtechnologies, particularly as they are affected by water service levelsand by the ability and willingness to pay on the part of the projectbeneficiaries. In addition to the technical and economic factors, assess-ments were made of environmental, public health, institutional, and socialconstraints. The findings of the World Bank research project and otherparallel research activities in the field of low-cost water supply andsanitation are presented in this series, of which this report is volume 14.Other volumes in the series are:

Volume 1. Technical and Economic Options, by John M. Kalbermatten,DeAnne S. Julius, and Charles G. Gunnerson [a condensationof Appropriate Sanitation Alternatives: A Technical andEconomic Appraisal, Johns Hopkins University Press, 1982].

Volume la. A Summary of Technical and Economic Options

Volume 2. A Planner's Guide, by John M. Kalbermatten, DeAnne S. Julius,Charles G. Gunnerson, and D. Duncan Mara [a condensationof Appropriate Sanitation Alternatives: A Planning andDesign Manual, Johns Hopkins University Press, 1982].

Volume 3. Health Aspects of Excreta and Sullage Management--AState-of-the-Art Review, by Richard G. Feachem,David J. Bradley, Hemda Garelick, and D. Duncan Mara[a condensation of Sanitation and Disease: Health Aspectsof Excreta and Wastewater Management, John Wiley and Sons,1983].

Volume 4. Low-cost Technology Options for Sanitation--A State-of-the-Art Review and Annotated Bibliography, byWitold Rybczynski, Chongrak Polprasert, and Michael McGarry[available as a joint publication from the InternationalDevelopment Research Centre, Ottawa, Ontario, Canada]

Volume 5. Sociocultural Aspects of Water Supply and Excreta Disposal,by Mary Elmendorf and Patricia Buckles

Volume 6. Country Studies in Sanitation Alternatives, byRichard A. Kuhlthau (ed.)

- vi -

Volume 7. Alternative Sanitation Technologies for Urban Areasin Africa, by Richard G. Feachem, D. Duncan Mara,and Kenneth 0. Iwugo.

Volume 8. Seven Case Studies of Rural and Urban Fringe Areasin Latin America, by Mary Elmendorf (ed.)

Volume 9. Design of Low-Cost Water Distribution Systems,Section 1 by Donald T. Lauria, Peter J. Kolsky, andRichard N. Middleton; Section 2 by Keith Demke andDonald T. Lauria; and Section 3 by Paul V. Herbert

Volume 11. Sanitation Field Manual, by John M. Kalbermatten,DeAnne S. Julius, and Charles G. Gunnerson.

Volume 12. Low-Cost Water Distribution--A Field Manual, byCharles D. Spangler

The more comlplete, book versions of volumes 1, 2 and 3 have beenpublished -- under the series title "World Bank Studies in Water Supplyand Sanitation". VQolumes 1 and 2 are available from the Johns HopkinsUniversity Press; Volume 3 is available from John Wiley and Sons-

Additional volumes and occasional papers will be published asongoing research is completed. Except for Volume 4, all reports may beobtained from the World Bank's Publications Sales Unit.

- vii -

TABLE OF CONTENTS

ABSTRACT .................................................

PREFACE .................................................. ix

I. INTRODUCTION ........................................ 1

II. THE ROLE OF THE HOUSEHOLD ........................... 4

A. Misinformation as an Obstacle to Efficient

Consumption . . 5

B. Development Communications . . 7

C. Opportunities to Improve Communications and

Education . . 9

D. Allocation of Resources within the Household .... 11

E. Opportunities for Influencing Household Choices. 14

F. Household Goals and Choice . ... . 15

G. Household Production . . 18

H. Opportunities to Enhance the Operation of the

Household Economy . . 20

III. THE ROLE OF THE COMMUNITY ........................... 22

A. Community Participation . . . 24

1. Community Consultation ..................... 24

2. Mobilization of Community Resources .. 27

3. Community Control of Programs .............. 29

B. Promoting Community Participation ............... 30

1. Costs of Participation ..................... 30

2. Benefits of Collective Action .............. 31

3. Enhancing Benefits ......................... 31

4. Reducing the Costs of Participation ........ 32

C. Organizational Processes ............. ........... 34

D. Developing Organizations ................... ..... 35

E. Relationship of Community Organizations to the

Bureaucracy ..................................... 35

IV. THE ROLE OF GOVERNMENTS IN MEETING BASIC NEEDS ...... 37

A. Political Will . .......... . 37

B. The Politics of Poverty .. 39

C. Prospects . . .... ........... . 40

D. Establishing a Role for the Private Sector ...... 40

1. Economic Efficiency ........................ 41

2. Government as Advocate for the Poor and

Handicapped .... ......................... . 42

- viii -

TABLE OF CONTENTS (continued)

3. Redistribution of Income ...... ............ 43

E. Public Production ............................... 43F. Legal Environment .............................. . 44

V. CONCLUSIONS ..... 46

A. The Household .................................. 46B. The Community ................................... 48C. The Government . . ................................ 50D. SiumTnary ....................................... 51

APPENDIX. FURTHER READINGS ............................ 52

- ix -

PREFAC

The ultimate objective of economic development is tomeet human needs. Among these needs, freedom from disease andliberation from ignorance are widely agreed to be among the mostbasic. However, despite historically unprecedented growth inproduction over the last quarter century, the number of peopleliving under life-threatening and subhuman conditions hasincreased. In a few countries, fragmentary evidence suggests thatthe poorest quarter of the population may have become moreimpoverished, raEther than less, in the period since World War II.

The discovery that poverty is not being overcomecontrasts with the recent finding that a few areas with very lowper capita incomnes have largely conquered disease and ignorance.Sri Lanka and the Indian state of Kerala are prime examples. Bothreport life expectancies and literacy rates similar to those ofNorth America and Western Europe and yet annually produce goodsand services valued at around $200 per capita. At the same timecountries with output per person three to five times as largesuffer from muCbL higher rates of premature death and illiteracy.

These insights suggest that development strategies thataim at increasing per capita production and incomes are neithernecessary nor sufficient to satisfy human needs. But moreimportantly, they indicate that the resources needed to provide anacceptable quality of life are available to nearly all of thecountries- of the World. Thus a search is now underway to identifypractice; steps toward meeting the human needs of very poorpeople. These efforts are focusing on means to provide essentialgoods and services to everyone.

In Oct:ober 1980, the World Bank assembled a group of 39people in Easton, Maryland to pursue this task. The groupincluded persons with experience in international agencies,research institutions and private voluntary organizations. Theparticipants brought with them expertise in water supply andsanitation, health care, rural development, nutrition, familyplanning, shelter, 'small scale industry, community development,education, development policy and economics. The group includedpersons with p=ractical experience in most of the developingcountries, The sagenda for the workshop was to identify practicalsteps to indcreas-e the effectiveness of development activities inmeeting basic hiiman needs and, in particular, means to enhance thebenefits to human health of investments in water supply andsanitation.

- x-

This monograph grows out of that workshop. Thepresentation reflects not only the discussion that took place atEaston, but also the ensuing correspondence and conversation thatthe workshop sicimulated. In addition, the paper draws upon areport of the proceedings of the workshop on which many of theparticipants ofEered useful comments.

A draft of the monograph was also reviewed by a numberof people inside and outside of the World Bank. The comments ofIrma Adelman, Horace W. Barker, David Bradley, Nat Colletta, KirbyDavidson, Mary Elmendorf, Arlene Fonaroff, Joseph Freedman,Raymond B. Isley, Bruce Johnston, John Kalbermatten, Peter Knight,Maritta Koch-Weser, Bernhard Liese, Patricia Rosenfield, PaulStreeten, Normun Uphoff and Christopher Willoughby have beenespecially helpful and are gratefully acknowledged. Remainingerrors and omissions are nonetheless the author's responsibility.

I. INTRODUCTION

Filth, disease, hunger and ignorance seriously blightthe lives of more than one and a half billion persons--a majorityof those who live in the developing countries. Life expectancyfor this group is only slightly more than half that of personsresiding in aff;Luent countries; a third of the children born tothe group die before reaching the age of five years. Theoverwhelming majority of the adults are illiterate and thus cutoff from many opportunities to improve their lives. Reducing thisstaggering waste must be high on the agenda of developmentpriorities.

The experiences of several areas have clearlydemonstrated thatt this tragedy is not inescapable. Millions ofpeople in the Iadian state of Kerala, as well as in Sri Lanka,China and several other places, have achieved levels of formaleducation and a physical quality of life rivaling that of the mostaffluent countries. Moreover, they have done so with remarkablysmall per capita incomes. This fairly recent discovery suggeststhat increasing per capita production is not essential in order tomeet the needs of the citizens of even the poorest countries. Atthe same time, information about the experiences of several middleincome developing countries, such as Brazil and Nigeria, suggestthat increases in per capita output do not lead inevitably tohigher standards of living.

Thus two important questions confront developingcountries: How did a few very poor countries succeed in meetingthe essential needs of their citizens? And, can those mechanismsbe introduced successfully in other countries?

These two questions have recently attracted wideattention. Many investigators have concluded that equitableaccess to food, and to education and other social services, is thecomm n characteristic of those low-income countries that have methuman needs. This conclusion supports the common sense notionthat goods and services are needed to improve health andeducation. But these studies have also signaled the less obviousfact that the value of the goods and services needed to meet human

needs is on the order of $165 per person annually--much less thangenerally has been presumed. This implies that in addition topromoting growth in production, development policies should seekto obtain from available resources greater benefits to people.These investigations have underscored the fact that the manner inwhich scarce resources are used is critically important, and havesuggested that the most significant neglected issues relate toachieving efficiency not in production but rather in theconsumption of resources.

These investigations have frequently emphasized the roleof enlightened -public policy in assuring equitable access toessential goods and services. Thus political will has been citedas an important factor in meeting human needs.. The political will-needed to implement programs that assure broad access has appearedprincipally where the overwhelming majority of the population isenfranchised. But it must also be recognized that broad politicaland social participation is itself an indicator of high levels ofhuman and social development. Thus, there is no clear basis forasserting whether human needs are met by popular governments orparticipatory government is nurtured by a literate society.

Moreover, the finding that governments which arecommitted to broad access to goods and services contribute most tomeeting needs provides little guidance on development policy.Consultants, development assistance agencies and even sovereigngovernments rarely have opportunities to create the politicalreforms that would be necessary in order to radically increaseaccess to essential goods and services. Hence it is necessary tolook for alternative approaches to the challenge of improvinghealth, education, shelter and opportunities.

This paper examines the options for more fully meetingthese essential human needs through better use of resources. Itbegins with the premise--already confirmed by the experiences ofthe several countries noted above--that the inputs required tomeet these needs are available to economies producing goods worthas little as $165 per capita a year (1982 prices). Thus the paperfocuses not on how to expand output but rather on how to improveconsumption of available resources. (This is not to say thatgreater production is undesireable, however.)

The first step is to ensure that production isdistributed so that everyone has access to required quantities of

- 3 -

essential goods. The considerable success over the past decade ofprograms to improve the earnings of both the rural and urban poorindicate that this goal is achievable without serious politicalupheaval or forcible redistribution of income and wealth. Thecontir.tity of these policies appears to have promoted developmentof a constituency and clientel for them, thus strengthening boththe program and its effectiveness. Rural development projectshave succeeded in improving the productivity of small farmers;investments in small scale industry now promise to do the same forthe landless, rural and urban poor. These efforts are not likelyto raise incomes dramatically but nonetheless they are capable ofproviding the resources required to satisfy human needs.

The second, and far less thoroughly explored, step is toensure that new opportunities to consume are used effectively.Consumption choices are either made or shaped by households,firms, communities and governments. However, even the mostsuperficial examination of the facts reveals that theseinstitutions have failed to use available resources as well aspossible in meeting human needs. Thus the immediate task is tounderstand why these decisions frequently are poorly made and thento devise policies and action programs to improve them. This isthe goal of the present paper.

- 4 -

II. THE ROLE OF THE HOUSEHOLD

The household more than any other decision making unitdetermines what individuals consume. Nonetheless, scant attentionhas been given to the question of how it carries out thisfunction. Most past thinking--and most public policies-- havepresumed that the individuals comprising a household share botheconomic resources and fundamental goals. According toconventional theories, choices are made in such a way as tomaximize the collective well-being of the household's entiremembership. Economists have generally compounded the error byproclaiming that the choices of households are optimal in theabsence of monopoly and external effects of production andconsumption activities.

However, the evidence indicates that the householdsoften do not use their resources to the greatest advantage. Forexample, each year several hundred thousand children are blindedby a vitamin deficiency that can be avoided by eating green, leafyvegetables which instead commonly are discarded. Similarly,closely spaced pregnancies deplete the physical capacities ofwomen and thereby unnecessarily endanger the lives of both mothersand children. UJrination and defecation in surface waters or inopen fields maintain the transmission of a large number ofdiseases including schistosomiasis, hookworm and cholera. A hostof other examples can be identified where the quality of life asreflected in nutritional status, good health, literacy and socialparticipation is severely limited by misuse of consumptionopportunities. In many of these instances human welfare could besharply improved at little or no cost.

These problems in the past often have been argued toreflect cultural barriers to development or the inherentconservatism of the poor. However, research during the 1970s intothe management practices of peasant farmers demonstrated thatobserved behavior is often rational, particularly if evaluatedwithin the framework of the values and opportunities of the poor.The decisions of peasants appear to reflect a more comprehensiveassessment of costs and benefits than has typically entered into"experts"' calculations. In addition, the poor value variousconsequences of production and consumption differently than doexpert advisers and academic researchers. In particular,

-5-

the poor generally avoid risks that might prove calamitous andstress quick returns from efforts and investments.

But the discrepancy between the behavior of the poor andthe professional judgments of how they should act also reflectsthe neglect of the interworkings of the household. Even casualobservation reveals that few household decisions result inuniformly shared benefits or costs. Age, sex and occupation, inparticular, ensure that individual members view and experience thehousehold differently. For example, children produce relativelylittle and at the same time place extraordinary demands on thefamily budget for schooling and health care. Women of childbearing age also have needs for nutrition and medical care. Thesespecial requirements compete with the family's ambitions to investin productive capital or to increase consumption. Persons workingoutside the home typically have distinctive needs for clothing andfor food. The increased sensitivity to the roles and needs ofchildren and women has underscored the fact that rivalry, conflictand injustice infect households.

A number of explanations are now being offered for thefailure of the household to use its consumption opportunitiesfully. The following subsections examine the ones most commonlyadvanced. The purpose of the discussion is not so much to providea rationalization for observed behavior as to illuminate theopportunities for community organizations and governments toenhance the performance of the household.

A. Misinformation as an Obstacle to Efficient Consumption

Households' most apparent economic handicaps derive fromtheir limited command of crucial information. The consequentignorance frequerLtly results in seriously inefficient use of theresources available to the family. This ignorance assumes severalforms. First, in many instances people hold views that havebeen contradicted by modern science. These views when acted uponare often harmful to their physical health. For example, in manyparts of Africa, people believe that if a mother consumesanimal-based foods during pregnancy, her child will acquirecharacteristics of the animal. As a result, pregnant women arenot allowed to eat milk products, eggs or meat, and thus consumetoo little protein. The consequent undernutrition combined withclose spacing of pregnancies results in serious depletion ofphysical reserves. Similarly, sharing defecation sites is thoughtby many people to cause infertility. This belief promotes casualdefecation and hence the spread of excreta-related disease.

-6-

Dracunculiasis--a severe, disabling parasitic diseasetransmitted exclusively by contaminated drinking water--has proveddifficult to control in some highly endemic areas because it isbelieved by many'to be a hereditary problem. People have observedthat the disease is peculiar to some families but not others.Transmission could be stopped by simply filtering drinking waterthrough finely woven cloth, sand, charcoal or other media. Butvictims have refused to adopt this low-cost solution on thegrounds that the disease is not "caused" but rather is "in theblood."

Alternatively, in some highly traditional parts of WestAfrica, households have refused to use an improved water supplyintended to interrupt transmission of disease. Local religiousteachings prohibit drinking water which has a "strange taste."This commandment, which is probably rooted in an ancient discoverythat contaminated water is dangerous to health, has been used tojustify continued reliance on familiar, traditional sources. Thusefforts to control diseases transmitted through unsafe drinkingwater have been frustrated. Scientific explanations of the causesof disease have had little impact on traditional practices.

Second, lack of consumer information frequently takesthe form of competing understandings of reality which crowd out orcontradict modern approaches to problems--especially efforts tocontrol disease. The idea that disease is caused by microscopiccreatures that invade and parasitise victims is often viewed withamusement by people who believe instead that curses and ill windsare the true causes. Efforts to control tetanus among new bornshas been difficult for this reason. Traditional people have beenreluctant to abandon the practice of controlling bleeding of theimbilicus by applying dung, in response to what appear to them tobe preposterous explanations for occurrance of disease. In suchinstances, entire systems of beliefs rather than individual"facts" guide behavior. Notions of organic growth based uponanalogies with agriculture, or of balance between hot and cold ormale and female often undergird understanding.

People are especially reluctant to abandon long-standingbelief s about the causes of disease where immediate results arenot obtained from adopting a new practice. Several programs havereported that people are more willing to doubt traditional beliefsif the severity or prevalence of a disease changes sharply. Acommunity in Oyo State in Nigeria with a long history ofdracunculiasis repeatedly dismissed attempts by health authoritiesto control the disease. Nevertheless, it sought professional helpwhen a drought forced a much larger part of the population toresort to a contaminated water source and hence the prevalence andseverity of the disease in the community escalated. The sudden

appearance of new facts that were clearly inconsistent with

- 7 -

traditional beliefs increased the community's willingness toconsider altcrnative explanations and to explore alternativesolutions.

Lack of information about affordable technical optionsfor meeting a recognized need is a third distinct form ofinadequate information. For example, many households (and publicauthorities) are unaware of the variety of options for safelydisposing of excreta. Most have seen modern flush toilets andunpleasant pit latrines. However, few are familiar with the rangeof affordable and esthetically acceptable intermediate solutionssuch as vented and/or water-sealed latrines. Even where peoplehave been informed of these options they have doubted that thefacilities were affordable, acceptable and more healthful. Onlyby observing these alternatives have people been convinced oftheir acceptability.

B. Development Commnications

Professionals in health care, family planning, watersupply, nutrition and the like have sought to bridge theinformation gap through a variety of development communicationsactivities. Mass media have been used to teach poor people thegerm theory of disease and the biochemistry of malnutrition, forexample. Radio has been the most successful medium; while theclient group is often illiterate, radios are widely owned.Printed media have been effective in a relatively small number ofcases. Sketches have replaced the written word in severalinstances in order to extend the reach of communications toilliterate persons. However, the achievements of posters havebeen especially modest, either because the symbols being used wereunfamiliar, or because the message was simply too complicated tobe conveyed at, a glance.

Multimedia approaches to development communications arenow being widelylem=loyed. "Distance learning" programs are beingdeveloped based-- bW. radio broadcasts and group discussions. Thegroups- are- organized to listen to the broadcasts, then to discussthe contents with-triained leaders. Written materials are providedto assist t-he groups in organizing their deliberations. Advocatesof the approach ma;intain that it offers a structured environment

-8-

in which questions and misunderstandings can be quickly resolved.In addition, they argue that listening groups provide communityreinforcement for new ideas and social support for changes inbehavior. The group dynamic is believed to make change less riskysocially, and hence more attractive.

The health and nutrition campaigns conducted by thegovernment of Tanzania are often cited as successful examples ofthis approach. With the aid of the local organizations of thenational political party, an estimated 90 percent of the. country'spopulation was informed about latrine construction, improvement ofwater supply, basic hygiene, food preparation and child care. Aformal evaluation of the campaigns revealed that a largepercentage of participants were able to recall principalmessages. About half of the participants initiated constructionof latrines. However, longer term follow-up has revealed that onlya small number were completed and used. The success of thecampaigns in promoting construction appears to have reflected theinfluence of the political party rather than a commitment to newlyacquired ideas. In the absence of individual commitment to thenew technology, longer-term use was disappointing.

The impact of development communications typically hasbeen disappointing. This failure appears primarily to reflect atendency of professionals to present new information in ways thatare intellectually satifying to them, but uniconvincing tolow-income people. Efforts to improve hygiene through educationand communications have typically sought to convey the elements ofthe germ theory of disease. The underlying notion has clearlybeen that once people are made aware of how gastroenteric diseasesare transmitted, t:hey will be willing to modify their sanitaryhabits. Excessive reliance on media technology has alsocompromised the effectiveness of communications activities.

However, most clients have not responded as predicted.As noted above, the most important explanatioa for failure hasbeen that the audience does not understand reality in the mannerthat underlies, say, the germ theory of disease. Disease isbelieved to result from "bad blood," the evil eye, ill winds,ancestral curses, etc. Thus, adoption of the modern scientificexplanation frequently requires that the individual reject anentire system of beliefs. Moreover, this system of beliefs oftenimpinges not only upon physical health but also on the mechanismsthat regulate social relationships and on the culture'sunderstanding of the relationship between man and nature. Thus itis not surprising that wholesale adoption of new ideas does notoccur.

- 9 -

The reluctance to embrace new theories of diseasecausation is also rooted in part in the fact that they must beaccepted on faith. Even with widespread adoption of a newpractice, improvements in health will appear only after a delay ofmonths, or perhaps even years. Hence direct confirmation of thenew practices' superiority is difficult to obtain. Few people arewilling to abandon their traditional beliefs about the causes ofmisfortune simply because an outsider offers an alternativeexplanation.

Finally, failure to adopt better practices in responseto communications activities also reflects a widespread humanreluctance to admit that older practices were harmful. Olderadults are particularly unwilling to concede that their ignorancehas contributed to the poor health or unhappiness of people theylove. As a consequence, people are typically conservative inembracing these new ideas. The reluctance is still greater forhealth-related changes which require that some part of theperson's system of beliefs must also be abandoned.

Lack of valid information about the role of excreta andwater in the transmission of disease is unquestionably a majorfactor in the persistence of this group of diseases. Theassertion is confirmed by the fact that better informed personscan and do live in areas of very high disease transmission withoutbecoming ill themselves. For instance, the staff of the DaccaCholera Laboratories (now known as the International Centre forDiarrhoeal Disease Research) work daily with cholera victimswithout contractirng the disease. Similarly, internationalbusinessmen and civil servants frequently travel to areas withoutadequate water supplies or waste disposal systems, and yet onlyoccasionally contract locally endemic diseases.

C. Opportunities to Improve Comminications and Education

For the reasons discussed above, the short-term impactsof communications and education activities are likely to bemodest. Nonetheless the foregoing discussion suggests a number ofconcrete steps t:hat might be expected to increase theeffectiveness of such activities:

First, communications/education activities should betargeted on those persons within the household who make decisionsand/or act upon new information. Often it is necessary for the

- 10 -

information to be supplied to the entire family. However,tn some cases this is not true; teaching adult males how toprepare green, leafy vegetables is probably a waste of effort, forexample. (Convincing them of the value of eating such foods wouldbe useful, however.) Focusing educational activities on those whoin point of fact make the related choices permits savings ofprogram resources. In addition, concentration of promotionalefforts allows more opportunities to tailor programs in order toreflect the people's initial knowledge and understanding, toincrease motivation and to mobilize social pressures to promotechange. Nonetheless, one should recognize that mobilizing acommunity-wide network of support for change may be necessary toadoption of new ideas.

Second, programs should seek to increase the rewardsfor adopting a new practice and at the same time should attempt tominimize sanctions against its adoption. Mass communicationscampaigns appear to have reduced desired family size in severalAsian and Latin American countries and thus have promoted familyplanning. Private advertising has created the notion (no doubtfalse in some settings) that infant feeding formula representsmodern and superior child care. School teachers have successfullyassociated better hygiene and use of latrines with progressive,modern practices. By enhancing the subjective gains from adoptinga new practice, these efforts have increased acceptance andretention.

Third, the social risks associated with innovationshould be minimized (or insured against) through appropriatepublic policies. Studies of the West African family suggest thatsuperior social status conferred by formal education has permitedyoung women to reject safely the instructions of traditionalhealers and older family members. Adoption of better childrearing practices (relating to immunization, hygiene, ornutrition) has been greater where mothers were better educatedthan their husbands or mothers-in-law. Education probablyredefines the peer group from which the innovator depends forassurance and acceptance. Broad improvements in employmentopportunities and more equitable laws regarding inheritance andownership of property also have increased women's willingness torisk innovation.

Agricultural development schemes in semi-arid sectionsof Kenya have provided insurance against drought so thatfarmers could withstand a crop failure. The insurance haspermitted development of land that was previously regarded aseconomically marginal by local farmers. It must be stressed thateven with a thorough understanding of the mechanisms that link new

- 11 -

practices with improved conditions, people will not innovateunless they are prepared to bear the economic, social, andreligious sanctions against deviation from traditional practices.

Fourth, messages should be fitted into local beliefs ifpossible. As noted above, many health education messages havebeen couched in the language of modern science. Often theelements of a health education message can be communicated withoutchallenging traditional beliefs. If the local cosmology can beleft undisturbed, the audience is more likely to acceptsuggestions for change. For example, the successful campaignagainst dracunculiasis in the Nigerian village noted earlier waslaunched when the incidence and severity of the disease rosesharply. The people were then prepared to consider an explanationfor the unusual outbreak of the disease. Indictment of a watersupply was not inconsistent with the view that the customaryincidence of the disease was due to hereditary transmission. Useof agricultural imagery and analogies has been used effectively toconvey family planning concepts. Similarly, introduction of oralredhydration therapy for diarrhea has been more successful whereit was presented as the cure for the dryness that may accompanywater stools. In this way the intuitively appealing, traditionalrule that one withholds liquids from persons with acute diarrheacould be left unchallenged.

D. Allocation of Resources within the Household

The household is made up of people with competing needsand aspirations. The manner in which these differences areresolved significantly affects the well-being of individualmembers. At the most elemental level, household members competefor the limited resources of the family. While the issue ofincome distribution among households has received widespreadattention, the important question of how the household dividesits resources among its members has been largely ignored.Competition for resources within the household presents peculiarproblems because the competitors are unevenly matched--they rangefrom newborn infants to adult males. The claims that can be madeeffectively are consequently varied.

Allocation of resources within the family is furthercomplicated by the fact that the needs and interests of theindividual members both diverge and compete. For examplepreschool children are especially susceptible to infectiousdiseases because their immune systems are immature. Theytherefore need greater medical attention than older children andadults. In addition, small children require diets high in bothprotein and calories because they are growing rapidly and becausethey often suffer diseases that impair absorption of nutrients.Pregnant and lactating women have similar dietary requirements.

- 12 -

In contrast, male adults have modest needs for protein but highrequirements for calories to support heavy physical exertion.However, the division of a family's supply of food rarelyrecognizes each member's needs. In relatively wealthy householdsthis does not present serious problems because nutritionalminimums are generally over-satisfied. However, very poorfamilies need to budget their food carefully to meet everyone'sneeds.

The allocation of food resources is illustrated by astudy of nutrition in the State of Tamil Nadu, India. It suggeststhat at least three different rules exist for allocating scarcefood within the family. Some households divide scarce food inroughly equal amounts. Others distribute food in proportion toperceived needs. (These needs may not correspond to thoseprescribed by nutritionists however.) Third, householdsfrequently rely on a triage system in which the most importantfamily members are served first and less important members are fedwhatever remains. The triage system is often defended as beingrational to the extent that it maximizes the productivity of themain bread winners. Obviously, none of these rules for allocationof scarce food is ideal in the sense of minimizing the effects ofmalnutrition on the family.

The needs of children for socialization and trainingalso compete with consumption and other investments by thehousehold. Sending a child to school not only requires the familyto buy uniforms, books, etc. but also reduces a family's income ifthe child could have been employed. Thus a conflict arisesbetween the short run interests of the family and the longer-terminterests of the child: the household is confronted with a choicebetween current consumption and investment in the future earningscapacity of a child. Furthermore, it is faced with a choicebetween expenditures that benefit it and those that will benefitthe families of its children.

The disadvantaged positions of children and women inparticular have been highlighted in recent years in discussions ofthe role of women in development. In addition to being granteda less than ideal share of the family's resources, often womenhave been assigned some of the most dreary tasks. Collectingwater and fuelwood are two notable examples. On the other hand,adult males (in part because of greater strength and physicalmobility) tend to assume substantial roles outside the homeespecially in earning cash incomes.

- 13 -

Voluntary, market exchange cannot be depended upon toresolve competltion for the resources of the household nor toassign tasks and responsibilities among members. Differences incontrol over resources and in capacity for decision making confergreatest authority on adult males, especially in traditional,agrarian societies. But more commonly a system of mutualexpectations and responsibilities has developed that determinesthe allocation of both goods and work.

Because conflicts over the use of a household'sresources could easily assume disastrous proportions, everysociety has established customary methods for settlingdifferences. Most frequently, the eldest male member of thefamily is recognized as the ultimate arbiter of differences. Notsurprisingly, in most situations he renders judgements consistentwith his own broad interests or with those of his immediate heir.

However, many important household decisions are simplyprescribed by custom or religion. The transfer of property on thedeath of a father or the manner in which a bride is chosen areexamples. These decisions are widely regarded as being soimportant that they should not be left to haggling and debate.These customs are often exercised under the shroud of religion inorder to enhance their authority and legitimacy. They are furtherreinforced by a host of social sanctions and rewards.Reinforcements may range from being recognized as a "good wife andmother" to being invited to become a member of the Council ofElders. Violation of these customs is widely believed to invitemisfortune. Ancestral curses and the wrath of God are invokedagainst deviant or disrespectful behavior throughout the world.

Because of these influences on decisions, importantchanges sometimes are not made on a rationalistic basis. Forinstance, a young mother is usually reluctant to challenge thewisdom and social position of her mother or mother-in-law, or ofthe traditional midwife. Thus, she may be convincedintellectually of the dangers of stopping the bleeding of a baby'sumbilicus by applying dung, but nonetheless be unwilling to riskher position by contradicting traditional wisdom. To assume sucha grave responsibility in the face of the host of dangers of latercomplications or illnesses within the family is frequently toogreat a risk for the woman to take.

- 14 -

Hence programs that seek to improve the way that thehousehold meets a basic need should recognize that they aremeddling with a complex and finely balanced system of reciprocalobligations and entitlements. For a program to succeed it will benecessary for new alliances to be forged and for new agreements tobe struck. Water supply, child care and excreta disposal areamong the most difficult activities to influence because theirimportance to the survival of the household and the community haveproduced deeply entrenched solutions to the needs. For example,fetching water has been defined as "woman's work" in most of theworld; to reduce sharply the effort required to satisfy this needwill upset the allocation of tasks within the household. Indeed,in rural areas men have often refused to maintain pipes and pumpson the grounds that women will use the idle time for frivolous orsocially disruptive purposes.

B. Opportunities for Influencing Household Choices

The role of custom and intrahousehold choice in shapingacceptance and use of an innovation suggests the following forprograms to meet human needs.

First, particular efforts should be made to promote theinterests of small children and women. Because these two groupspresently have modest direct influence over the decisions of thehousehold, efforts should be made to reduce the cost to the familyof satisfying their needs. Food subsidies have been used toencourage better feeding of small children. By providinginferior-quality foods, the problem of misappropriation has beenlimited. Legal sanctions have been provided in numerous placesagainst families that fail to construct a proper latrine and/orthat permit children to defecate at random.

Second, behavioral change should be facilitated byeither convincing existing leadership to support the change, or byencouraging their substitution by new, more modern influentialpersons. Because much of the behavior that needs to be changed issanctioned by the larger family, community or religion, changeoccurs slowly and at great risk to the innovator. Efforts toco-opt traditional leadership have not been exceptionallysuccessful. By focusing persuasion on a fairly small number ofpeople--midwives, chiefs, etc.--greater effort and attention canbe given to convincing them of the virtue of change. In addition,their positions of authority can be exploited to give greater

- 15 -

credibility to reforms. However, traditional leaders havedisplayed predictable reluctance to accept the view that old waysshould be abandoned. Introduction of a new, attractive technologymay provide a graceful way for traditional leaders to justify anew approach to problems.

A more frequently successful approach has been todisplace traditional authority. Advertisers have promoted thenotion that people can affiliate with a more modern, successfulgroup by adopting new practices; advertising for tobacco andinfant formula has followed this strategy. Installation of watersupplies and latrines at schools has sometimes facilitatedimprovements in hygiene by associating their use with theesteemed, modern role of the teacher.

Third, programs should be designed to minimizethe redistribution of responsibility within the family.Innovations that substantially affect the distribution of costs orbenefits are likely to encounter problems of acceptance. Theeasiest way to accomodate this problem is to design interventionsin such a way that the individual who has traditionally met theneed can continue, to do so. For example, water supply projectsthat rely upon handpumps have frequently failed because males haverefused to accept responsibility for maintenance; water supply wasviewed as women's work. Efforts are now underway to constructlight-weight pumps that could be both pulled from the shaft andrepaired by women. This is expected to link incentives andcapacity to maintain the pump. And perhaps as importantly, such adevelopment would preserve traditional lines of authority andresponsibility. Commercialization of water supply is analternative. An organization (public or private) might beestablished with responsibility for those aspects of operations ormaintenance that are beyond the strength or skills of theperson(s) traditionally responsible for fetching water.

Legal reforms may also prove useful. These reformsshould increase the authority or power of winners or diminish therole of opponents of change. Women may be permitted to hold legaltitle to and to inherit land, for example. Expanding educationopportunities may increase women's employment opportunities makingthem more independent financially. These changes are likely toincrease the status and decision-making authority of women.

F. Household Goals and Choice

Experts frequently have been dismayed by the refusal ofthe household to adopt new ideas and practices that professionalludgements indicate are in its interests. The failure of the poor

- 16 -

in particular to adopt an innovation is commonly attributed tostubborn conservatism. However, the speed with which peasantfarmers have adopted better agricultural practices suggests thatthe poor generally are rational at least when confronted byimmediate economic opportunities. Thus it is worthwhile toinquire further into the question of why the poor and needy, whenwell informed about opportunities, still fail to adoptinnovations. Several explanations are available.

First, outside experts have often not fully understoodor have even neglected important factors or issues that inpractice influence the attractiveness of an option. Local people,with their long-standing, intimate knowledge of a situation oftenanalyze an issue more thoroughly and marshall facts more fullythan the experts. For example, villagers have been unenthusiasticabout construction of pit latrines behind their homes because mostfamily members defecate during the day while away at school or inthe fields. The proposed latrines would not meet the true need.Operation and maintenance of village wells have been underminedbecause villagers refused to cooperate with other families whowere of a different caste or religion. Sharing of community watersupply has also been frustrated by family rivalries that prohibitsharing. West Africans frequently have been reported to haverefused to use a well located near a neighbor's house for fearthat the neighbor would poison the well.

Efforts to improve excreta disposal have been frustratedby planners' neglect of small but important design issues. Thelocation of latrines has been a particularly notable problem. Forexample, even where potential beneficiaries were aware of thebenefits to health of using latrines, they have refused to do sobecause of the embarassment attached to using a facility plainlyvisible to neighbors. Others have refused to employ a latrinebecause it faced a religious shrine. What has been interpreted asconservatism on examination often has emerged to be a rationalresponse to a more complete set of facts.

Second, experts commonly misjudge trade-offs among thehousehold's objectives. Especially in programs to meet physicalneeds for shelter, food, water supply cr health care, designersneglect the importance that people attach to recognition, hope andvariety. Thus carefully designed, economical but unpalatablediets have been rejected. Funds that might have been invested inimmunizing children have been spent instead on radios or electric

- 17 -

lighting for the home. Low-cost housing in both developed anddeveloping countries has often been rejected because it providesshelter but does not facilitate socializing with neighbors orexpressing individuality. An unexpected consequence of Bank-financed slum upgrading projects has been that families frequentlyhave spent much more on upgrading their properties than expertsfelt the poor could afford. Part of the explanation lies in anunderestimation of incomes and in families' drawing on theresources of the extended family. But it now appears that peopleare willing to sacrifice a larger share of income for good housingthan preliminary analyses suggested.

Third, the benefits and costs of an activity oftenaffect individual members of the family in ways that analysts donot fully anticipate. The notion that external benefits and costswill generally discourage efficient use of resources is widelyunderstood. For instance, if an individual or householdinadvertently benefits neighbors by improving their property,maintaining good health or eliminating waste water and trash fromtheir lots, the value of the effort is greater than the individualor household would be willing to pay. This conclusion providesthe rationale for public undertakings to remove storm water,provide police protection or maintain street lighting. However, asimilar process appears within the household: in parts of WestAfrica, urban migrants are obligated by custom to help relativesseek health care and training in the city. In addition, they areexpected to provide shelter and advice to other family membersmoving to the city. Villagers seek to increase this obligation bycontributing to the cost of improvements to the urban cousin'shouse. Thus the costs of improving his dwelling--and to someextent the benefits--are shared by the extended family. A partialexplanation for the "irrational" expenditures on housing in a slumupgrading scheme is that the costs are not being borne entirely bythe home owner.

Finally, low-income people frequently assess risks andtemporal choices differently than relatively affluent experts do.Poverty compels people to focus on the near term, and to neglectless immediate problems, say of the probability of infection orinfertility. This preoccupation with immediate effects diminishesthe attention given-to preventive medicine, hygiene, education andimmunization. Yet these are all highly cost-effective methods ofimproving the physical quality of life. These highly subjectivediscount rates cannot be readily changed. Instead, benefits must

- 18 -

be made to appear larger and more immediate while costs areminimized or deferred. Providing political or social rewards fordesirable behavior may also increase support for a scheme.

G. Household Production

Many services or products being offered by a governmentprogram have no beneficial impact unless they are further"processed" by the household. This observation is the basis forstudies of the "new household economics." Briefly the assertionis that households purchase goods from the market (or obtain themfrom public agencies) which must then be combined with households'labor and assets to meet more concrete needs. For example, rawvegetables, meat, fire wood and water must be combined with amother's efforts and a family's pots in order to produce stew.

Public programs intended to meet human needs typicallysupply only one of several inputs needed to improve life. Forexample, a protected rural water supply generally requires thatthe family allocate some of its labor supply to operating ahandpump and carrying buckets of water to the home. Since mosthandpumps are designed to serve several hundred people,considerable queuing occurs; hence families must also allocatepart of their labor supply to the task of standing in the queue.Moreover, in order to enjoy a safe supply of drinking water,containers must be kept clean and the storage container protectedfrom animals and from children's dirty hands. To benefit fullyfrom an improved water supply, families must also invest furtherefforts in food preparation, housekeeping, laundry and bathing.Each of these activities takes not only time and water but alsoother inputs such as rags, brushes and containers. Providing awater supply alone does not meet a human need; the water must befurther "processed" by households to reduce disease transmissionand to promote hygiene.

Neglect of such pedestrian truths has played a majorrole in the failure of water supply and exereta disposal projectsto improve health. The point was made most forcefully by awidowed Guatemalan mother of eleven. After the local sanitarianhad lectured her on the importance of cleanliness she complainedthat in order to support her family she had to work twelve hours aday. At the end of the day, she said, she was pleased withherself if she could remove the "seen" dirt in her house; she hadno time for the unseen.

- 19 -

Probably the most scarce household resource is the timeof the person--usually, the mother--who produces the consumablegood for the family. Low-income families often do not have timeto bathe, scrub or cook in a way that would meet with the approvalof inspectors, educators and promoters. Even more importantly,the families often do not recognize the potential value ofadopting particular improvements. Hence they are reluctant toreallocate their limited capacities and assets to the recommendedtask.

Many water supply projects were expected to deal withthe problem of time by relieving women of the drudgery ofcollecting water from a distant natural source. By installing ahandpump or standpipe supply near the home, distances traveled toobtain water could be slashed. However, women have insteadfrequently been reassigned to still more onerous tasks. They havebeen required to cultivate more land or expand otherincome-earning activities. Often the now lighter task of fetchingwater has been reassigned to children in order to free the olderchildren or women to assume heavier tasks.

These redistributions of responsibilities have oftenfrustrated program-designers' attempts to improve the lives ofwomen. Rather than providing the mother with additional time forleisure or home-making, often the improved water supply hasinstead enabled the family to increase its income. Thisexperience illustrates how the internal household economy exploitsnew opportunities. It, in addition, underscores the fact that thehousehold, with its peculiar methods of decision making, will usenew resources in ways that: advance its goals.

If a program is confident that its aspirations aresuperior to the uses that families will make of a new opportunity,then it must provide incentives and additional opportunities inorder to influence the choices of households. For example,simultaneous introduction of an improved water supply and ahandicraft project might encourage families to allocate the timesaving to cottage crafts. This might support the objectives ofimproving child-rearing as well as reduce the burden on women ofcollecting water.

However, one should always recall that the household hasa more thorough grasp than the program's designers of both thefamily's goals and the objective facts, and hence is better

- 20 -

equipped to make decisions about its welfare. Thus experts shouldbe very cautious in interfering with the choices of households.

The new household economics also stresses the fact thathouseholds often must adopt new methods ("productiontechnologies"), and manage them well, in order to realize thepotential benefits of an innovation. Families vary widely intheir command of particular inputs and in their skills in homeproduction. Information alone is not likely to transform thebehavior of the household. Flannelgraph presentations on cropproduction will not make successful farmers; neither willexhortation transform homemaking skills. For example, an improvedwater supply generally requires that new techniques be adopted inorder to launder clothes. Women (at least ideally) would nolonger congregate along the bank of a river or shore of a lake topound the wash on rocks. Rather, wash tubs and scrub boards mightbe required.

The willingness of people to learn new ways ofsatisfying a need is much greater when natural calamity ormodernization cut them off from traditional solutions. Drought,flooding, epidemics, urbanization and irrigation of agriculturehave provided powerful impetus for innovations. Theseenvironmental changes have often dramatically affected the cost oreven feasibility of contirnuing to rely on old ways.

H. Opportunities to Enhance the Operation of the HouseholdEconomy

An appreciation for the household as an economic unitsuggests the following about the design and implementation ofprojects to meet human needs.

First, where the inputs needed for adoption of a newtechnology are not presently available to the family, they mayneed to be provided if the scheme is to succeed. The timerequired to use the improvement is often ignored or underestimatedin designing projects. For example, a village handpump may reducethe distance to a water supply but because large numbers of peopleshare it, queuing may take inordinate amounts of time. Villagewater supply projects are often designed in such a way thathandpumps must operate sixteen or more hours a day. Thus usersmust be able to go to the well at all hours of the day, whichconflicts with farm work. Similarly, halting the transmission of

- 21 -

excreta-related diseases will be very difficult if families cannotafford diapers, and the floors and walls of their houses cannot bescrubbed clean. Soap Ls perhaps the most homely example of amissing input. Even with an ample supply of safe water, fecalcontamination of living areas by small children may continueunabated.

Second, projects that reduce the time required to meetfamily needs should consider the uses that are likely to be madeof the saved time. If improving the role of women is an objectiveof the project, then components designed to employ, this labor wellmay be appropriate.

Third, innovation should be introduced, if possible,when changes in the environment are forcing people to devise newways of satisfying their needs. Urbanization and changes inagricultural practices due to, say, introduction of irrigation,are examples of changes that are likely to facilitate adoption ofnew household production technologies.

- 22 -

III. THE ROLE OF THE COMMUNITY

Meeting many basic human needs requires collectiveaction. Often, production of the necessary goods and services canbe undertaken at reasonable cost only if a single producerresponds to the demands of the entire community. For example,urban water and sewerage services can be produced at roughlytwo-thirds the cost if the demand is met by a singleinstallation rather than two. Similarly in small communities,education, medical care and extension services can be provided atmuch lower cost and higher quality if a single organization isresponsible for their production and can therefore fully employspecialized staff and equipment, and maintain larger stores ofsupplies and drugs. A large part of the explanation for thesuccess of Kerala, Sri Lanka and other low-income areas in meetinghuman needs lies in the communities' abilities to mobilize publicprograms. These people are politically articulate and thus ableto place demands on governments. They are also skilled inundertaking community activities themselves.

These economies of production also imply that largeinitial investments are generally necessary. Moreover, operationsthat are subject to economies of scale are more economical if the"market" can be fully exploited. In the case of water supply andsanitation, investments are not only large but long-lived,implying the need for considerable finance. Rarely is anindividual or private company willing to mobilize the resourcesnecessary to meet these needs, largely because of the very longperiod necessary to recover the investment, and the consequentrisks (which are often exaggerated by political instability).

Monopolization of supply is encouraged by economies ofscale since large, early entrants into the sector encounter lowerunit costs and thus can underprice potential competitors.However, posession of a monopoly is likely to provoke efforts bygovernments either to regulate or to take-over the enterprise.This threat further reduces potential profitability to privateinvestors. Thus unless reliable assurances can be obtained fromgovernments that firms will be allowed to operate freely, privatecapital is not likely to flow into these sectors. Geographicallydispersed small communities are often simply unattractive toprofit-seeking firms. The practical response to these problems issome sort of collective public undertaking to provide the service.

- 23 -

Communities of low income people must deal with most oftheir problems in developing countries without help from regionalor national governments because at present the latter areincapable of providing assistance: Most governments in thedeveloping world have not yet succeeded in creating anadministrative system that penetrates low-income communities. Theabsence of a functioning bureaucracy is most notable in ruralareas and low-income urban neighborhoods. Governments areconsequently poorly equipped to minister to the needs of thepoor. They are frequently unable to advise communities of newopportunities or programs, and often they cannot effectivelyadminister the implementation or operation of projects. Thisweakness severely limits the role of official developmentassistance organizations which do not maintain field staff in thecountries and cannot rely on the bureaucracy for outreachactivities. National governments are not likely to fill this gapin the near future, even if that were desirable; few have thefinancial resources to pay for such a bureaucracy. Moreover, evenif the financial constraint could be overcome, civil servantsgenerally resist postings to isolated areas that lack basic socialservices and amenities.

Thus communities mist organize themselves if they are tomeet collective needs. Local responsibility is probably desirablein any event because it facilitates greater responsiveness andaccountability. But involvement of the community in the design,execution and operation of projects is often confounded by thelack of developed organizational resources in needy communities.A major part of the explanation for underdevelopment is that thecommunity is unable to act collectively to define priorities,identify the implications of alternative course of action, andresolve amicably internal conflicts.

The representation of villages as idyllic, isincreasingly being recognized as inaccurate. Rather, traditionalsocieties are typically wracked by dissensions and divisions thatare compounded by poverty. Interfamily and intercaste strife hasoften outlived even the memory of the conflict or insult thatprovoked it. Furthermore, in stagnant economies, most gains areachieved at the -expense of other community members. This factboth heightens and hardens divisions. For such communities toundertake cooperative ventures spontaneously would require thatthey deny their traditions and problems.

- 24 -

Nonetheless communities can participate in developmentin a variety of ways that both stimulate and shape programs. Thefollowing subsection explores the major forms of participation.Later subsections examine devices for promoting communityparticipation.

A. Community Participation

Participation by entire communities in new programs isdifficult to obtain, especially where the activities are beingpromoted from outside. Ideally the community should choose therange and quantity of services that are to be provided and devisea means of mobilizing the resources needed to develop and then tooperate the scheme. In addition, the community should establishmechanisms to control the scheme in order to ensure that resourcesare used properly, and that operations and maintenance are carriedout. Rural areas--except those with lengthy experience inmanaging irrigation water--rarely possess such mechanisms.Squatter settlements and low-income urban neighborhoods are stillless likely to have effective community organizations.

1. Community Consultation

Community participation has been sought at a variety ofstages. These include consultation to determine priorities andpreferences, mobilization of resources and control of programs.These topics are explored in the following paragraphs.

The most extensive efforts by program sponsors have beendesigned to solicit the views of the community regardingpriorities, standards of service and affordability. This level ofcommunity participation might be described more aptly as"community consultation." Where consultation is seriouslyattempted, program sponsors offer several distinct options fromwhich the community is invited to choose. However, the range ofoptions presented is typically quite narrow. For example, ahousing scheme does not generally entertain the possibility thatpotential beneficiaries might prefer instead to invest scarceresources in education; rather, it might present alternativefloor plans and construction standards for consideration.

The process of consultation is typically initiated bythe sponsors. A public meeting is scheduled at which the programis described and the options elaborated. The opinions of thegroup are solicited and often an effort is made to obtain aconsensus, or a vote is taken. Whether attendance at the meetingis representative or whether people feel bound by the choices madeat a meeting is often controversial.

- 25 -

Community consultation is in effect usually a form ofmarket research. The importance of assessing the level ofinterest in a proposal and of determining the detailed preferencesof the community is obvious. However, the ability of publicmeetings to achieve this objective is sometimes open to dispute.In traditional societies and in poorly organized urbansettlements, the spokespersons for the community are likely to berepresentatives of the elite (often land-owning) group. Theirleadership role often derives from their economic power in thecommunity. This fact in turn taints their views and judgements.Furthermore, the presence of elites at public meetings may alsohave a chilling effect on frank discussion and on expression ofpreferences by poorer members of the community. Nonetheless, theelites frequently have the recognized authority to admit outsidersto the community; thus their acceptance must be obtained if theviews of the community are being sought.

Frequently, the options being presented are unfamiliarand hence difficult for local people to evaluate. The need topresent new, "appropriate" technologies compounds the problem. Inaddition, hypothetical economic choices are notoriously poorpredictors of people's actual willingness to pay for a new serviceor product. Especially when a flnancial or political commitmentis being offered by government, communities are likely tooverstate their willingness to contribute to the cost either ofconstruction or of operations and maintenance of a scheme.

The process of collective choice is likely to be poorlydeveloped and thus to provide only a very rough approximation of acommunity's views. The use of voting to express preferences isnot fully accepted in many societies. Villagers are more likelyto resolve differences by submitting to traditional leaders orcustom. Moreover, the moral obligation to accept a collectivechoice obtained by balloting is not universally acknowledged.Program designers must, therefore, be careful not to misinterpretpoliteness and apparent enthusiasm for genuine interest andsupport. They should try to determine how important communitydecisions are made and rely more heavily on those mechansisms.

Community consultation may also serve a politicalfunction. By encouraging people to air their views and byobtaining open commitments to a proposal, the process may serve toenhance commitment to the program and to mobilize community-widesocial pressures to support its implementation and operation.

The hazards of community consultation are vividlyillustrated in this story told by Aziz Tannous:

"As Village Welfare Workers we had been summonedby Ilat, a nearby community, to cure theirchildren of fever. When we visited the village,

- 26 -

we found several cases of typhoid, malaria, anddysentery plus a high incidence of infantmortality.

"We traced the probable source of trouble to atiny spring which flowed into a stagnant pool inthe middle of the village. Though this poolprovided drinking water for the villagers, theywaded in it and shared it with their animals.

"So we thought that our line of action was clearand simple. Dig the pool deeper, cover it with astone structure and install a hand pump. It wasas simple a project as that.

"One evening we called the elders to a meetingand informed them of our plan, requesting them torender as much help as they could. There seemedto be general agreement. In our lack ofexperience, however, we had not yet learned thesubtleties by which a 'yes' may mean a 'no' incertain cases. The following morning, when wecame to the village, ready to begin the project,we found the place practically deserted. Theyhad all gone to their fields. The mukhtar(headman, a government official) made hisappearance to tell us that the people refusedflatly to let us install the pump. Let usinstall the pump! That made us pause and think.So that was how they felt about it; that we wereimposing on them something they did not reallywant. And all the time we took it for grantedthat we were satisfying their urgent need.Something was certainly wrong.

With much difficulty we were able to bring themto another meeting a few days later. In thecourse of the discussion we did our best to makethem talk freely; and they told us a great deallThe following are more or less direct quotations;

"Our fathers, grandfathers, and greatgrandfathers drank from this water as it is, andI don't see why we should make a change now.

- 27 -

"You say that you want to install a pump at thespring; but I for one have never seen a pump, nordo I know what might happen if it should be putthere."

"I tell you what will happen. The water willflow out so fast that the spring will dry up inno time."

"Not only that, but the iron pipe will spoil thetaste of the water for us and for our animals."

"You have told us that the water is the cause ofour illness and of our children's death. I donot believe that, and I can't see how it couldbe. To tell you the truth, I believe that thematter of life and death is in Allah's hands, andwe cannot do much about it."

"One more thing. We don't understand why youshould go to all this trouble. Why are you soconcerned about us?"

"You say that the pump will save our women mucheffort and time. If that happens, what are theygoing to do with themselves all day long?"

At the close of the meeting we realized that wehad blundered. We had to begin from thebeginning, taking nothing for granted."

2. Mobilization of Community Resources

The second stage of participation is in mDbilizingresources. - Rural -development projects, especially, have reliedupon community contributions and self-help to produce affordablesocial servi-ces -and housing. Typically, local contributions ofmaterials and unskilled labor have been required frombeneficiaries.

Participation in providing resources has been largelysuccessful in instances in which the benefits of a scheme accrued

- 28 -

directly to those who contributed. Housing and slum upgradingprojects that require self-help construction have been quitesuccessful, for example. However, in other sectors where therewards are widely distributed--such as education, health care orroad maintenance--contributions of materials and labor have oftenbeen difficult to mobilize. In a few instances, a major landlordor employer has compelled his dependents to contribute tocommunity projects with the effect that the poorest have borne adisproportionate share of the costs of the scheme. For example,in Nepal, the poor have been found to bear an unfair share of thecosts of supplying irrigation water. Nonetheless, localcontributions reduce the budgetary cost of projects and should besought wherever practical.

Mobilization of resources by the community has been mostsuccessful at the stage of the initial investment. Efforts tosustain a program through periodic contributions have generallyfailed. The greater difficulty in meeting recurrent costs fromlocal contributions may be explained by a variety of factors.First, as time passes, any inequities in the distribution ofeither benefits or costs become more evident. These inequitiespromote resentment and undermine popular support for the scheme.For example, persons who no longer have school-aged children willoften object to assisting in the maintenance of schools.Cooperative health care programs have been disrupted because themajority of the community did not obtain services during the yearand thus withdrew support from the scheme, crippling its finances.

Many self-help activities have produced disappointingresults because too much had been expected. In addition toimposing an economic burden on beneficiaries, self-help taxes thetechnical and organizational capacities of the community. TheMalawian Self-Help Water Supply Program discovered that the peoplecould carry out only the simplest of tasks and then only withcareful supervision. Organization and supervision of such effortsgenerally must be provided discreetly by the project team. Afterthe community has developed skills in operating collectiveenterprises, less outside assistance will be required.

Recovery of operating costs has been most successfulwhere charges were clearly related to benefits. User-charges forwater supply, solid waste disposal and drainage are widelyaccepted for example. In addition to being at least roughly fair,these charges often have been legally enforcable. Health carecooperatives in Korea succeeded in meeting their costs by imposing

- 29 -

a tax collected by rice milling cooperatives. But reliance onvoluntary contributions generally has proved disappointing.Staffing health posts with unpaid volunteers failed after a briefinitial period of success in Tanzania because the workers hadhoped to be absorbed into the government service but were not.Success has been greatest where a small number of people ofsimilar status were collaborating and thus could apply socialsanctions to those who failed to contribute. Maintenance ofirrigation works in the Philippines, Korea, Thailand and otherplaces has followed the latter pattern.

Local contributions, intended to defray the cost ofoperations and maintenance, have been especially difficult tocollect in areas where the service is regarded as a nationalgovernment responsibility. For example, throughout Africa and theIndian sub-continent, rural water supply schemes have flounderedbecause the beneficiaries refuse to provide direct financialsupport, arguing that government should provide the service. Theunwillingness to pay is reinforced by the fact that in some ofthese countries for many years the services were provided to thewealthy without direct charge. Governments introduced the notionof direct cost recovery from beneficiaries only when policies wereadopted to provide rural and low-income people with services. Thelatter groups are now frequently holding out for equitabletreatment.

3. Community Control of Programs

The third stage of participation is in management of aprogram. As noted above a central problem of programs to servethe rural poor is that the formal bureaucracy does not reacheffectively to this level. Difficulties in recruitment ofcompetent staff, resistance to posting to rural areas and poorcommunications make it very difficult for governments to provideeffective oversight. Local communities that are interested in thesuccess of a program and aware of the bureaucracy's capacities tooversee programs can ensure greater accountability for resourcesand for performance. This level of participation obviouslyrequires a fairly high level of awareness among the beneficiariesand a willingness to work with and through the formalbureaucracy. In addition, it demands that the higher levels ofbureaucracy are competent and responsive to local complaints.Responsive bureaucracies typically evolve only after communitieshave acquired significant political power.

- 30 -

B. Promoting Coumunity Participation

The literature on community participation offers fewexamples of successful attempts to create effective localorganizations. This failing in part no doubt reflects thewidespread view that participation is costless to beneficiariesand yet yields significant benefits. However, such a view impliesthat community organizations should have emerged spontaneously asopportunities for collective action appeared. This has not beenthe case, largely because joint action does impose costs onparticipants. Where community efforts must be complemented bysupport activities from government, the style and content of thebureaucracy's contributions also influence the process ofcommunity organization.

1. The Costs of Participation

Involvement in a community organization that seeks tomeet a priority need imposes four kinds of costs on participants.First, joining an organization entails sacrifice of individualfreedom. In order to reap the benefits of collective action, themembers of a group must subordinate their individual interests tothose of the group as a whole. This is a sensible thing to do onlyas long as participation in the group yields benefits thatoutweight the costs of this loss of personal freedom. (The mostcompelling argument for arms-length, market exchange is that itpermits individuals to satisfy needs without such a sacrifice ofsovereignty.)

Second, participation in a group requires that at leastpart of the membership invests time in the organization'smanagement. Priorities must be established, the implications ofalternative courses of actions must be evaluated and the benefitsand out-of-pocket costs of the effort must be distributed amongthe members. Especially in instances where the organization ispursuing several objectives simultaneously, the tasks of settingpriorities and distributing costs and benefits are likely togenerate conflict and thus require substantial expenditures oftime for negotiation and discussion.

Third, individual participation, in most cases, requiresan outlay of scarce resources. Beneficiaries/members are usuallyexpected to contribute labor, materials or money to carry out thefunctions of the group. These outlays are additional to theeffort that must be spent in organizing the group. Equitablemechanisms for collecting these resources are difficult todevise. Hence efforts to finance the scheme often produceconflict.

- 31 -

Finally, participation in a group carries with it therisk that failure of the group will jeopardize the member'sability to meet his needs. A common problem of localorganizations is that unresolvable conflicts emerge thatdestabilize the organization and thus cripple its ability tofunction.

In addition to the costs to the community, whereverhigher level organizations must be established to assist orsupervise community activities, the costs of operating theseorganizations should be recognized. The unplanned, randomdevelopment of local demands places great stress on government'sfinances and manpower resources as well.

2. Benefits of Collective Action

The sacrifices enumerated above must be overshadowed bythe benefits to individuals if they are voluntarily to becomemembers or to maintain participation in a local organization.Mobilizing participation can thus be considered in terms ofefforts to reduce these sacrifices or to enhance benefits as theyimpact individual members.

A review of the history of community developmentsuggests that the successful efforts to create local organizationshave generally been devoted to dealing with serious productionproblems. The very long history of collective efforts to developand maintain irrigation works in South and South East Asia are themost notable examples. The frequently cited Anand Milk Producers'Union is another model of successful community organization.However, few consumption-oriented local organizations havesucceeded. It appears that groups which distributed tangiblebenefits in proportion to individuals' efforts are more attractivethan those offering intangible benefits according to need ordemand.

3. Enhancing Benefits

Several means are available for enhancing the perceivedbenefits of participation in local groups. The first is toincrease popular awareness of the value of the benefits of aprogram. A rash of burglaries has motivated suburbanites inadvanced economies to organize private police patrols, forinstance. Unhappily, most consumption-oriented developmentprograms respond to needs that are not clearly recognized by thetarget population. Preventive health care and improved sanitationare under-appreciated, esecially by poor people, probably because

- 32 -

these programs respond to risks of disease, while the people areaware that they already have a variety of significant problems.As one Tanzanian put it, "don't talk to me about the dangers ofdirty water; my problem is what to feed my family tomorrowmorning."

The perceived importance of a benefit can be enhancedthrough education, marketing and politicization. Health andhygiene education have been widely promoted as a means ofimproving use of health care, water and excreta disposal. Theseefforts probably should be viewed, in addition, as means ofenhancing perceived benefits and thus mobilizing community supportfor programs. Broad, public information/marketing efforts appearto be the most promising devices for increasing demand. Forexample, mass media might be used to enhance the image of pipedwater supplies or of improved latrines. Such efforts should firstidentify possible motives for adopting the improvement (status,health, privacy, esthetics, etc.) and then stress the contributionof the innovation to meeting this "need" or group of "needs."

In highly politicized societies, broad social andeconomic sanctions can often be mobilized by politicalauthorities. The party can present issues in relationship topolitical ideology and thus give a reform greater legitimacy. Inaddition, it often can stigmatize political "deviance" in order tomotivate socially desirable behavior. China, Cuba and Tanzaniahave made noteworthy efforts in this regard in promoting literacy,sanitation and child spacing. In other societies, socialpressures provide additional incentives to fulfill communitygoals.

4. Reducing the Costs of Comminity Participation

The second broad strategy for promoting communityorganization is to reduce the costs--and risks--of participation.In small communities, the largest deterrent to collective effortsis usually fear of socially disruptive conflict. Communityorganizations must choose objectives, priorities and tactics, andmust mobilize resources and distribute benefits. Each of thesedecisions and actions presents opportunities for conflict toemerge. Thus if the group is to remain effective, it must be ableto surface and resolve these conflicts before they become devisiveand endanger the survival of the organization. The ease withwhich conflicts are resolved depends upon their seriousness andupon the organization's skills in identifying and mediat'ngdifferences.

- 33 -

The degree of conflict likely to emerge can be minimizedby keeping organizations small, restricting membership to personswith harmonious objectives, narrowly defining objectives, anddistributing net benefits equitably. Large organizations are moresusceptible to conflict than small ones simply because the largernumber of participants increases the diversity of objectives,expands the opportunities for disagreement over objectives andexplodes the number of one-to-one comparisons of individuals'gains from the organization. In addition large numbers complicatethe process of conflict resolution by demanding that moreinformation be amassed and greater numbers of people induced toaccept the inevitable compromises. However, very largeorganizations may achieve an impersonal character similar to thatof competitive markets and thus escape the need to resolveconflicts openly.

Establishing groups with homogeneous membership is alsoa means of reducing conflict. If the participants in anorganization share common problems and capacities for resolvingthem, then the likelihood of serious differences in prioritiesemerging is smaller. The early failures of the Bangladesh RuralAdvancement Committee illustrate the problem. Under the initialdesign both landowners and landless laborers were expected tocollaborate in resoving community problems. The experimentencountered serious conflicts among members because the concernsand interest of the landowners were competitive with those of thelandless. After the scheme was reorganized to include only thelandless, it developed into an effective organization.

Conflict appears most likely to appear when themembership of the group includes people with grossly differentincomes and wealth. Variations in family status, sex, age andcaste or tribe are also important sources of differences forgroups providing social services, since these characteristicslargely determine needs.

Setting up groups with limited membership may create newelites and diminish the ability of communities to resolve theproblems of all their members. Since the early innovators are bydefinition the best qualified to perform organizational tasks,those who are not included will generally be left with the mostdifficult problems and the least effective leadership. This factargues for focussing public programs on the poor who are leastable to meet their needs without assistance.

The third device for limiting conflict is to simplifygoals as much as possible. Organizations with multiple objectivesnot only accumulate the conflicts peculiar to each objective butalso raise problems of allocation of resources among the numerous

- 34 -

objectives. For example, a dairy marketing cooperative thatextends itself to offer family planning services jeopardizes itsoriginal successes by increasing the potential for conflict.

Finally, establishing organizational goals so that allthe membership sees itself as obtaining net benefits from theventure enhances the group's commitment to preserving it.Environmental improvements often entail providing services toeveryone in an area regardless of their perceived need or demand.Inclusion of unwilling participants then creates tensions thatthreaten the survival of the organization. This problem can bereduced by broadening the organization's objectives to includeactivities such that all participants perceive themselves as netbeneficiaries. Water supply, drainage and sanitation might beundertaken by a single group, for example. However, as noted inthe previous paragraph, this strategy carries with it seriousrisks in that it complicates the process of conflict resolutionand expands the scope for conflict. The alternative is to reducethe membership of the group to include only willing participants.

C. Organizational Processes

The processes that are employed in organizing the groupand in carrying out its functions should be as simple andacceptable as possible. The continuum of options ranges fronthe individual acting alone in his own interests to communityorganizations with inclusive membership acting for the commongood. The individual relies upon voluntary exchange to effect hisgoals and obtains all the benefits of his choices. At the otherextreme, collectivities must rely upon more complex techniques ofdecision making and enforcement.

Community organizations must secure the broad support oftheir membership for any decision that is taken. This task ismade more complex by the fact that incentives are diluted by largenumbers. Moreover, the complexity of these calculations andchoices expands with the size of the organization and thediversity of the goals it is pursuing. The mechanisms forresolving differences include resort to traditional, hierarchialauthority (the African system of chiefs), negotiation andbargaining, and various forms of polyarchy. As the managementtask grows more complex, it becomes increasingly important thatthe technique of collective decision-making be as simple as

- 35 -

possible and that it command support of the membership.Introduction of formal (though inevitably arbitrary and imperfect)modes of organization and decision-making can reduce opportunitiesfor conflict to appear. This issue of what constitutes a sociallysatisfactory resolution of a conflict is probably the mostdifficult aspect of community participation since it must bedetermined for each setting.

D. Developing Organizations

External organizations can assist communities in formingworkable organizations. Extension agents can be provided to aidin setting up meetings and in outlining the opportunities thatwill be afforded by collective efforts. However, becauseestablished bureaucracies have often acquired reputations for poorperformance, it is important to consider the credibility of theorganization offering help. New institutions may be moresuccessful in fostering community organizations. Model bylaws andstructures can be developed and supplied to formal localorganizations that are expected to hold assets or conductfinancial operations. Legislation can be enacted to give properlyconstituted local organizations legal authority to carry outspecific functions. For example, the Philippines rural watersupply program has relied extensively on community-organized LocalWater Authorities. In addition, Women's clubs, organizations ofschool children, and farmers groups may be encouraged in order toprovide community members with experience in developing andoperating local organizations. Malawi's rural water supplyprogram has provided a limited range of engineering designs forpossible adoption by communities.

Community participation may be incubated in somecircumstances. The highly successful Malawi rural water supplyprogram achieved fairly high levels of popular participation byfirst developing a felt need through government-operateddemonstration schemes. Initially, improving water suplies was nota high community priority. However, after the officials of theproject developed and operated a successful gravity water supplysystem, community interest increased markedly. The clear lessonof this experience is that schemes that offer significant netbenefits can be successfully promoted by showing the potentialbeneficiaries the scale of the advantages. Under suchcircumstances, the initial problem is not one of establishing aformal organization but rather of promoting interest.

X. Relationship of Community Organizations to the Bureaucracy

The foregoing discussion has focused on localorganizations. Community participation, as discussed thus far,has referred to indigenous groups organized to deal with a

- 36 -

community's needs. However, many functions require largerorganizations either because the problem being addressed requiresinvestments that are beyond the community's capacities to finance,affects a number of communities, or requires resources that cannotbe effectively employed at the community level. Major investmentsin transport, water supply or drainage for example, typically mustbe financed from borrowings from financial markets and may requirespecial provisions for supply of foreign exchange. Exploitationof water resources often affects down stream users and henceshould be planned with an awareness of the external consequences.Hospitals, machine shops, specialized physicians, highly skilledcraftsmen and engineers are examples of specialized resources thatoften cannot be used effectively at the level of a neighborhood orvillage.

In order to deal with problems that require such inputs,a multi-level organizational structure is often needed. Atcommunity level, the simple, routine functions are carried out.Support and perhaps referral are offered by more formal,professionalized organizations located in the regions. Planning,policy formulation and resource mobilization are provided at thenational level. Generally these support organizations are partsof the formal bureaucracy.

The Indian three tier system for the operation andmaintenance of village water supplies illustrates this notion.The community organization provides for recovering part of thecosts of the system and operates and maintains the physicalequipment. Assistance is provided by the formal bureaucracy inplanning and executing works, procuring spare parts and supplies,and carrying out heavy maintenance. The national government setstargets for coverage and levels of services, offers policyguidance and mobilizes local and foreign resources.

- 37 -

IV. THE ROLE OF GOVERNMTS IN MEETING BASIC NEEDS

The failure of developing countries to meet the basicneeds of all their citizens is often attributed to a lack ofnational political will. The fact that these needs have beensatisfied by some of the poorest economies lends some credence tothis accusation. On the other hand, detailed reviews ofsuccessful attempts to meet needs strongly suggest thatgrass-roots initiative is the critical input. If this is the casethe role of government at national and even regional level may befairly limited. However, despite the fact that communities may beable to meet many of their own needs, people have not oftenspontaneously seized these opportunities. This failure impliesthat some external impetus or facilitation is required.

This section examines the possible roles of governmentin promoting activities to meet basic needs and outlines somespecific functions that governments can undertake. It begins witha discussion of the politics of meeting basic needs, then exploreslegal reforms and support activities that governments can pursue.

A. Political Will

Governments are often reluctant to implement majorprograms to meet needs, particularly among the rural poor, forhealth care, water supply and sanitation because these programstypically have few tangible, short run benefits but significantshort-run costs. In particular, improvements in water suppliesand waste disposal typically require large initial investments.Thus, if they are funded, they significantly diminish governments'ability to pursue other objectives. Education, nutrition andcrisis medical care, in contrast, require relatively modestfront-end outlays.

The political attractiveness of programs can beincreased to some extent by adopting technologies with low capitalcosts. Thus a major attraction of simple water supply andsanitation options is that they permit governments to address animportant need without seriously depleting their revenues andhence their abi-li-ty to cultivate support from the electorate.Ideally the benefits from a program would appear within the sameelectoral cycle as the major outlays.

- 38 -

Investments in water supply and sanitation are alsounpopular with governments because the services often are nothighly prized by the electorate. Many other social servicesincluding education, nutrition supplementation, and crisis medicalcare are more popular; hence providing them yields greaterpolitical advantage. Clients generally place high priority onimprovements in water supply only when seasonal shortages arecommonplace. Even then, governments obtain credit primarily forconstruction of civil works--the visible manifestation ofconcern--rather than more mundane functions such as leak detectionor water treatment. Thus efforts are needed to increase publicawareness (and enthusiasm) for such projects and to delay privatecosts to beneficiaries. Such efforts will enhance a project'spolitical appeal and thereby increase its likelihood of beingimplemented. Unfortunately, those who are worst off generally areleast aware of the importance of safe water and of sanitarydisposal of excreta.

The political calculus outlined above appliesprincipally to single projects but also infects entire programs ofpublic expenditure. Authorities are likely to lose politicalsupport if a project imposes greater sacrifices than benefits onany citizen. However, the injured group often can be mollified byproviding it with greater advantages under another project.

Integrated development projects are for this reasongenerally much less attractive to governments than to developmentspecialists. For example, a project that provides irrigation,drainage, distribution of fertilizer and pesticides, small-holdercredit, extension services, primary schools, health clinics,roads, marketing facilities, etc. to one group but offers nothingto a second is politically provocative. Hence, governmentsusually prefer to provide a balanced program which offers somebenefits to all politically significant groups rather than toattempt to maximize impacts by focusing efforts.

Governments can sometimes violate the interests ofparticular groups and yet retain their allegiance if they enjoythe electorate's goodwill. Goodwill is garnered first bymaintaining a positive balance of benefits and costs with a groupand second by adhering to a shared ideology. Abstract politicaland economic theories generally allow governments greater scope of

- 39 -

action than do bread-and-butter projects. For example, freedomfrom hunger is an almost universally shared value; governments arepermitted by public opinion to provide food even to theundeserving poor in order to avoid starvation. Disaster reliefalso enjoys very wide political appeal. In contrast,subsidization of higher education is usually controversial.

However, even within a single country various politicalideologies may be supported by different groups. Opportunities togenerate additional goodwill by embracing a set of beliefs orcustoms are then modest. International initiatives such as theInternational Drinking Water Supply and Sanitation Decade have hada significant impact on political ideology and thus have reducedthe financial and political costs of policy reforms. Theseinitiatives provide a practical means to strengthen governments'ability to deal with problems of the very poor.

B. The Politics of Poverty

Governments' enthusiasms for dealing with the problemsof the poor are also constrained by the fact that the potentialbeneficiaries are generally politically inarticulate. Most of thevery poor reside in scattered villages or recently settled slumsand hence are not visible to governing elites. Moreover they arenot well organized and thus are not usually able to expressclearly their views to government. Divisiveness among villagersand the absence of recognized, authoritative spokespersons forthem often further diminish their political importance. Theexceptional performance of Sri Lanka and Kerala in meeting humanneeds reflects to a large extent the fact that their poor havebecome politically articulate.

Even governments with a sincere desire to meet the needsof all citizens must recognize that leaders of organized religionand educated elites must be cultivated. If officials are toremain in power they must accomodate concentrations of influentialand the well-organized people. Moreover the political systems ofmany developing countries are severely strained by tribal, ethnicand religious divisions. Thus they are much more fragile thanthose found in economically advanced countries. The orderlinessand predictability essential to economic and social progress canoften be maintained only by skillful political manueverings.

- 40 -

An essential step in meeting human needs is to ensurethat the people can effectively communicate to government and thatthey are able to impose sanctions on public officials if theirneeds are not addressed. Grass-roots organization and thedevelopment of effective community leadership provide two means bywhich the poor may increase their political importance. Thesedevices confront governments with blocs of influence and provideclear lines of communication between the people and government.The needs and desires of the people must then be taken mreseriously. These forms of community organization are fostered bysuccessful experiences in dealing with governments.

C. Prospects

On the whole, the immediate prospects are bleak forfunding massive public programs that respond to the needs of thepoor. Only if the interests of the non-poor are balanced withthose of the poor and/or the ideological climate for meeting theneeds of the poor improves sharply is rapid progress likely tooccur.

In the short term at least, the most promising publicinitiatives are for governments to encourage and facilitate localprograms tco meet basic needs. This option presents smallpolitical rLsks and in addition both reduces demands on nationalgovernment finances and promises to mobilize non-governmentalresources. However, even where credit arrangements, extensionservices and other resources have been offered by governmentsponsored programs, people have often chosen instead to try tooutwait government in order to gain the same treatment as theirwealthy neighbors had obtained earlier. For example, low-incomecommunities in such diverse places as Tanzania, Brazil and Indiahave protested having to pay for their needs for improved watersupplies from meager private resources.

D. Establishing a Role for the Private Sector

Medical care, food, shelter, water supply, wastedisposal and education all are produced and distributed in variouscountries by both private enterprises and public institutions. Amajor political issue confronting governments is, thus, the extentto which the private sector should be allowed or encouraged torespond to needs, and in what capacity. The major questionaffecting the role of the private sector in providing basic

- 41 -

services relates to its ability to allocate the goods efficientlyand to distribute them in a socially desirable manner.

1. E conomic Efficiency

The principal economic argument for governmentinterference in the market has been that markets cannot allocatecertain goods efficiently. The problem arises wheneverconsumption by an individual necessarily affects the well-being ofothers. If the spill-over effects are positive, less tends to bespent on the item than the interests of society dictate. Theimmunization campaign against smallpox is perhaps history's mostvivid example of this phenomena. By deciding on behalf ofindividuals rather than allowing them to elect to be immunized,the world's governments were able to interrupt the transmission ofthis disease long enough to eliminate the reservoir of the virus;immunization and treatment are hence no longer necessary. Thepresent value of future benefits from this program are estimatedto be on the order of 100 times its costs. Had individualscontinued to choose for themselves whether to be immunized, it isimprobable that the disease would ever have been eradicated.Indeed the vaccine had been available for three-quarters of acentury with little progress being made, before the concertedpublic program was initiated.

Sanitation is a second example of an activity which mustbe pursued by entire communities if major benefits are to beobtained. Research has demonstrated that gastrointestinaldiseases are transmitted not only within the house but at schools,work places, markets, restaurants and other public places. As aconsequence, community-wide improvements are necessary if healthbenefits are to be obtained.

"Externalities" or "neighborhood effects" argue forcommunity-wide participation in the decision to consume. In mostinstances the community organization selected to make thecollective choice will be an established unit of government.Exceptions do exist however. Where a relatively small, compactgroup with harmonious interests expects to share in the benefitsand costs of a decision, local associations, neighborhoodorganizations, cooperatives or condominiums may be establishedinstead. The function of the group, however formed or operated,is to include all major beneficiaries in the process ofdecision-making in order to maximize the gains over costs.

- 42 -

As discussed earlier, the organization and operation ofinformal groups is time consuming and thus costly. These effortsalso frequently unearth rivalries within the group that threatenits success. Collective decisions rarely impose identical burdensor confer similar benefits on everyone. The inequities thatresult from such collective efforts threaten cooperation even wheneveryone is on net a beneficiary; if some community members are onnet losers, the possibilities for voluntary collaboration areindeed dim.

Thus collective decision-making should only be attemptedwhere the net gains are substantially greater than those thatwould accrue if individual community members acted independently,and where these benefits are very widely shared. Communityorganizations that have already established themselves, and havedeveloped methods for resolving conflicts and managingopportunities are more likely to be able to withstand conflictthan those organized for a particular purpose.

2. Government as Advocate for the Poor and Handicapped

A second justification for governments' becominginvolved in a sector is to ensure that all citizens obtain minimalquantities of essential goods or services. The argument forintervention is that for reasons of poverty, mental or physicalhandicaps, dependence or ignorance, some members of societyconsume less in free markets than the public interest dictates.

For example, governments, even in economicallyconservative countries, support free, compulsory primary educationin order to ensure that children are equipped to occupy adultroles in society. This choice is often in conflict with the shortterm economic interests of individual households, especially inrural areas. Similarly, maternal and child health services areoften provided to citizens without charge in order to ensure thatthose members of society who have relatively little authority overthe expenditure of family incomes nonetheless are assured accessto important services.

Water supply and waste disposal projects funded by theBank generally provide that households are charged a basic,"life-line" rate for a quantity of water judged necessary for

- 43 -

essential domestic requirements. This policy may serve toredistribute a modest amount of income if the life-line rate isless than that charged for additional amounts. However, its moreimportant functions are to encourage households to consume anamount of water sutficient to protect health and to ensure thatwomen and children receive minimal amounts of these essentialgoods and services.

3. Redistribution of Income

The third reason for governments to become involved inconsumption decisions is to redistribute opportunities toconsume. While this motive is often cited, in practice it rarelyis the reason for government intervention. The major exception isSri Lanka which provided subsidies on a wide range of commoditiesuntil the mid 1970s. Redistribution of selected essential goodssuch as food and clothing is generally more acceptable politicallythan direct redistribution of wealth or money incomes. Governmentintervention in the provision of education, health care, watersupply, sanitation, nutrition and shelter is instead motivatedprincipally by the belief that reasonable choices are not likelyto be made by individuals.

E. Public Production

Government involvement in decisions to consumeparticular goods does not imply that governments ought to producethem as well. Production by public agencies generally entailsexcessive levels of accountability to political authorities andthus preoccupation with achieving numerous and often conflictingtargets. Moreover, political accountability also implies thatpublic enterprises are severely disciplined for failing to meettargets yet not rewarded for over-achieving them. Thisdiscourages innovation and assumption of risk, and henceundermines the dynamism of public enterprises. Especially overlengthy periods of time, the economic efficiency of publicenterprises typically erodes.

Public enterprises also assume the burden of employmentand personnel policies established by civil service regulations.

- 44 -

These practices were typically instituted to fend off accusationsof favoritism in hiring and of undue enrichment of employees frompublic resources. However, their additional effects are to reduceflexibility in recruitment and hiring, thus undermining thecompetitiveness of public agencies as employers. As a result,public agencies are often burdened with disgruntled andunderproductive workers who cannot be easily discharged.

The accounting and financial practices of publicagencies rarely provide timely management information. Thesepractices are instead primarily concerned with achievingaccountability for cash resources allotted to an agency and forfacilitating budgeting. The effect of non-commercial accountingprocedures is to reduce sharply the usefulness to management ofaccounting reports.

The principle argument in favor of public production isthat some services are subject to large economies of scale inproduction and physical distribution. As noted earlier, the totalcost of supplying water on average increases by about two-thirdswith a doubling of output. Similarly, large hospital facilitiesare able to utilize more fully sophisticated staff and equipment.Specialized services can thus be provided at lower cost in large,monopolistic institutions. Analogous economies appear ineducation and development of land for housing. These economies oflarge scale production give initial entrants into the business adecided cost advantage over potential entrants and thus permitconsiderable control over prices, quality and availability.Public production at least places these temptations in the handsof politically accountable managers.

Alternatively, these natural monopolies can bedisciplined through public regulation of prices and services,while retaining private ownership or at least private operatingauthority. However, the franchises, contracts and regulationsmust be carefully drafted in order to ensure that theseorganizations function in the public interest.

F. Legal Environment

Inappropriate legal restrictions on adoption ofaffordable technologies have been major obstacles to meeting basichuman needs, especially in urban areas. This observation applies

- 45 -

with particular force to water supply, sanitation and healthcare.

Many countries at the time they achieved politicalindependence, adopted the construction, sanitation andprofessional codes of the metropolitan country. These laws hadbeen developed under different economic, climatic and socialcircumstances, and were not adapted to local requirements.Moreover many of the details had been specified prior to theemergence of a scientific basis for such judgments and have sincebeen rendered obsolete.

Public officials seeking to emulate advanced economieshave generally pursued international standards particularly forhealth care and sanitation. While the folly of this policy is nowwidely recognized, the legal constraints persist. Plumbing andsanitation codes for example, often prohibit on-site disposal ofexcreta and, where on-site methods (pit latrines and septic tanksprimarily) are allowed, building codes require that the facilitiesbe located at distances from wells and houses which effectivelyprohibit their construction in established neighborhoods. Theseexcessively conservative requirements also exaggerate the cost ofon-site disposal in new developments.

Governments should carefully review the laws affectingadoption of low-cost solutions to needs for water supply, wastedisposal and health care. Particular attention should be given toconstruction and plumbing codes, zoning restrictions, materialrequirements, licensure of craftsmen and health workers andaccreditation of other professionals. For example, plumbing codesfrequently prescribe the materials from which pipes and fixturesmay be made. These prescriptions often prohibit the use ofrecently developed plastics which are both cheaper and, morereadily manufactured and serviced domestically. Revisions of lawsand codes should not seek to force adoption of alternativetechnologies but rather should broaden the range of options fromwhich designs may be selected.

Land-use and plumbing codes should be revised to permitthe use of methods of excreta disposal such as the compostingtoilet, and the~-double vault latrine. The use of on-site septictanks, should=-be permitted. Small-bore sewers should alsobe allowed, -t:oco-1lect sullage and effluent from the tanks, wheresoils do not:-pe=rmit-on-site absorption. (Small bore sewers allowconstructi-on of _hlines at lesser depth than with conventionalsewers.) Health codes frequently must be revised to allow sewersto be constructed at these alternative standards.

- 46 -

V. CONCLUSIONS

The aim of this paper has been to identify practicalsteps that governments might take to meet the needs of theircitizens for water supply and waste disposal. The currentinterest in meeting human needs was stimulated in large part bydiscovery in the mid 1970s that Sri Lanka, Cuba, the Indian Stateof Kerala and China, among others, appeared to have achieved ahigh physical quality of life with very limited resources. At thesame time, evidence was accumulating that several of the mostrapidly growing economies had failed to improve significantly thephysical well-being of their citizens.

Most of the studies that have sought to explain thesestartling facts have taken a broad, aggregative approach. Theyhave revealed that those areas which have been especiallysuccessful have been characterized by equitable distributions ofincomes but more importantly have afforded equitable access toeducation, food and social services. Thus many investigators haveconcluded that broad political participation and enlightenedpublic policies have been the most important underlying factors;this suggests that political will is the key to meeting humanneeds. However, the conclusion offers little practical guidanceto governments on how to transform political will into action.

This paper has sought to fill this gap by providing adeeper understanding of the reasons for some countries' having methuman needs. It argues that the explanation lies in the abilityof successful countries to use available resources andopportunities more effectively. The major participants in thisprocess are the household, the community and the formalgovernment. The paper has argued that in most developingcountries the performance of each can be considerably improvedthrough enlightened programs.

A. The Household

The household is the most important unit influencing theuse of resources. However, it often fails to exploit to greatestadvantage its opportunities to consume and it frequently consumesin ways that are inimical to the interests of its members. Thesedeficiencies are due to lack of consumer information, traditionsand religious beliefs that produce less than ideal behaviors,failure to allocate resources--especially food--to the most needyfamily member, and lack of skills for adopting and exploiting newproducts and processes.

- 47 -

In addition, households frequently reject the steps recommended byexperts to satisfy needs because the measures are poorly adaptedto their perceptions and aspirations and to the constraints theyface.

Efforts to communicate development information to thepoor should be further strengthened by the following:

o Messages should be targeted on the person(s) withinthe household who will make the decision or act uponthe information. This would both concentratecommunications efforts and permit more precisetailoring of messages and methods. However,commanication should also seek to build support forchange among those whose approval or consent isneeded for wide adoption of improved practices.

o Communications should be devised to improve the imageof affordable innovations and to reduce popularresistance to their adoption. Stress on technicaladequacy and low cost can stigmatize an alternativeas being an inferior option.

O Attempts should be made to minimize the economic andsocial risks attached to adopting new ideas throughsuch activities as improving women's access toeducation and employment; if social risks ofadoption are not reduced, change often threatens theinnovators and even livelihood and social position.Encouraging people to think of themselves as membersof more modern innovative groups can also providepeer support for change.

o Messages should be made congruent with local,traditional beliefs and should be presented in thelocal idiom in order to facilitate understanding andacceptance.

Acting upon both old and new information is oftenfrustrated by custom and by traditional patterns ofdecision-making within the household. These obstacles toadvancement should be minimized by the following activities:

o Programs should be designed to minimize shifts inresponsibilities, and in the distribution of costsand benefits within the household. Transforming atask that has traditionally been the responsibilityof women and children into "men's work" is likely toevoke social resistance from both groups.

Community and religious leaders and such local'authorities" as birth attendants should be enlistedto support improved practices or, if this is notpossible, efforts should be made to associate the new

- 48 -

0 The capacity of affected groups such as women andchildren to adopt changes should also be promoted.Subsidies, direct assistance and legal reforms thatenhmnce economic and political power should beconsidered.

The capacity of households to exploit new opportunitiesdepends first on their having the necessary time and complementarygoods, and second, on their being able to master new techniquesfor meeting needs. Thus the following measures should be pursued:

o Programs should assist households in securingcomplementary inputs (soap, wash tabs and scrubboards) where these are needed in order to exploit anew opportunity (an improved water supply).

o The value of resources that are freed by adopting anew technology (such as the time of women andchildren) should be enhanced through activities topromote their employment in alternative uses.

O Innovations should be introduced if possible at thesame time that changes in the social and economicenvironment such as urbanization or introduction ofirrigated agriculture are forcing people to devisenew ways of meeting their needs for food, shelter,water and waste disposal

B. The Coummnity

Community participation in devising a plan of action,mobilizing resources and managing programs should be sought. Thevalues, institutions and support mechanisms of the communityinfluence the opportunities and actions of the individualhousehold. Moreover, many needs require collective action andcannot be carried out economically either by individuals orprivate firms. Consultation with the community can reveal thelevel of interest, preferences and constraints and can buildsupport for an innovation. However, the frequent failure ofefforts to promote community participation suggests that communityparticipation should not be regarded as a panacea.

Consultation should be regarded principally as a form ofmarket research. While the process of consultation can shapedemands, the central issue is nonetheless one of determining thepriority of a program and the depth of individuals' commitments toit. Attention should therefore be given to the representativenessof participation in the consultation, and to the group's authorityto speak for the community and to obtain compliance with itsdecisions.

- 49 -

Contributions of funds, materials and labor by thecommunity in mtobilizing resources can reduce the cost togovernment of meeting a need. In addition, contributionsdemonstrate commitment to the program's goals, and promoteself-reliance and local accountability. Such involvement is mostlikely to be successful where participants see themselves as beingtreated equitably by the scheme. Capital contributions aregenerally less controversial than contributions to operation andmaintenance since inequities in the incidence of benefits havegrown more apparent with the passage of time. Payments related tobenefits received are generally most acceptable.

Community control of programs can supplementbureaucratic control. Because the formal bureaucracy is oftenineffective or even non-existent in many low-income areas,accountability to the community is especially important as a meansof ensuring that resources are properly used and that work iscarried out in a timely manner.

Community participation can be encouraged by reducingcosts and increasing benefits to the individual participants. Thecosts of participation include a) the losses of welfare thatresult from subordinating individual interests to those of thegroup, b) the time invested in organizing and managing the group,c) the contribution of resources to carry out the work of theorganization, and d) the assumption of the risk that theorganization may at some.time fail to satisfy a basic need.

Benefits must overshadow these sacrifices if individualsare voluntarily to join an organization. It is also importantthat they recognize that gains represent benefits; expertjudgements of persons' needs are not sufficient. The perceivedbenefits can be enhanced by promoting awareness of the value ofthe effects of a program; this may be achieved through education,mass marketing and political or social sanctions.

The cosat of participation may be reduced by limiting anorganization's membership and goals. This not only ensuresindividuals that their interests are well represented, but alsoreduces the efforts that must be expended to keep the grouporganized and functioning. A similarity of interests amonghomogeneous members also limits the likelihood of conflict. Theadvantages of small groups can often be obtained by forming basegroups that are related formally to larger organizations whichperform technical and higher-order administrative tasks.

Governments and other groups can promote localorganizations by encouraging formation of clubs and interest

- 50 -

groups in order to develop organizational and management skills.They may also devise model legislation, bylaws, organizationcharts, systems of accounts, etc. to simplify establishing a localorganization that must have formal, legal responsibilities such asownership of a water supply system or collection of charges.

Many activities will require a broader range of skillsthan are available at community level or could be used effectivelyby small groups. The formal bureaucracy may then need to offertechnical assistance, skilled craftsmen, policy and planningadvice, etc. These functions generally can be provided bestthrough a multi-tiered structure operated by government.

C. The Government

Governments must develop balanced programs of publicexpenditures if they are to remain in power. These expendituresmust provide constituents with net benefits, at least in total.Programs aimed exclusively at meeting the needs of the pooroften provoke resistance among the more influential andwell-organized elements of society. These political calculationscan be softened to some extent if a political ideology can bedeveloped that places high value on meeting the needs of thedisadvantaged. The underserved are relatively unimportantpolitically because they are poorly organized and lack articulatespokespersons. Their needs would receive greater attention ifthey were to become better organized. Without such animprovement, governments are limited in what they can do to meethuman needs. Meanwhile, the most promising public initiatives arefor governments to encourage and facilitate local self-helpefforts and programs.

Governments should carefully review the roles of thepublic and private sectors. Public intervention is needed toensure that external effects of consumption are recognized inallocations of resources, protection of the very poor and thehandicapped, and (often) in redistribution of income and wealth.However, these are problems of consumption choice, and do notimply that governments should produce the goods and services.Public enterprises are faced with., excessive accountability topoliticians, interference in day-to-day management and employmentdecisions, and inappropriate procurement and accountingrequirements. Thus, they are frequently unable to functionefficiently. Granting franchises and/or contracting with privatefirms is often an attractive alternative. This permitsgovernments to avoid criticisms for unduly benefiting some groups,and generally reduces costs.

- 51 -

Finally, governments should review the legal environmentto make certain that innovation is not being thwarted by obsoleteregulations of construction, plumbing, land use and craftsmen.Laws should be rewritten to permit the introduction oftechnologies that satisfy performance objectives; these laws wouldreplace detailed specifications of materials and designs in manycountries.

D. Summary

As this report points out, the problems underlying thefailure to meet the basic needs of the poor are only in part areflection of indifference among governments and elites. They arealso consequences of a tangle of social obligations, culturalpractices and family traditions. These socio-cultural factors areoften intertwined with religious beliefs and elaborate explantionsfor the events of the natural world. These complex problems willnot vanish with investments in water supply or health care.

Yet if development authorities approach these problemsand issues with a realistic understanding of what must be done,progress can be made. However, that progress is not likely to bedramatic. This report has set forth what now appear to be themost promising steps toward that goal. Their introduction shouldbe monitored and carefuly analyzed to form a still more detailedand effective strategy for meeting human needs in developingcountries.

- 52 -

APPENDIX. FURTHER READINGS

Clarke, William c. and Bruce F. Johnston, Redesigning RuralDevelopment: A Strategic Perspective, Baltimore: JohnsHopkins University Press, 1982.

Glennie, Colin, "A Model for the Development of Self-Help WaterSupply", World Bank Technical Paper, No. 2, Washington: TheWorld Bank, 1982.

Knight, Peter (editor), "Implementating Programs of HumanDevelopment," World Bank Staff Working Paper, No. 403,Washington: The World Bank, 1980.

Rifkin, Susan B., The Human Factor: Readings in Health,Development and Community Participation," Contact, SpecialSeries No. 3, Geneva: Christian Medical Commission, June1980.

Rogers, Everett M. and D. Lawrence Kincaid, CommunicationsNetworks: A New Paradigm for Research, New York: The FreePress.

World EBank A World Bank Paper. March 1976. 98 Number 1: AppropriateWorld Bank pages (including 4 annexes). English, Sanitation AlternatIs:

Publications French, and Spanish. A Technical and EconomicStock iYos. PP-7602-E, PP-7602-F, Appraisalof Related PP-7602-S. $5.00. John M. Kalbermatten,

Interest DeAnne S. Julius, andVillage Water Supply: Charles G. GunnersonEconomics and Policy in tht This volume summarizes the techni-Developing World cal, economic, environmental,health, and sociocultural findings ofRobert J. Saunders the World Banks research programand Jeremy J. Warford on appropriate sanitation alternativesAddresses the problem of potable and discusses the aspects of pro-water supply and waste disposal in gram planning that are necessary torural areas of developing countries implement these findings. It iswhere the majority of the poor tend directed primarily toward planningto be found. Emphasizes the officials and sector policy adviserseconomic, social, financial, and for developing countries.administrative issues that character The Johns Hopkins Uniuersity Press,ize village water supply and sanita- 1982. 172 pages (including bibliogra-tion programs. phy, index).

The Johns Hopkins University Press, LC 80-8963. ISBNl 0-8018-2578-4,1976. 292 pages (including 4 appen- $12.95 (i9.10) paperback.dixes, bibliography, index).LC 76-11758. ISBNl 0-8018-1876-1,$21.00 (i12.70) hardcouer. Nurnber 2: Appropriate

Laboratory Testing, Field Sanitation Alternatives:Trials, and Technological French: L'alimentation en eau des A Planning and DesignDevelopment communautes rurales: economie et ManualContains results of laboratory tests politique generale dans le monde en John M. Kalbermatten,carried out on twelve hand pumps for developpement. Economica, 1978. DeAnne S. Julius,the World Bank and presents recoin- ISBNI 2-7178-0022-0, 45 francs. Charles . Gunnerson. and

mendtios fo imroveent in er- Spanish: Aqua para zonas rurales y D. Duncan Maraformance, safety~ and durability. poblados: economia y politica en elRural Water Supply Handpumps Project mundo en desarrollo. Editorial This manual presents the latest fleldReport Nlumber 1. March 1982. 122 Tecnos. 1977. selected portions of other publicra-pages (including 3 appendixes). ISBIY 84-309-0708-4, 575 pesetas. tions on sanitation program plan-Stock No. WS-8202. $5.00. ning, and describes the engineering

details of alternative sanitationWorld Bank Studies in Water technologies and how they can be

Municipal.Water Supply Supply and Sanitation upgraded.Project Analysis: Case The United States has designated the The Johns Hopkins University Press,Studies 1980s as the International Drink- 1982. 172 pages (including bibliogra-Frank H. Lamson-Scribner, Jr., ing Water Supply and Sanitation phy, index).and John Hiuang, editors Decade. Its goal is to provide two of LC 80-8963. ISBN 0-8018-2584-9Eight case studies and fourteen exer- nheedssafewaterandsahnimtanry $15.00 (l10.50) paperback.cises dealing with the water and nedisposalfehma wa steands-ntoallwastewater disposal sector. disposal of hLuman wastes-to all

people. To help usher in this impor-World Bank (EDI), 1977. ix + 520 tant period of international research Appropriate Technology forpages. (Available from ILS, 1715 Con- and cooperation, the World Bank Water Supply and SanitationnecticutAuenue, Nl.W., Washington, published two volumes on appro-D.C. 20009, U.S.A.) priate technology for water supply Volume 1: Technical and

and waste disposal systems in Ecqnomk Options$8.50 paperback. developing countries. Since the John M. iKalbermatten,

technology for supplying water is DeA S J and

Village Water Supply better understood, the emphasis in Channe S. unlus o anthese volumes is on sanitation and Charles G. GunnersonDescribes technical aspects, costs, waste reclamation technologies, their Reports technical, economic, health,and institutional problems related to contributions to better health, and and social findings of the researchsupplying water for domestic use in how they are affected by water ser- project on "appropriate technology"rural areas and proposes guidelines vice levels and the abillty and willing- and discusses the program planningfor future World Bank lending in this ness of communities to pay for thesector. systems.

necessary to Implement technologies Volume 3: Health Aspects of Volume 10: Night-Sollavailable to provide socially and Excreta and Sullage Manage- Compostlngenvironmentally acceptable low-cost mn-ASaeo-h-r illI hvLwater supeplny ankd w'ase tdisp -osal ment-A State-of-the-Art Hililel 1. Shuval,

Review Charles G. Ounnerson,December 1980. 122 pages (Including Richard G. Feachem, and DeAnne S. JuliusbIbilography). David J. Bradley, Describes a safe, inexpensive treat-Stock Nto. WS-8002. Free of charge. Hemda Garelick ment method for night-soil compost-

and D. Duncan Mara Ing that is Ideally suited fordeveloping countries because of Its

Volume la: A Summary of Provides Information on the ways in simplicity In operation, limited needTechnical and Economic which particular excreta disposal and for mechanical equipment low costOptions reuse technologies affect the survival and Its effectiveness In inactivating

and dissemination of pathogens. It Is pathogens.John iM. ICalberrnatten, Intended for planners, engineers,DeAnne S. Julius, and economists, and health workers. December 1981. 81 pages (includingCharles 0. Gunnerson December 1980. 303 pages (including bibliography, 2 appendLxes).A summary of the final report on 14 appendLxes, references). Stock No. WS-8101. $3.00.appropriate technology for water sup- Stock No0. WS-8005. $15.00. VOlUMe 11: A.3anitatontply and waste disposal In developingcountries, a World Bank research pro- Field ManualJect undertaken by the Energy, Water, Volume 4: Low-Cost John M. IKalbermatten,and Telecommunications Department tnology Options for IeAnne S. Julius, andIn 1976-1978. Tcooo pin o eneS uis nDecember 1980.38 pages. Esgsh Sanitation-a State-of-the- Charles G. GunnersonDecemberh1980. 8 pages. Englsh, Art Review and Annotated December 1980. 87 pages.French. B1

Stock (10. WS8005. $5.00.Bibliography Stock Noa. WS-8007. $5.00.Stock Nlo. WS-8003. S3.00. Witold Rybczynski, SokIo S80.$.0

Chongrak Polprasert, and A oe or we uevetopmentVolume lb: Sanitation Michael McGarry of a Self-Helcp Water SupplyAlfternative for Low-income A comprehensive bibliography that Pr gramCommunitie-A Brief describes alternative approaches to Colin GlennieIntroduction the collection. treatment, reuse, andD. Duncan Mara disposal of wastes. Presents one version of a practical

Describes, In non-technical language, A Joint World Bank/lInternational munity participationg wath high comthe various low-cost sanitation Deuelopment Research Centre publica- programs In developing countries.technologies that are currenUy avail- tlon. 1978. Available from International Consideration is also given to sanita-able for low-income communities In Deuelopment Research Centre (IDRC). tion program development and prac-developing countries and presents a P.O. Box 8500, Ottawa KIG 3H9, tcal guidelines for programgeneral methodology for low-cost Ontario (Canada). development are Included. One of asanitaton program planning. series of Informal Working Papers pre-

pared by the Technology Advisorytebruary 1982. 48 pages. Volume 5: Soclocultwral Group, established under UNODPs

Stock (1o. WS-8201. $3.00. Aspects of Water Supply and Global Project executed by the WorldExcreta Disposal Bank.

Volume 2: A Planner's Guide Mary Elmendorf and Technology Advisory Group WorkingJohn M. Kalbermatten, Patricia Buckles Paper Number 1. October 1982. 45DeAnne S. Julius, This report was prepared as part of pages (including 2 annexes,D. Duncan Mara, the World Bank research project con- references).and Charles G. Gunnerson cerming appropriate technology for ISB(1 0-8213-0077-6. $3.00.water supply and waste disposal.Provides Information and Instructions Social and cultural factors Influencing World Bank Research Inon how to design and Implement responses to water supply and excreta Water Supplyu and Santaappropriate technology projects disposal technologies are Investi-based on the flndings reported In gated In seven case studies of com- tion-Summary of SelectedVolume 1: Technical and Economic munibes In the rural and urban fringe PublicationsOptions, areas of Latin America. A bibliography summarizing theDecember 1980.194 pages (includitig December 1980. 67 pages (Including 3 papers in the Water Supply andreferences). annexes, references). EngiLsh and Sanitation Series, as well as the WorldStock NIo. WS-8004. $5.00. Spanish. Bank studies In Water Supply andSanitation published for the

Stock (1o. WS-8006. $53.00. World Bank by The Johns HopkinsUniversity Press.

Nlovember 1980.Stock No. WS-8000. free of charge.

WORLD BANK PUBLICATIONSORDER FORM

SEND TO:WORLD BANK PUBLICATIONS WORLD BANK PUBLICATIONSP.O. BOX 37525 or 66, AVENUE D'IENAWASHINGTON, D.C. 20013 75116 PARIS, FRANCEU.S.A.

Name:

Address:

Stock or ISBN # Author, Title Oty Price Total

Sub-Total Cost:

Postage & handling fee for more than two free items ($1.00 each):

Total copies: _ _ Air mail surcharge ($2.00 each):

TOTAL PAYMENT ENCLOSED:

Make checks payable: WORLD-BANK PUBLICATIONS

Prepayment on orders from individuals is req=usted. Purchase orders are accepted from booksellers, library suppliers, libraries, and institutions.All prices include cost of postage by the least expensive means. The prices and publication dates quoted in this Catalog are subject to changewithout notice.

No refunds will be given for items that cannot be filled. Credit will be applied towards future orders.No more than two free publications will be provided without charge. Requests for additional copies will be filled at a charge of US $1.00 per

copy to cover handling and postage costs.A,rmajl ceiivery will require a prepayment of US $2.00 per copy.Mail-order payment to the World Bank need not be in U.S. dollars, but the amount remitted must be at the rate of exchange on the day the

order is placed. The World Bank will also accept Unesco coupons.

**w TD353 .W67 v.13 c.2

Co,l laday, Fredrick L .Meeting the needs of the

poor for water supplyand waste disposal I

fl 1te 1 t a _ s4

The World Bank

Headquarters European Office Tokyo Office U1818 H Street, N.W. 66, avenue d'Iena Kokusai BuildingWashington, D.C. 20433, U.S.A 75116 Paris, France 1-1 Marunouchi 3-chomeTelephone: (202) 477-1234 Telephone: (1) 723-54.21 Chiyoda-ku, Tokyo 100, JapanTelex: WUI 64145 WORLDBANK Telex: 842-620628 Telephone: (03) 214-5001

RCA 248423 WORLDBK Telex: 781-26838Cable Address: INTBAFRAD

WASHINGTONDC

ISSN 0253-7494/ISBN 0-8213-0238-8