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S
C.L.E.A.N.The Key to Sustainable
Total Sanitation
Team 19
Kristy HackettSamantha Kearney
Theresa Lee
Nicole LipanaJulia Roy
Anjum Sultana
Can Global Sanitation 2020 Contribute to China’s Prosperity?
?
Sanitation
Improve health
Human capital
Opportunity cost
ProductivityLabor
Education
Environment
Catalyst for economic prosperity
Where to invest?
?
Where to invest?
Why South East Asia?
S Soft PowerS International reputation
S Political interest
S Regional Stability
S Need for sanitation improvement
S Economic GainsS Growing population
S Increasing purchasing power
S Geographical proximity
S Economic interdependence
S Access to natural resources
S Established infrastructure
S Similar rural urban divide to China
S Relative cultural similarity
Cambodia, Indonesia, Timor Leste
S Rural/Urban Divide
S Disproportionate access to improved sanitation
S Cambodia – 20% vs. 73%
S Indonesia – 39% vs. 73%
S Timor Leste – 37% vs. 73%
S 93 Million people in rural areas
Economic Cost :: Sanitation
Cambodia, IndonesiaTimor Leste
S US $6.2 Billion loss due to lack of sanitation [1]
S Health
S Productivity (Labor, education)
S Environment (water, land)
S Tourism
China
S China’s bilateral trade with these countries will increase by
US $240 million per year if universal sanitation coverage is
attained
[1] Water and Sanitation Program (2008)
What and how to invest?
SWhat?SHow?
Economic Technical
Cultural Scientific
Feasibility
Step 1: Community Engagement(Create Demand)
S Community-Led Total Sanitation (CLTS)
S Originated in Rajshahi, Bangladesh by Kamal Karr
S Benefits:
S Community Ownership
S Behavioral Change
S Community Empowerment
S Evidence-Based
S Decrease rates of open defecation:
S CLTS: 92%
S Non-CLTS: 28% [2]
[2] Rashid et al (2009)
Pre Triggering
• Selection
• Building Rapport
Triggering
• Participatory Sanitation Profile Analysis
• Ignition Moment
Post Triggering
• Action Planning
• Follow Up
Process of CLTS
Demand Supply
Step 2: Ecological Sanitation(Provide Supply)
Conventional ApproachEcoSan Approach
Urine diversion dehydration
(UDD) toilets
Composting toilets
Vacuum sewersSemi-
centralised biogas plants
EcoSan Options
CLTS(Demand)
EcoSan(Supply)
C.L.E.A.N.
Lessons Learned
Project RolloutFund Build Adopt Report
Introduction of EcoSan and Solution buildingDevelop plan Funding request
TriggeringParticipatory Sanitation Profile Analysis Ignition Moment
Pre-triggeringEngage community Building rapport Identify sanitation problems
C.L.E.A.N.Evaluation
Acceptability• Community-led• Participatory• Feedback loops• Equity-focused
Cost Effectiveness• DALYs avoided/
1$ spent
Health Impacts• Change in %
ODF • Diarrheal disease• <5 mortality
Environmental Impacts• Local water
quality
C.L.E.A.N. :: Monitoring & Evaluation Template
Region
CLTSEcoSan
C.L.E.A.N.
Recommended Evaluation Design
Randomized Controlled Trial (Gold Standard)
Carried out by University partners
C.L.E.A.N. :: A Multi-faceted Approach
Stakeholder Integration
Policy: Governments & Institutions
Implementation: Civil Society & NGOs
Research: Universities
Benefits
Knowledge transfer
Evidence building in the scientific community
Capacity building of community
Soft power gains for China
Project Budget
US $5 Billion per year for 3 years of full-scale implementationCambodia; 27%
Indonesia; 70%
East Timor; 3%
Additional Recommendation :: China in parallel
Vast inequities between rural and urban populations within China
Curb criticisms of not dealing with sanitation problems at home
Lessons learned in neighboring countries are transferrable
Strengthen research partnerships
Become a world leader in environmentally sustainable sanitation initiatives
Key Messages
1. C.L.E.A.N ignites the demand for and provides the supply of improved sanitation
2. Benefits of C.L.E.A.N. go beyond sanitation, addressing issues of equity and global responsibility
3. Improved sanitation in South East Asia leads to returns on investment and improves international relations and furthers economic gain
Thank You.Questions?
ReferencesReferences
Avvannavar, S. M., & Mani, M. (2008). A conceptual model of people’s approach to sanitation. Science of the Total Environment, 390, 1-12.
Cheng, J. Y. S. (2013). China-ASEAN Economic Co-operation and the Role of Provinces. Journal of Contemporary Asia, 1–24. doi:10.1080/00472336.2012.757430
Ferguson, R. J. (2012). China’s Long-Term Relations With Southeast Asia: Beyond The Pivot. Culture Mandala: The Bulletin of the Centre for East-West Cultural and Economic Studies, 10(1), 3–20.
Florini, A., Nachiappan, K., Pang, T., & Pilcavage, C. (2012). Global Health Governance: Analysing China, India and Japan as Global Health Aid Donors. Global Policy, 3(3), 336–347. doi:10.1111/j.1758-5899.2012.00173.x
Hubbard, B., Sarisky. J., Gelting, R., Baffigo, V., Seminario, R. & Centurion, C. (2011). A community demand-driven approach toward sustainable water and sanitation infrastructure development. International Journal of Hygience and Environmental Health, 214, 326-334.
ReferencesReferences
Langergraber, G., & Muellegger, E. (2005). Ecological sanitation – a way to solve global sanitation problems? Environmental International, 31, 433-444.
Montgomery, M. A. A. (2007). Water and Sanitation in Developing Countries: Including Health in the Equation (pp. 16–24).
Mosler, H-J. (2012). A systematic approach to behavior change interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline. International Journal of Environmental Health Research, 22(5), 431-449.
Murphy, H.M., McBean, E.A., & Farahbakhsh, K. (2009). Appropriate technology – a comprehensive approach for water and sanitation in the developing world. Technology in Society, 31, 158-167.
Nelson, K. L., & Murray, A. (2008). Sanitation for unserved popualtions: Technologies, implementation challenges, and opportunities. Annual review of Environment and Resources, 33 199-151.
ReferencesReferences
Rud, S. & Munch, E. V. (2008). Ecological sanitation: Selected example projects from Sub-Saharan Africa, Asia and Europe. International Conference: Pahtways towards Sustainable Sanitation in Africa. Ouagadougou, Burkina Faso.
SOIL (February 2011). Introduction to EcoSan toilets.
UNICEF, & World Health Organization. (2012). Progress on Drinking Water and Sanitation (pp. 1–66).
Water and Sanitation Program. (2007). Economic Impacts of Sanitatn in Southeast Asia Summary (pp. 1–14).
Water and Sanitation Program. (2012). Introductory Guide to Sanitation Marketing Implementation (pp. 1–14).
Water & Sanitation Rotarian Action Group (2012). Guidelines for planning sustainable sanitation projects and selecting appropriate technologies. Wasrag Technology Series.
ReferencesReferences
WaterAid. (2011). Construction Of Ecological Sanitation Latrine (pp. 1–68).
Werner, C., Panesar, A., Rud, S.B. & Olt, C.U. (2009). Ecological sanitation: Principles, technolgoies and project examples for sustainable wastewater and excreta management. Desalination, 248, 392-401.
Whittington, D., Jeuland, M., Barker, K., & Yuen, Y. (2012). Setting Priorities , Targeting Subsidies Among Water , Sanitation , and Preventive Health Interventions in Developing Countries. World Development, 40(music), 1546–1568.
World Health Organization. (2012). Global Costs And Benefits of Drinking-Water Supply And Sanitation Interventions To Reach The MDG Target And Universal Coverage (pp. 1–67).
Appendix AAdditional Recommendation ::
China in parallel
Yunnan province
Rural population: 31.375 million
46.3% in need of improved sanitation
Total cost: US $745 million
Including cost of technology, facilitators, evaluation, and overhead cost
Appendix B: Cambodia, Indonesia, Timor Leste
Government – Ministry of Health, Water & Environment, Education (multi-sectional)
NGOs
Universities and Researchers
Leading Sanitation Experts within Ministry
Regional District - Health & Environment
District
Community/Village Level
Elders, Leaders, Village Governing Council
Appendix C: Stakeholder Engagement
Appendix D: Why Not Africa?
Maintaining Current Investment Proportion
Harder to Achieve Universal Sanitation
Risky Investment
No Established Infrastructure
Strength
- Natural resources
- Large population (900M, to double)
- Emerging market
- Rising middle class
Many ODF initiatives
Weakness
- Low level of infrastructure
- Political uncertainty (Human Rights and conflict)
- Sanitation infrastructure can’t support population growth
- Low level of ODF in both urban and rural area
- Distance from China is high, meaning increased cost
- Most need
Opportunity
- Generate trade and extraction
- Increased purchasing power
- Room to improve ODF%
- Global stability and recognition
- High reward
Threat
- Uncertainty about whether resources exist
- Urbanization
- Environment
- Sanitation low in urban areas
- Unfeasible sanitation target due to many confounding issues
- Increased cost due to distance
- Soft power decreases
- High risk
Appendix E: SWOT Analysis for Investment in Africa
Total Cost to achieve universal sanitation coverageSSA: US $52 BillionSEA: US $10 Billion
Benefit:Cost RatioSSA: 2.8SEA: 5
Appendix F: Biogas
Appendix G: Composting Toilets
Appendix H: Urine Diversion Dehydration
Appendix I: Evidence of CLTS
Not Effective
Appendix J: Budget for China C.L.E.A.N. Program
Appendix K: Global Budget Calculations
Appendix L: Philanthropy
Lots of money with comparatively little economic ROI
Foreign aid can simply be aid and doesn’t have to come with strings attached
This further improves international relations, friendliness and soft power
Appendix M: Evaluation Methodology
Qualitative:
In-depth interviews with key stakeholders at community level (women, children, youth, facilitators, village government members)
Focus on equity of uptake/participation/decision making
Appendix N: Evaluation Methodology
Quantitative:
Household Surveys (pre/post) in each village
Measures of water contamination
RCT: compare changes in indicators between arms
Surveys to capture:
Health indicators
Cost effectiveness data
HH hygiene/sanitation knowledge
Attitudes towards C.L.E.A.N. approach
Appendix O: Five Year Plan :: GANTT Chart
Appendix P: Evidence for CLTS
Appendix Q: EcoSan Selection(s)