Sanitation and the MDGs: Making the Politics Work

"Why is it that Sanitation and Hygiene (S&H) policies, backed by sound epidemiological evidence, and supported by solid socio-economic arguments for increased investment, are still being overlooked by so many governments?"

It is this question that the author of this 2-page opinion piece, the Overseas Development Institute (ODI)'s Peter Newborne, deems central to any investigation of the world's slow progress toward meeting Millennium Development Goal (MDG) #7. Newborne cites statistics indicating that it seems unlikely that we will indeed succeed in halving the proportion of people without access to improved sanitation by the year 2015. For Newborne, failures in sanitation policy-making are to blame.

To defend this claim, the author points to a sanitation success story and unearths the elements of its policy-related progress. When the regional government in southern Ethiopia shifted its approach from providing hardware subsidies (e.g., distributing concrete latrine slabs) to encouraging households to construct simple latrines from locally available materials, there was a substantial increase in the number of household latrines in a 3-year period (2003-2006) - including a leap in coverage from 16% to 94% in one district. According to Newborne, the following 3 features of this approach represent successful sanitation policy-making:

1. Strong strategy: S&H became part of a package for basic community health. Strong leadership was provided by the Head of the Bureau of Health (BoH), and his team of senior civil servants and health officials were open to the preventive approach. The S&H strategy was manageable within existing financial resources/constraints, and was administratively feasible.
2. Strong political positioning of the strategy: It was conceived and presented to make it politically attractive to other Bureau heads and politicians in the regional cabinet. Concepts not specific to S&H were used, such as: the "right to basic health", "participation", and "accountability". Also fortuitous, Newborne claims, was the timing: The development of the strategy in late 2003 and early 2004 coincided with rallies for the 2005 national election. Further, the S&H strategy was inspired by regional needs, rather than being donor-driven.
3. Good communication of the strategy: Key elements of policy were formulated in brief, general terms, giving the BoH approach the flexibility to evolve. Communication documents used non-technical language to inspire, persuade, and mobilise non-technical actors. In the outreach to households, a mixture of command and encouragement was employed, which was seen to be powerful: people taking forward their own development, with pressure, nevertheless, exerted by government.

For Newborne, this example illustrates the fact that, "strategising, political positioning and communication must be grafted on to the evidence base. The positioning of S&H as a key preventive measure in community health is a strategic option that will be useful in many countries. Meanwhile, political promotion of sanitation requires...the framing of development objectives in terms of political goals." To explore how this policial framing and communication might look in a concrete case, Newborne points to the acronymn "WASH" - Water, Sanitation and Hygiene - which he characterises as a "convenient short-hand for links that must be made 'on the ground' between water supply and S&H, i.e. in implementing development objectives. And WASH campaigning...has been successful in mobilising a groundswell of public interest in S&H...[even though] WASH is not the strategic or political 'ticket'."

Newborne concludes that "[t]he aim must be to take other cases of recent political breakthroughs and look for lessons in political communication, including insights into underlying political motivations. Practical collaborative research/policy work could also help to create new successes, by working with key stakeholders in selected countries to frame and interpret sanitation in appropriate strategic and political terms."