Quantifying Averted Disability-Adjusted Life Years as a Performance Indicator for Water Quality Interventions: A Review of Current Methodologies and Challenges, Water, http://www.mdpi.com/2073-4441/10/6/744
Using behavioral science to promote latrine use in rural India. 3ie, May 2018. This video captures insights on the barriers to latrine use in different states in India and reinforces the need for high-quality evidence on effective behaviour change interventions for informing sanitation programmes and policies.
An update to the WHO-led systematic review of the ‘Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease’ by Wolf et al. (2018) was published in TMIH in May.
I re-read it last week with a water supply hat on, and was interested to see how they’ve improved on the 2014 version. The main difference, apart from including studies recently completed, is that they’ve updated the structure of the meta-regression to allow for separate results for “piped water, higher quality” and “continuous piped water”. This means there’s additional comparisons to be made (with more relevance for SDG6 “safely managed” definitions).
As background, their meta-regression approach allows estimation of service level transitions that have not been directly observed in studies. This builds on ‘network meta-analysis’, a technique increasingly being used in economicevaluations of health interventions where there are no head-to-head trials between options.
Below is my visualisation of the key results (building on the diagrams of the 2014 review’s results in this WHO publication). The numbers are percentage reductions in diarrhoea morbidity risk associated with each transition – explanation below the figure.
* / ** see note at bottom of post
I made this based on table 3 of Wolf et al. 2018, calculating % reduction = 1 – risk ratio. In my view, the transitions most likely to happen in practice, as a result of investments, are the incremental ones. Therefore, I have put these in bold blue. Those transitions less likely are in bold back, and those fairly unlikely are in italics. By “unlikely”, I mean that those people remaining with unimproved water are now predominantly in rural areas, where the direct transition to a safely managed water supply (meeting SDG criteria for both quality and continuity) is unlikely to be affordable in many settings. This reduction (75%), which the authors estimated indirectly, would appear to be the reduction maximally achievable with water supply. Some more notes are at the bottom of this post.
What should we make of these results? I would make two observations, and then two arguments based on the economic implications.
There is good evidence that improving people’s water supplies can reduce diarrhoea, which is among the top three contributors to the all-age disease burden amongst the two quintiles of countries with the lowest human development. For the transitions in the figure previously reported in the 2014 review, the only change is that the point estimate for improved off-plot to piped on-plot has fallen from 14% to 13%.
The reduction varies by level of service attained. Piped water reduces diarrhoeal morbidity more than off-plot supplies, when provided at high quality and continuity. The continuity effect most likely happens via a direct increase in quality, though also via the fact that people are less likely to use secondary sources and improper storage.
What does this mean for the economics of water supply provision, specifically the comparison of investment options?
There is an equity/efficiency trade-off to be made in investment prioritisation. Improving water quality in existing piped supplies has the largest single incremental effect (68%), and there are hundreds of millions of people in urban areas of developing countries using piped services which are not safely managed. Investments in this area are therefore important. However, any improvement in service level for populations using unimproved supplies should arguably be the highest priority on equity grounds, even if to an improved off-plot supply which has only an 11% reduction. Firstly, these populations are most likely to concentrated in rural areas where mortality risk from diarrhoea is highest. Furthermore, in such populations the 11% reduction is likely to be applied to a number of annual diarrhoea cases per capita which is higher than in most urban areas, where people also live closer to health services. Decisions obviously also take place not only on the effects side of the equation, but the cost side too.
Broader benefits should also be taken into consideration. Time savings are often associated with a move from unimproved to off-plot improved supplies (and again in a move from there to on-plot piped). These have an economic value. Water quantity increases associated with a move to on-plot supplies decrease the opportunity cost of using water for handwashing, meaning it is more likely to happen. While improved continuity has a much smaller incremental impact (17%) than improved water quality (68%), improvements in continuity reduce wasted time and money invested in coping strategies and the use of secondary sources. These results are also based on a small number of studies (see below). In short, any decision should be based on a lot more than relative risk reductions.
Decision-makers are rarely faced with simple choices of ‘urban versus rural’, ‘pipes versus handpumps’, or ‘quality versus continuity’. The factors above are all built into the calculus of local government agencies and Ministries of Water when they make their investment plans. I would argue that the principle of “first a basic service for all” should be factored into any such decisions.
The bold blue figures are the ones for which we have studies with a direct comparison (though studies also exist comparing unimproved and piped) – see table 2 in the paper.
The asterisks denote that transitions to “piped, higher quality” rely on one study, and to “continuous supply” on twostudies (against 6, 7 and 11 studies for other key transitions). So, these should be interpreted with caution.
I left out the results for point-of-use filters with safe storage to avoid cluttering the diagram, but the reductions for these are 48% (on an unimproved source). POU chlorination has limited impact after blinding is accounted for.
These are point estimates. Some of the upper bound 95% confidence intervals for risk ratios in table 3 are higher than 1, i.e. the result is not statistically significant.
Safe sanitation is essential for health, from preventing infection to improving and maintaining mental and social well-being.
Developed in accordance with the processes set out in the WHO Handbook for Guideline Development, these guidelines provide comprehensive advice on maximizing the health impact of sanitation interventions.
The guidelines summarize the evidence on the links between sanitation and health, provide evidence-informed recommendations, and offer guidance for international, national and local sanitation policies and programme actions.
The guidelines also articulate and support the role of health authorities in sanitation policy and programming to help ensure that health risks are identified and managed effectively.
The audience for the guidelines is national and local authorities responsible for the safety of sanitation systems and services, including policy makers, planners, implementers within and outside the health sector and those responsible for the development, implementation and monitoring of sanitation standards and regulations.
A quiet rickshaw pulled by a bicycle is the norm for getting where you need to go in Bangladesh. But in fast-paced Vietnam, the roar of motorbikes is everywhere. In these two diverse countries, the way toilets are bought and sold differs as much as their transportation styles.
iDE is building markets for toilets in seven countries that span two continents. No matter how different these environments are, our approach is our rock. We use human-centered design to identify market failures, understand all users, and develop products and business models that enable sanitation markets to thrive. Our approach provides a standardized but flexible set of tools that guide us through phases of discovery, design, and iteration.
Private sector-driven Bangladesh
Bangladesh has a well-developed manufacturing sector. Accordingly, iDE’s Global WASH Initiative convinced a national plastics company that sanitation for low-income households is a profitable market.
Our local partner, RFL, is a plastics manufacturer. They have thousands of retail outlets across the country and the brand holds an enviable position in the hearts of their customers. In the coming months, RFL will be mass producing the SanBox, a low-cost hygienic toilet that’s easy to install.
“RFL is becoming the brand owners on improved sanitation. ” — Conor Riggs, Technical Director-Programs, iDE Bangladesh
On the other end of the spectrum, we have Vietnam, where our program is designed to train the government how to implement a successful sanitation marketing program, enabling the government to then catalyze local supply and demand for hygienic latrines among rural households.
This extra layer between us and the end consumer means we have less control over what happens on the ground. But progress in Vietnam is impossible without government involvement.
Succeeding for different reasons
In Vietnam, our approach is one of three government-approved approaches. We are happy to see that market-based ideas are influencing their sanitation strategy going forward. In Bangladesh, our private sector partner not only sees the economic potential of the sanitation market, but is willing to take on the financial investment required to capitalize on it.
The essential ingredient
The essential ingredient is business. Each country has businesses that need customers — businesses that want to grow their reputation and their income. And each has customers who have aspirations to improve their lives — a toilet for the family is part of their dreams.
“We had been dreaming of a latrine for a while. Our new latrine is safer for my mother and for my children. My next dream is to raise our children with good education and food.” — Latrine Customer, a widow with 4 children and 2 mothers
Building markets is a flexible approach that allows room for creative problem solving and local adaptation. It requires a willingness on the part of NGO management to pivot as needed throughout the life of a program, and a commitment to design the program based on local insights. The diagram below illustrates how we analyze key criteria of markets as a backdrop for designing an appropriate business model.
Our success is due to the fact that we never go into a country with a plan to replicate a specific product or business model. First, we seek to understand what people really want and need. Unsurprisingly, the barriers and opportunities to selling toilets in Bangladesh are different than those in Vietnam.
A handful of popular authors in the new discipline of Behavioral Economics — Nudge by Thaler & Sunstein, Thinking Fast and Slow by Kahneman, and Predictably Irrational by Ariely — reveal important clues about how people make choices. In the moment of decision, we let our emotions rule the day. It’s only later that we justify our choices through the process of rationalization. In fact, in order to change a habit, the new science says we must change our sense of identity. In other words, to be vegetarian, we need to become “the kind of person who doesn’t eat meat.”
Maybe this isn’t earthshaking news, but what is surprising is that we came to the same conclusions in our work selling toilets to rural families in Cambodia.
Millions of people in the developing world don’t have a place to go to the bathroom. This massive public health crisis is hard to get people to pay attention to, and even harder to solve. iDE is dedicated to solving this problem, but not by giving toilets away. Instead, we fill a gap in the market with affordable, desirable toilets designed specifically for rural families at the base of the economic pyramid. With a thriving customer base, toilets are likely to be available for a long time, not just while charity dollars hold out.
Selling Behavior Change
As a market-based organization, we admire a good sales pitch. It’s counterintuitive in our society, however, to believe you can help people by refining the art of the sales pitch. But try selling a toilet to someone who has open defecated their whole life and has big time demands with modest economic resources to meet them. Making a purchase decision with a delayed benefit requires some persuasion.
“It’s just a hole. Why do you need more?” — An Unconvinced Husband
A good sales person knows why it’s easier to deal in a product like cell phones rather than toilets. Toilets, despite their ability to prevent disease and death, are not sexy, income generating, or representative of a flashy lifestyle. A “pull” product, like a cell phone, motorbike, or goat, for example, is easier to sell and requires less customer education. These products may be a symbol of status or generate income — they are purchases that are often driven by desire, rather than rational need.
“Why invest in a toilet when I can invest in land or animals?” — Rationalization at work.
Conversely, there are “push” products that people know they should buy, but don’t immediately desire, like a toilet. iDE’s Global WASH Initiative shines here. We have found that “push” products require a more sophisticated form of selling — one that involves selling to the problem, not the product. Our sales agents are trained in this approach to sales by Whitten & Roy Partnership, a sales and management change consultancy that works extensively in the development world.
I used to walk, now I have a bike. Next, I want a motorcycle. That’s what modern is. — Research Participant
During the research phase, which we call a Deep Dive, we discovered the customer’s motivations to desiring a toilet. We collected insights that helped our product designers keep the customer at the center of the solution. But a good product design is only the starting point. It won’t get into the customer’s hands unless we understand the behavior change required for long term adoption. Once we understand the messages that will trigger behavior change, we must next design a method to deliver them to people in the right way.
Can the Government Sell Toilets?
We felt there was an appropriate role for the government of Cambodia to be the messenger of a “push” campaign. We wanted to explore how government employees could play an active role in behavior change by delivering (pushing) the message via in-village social marketing events. To test this theory, we conducted a one-year pilot in partnership with the Water and Sanitation Program of the World Bank, and 17 Triggers, a Cambodian firm with expertise in social marketing.
QUESTION: How do we get people to shift from open defecation, which requires no upfront investment, to investing their money in a latrine? And how do we break down this process of change so that government employees can deliver the message if training is provided?
ANSWER: Design games to deliver trigger messages in a supportive, social environment.
A few conclusions from our pilot
Perception of Money. We had to take on people’s perception of money itself. We designed a game that changed their perception of money, price, and what they believed they could afford. We knew there was room to influence how people prioritized purchases, we only had to introduce the right sales technique through a game that’s enjoyable to play.
Emotional Drivers. In many cultures, it’s not acceptable for women to be seen open defecating, so they often wait for nightfall. Once we got women talking candidly about the problems they encountered during their nightly ritual, feelings of shame and fear became strong drivers to action. We created puzzles that, once assembled, visually portrayed this emotional narrative and provided a spark for the much-needed conversation to take place.
We used to eat less so that we did not have to go out in the day time. Now we can have a full meal without worry. — Female Latrine Customer
Many rural people in developing countries have a strong desire to feel modern, so one of our puzzles revealed the shame that comes with asking visitors to use the bush.
We learned to avoid rational health messages until after the purchase. Just as Behavioral Economists have been reporting for years, practical arguments are weak motivators to purchase.
Make it Social. We hosted events in a social environment. The games we developed were designed to use social interaction as a positive driver of behavior change. Community influences play a large role in shaping individuals’ beliefs. We made the experience fun and interactive to create an open and safe space where people could loosen up and share their experiences.
Make it Actionable. Provide an easy way to act. A key part of leading people down the path to behavior change is to offer an actionable step in the right direction. We made it easy for people to place an order on a latrine immediately after the village meeting.
From Behavior Change to Impact
iDE’s sanitation marketing program in Cambodia is selling 6,000 toilets per month on average, an unprecedented achievement in WASH development globally. At this rate, we are on course to reach 100% coverage in our program areas by 2025.
We place a high value on monitoring toilet sales and the overall business performance of the local entrepreneurs who manufacture them. Our local Monitoring & Evaluation staff collects business data every two weeks in the field, which is uploaded to our global team for analysis. This data is an essential input for management decisions. But — despite our data-loving culture — it’s hard to deny that the most telling indication of impact is best captured in an image.
Rubina Lama is playing at a temple near her school in Kathmandu when the ground begins to tremble. When the earthquake stops, she tries to stand up, but realizes she can’t move. The bricks are too heavy on top of her small, seven-year-old body. Rubina opens her eyes, but cannot see the sky.
Several days later, Kriti Biadya and Ritesh Adah are surveying the damage at Rubina’s school. Kriti and Ritesh are employees of Splash, a nongovernmental organization (NGO) that cleans water for kids living in urban poverty. Splash’s water filtration systems are installed at over 170 schools throughout the Kathmandu Valley, and the team is out checking each school’s water system for damage.
Kriti and Ritesh find Rubina and her parents living in a classroom of the Shree Nandi School, the school in which Rubina once studied. Rubina, pulled from the rubble days ago, is in great pain. Both of her legs are broken and part of her pelvis is crushed. Her internal infections are becoming life threatening. She needs immediate care.
Kriti contacts her colleagues at Splash-Nepal, who respond at once. The Splash-Nepal team — accompanied by photographer, Gavin Gough — rush to move Rubina to Sushma Korala Memorial Hospital where orthopedic and pediatric surgeons from Mercy Malaysia agree to assist. Rubina is preppred for surgery. For the first time in nearly a week, there is hope.
The 7.8 earthquake that struck Nepal on April 25th 2015 killed more than 9,000 people and injured over 23,000. News of the Nepal earthquake spread quickly around the world as foreigners scrambled to deliver aid. Within days, Nepal’s arterials clogged, their airways congested, and at times, even their borders closed. Disaster relief was slow at best.
Meanwhile, Splash was delivering clean water to more than 100,000 people per day throughout the Kathmandu Valley. Splash — although not in the disaster response business — has a business model in Nepal that enabled immediate response in a crisis.
Splash has been providing clean water for kids in Nepal since 2007, with the goal of providing sustainable WASH (Water, Sanitation, and Hygiene) in all 650 public schools across Kathmandu by 2020. When the earthquake hit, Splash had 26 local staff implementing water projects across 171 schools, serving clean water to over 60% of the student population in Kathmandu.
Splash relies on local infrastructure, local intelligence, and local collaboration. Without having to import supplies or recruit workers from outside the country, Splash wasted no time. The day after the earthquake, Splash-Nepal employees were back at work, surveying the damage of their water filtration systems, running ad hoc seminars on sanitation and hygiene, supporting colleagues who had lost their homes, distributing clean water to the community, and finding help for children injured during the disaster.
Six months later, Rubina is walking to her school to meet Gavin, the photographer who had accompanied her and the Splash-Nepal team to the hospital. At Rubina’s school, a new building now stands beside the old one. Classes are back in session, and clean water is flowing from Splash’s taps.
Rubina is wearing a festive pink dress. She greets Gavin in traditional Nepali fashion. They sit together amongst the school’s ruins and Rubina shows him the tiny scars on her legs. Then she asks him to watch her run. Gavin does, capturing her movement with his camera. Rubina is smiling as she dashes past the temple that nearly claimed her life.
April 25, 2016 marks the 1-year anniversary of the 7.8 magnitude Nepal earthquake — the first in a series of tremors — that devastated the Kathmandu Valley.
The day after the first earthquake, Splash staff in Nepal began surveying the damage at their partner schools, realizing they were the first relief aid to arrive. “The schools were very amazed,” said Kriti Baidya, a Partner Support Coordinator at Splash Nepal. Not one of Splash’s hard-wired water filtration systems had been permanently damaged. “The Splash team was at the school giving a hygiene training to the children [when the second earthquake, a 6.7 magnitude tremor, struck on April 26, 2015]. We faced the earthquake in the school itself.” Kriti recalled. It was lucky that the first, and most powerful, earthquake had hit on a Saturday when schools were not in session.
Days after Disaster
In the days, weeks, and months following the initial earthquakes, many communities and suddenly homeless families relied on Splash’s existing high volume water filtration systems in public schools. “The Splash filter system is one of the things that helped people because right after the earthquake most people took shelter in the schools. They drank pure water from that filter system, which helped,” confided Madan Dhodari, another Partner Support Coordinator at Splash Nepal. Within two weeks of the first earthquake, the Splash Nepal team began holding public workshops on critical WASH (Water, Sanitation, and Hygiene) behaviors, educating their fellow survivors on how to keep clean and stay healthy during those hard times.
“Whatever the situation was, we never gave up,” said Kriti.
As the Nepalese people banded together and other aid agencies joined the recovery efforts, communities began to rebuild. Families found new homes and, for some, life returned to normal — a new normal. For many, the fear of imminent disaster was crippling to their recovery. Light aftershocks and rumors of more earthquakes reverberated across Kathmandu Valley, sending the city into a sleepless worry and flooding the hospitals with cases of post-traumatic stress.
Eventually, classes resumed at schools, but were often held in TLCs (Temporary Learning Centers); structures made of bamboo that, according to some schoolteachers, leaked when it rained and emitted a fine powder when it was dry that made the kids feel sleepy and ill. “The TLC is not the solution,” Splash Nepal’s Health & Hygiene Officer, Sushma Kuikel, remarked. “They make a lot of problems for the students.”
Then, on September 23, 2015, the people of Nepal were hit by another devastating shock: border blockades between Nepal and India that stopped the import of necessary goods, like building materials, equipment, and fuel. Another new reality settled over Nepal.
“During the earthquake, there was bonding,” recalled Shruti Bista, another Partner Support Coordinator at Splash Nepal. “People were ready to help each other, but during the fuel crisis, it was a competition for where you could get fuel.”
“The whole year we faced problems after the earthquake,” Madan confirmed. “It may not be the result of the earthquake, but the whole year was not good for us.”
Business (Not) As Usual
“It has changed a lot,” Krity Bajracharya, Health & Hygiene Officer at Splash Nepal replied when asked how the year’s events have affected the implementation of Splash’s work. “In some of the schools, the water source has completely dried up, so it has been really difficult. And in other schools, due to the destruction of the buildings, we have had to move a lot of our drinking and handwashing stations.”
One positive change for Splash has been the enforcement of new and stricter safety standards for building construction and design. “Now because the earthquake, people are very cautious and following the building construction rules. Good things are happening now,” said Rojita Maharjan, Social Business Coordinator at Splash Nepal.
It’s true. Splash Nepal has dedicated much of this year’s resources to retrofitting the water storage tanks and plumbing at the 164 schools currently using Splash’s water filtration system to meet these improved safety standards. Meanwhile, Splash has adopted a reformed approached at the 47 new installations scheduled for 2016, enforcing stricter engineering standards for improved safety and disaster preparedness. “Now we are planning; keeping the earthquake in our minds,” said Sujan K.C., Operations Assistant at Splash Nepal.
When asked to reflect on the past year, Splash Nepal’s Hygiene Team became giddy as they recounted the endeavor of delivering portable water filters to 75 schools in the rural Southern Lalitpur region of Nepal — the area of Kathmandu Valley most affected by the earthquake. “It was completely different than what we had been doing with Splash, but it was the most satisfying work.” What made it satisfying? Sushma beamed: “The smiles of the students.”
“We need to work more on water sources,” Madan advised. In a city faced with unforeseen challenges, Splash is making steady progress toward achieving 100% coverage of full water, sanitation, and hygiene services at all 650 public schools in the Kathmandu Valley. While Splash adapts to the changed urban environment, schools seek to get students back into permanent buildings; a slow process hinged on government funding and expected to take two to three years.
“Splash Nepal is now more focused on the access to drinking water,” confirmed Rojita. “Quantity and quality are both challenges.” Despite water supply being an unexpected dilemma, the Splash Nepal team seems unfazed. Already, Splash has begun forging new partnerships with local experts to troubleshoot the issue of water supply and access. “Splash work is never for the short term,” Rojita explained. “We continuously work with the schools. They are a partner and a friend.” And Splash never leaves a friend high and dry.
Standing in front of a sea of 1,000 peers, one teen does what most high school students would not do for $1,000: show their school how to use a menstrual pad.
As an American woman, I tend to take the access to pads or tampons that I have to manage my period for granted. In many of the countries where Splash works, girls are not given this luxury, especially at school. For many girls, the first time she learns about menstruation might be the day it begins — which can be a terrifying moment if she has no prior warning or understanding of what’s happening. And once her menses begins, she may not have access to menstrual materials or a safe space to change her pad. In developing countries, school toilets often do not have locking doors, water for cleaning, or bins to dispose of used pads. Every single girl faces menstruation. At Splash, our goal is to make that experience a little more dignified, safe, and positive.
On May 28 2016, schools in Addis Ababa, Ethiopia that partner with Splash will be holding their second annual Menstrual Hygiene Day celebration. In preparation, Splash staff has trained a group of 20 interested students to take part in a Hygiene Club. The Hygiene Club uses fun, interactive games and engaging materials to increase students’ knowledge and advocacy. One of the key hygiene topics is proper menstrual hygiene management. Splash trains teachers to work with both boys and girls to break down existing taboos and myths on menstruation. In doing so, we help to identify girls’ needs in each school.
On Menstrual Hygiene Day, Splash’s Hygiene Clubs are standing up (literally, in front of their peers) for menstruation. Together, boys and girls, teachers and students, will advocate for girls and the importance of not letting menstruation interfere with a girl’s ability to attend school, feel confident, and be safe. Our goal is to encourage schools to have toilets that are secure, private, and stocked with materials to help girls manage their periods.
When I watched kids perform this demonstration for the first time, I was in awe. How inspiring it was to witness kids stand up for each other in a way that was so natural and honest. There was nothing taboo about it.
Megan Williams is the Health & Hygiene Manager at Splash, a nonprofit organization dedicated to helping urban poor kids grow up healthy by ensuring they have clean water, clean hands, and clean toilets at school and in their communities.
Experts say the most productive people don’t look at their phones first thing in the morning. You shouldn’t do it, they say. But on July 27th, as I swiped open my email and wiped the sleep from my eyes, I was glad I did.
The first subject line in my inbox read: Cholera Outbreak in Lalitpur. My heart sank. People in Nepal have faced enough recently: catastrophic earthquakes, freezing winter temperatures, floods, political crises and gas and food shortages. And now this?
The email claimed 17 cases of cholera had been reported. As the Health & Hygiene Manager of Splash Nepal, I immediately forwarded the alert to my colleagues.
When I arrived at the Splash Nepal office later that morning, the rest of the team was already in emergency response mode. They, too, had ignored the experts and checked their emails that morning.
Splash contacted the Nepal Public Health Office, the District Education Office (DEO), and the other government and NGO allies we had joined forces with in the aftermath of the earthquake. Together, we identified the four zones of Lalitpur most affected by the initial outbreak.
As an initial step, the DEO commissioned the Environment and Public Health Organization (ENPHO) to survey the water quality of all Lalitpur schools. Thankfully, all schools with a Splash filtration system tested negative for coliform.
But the number of reported cholera cases in the area was rising, and our team worried about it spreading to the kids at our partner schools — the ones we promised to help protect from water-borne disease. The Splash team knew that students in Kathmandu needed more than our standard clean water intervention. They needed intensive hygiene education and long-term reinforcement from those they look up to: adults.
We had our objectives. Our immediate goals were: to ensure the water flowing from Splash’s filters remained free of microbial contamination; and to make parents and community members aware of cholera and teach them how to prevent it from spreading. Since adults serve as both role models and behavioral guides for children, we began including parents, teachers, school administrators, and community members in our hygiene education activities.
We started with the communities. Working with key players in local development and government, we identified women’s groups and communities that were in the cholera outbreak areas. Then the Splash Nepal team gave awareness presentations and lessons on how to ensure safe drinking water and keep up proper personal and environmental hygienic practices at home.
Next, we targeted the people responsible for ensuring children’s health throughout the course of the day: the school administrators. Whether we had worked with a school previously or not, we wanted to ensure that all school principals had the knowledge and resources to ensure their students had access to clean, safe drinking water. We invited principals from high-risk zones to several 2-hour training sessions on preventing cholera in schools and provided them steps for keeping kids safe at school. In collaboration with UNICEF, Splash distributed educational materials so that principals could share these health lessons with their school staff.
Splash Nepal also organized Hygiene Event Days at schools with a focus on cholera awareness and prevention and invited school parents and the local community members. As with Splash Nepal’s annual Hygiene Event Days, the purpose is to celebrate the school’s access to clean, safe drinking water, and to spread messages about the importance of proper hygiene. With support from the Rotary Club, we were able to obtain donations of soap and Piyush (chlorine drops) for home use to distribute to adult attendees.
All the while, Splash continued to ensure that kids at Kathmandu schools had the cleanest water possible. Our team visited every single one of our partner schools across the Kathmandu Valley to re-test the water quality and proactively sterilize each filtration system. On our visits, we reminded teachers and staff to resupply soap, encourage handwashing, and ensure clean water is available to all students all the time.
Strong collaboration with government and other NGOs is key to reaching the maximum number of people. So far, our Cholera Outbreak Response campaign has reached over 10,000 children and adults directly and thousands more indirectly through the distribution of information, soap, and chlorine packets.
Despite all this concerted effort, the outbreak isn’t over yet. Every day, Splash Nepal continues to support extra hygiene programs at schools across the Kathmandu Valley. And every morning, I wake up and check my email for updates.
Why does Splash focus on urban areas? When I joined the Splash team two years ago, this question was at the forefront of many external conversations. It’s been encouraging to hear these conversations gradually evolve. Earlier last month I attended World Water Week in Stockholm, Sweden, where I heard water experts from around the world ask the inverse of these questions: Why aren’t we talking more about urban needs and realities? What about cities? Although the water, sanitation, and hygiene (WASH) sector has historically been focused on rural areas, a shift is taking place as more attention is paid to the growing needs of the urban poor.
This shift represents an important, though delayed, response. More than 54% of the world’s population now lives in urban areas, a proportion that is expected to rise to 70% by 2050. The majority of this urban growth will take place in developing countries — especially in Asia and Africa, where birthrates soar and families are moving in droves from the countryside to cities. The combined population of the world’s least developed countries will double by 2050. If we are not looking ahead at how to improve critical services and infrastructure in the world’s poorest and densest cities, we are missing the opportunity to reach the poorest where they are — and where they will be. Existing WASH infrastructure will deteriorate as it buckles under the weight of new users. The “last mile” (a popular term in global development), will take on a new face in the coming decades as we struggle to serve those who are moving closer and closer to urban epicenters.
That is why Splash fills a unique role: improving WASH services in major urban areas in Asia and Africa. Through our work in schools, hospitals, orphanages, and shelters, we focus specifically on kids — helping to protect those who are most vulnerable to water-borne disease. We simultaneously aim to influence the behaviors and shift the social norms of those surrounding these kids, working in close partnership with local governments as well as the staff at the institutions we serve.
Splash believes that the first step in solving a problem is quantifying it. So between October 2014 and February 2016, we partnered with local governments and independent surveyors and water quality labs to coordinate citywide surveys assessing WASH coverage at every government-funded school in Addis Ababa, Ethiopia; Kolkata, India; and Kathmandu, Nepal. Never before had the status of urban school WASH coverage been so comprehensively examined. The availability and quality of WASH infrastructure was assessed and water quality samples were taken from nearly 3,000 schools serving more than 1,000,000 children — totaling 100% of public schools in each city. The data revealed the unequivocal need for increased WASH investments in urban schools. While these schools do indeed have access to water points, they largely lack safe and consistently available drinking water. The aggregate drinking tap-to-student ratios were more than double that of minimum global standards and the toilet-to-student ratios were even worse. Less than 7% of all schools surveyed had soap available for hand washing.
Solutions to these problems are available now and Splash believes that their impact can extend beyond the school walls. Water, sanitation, and hygiene infrastructure improvements must be coupled with initiatives that ensure the sustained maintenance and functionality of WASH hardware while changing behaviors for the long term. Kids and schools are access points for influencing parents, families, and communities and are thus important change agents in strengthening intergenerational values towards WASH.
It may not take long hours of travel to physically reach the kids living in these cities — but it will surely take long hours of problem solving, coordination and collaboration across sectors, and creative advocacy and blended financing to address the complexity of urban WASH challenges. Kids living in urban poverty may not be the hardest to reach geographically, but they will continue to be overlooked unless our sector turns its collective powers of attention and resources towards their realities. Our mandate to serve all humans with safe water and adequate and adequate sanitation and hygiene by 2030, as per the UN’s Sustainable Development Goals, is clear. Splash has been working towards these goals for nine years. Our efforts to improve the lives of kids in urban institutions has never been more pressing. The question should no longer be why? — it should be how?
I believe that all people — no matter what color, religion, ethnicity, or class — want things to be better, for themselves, for their families, for their communities, for their countries, and for the world. If we are divided, it is because the world is a complex place. It’s hard to see that the rising tide is lifting all boats if the water isn’t lapping at your own skiff.
A hundred years ago, more than half the population of the world lived on less than $2 a day (adjusted for inflation). That amount is now less than 12%. While the world population has also grown in that time, the sheer number of poor people is less now than ever before.
I believe this change has happened because we have learned about the root causes of poverty and how to solve them. The answer is opportunity.
When poor women and men have the ability to earn an increased income, their lives change. They become leaders of farm businesses, not subsistence farmers. They become trusted advisors and salespeople, not charity cases. They open up seed stores and market stalls. They become entrepreneurs.
Opportunity powers markets, the creation and exchange of products between people. I believe in the power of markets as the most powerful force for significant, widespread, and lasting impact on rural prosperity.
At iDE, we focus on making opportunities happen. We help latrine business owners to hear what their customers need so they can design and deliver cost-effective sanitation options. Our Farm Business Advisors travel the distance to listen to the difficulties of farming in remote places, then help connect rural farmers to urban markets so that they can obtain the equipment and seeds that they need to grow more, better crops and also deliver their harvests to waiting buyers. We listen to people who tell us what they need to be able to improve their lives, and we connect them to finance, business training, and communities of practice.
On October 12th, 2016, Splash received the following email from Dawit Alemishet, Splash Director of Ethiopia:
I would love to share the inspiration of my day while visiting our partner site, the Edget Besira Primary School. I just cannot sleep without telling you of this testimonial I received from the school’s principal.
The Edget Besira Primary School is located near the largest open market of Merkato in Teklhaymanot area. In this new academic year, more than 1,250 students have already enrolled in the school. Most of the school children are coming from the very poor families living in slum houses. One of the biggest challenges of the school was that most of the children are involved in the street vending labor to cover their lunch and other personal expenses. Therefore, they were missing the afternoon class often. When Splash intervened there was only nonfunctional taps, water reservoir, pipelines, and damaged water station, and out of service latrines.
Fortunately, with Splash’s intervention supported by the Lake Union Rotary Club of Seattle and the Rotary Club of Addis Ababa West, this terrible situation was changed. Both the primary and kindergarten campuses now have separate child-friendly water stations for drinking and hand washing purposes. We built two drinking stations with 24 taps, and 15 taps for two hand washing stations. In total, we put 5 water stations in the school that connected to the two water filtration systems. In addition, we provided two water tanks with the volume of 5,000 liters and rehabilitated existed water reservoir tanks and facilities. Of course, our hygiene team has given excellent trainings as well during the last year.”
Dawit went on to say the school staff had reported that, in one year since Splash’s intervention and assistance in accessing existing public financing:
The student’s attendance doubled;
The pass rate increased from 45% to 94%; and
The school had effectively used over 90% of their annual allotment for infrastructure improvement.
“The parents are now asking for their children to stay in the school the whole day because their children are performing so well. I hope the health impact is there too. Though our contribution is like a small drop, our work is having an immediate impact. I am very happy to able to see and hear of this contribution with Splash. Thank you all for supporting this life changing project in Ethiopia with Splash!
I hope you enjoyed this report.
Splash whole-heartedly thanks Dawit and his team for their tireless work, Rotary International for funding this project, and all our donors who support Splash’s clean water projects around the globe.
Why WASH organizations need to hire and grow business-savvy leaders
Every organization knows the pain and disruption caused by bad hiring decisions, or waiting for an employee to develop the necessary skills to excel in a position he or she is not a fit for. Make a bad hire and the manager, the team, and the organization will suffer, operating at less than their full potential due to marginal or toxic employees. On the other hand, great hires are self-driven to deliver, grow, and execute in a way that brings people and organizations together.
I work for iDE, a nonprofit organization that has been implementing market-based development programs for over 30 years. iDE is sometimes approached to provide technical support on water, sanitation, and hygiene (WASH) market development for other organizations. One of the biggest challenges we’ve discovered in doing so is that these organizations are staffed with health and engineering experts who are knowledgeable in their technical fields but lack a solid understanding of how markets and businesses operate. Although business is not rocket science, it is difficult to discuss marketing matters in depth without, for example, shared language around profit, risk, and competition. When it comes to successfully managing a sanitation marketing program, hiring business-savvy program leadership is critical.
This basic belief informs iDE’s hiring choices — over 80 percent of the executive leadership in iDE’s WASH programs have a business and/or economics background, with the rest from more technical WASH and international development backgrounds such as engineering, agronomy, and water resource management. In iDE’s experience it has been much easier and faster to train business-savvy staff on the technical aspects of WASH, than to coach staff from traditional development or charitable backgrounds to understand businesses and markets.
The costs of hiring the wrong people
80 percent of turnover is caused by bad hiring decisions. 1
Replacing an employee costs between one-third and five times the employee’s salary. 2
Managers spend time coaching employees who are a bad fit for their positions, taking time away from providing technical leadership to their team.
It’s difficult, if not impossible, to achieve profound results with the wrong team in place. But if we truly want to drive progress towards the U.N.’s goal to “ensure access to clean water and sanitation for all,” 3 I believe these four things should be considered by any organization working in WASH:
Invest in recruiting talent with business acumen.
Identify and develop business leadership skills.
Incentivize potential leaders competitively, taking into account the opportunity cost candidates face forgoing potentially lucrative private sector positions, and not just the prevailing wages of the nonprofit labor market.
Incubate and foster an organizational focus on training and knowledge sharing.
Investing in business thinking
WASH problems do not exist in a vacuum but are part of complex market systems, with customers who desire beautiful products for the lowest price, manufacturers who want a large demand with a significant profit margin to justify new product lines, and distributors who connect the two. Traditionally, WASH development interventions have only addressed one of three aspects of the WASH problem: technical, social, or economic. If the problem is perceived to be technical, engineers create a technical solution; if the problem is social, psychologists, sociologists, and anthropologists identify behavior change triggers; if the problem is economic, economists develop more efficient systems of resource allocation.
iDE believes that all three aspects must be addressed to achieve a sustainable solution. Solving only one part of the problem may work in the short term (i.e., the project’s period of performance), but may break down in the absence of an ecosystem of drivers. If an organization is serious about being market-based, it also needs to make serious investments in market-savvy people.
Too many organizations make hiring decisions in the context of the nonprofit sector alone, ignoring the broader pool of talent that could be attracted with offers that compete with the for-profit sector. In one of the most popular TED talks on social innovation, Dan Pallotta calls out five types of discrimination that society places on nonprofits as compared with the for-profit sector, the first being compensation:
“In the for-profit sector, the more value you produce, the more money you can make. But we don’t like nonprofits to use money to incentivize people to produce more in social service. We have a visceral reaction to the idea that anyone would make very much money helping other people. Interestingly, we don’t have a visceral reaction to the notion that people would make a lot of money not helping other people. You know, you want to make 50 million dollars selling violent video games to kids, go for it. We’ll put you on the cover of Wired magazine. But you want to make half a million dollars trying to cure kids of malaria, and you’re considered a parasite yourself.” 4
To solve some of the most intractable problems of the world, development organizations cannot afford to not attract the best and the brightest. Being able to compete in the broader labor market is even more salient in the social enterprise space. Here, CEOs are expected to have all the skills and talent needed to run a business and live up to expectations of profitability (arguably in less marketable spaces and shorter time frames) without the incentives of a typical start-up environment, namely equity. This scenario, argues Eikenberry and Kluver, becomes a barrier to hiring talented people, as the opportunity for potential leaders to financially gain from business successes is limited. 5
If equity is not an option, organizations should consider subsidizing professional development, in recognition of the wider financial and non-financial benefits that would accrue on the rest of the organization from investing in high potential individuals. Other non-equity compensation schemes include results-based incentives, which can help attract people who excel in business to be interested in social entrepreneurship.
Building a pipeline of future leaders
Understand leadership versus management
Leadership in WASH has become a recurring theme in the sector, evidenced by its increase in prompting many discussions, conference presentations, and conversations among practitioners. The theme of leadership was a major topic at the 2016 WEDC Conference, and there are countless blog posts similar to things like, “Are you a water manager or leader?” 6 However, leadership should not be confused with management, and hiring leaders requires an understanding of their mindsets.
Psychologist Carol Dweck studies implicit theories of intelligence, and has argued that people fall on a continuum according to their beliefs about where their ability comes from. A “fixed mindset” assumes that our character, intelligence, and creative ability are static givens that we cannot change in any meaningful way; success is the affirmation of that inherent intelligence. A “growth mindset,” on the other hand, thrives on challenge and sees failure not as evidence of unintelligence but as a springboard for growth.
“A “growth mindset” creates a passion for learning rather than a hunger for approval. Its hallmark is the conviction that human qualities like intelligence and creativity, and even relational capacities like love and friendship, can be cultivated through effort and practice. Not only are people with this mindset not discouraged by failure, but they do not actually see themselves as failing in those situations — they see themselves as learning.” 7
This framework is helpful in understanding the types of people that are best suited to an organization’s culture and the objectives it seeks to achieve. Organizations interested in making quantum leaps in progress need employees who can embrace failure as part of the innovation and growth process. To make failure productive, a “growth mindset” is more conducive for exploiting learning opportunities. In contrast, a “fixed mindset” might be more appropriate for positions primarily focused on refining and perfecting metrics of a fixed standard.
This difference in “fixed” or “growth” mindsets is another dimension of how an organization understands the difference between managers and leaders. Marketing guru Seth Godin argues that the two are acutely different. He says:
“There’s practical everyday management, and then there’s leadership. Leadership is not practical, and it’s not everyday. You think you’re being a leader, but you’re probably being a manager… Managers try to get people to do what they did yesterday, but a little faster, a little cheaper, with fewer defects… What’s not happening is leadership… Leadership means embracing the failure of your people if it leads to growth… Managers want authority. Leaders take responsibility. We need both. But we have to be careful not to confuse them.” 8
Against the two frameworks of “growth vs. fixed” and “leadership vs. management,” the WASH sector has consistently invested in managers, but should make more deliberate investments in the growth of leaders to maximize the potential for transformational impact.
Identify high-potential leaders and create growth opportunities
Organizations in the WASH sector should be actively on the lookout for potential leaders, deliberately creating opportunities to “fast-track” their growth by exposing them to situations in which they can gain the necessary experience and credibility to lead their own teams. Working in development contexts is often characterized by patriarchal social dynamics, so the WASH sector needs to pay particular attention to creating an enabling environment for rising women leaders, local and international. Donors often recommend gender equitable staffing, but the reality of the field is that it is difficult to hire women to work in a mixed-gender environment in some cultures and that women rarely even apply for top leadership positions. Even for those positions that are culturally appropriate gender-wise (such as translation), women may still need their husband’s explicit permission to stay overnight, making travel across far distances more difficult. Fostering an environment where gender, age, and cultural dynamics are taken into account will be critical to the success of any leadership development efforts.
Institutionalize ongoing professional development
One of the key factors of iDE’s success in the Cambodia sanitation marketing program has to do with the professional development structure surrounding staff at all levels. With support from sales consultancy Whitten & Roy Partnership (WRP), iDE developed a multi-tiered cascading coaching structure, where staff at every level receive weekly coaching from their supervisor. Unlike an annual training workshop, this coaching structure allows the individual to receive real-time feedback and a consistent touch point for focusing on growth areas. Using simple frameworks, WRP has also provided iDE with depersonalized language to discuss challenge areas that may otherwise go undiscussed until too late.
Incentives as a tool to unleash creativity and ownership
In addition to incentives for top level executives, iDE has used financial incentives to influence staff behavior down to the field level, especially those in sales-driven roles. With the right training and coaching support, incentives motivate employees to take ownership and increase their creativity in problem solving. Instead of having activities micromanaged, staff are given targets to hit, and also the (relative) freedom to figure out how to hit them. When structured appropriately, iDE’s experience has demonstrated that incentives drive ownership, creativity, and results.
Keeping leaders engaged
Make time for “Make Time”
Featured as one of the top 10 leadership stories of 2015 in FastCo was an email that a Google employee sent to the rest of his colleagues about time management. In this email, Jeremiah Dillon posed a simple time management challenge to his colleagues: to schedule and respect Make Time. He wrote:
“Stop. Breathe. Now, think about how you’re managing your time. Speaking for myself, I have some room for improvement. It’s been said there are two paradigms to scheduling — the manager and the maker. The manager’s day is cut into 30-minute intervals, and they change what they’re doing every half hour. Sorta like Tetris — shifting blocks around and filling spaces. The maker’s day is different. They need to make, to create, to build. But, before that, they need to think. The most effective way for them to use time is in half-day or full-day blocks. Even a single 30-minute meeting in the middle of “Make Time” can be disruptive. We all need to be makers.” 9
In our capacity as leaders (versus managers), we have the responsibility to make and create, and not just to optimize or troubleshoot. To do so effectively, there needs to be dedicated time for immersion in thought, experimentation, and tinkering. To create strategic vision, there needs to be space freed from daily operational concerns. Beyond embedding a culture of effective time management, organizations should also create opportunities for leaders to come together and reflect. At the country, portfolio, and global level, iDE holds workshops and retreats dedicated to having shared moments of reflection and creation.
Knowledge management for a collaborative leadership culture
Leadership, at moments, can be solitary, especially in organizations that fall into silos. To maximize learning, minimize repeated mistakes, and build a strong culture of collaboration and camaraderie, iDE has invested in knowledge management as part of culture building. Knowledge management is a dedicated role on iDE’s Global WASH team, and one of the main goals of the knowledge management department is to facilitate peer learning relationships among WASH leaders themselves. A WASH Program Director in Africa can relate to similar challenges of running a WASH program in Asia.
However, efforts to create peer-to-peer connections and knowledge sharing are not limited to the “leaders.” In fact, knowledge management has succeeded when the culture of sharing and collaborating permeates every layer of the organization across different departments and geographies. Leaders who actively engage in learning from their peers and sharing their experience with others are much more likely to set examples for their staff, and find ways to support their staff in similar engagements.
A critical part of achieving the ambitious Sustainable Development Goals from the U.N. will be to invest in developing and nurturing transformative leaders. Informed by the latest research on leadership and organizational experience, I recommend four key priority focus areas for leadership development:
Hire the best and the brightest, and invest in market-savvy people.
Invest in long-term growth through ongoing professional development and deliberately create opportunities to fast-track emerging leadership.
Provide incentives that reward innovation and motivate leaders to take risks.
Foster an environment that allows staff to reflect and learn; respect Make Time; and invest in collaborative knowledge management.
Thanks to Valerie Labi for contributing her insights and experience to this article.
With expertise in human centered design, microfinance, and social entrepreneurship, Yi Wei has been a part of iDE’s work in sanitation, clean water, and hygiene since its inception. She was instrumental in growing the Cambodian flagship sanitation program to be the largest improved rural sanitation program delivering improved latrines in the sector to date. Now as the Global WASH Director, she is ready to guide the program to even more impressive achievements.
Thinking about markets for the poor — using game theory
Solving poverty is no game, but serious business. However, there’s a benefit to thinking about market systems in the terms of games like poker. Poker, for example, is what economists would consider a “zero-sum game,” because everyone enters the poker game with the same amount of money as everyone else and play until only one person holds all the cash.
No additional money has been created, but simply changed hands: in this case, creating one winner and lots of losers.
Many people incorrectly have the impression that creating markets and encouraging businesses to sell to the poor is a zero-sum game. They think that these businesses are the only winners, and that it does nothing to improve the incomes of people living in poverty.
That is so far from the actual case. Instead, iDE supports markets that economists would call “positive-sum games,” where additional wealth is created by the market players and there are multiple winners. For example, when a small-scale farmer can purchase a new water pump from a local agriculture dealer, not only does the dealer make a profit from the equipment sale but now the farmer is able to increase her harvest. Both make more income and both win.
But it’s really more than that. People who make less than $2 per day do not live in isolation, but often are part of communities where the majority earn the same small amounts.
So when a farmer increases her income or a dealer is able to make a profit in their business, they buy things in their community.
The farmer is now able to send her children to school (free primary education is not commonplace in Asia or Africa).
The dealer is able to expand his house with a new latrine.
This employs local teachers and masons, who in turn need to purchase food and housing. With their increased income, they often buy a bicycle, soap, or a TV. Everyone’s income and livelihoods increase.
When people ask me if the interventions that iDE engages in are sustainable, this is the kind of real-life scenario that I use to describe how our work is rooted in what people really want and how they use it to improve their lives.
I like to think of this as a super-positive-sum game, and it’s why I’m committed to iDE’s approach to solving poverty. We’re so positive this works that we make a promise to our donors that every $1 received by iDE will result in at least $10 in improved income for our market players.
We know this because we constantly measure it. And that’s only the direct income (the positive-sum), not the super-positive impact this investment has on the communities these people live in (which we haven’t figured out how to measure, or receive funding to measure…yet!).
In 2007, Splash began our work in China to reach over 1,100 orphanages spread across a country that spans 3.7 million square miles. Ten years later, Splash is set to reach our goal of providing safe water to every single orphanage in China, benefiting over 120,000 children. As we approach this milestone, a new challenge has emerged — how to ensure the long-term service and maintenance of the water filtration systems across the vast distances that we operate, in the most cost-efficient way possible.
Splash uses commercial grade water filtration systems to ensure the highest quality standards for purification. The systems, while incredibly durable and cost-effective, do require annual servicing, and occasionally things go wrong. For example, at one site in 2016, the heat unexpectedly went off during the winter break, causing all the water pipes to freeze, which shut the water system down entirely. While some orphanages have staff comfortable handling minor to major problems, many sites are simply not equipped to do so.
For years, the Yunnan-based technical team provided routine maintenance and responded to service calls in person. With sites spanning from Shanghai to Xinjiang, our small technical team could travel up to 4,000 kilometers to service the water filtration systems. They faced additional hazards in our orphanage sites in Tibet, located 5,000 meters above sea level, where they needed supplemental oxygen masks to complete their work. As Splash looked to devise a long-term sustainability strategy, it was clear that we would have to think outside of the box and devise a more efficient solution.
We’ve witnessed how communication technology is radically changing the lives of the world’s poor, even in far-flung regions of China. WeChat, a mobile app and messaging platform that has taken China by storm (read more here) has over 846 million monthly active users, and has become a ubiquitous fixture of modern life in China, much like WhatsApp in India or Facebook Messenger in the United States. People and businesses use WeChat for mobile payments, social marketing, shopping, games, customer service, even charitable giving. Why couldn’t Splash use it to help ensure clean water for kids?
With the generous support of FIL Foundation and a tech-savvy WeChat developer, Eggplant Digital, Splash decided to take the leap and develop a mobile app. Our goal was to leverage our Salesforce data with a customized WeChat interface that would allow users to verify their account and filter system information, receive automated reminders of upcoming maintenance, and view instructional guides, while also requesting spare parts and expert support via the WeChat app. The customized WeChat app launched this month and has already generated rave reviews from orphanage staff.
“Very good! Before this we relied on the telephone and QQ messaging, now there is a new way for easier and faster communication between us.”- Mr. Guan Changyong, Director of Panjing City SWI of Liaoning Province
When the orphanage can’t solve a problem on their own, they have the option to submit a help request directly to our team. Help requests use WeChat’s capability to send pictures and video recordings to allow users to explain the issue they are facing. The feature enables Splash’s local team in China to follow up directly through WeChat messaging. Thanks to our state-of-the-art use of technology, Splash has a new tool to help ensure clean water for tens of thousands of kids across one of the world’s largest countries, without having to send our staff to every corner of the country.
As many tech firms know, the first version is never the last. We need innovative partners to help us continually improve our technology solutions. In the future, we hope to use WeChat for mobile fundraising campaigns in China and partner with Tencent, the parent company of WeChat, to leverage their powerful mobile platform and innovative charitable support. Splash is also looking for local partners in China to help us streamline the supply chain of spare parts that each of our partner sites depend on, for which we have created a local sustainability network.
If you are interested in supporting our work, you can donate here or connect with our local sustainability network, by contacting our Splash China team. Splash projects in China can also receive local donations through our joint project account with China Charity Federation, funding filter replacement parts. We received our first local donation from Watsons at the end of 2016 and are excited to grow our local funding partnerships to help sustain clean water for every orphan, abandoned or disadvantaged child. Please contact us if you are interested in donating through China Charity Federation to be eligible for a tax-deduction in China.
Splash aims to improve the health and development of children in dense, urban areas by ensuring they have clean water, clean hands and clean toilets. Founded in 2007, Splash has completed over 1,700 projects serving more than 400,000 kids in eight countries: China, Cambodia, Bangladesh, Ethiopia, India, Nepal, Thailand, and Vietnam. Over the next five years in Kolkata, India; Addis Ababa, Ethiopia; and Kathmandu, Nepal; Splash aims to reach 100% of public schools with full WASH coverage to ensure that over one million children have clean water, clean hands and clean toilets by 2021.
Taking an investment approach to grant making, the FIL Foundation funds strong charities where a grant can add lasting, measurable value. The Foundation seeks to support strategic initiatives that enable charitable organizations to reach new levels of achievement. Grants are intended to strengthen charities and encourage the highest standards of management and long-term sustainability.
iDE brings real-time data and entrepreneurial thinking to successfully tackle global poverty issues
A version of this article was posted on zilient.org in June of 2017.
In Cambodia, nearly 60% of rural households do not have a toilet and instead practice open defecation, resulting in problems like increased diarrheal disease that is a leading cause of death for children. The government set a goal to increase national sanitation coverage to 100% by 2025 (starting from 34% in 2010), a challenge that can not be met by simply giving toilets away because of the costs involved. iDE started to address this issue in 2011 by developing a new latrine that was extremely affordable and easy to make for local concrete manufacturers, selling over 200,000 latrines in five years. While these numbers indicated a successful business model, something new had to be done to continue to sell at this rate and reach the 100% goal as the market for toilets eventually reached saturation.
Unveiling a new way to sell toilets
Thai Rotha, an iDE sanitation sales agent, parks her motorbike outside a wooden framed home on stilts. She gets off and opens her smartphone to note the location: Kachow (village), Popeus (commune), Sveyontor (district), Prey Veng (province), Cambodia (country). She also tags the GPS coordinates. Rotha meets with the female homeowner in the shade underneath the house to escape the oppressive heat of the dry season, her friendly manner quickly putting the potential customer at ease. Rotha uses a laminated book with drawings that convey how the lack of sanitation contributes to sickness in the family, especially for children. As she talks, Rotha pulls out her smartphone and shows the woman pictures of toilets installed in the village next door within the last month. The woman wants to buy, but she says she and her husband have no money to spend on it right now. Rotha notes the decision and also sets a reminder to follow-up. Rotha gets back on her motorbike and sets off for the next client. By the end of the day, she will have visited six homes and made three immediate sales.
Rotha, age 23, is the youngest of five siblings and still lives with her parents near Phnom Penh. A friend told her about iDE, an international development non-profit organization that addresses global poverty by using donor funding to build business solutions that scale. Before becoming a sanitation sales agent (iDE calls them “sanitation teachers” or STs) eight months ago, she was unable to make much money. As a sales agent, Rotha is not an iDE employee; instead, she is part of a cadre of agents going door-to-door in Cambodia’s most rural communities, receiving a commission of $4 for every $34 latrine that she sells. She’s made $300 in eight months, enough to purchase a new motorbike, and is now saving money for the future.
The reason for her success lies in the power of her smartphone to feed data to a cloud-based management information system (MIS), capturing both the sales Rotha makes this day as well as those she doesn’t.
Balancing supply and demand with data-driven insights
In iDE’s offices in Prey Veng, Thai Rotha’s orders are received by San Ounsa, her Supply Chain Coordinator. At 26, just a few years older than most of her agents, Ounsa attended Svay Rieng University and has a Bachelor’s degree in Rural Development. She comes from one of the poorest provinces in Cambodia, which also happens to be where some of the best toilet businesses have emerged as well. As an international social innovation organization, iDE’s employees tend to be citizens of the country they are working in (93% of its total workforce of nearly 1,000 employees are locals).
Ounsa’s job is to review the orders entered by sanitation agents in Salesforce. While the software automatically assigns the order to the closest latrine business owner to the customer, Ounsa determines if that manufacturer will be able to deliver the latrine in a timely manner. Ounsa contacts the business owner to check out how things are going. These small businesses sometimes shut down suddenly, for example when the owner has to go help out his family or get a harvest in. Once Ounsa confirms the business has the capacity to fill the order, she negotiates an anticipated delivery time frame to the customer, then the business makes a phone call to the customer to arrange for delivery.
In the original business model, where agents and manufacturers were exclusively connected, business owners who had high-performing sales agents struggled to keep up with the demand, while other manufacturers whose agents were having trouble making sales sat idle. The new mobile ordering process untethered agents from manufacturers, enabling iDE to resolve this market bottleneck by decreasing the time it took from order to delivery and increasing the number of orders fulfilled. Being able to view sales and delivery data in real-time exposed this load-balancing issue, and also provided a means for the supply chain coordinator to re-balance orders to ensure that everyone involved stayed as busy as possible.
The paper trail vs. the digital highway
Prior to iDE’s MIS, each sanitation sales agent was coupled to a single latrine manufacturer. The agent would travel to remote villages and collect orders on paper. Days later the order would reach the latrine business owner. Depending on how many orders the latrine manufacturer was already working on, fulfilling a new order and getting it to the remote village for installation could take weeks. By then the customer may have decided to cancel buying the toilet.
iDE had begun to explore the idea in 2014 that a MIS could be implemented to help sales. While in the process of adopting Salesforce to handle the measurement and evaluation needs required by their donors, iDE created a new custom-built app based on the actual sales process that would capture transactions at the most granular level. Using TaroWorks, iDE designed the data collection app for smartphones to enable remote sales agents to enter and upload orders from the buyer’s location. This accelerated the process, eliminated paperwork, and minimized mistakes in ordering and transcription. With better tracking and faster completion, the agents saw a reduction in cancellations and became more motivated to make sales as their incomes started rising.
Although Salesforce originally designed a customer relationship management solution to help sophisticated sales teams pull in big deals, the customizable nature of Salesforce made this shift to capturing individual toilet sales data possible. While other companies had started to explore this potential with Salesforce, iDE’s implementation was the first to use it in an international development context.
Coordinating a network of independent suppliers
In Cambodia, Michel Dauguet leads the sanitation marketing program. iDE’s organizational structure is extremely decentralized, with each of its eleven country offices having strong autonomy in the management of their local programs. A veteran businessman with more than 20 years of experience in southeast Asia, Michel was previously the CEO of a number of medium-sized companies including several that he founded. He speaks quickly and passionately about how having data in near real-time has boosted the speed of innovation.
Michel says, “Before the MIS, we had no idea of the backlog. We didn’t even know we had a block in the supply chain. We had reports that the supply could not follow up with the demand, but it was hard to discern if it was a bottleneck in the production capacity, meaning we needed more latrine business owners, or the existing ones needed to produce more. Another option was that the production was sufficient, but the peaks and valleys, the volatility in demand, caused problems. Is the problem that the manufacturers are subject to a stop-and-go type of process where they have a lot of orders and have to hire a lot of staff and then they have no orders and have to decrease their production capacity significantly?”
The MIS not only answered these questions, it also gave the management team a powerful tool to address other persistent issues. A lot of well-intentioned ideas — both in the private and non-profit sectors — fall apart in execution and management. But with the MIS, iDE better understands closing rates by individual sales agents as well as sales teams and the change in the backlog from day-to-day.
“What is valuable to the funder is much more precise information. Data is messy and without an MIS to organize it, it can hide inefficiencies and be ignorant of unwarranted behavior or negative effects on the community. All of these are evaluation questions that a donor would normally have to fund deliberately, but with an MIS all of these questions can be much more easy to answer,” says Michel.
Implementing an MIS like this, however, is rarely funded by traditional donors, whose grants focus on program activities that are measured by numbers of households reached rather than addressing program efficiencies. The Australian Government, focusing on enhancing the accountability and effectiveness of aid programs, and the Stone Family Foundation, supporting increased access to sanitation for the poor through business models that scale, underwrote the development of iDE’s MIS.
iDE’s Sales Managers constantly review sales agents’ performance, identifying both those who are struggling to make sales as well as the high-performing individuals. Because everyone involved has sales goals that lead to incentive payments, everyone is interested in increasing sales. Lessons learned from outstanding sales agents get passed on to those having trouble through regular meetings between managers, coordinators, and agents. The order data is shared with everyone, so the whole team knows the latest on how many toilets have been sold, where, and how long it takes to get them installed.
Analyzing data to fill in the market gaps
When iDE first implemented the MIS, they wanted to capture sales data to speed up the delivery process. But sales ended up being only part of the story. Looking at the data, Michel discovered that something very important was missing: information about sales attempted but not successful. What would have been overwhelming to track on paper, was actually very simple to add to, and analyze with, the existing MIS.
Michel explains, “When you looked at our sales on a map, they looked like little points of light with lots of darkness in between: villages that simply weren’t buying latrines. I called it the Dark Matter report — in astronomy, dark matter is all that blackness around the stars.”
“We learned that we were leaving out significant parts of the market,” Michel says.
Estimates said that it would take six months to visit all the villages. Then the data started coming in and the sales teams were reporting they had done so in just two months.
“There was a wave of realization among top management that there was self-inflicted damage caused by poor sales planning and the teams were not fully exploiting the actual accessible market. Without the data, the sales coordinator could have said, ‘You don’t know my market context,’ but now we had an objective arbitrator that allowed us to have a productive discussion about sales planning.”
In one week, Thai Rotha visited three different villages, making 19 sales calls, and selling six latrines. San Ounsa and Rotha review the Dark Matter report to determine what they can do to convert those 13 missed opportunities into future successes. Michel reviews the Dark Matter report with Sales Managers to identify areas where other options may be needed to increase sales, such as new latrine designs, financing options, or targeted subsidies for the poorest customers.
The MIS serves as a backbone that infuses a high level of rigor and transparency, which is why iDE is replicating it across its other programs. For example, in Ghana, a new sanitation business called Sama-Sama has been designed from its beginning to gather very granular data and make it accessible to every level of the company.
“The MIS is definitely the spine of the program,” Michel says. “It’s really amazing when you visit a provincial office. Once you give the tool to the people and teach them how to do custom reports, charts, etc., it is amazing what they come up with. They are developing their own dashboards and visualizations and they are interrogating the data in ways that you can never think of. This is incredibly empowering for all members of the staff.”
Thanks to Glen Engel-Cox and Dan Clark for contributing to this article.
Chris Nicoletti leads iDE’s global measurement efforts in close cooperation with iDE’s Research and Evaluation Specialist and Information Systems Architect. Chris provides strategic leadership and technical support to country programs by conducting rigorous impact evaluations, designing and implementing efficient management information systems and effectively communicating data for managers and external audiences. He holds an M.S. in Agricultural and Resource Economics from Colorado State University.
If you don’t remember the 2016 famine in Ethiopia you shouldn’t be too surprised, because it didn’t happen. It didn’t happen despite the fact that 2016 was the worst drought in Ethiopia for the last 50 years, eclipsing the infamous drought of 1984. It also didn’t happen despite the fact that Ethiopia’s population doubled since 1984, from 50 million people to 100 million. If you look back at news reports on the region from the beginning of 2016, many predicted that famine was inevitable by summer. But it didn’t happen.
It’s not that food wasn’t a problem. It was. Ethiopia tried to address the problem by itself initially, but quickly realized that current food supplies wouldn’t suffice. The government requested a substantial amount of foreign aid, much of which was supplied, and then did a good job of getting the food distributed to needed locations, mainly the rural countryside where sustenance farming is still the primary way of life.
But the real story was how 30 years of proactive policies and development interventions created a stronger, more effective market climate that helped people survive what could have been a disaster.
Ethiopia is a land-locked country in the Horn of Africa in close proximity to the equator. While average precipitation across the country is 47-inches per year, drought occurs regularly because of the natural El Nino weather pattern that causes rainfall to vary wildly from year-to-year, including some locations receiving as little as 20% of the normal annual precipitation. 2016 proved to be a particularly difficult year for most regions of the country, with the worst drought recorded in the last 50 years.
The drought that occurred in Ethiopia in the mid-1980s prompted a global response that culminated in both the “We Are the World” media event and accompanying Live Aid concerts. The approximately $200 million raised, however, did little to prevent 900,000 deaths from the resulting famine. Money never got to the people it was intended to help, and instead was used to buy weapons the government needed in their fight against insurgents. While the root cause of the famine may have been the drought, misplaced charity and bad government policies drove the famine into becoming a disaster that became news across the globe.
An economic miracle?
An Ethiopian government change in 1991 has led to two decades of stability without instances of the racial or sectarian conflicts that continue to plague its neighbors, Somalia to the southeast and Sudan to the west. Ethiopia has become an economic powerhouse, recording double digit growth for the last decade. The government says that it is on track to meet the UN’s Millennium Development Goals and will obtain middle-income country status by 2025.
Even so, underlying conditions that could lead to future famines continue to grow, conditions totally unrelated to conflict. A constantly expanding population puts a strain on an already stressed food supply system. Three-percent population growth in sub-Saharan Africa outpaces the rest of the world (e.g., 1-percent in the EU, North America, and Asia). Agriculture must dramatically increase to keep up with this demand, but production rates are a third of Western farms (e.g., 2,325 kg cereal production per hectare as compared to 7,637 kg in the US). And the predicted effects of El Nino, as well as the unpredictable effects of climate change, means that future drought conditions will be more severe and last longer.
A business solution to famine
It may seem obvious, but the solution to drought is to make water available. Unfortunately, the majority of Ethiopian agriculture follows traditional practices that rely on rainfall alone, limiting harvests and income. But another benefit of three decades of stable government has also enabled international development groups to address this issue. For example, iDE, an international non-profit that focuses on creating business opportunities to address poverty, has been working in Ethiopia since 2007 to bring key technologies like inexpensive pumps, drip irrigation, and modern farm rotation techniques to grow crops in the dry season and replenish degraded soil.
To spread these technologies, iDE trains a network of local micro-entrepreneurs based on their Farm Business Advisor model. These Advisors come from farming families, so they have a background in agriculture, but lack access to enough of their own land to be full-time farmers themselves. After receiving technical training from iDE on how to promote and sell resource-smart technologies, they travel from rural farm to rural farm, convincing farmers to invest and grow dry season vegetables by using a realistic cost-benefit analysis based on the farmer’s own field to calculate the cost of implementing the technology versus the profit to be made. iDE’s Advisors are helping their clients, themselves, and their country prepare for the next famine.
iDE’s return on investment for donations supporting the creation and support of Advisors and other programs in agriculture in Ethiopia is $14.90 of increased income for clients for every $1.00 spent of donor funds. This number is based on direct annual returns as measured by their measurement and evaluation team and does not include income generated from the ongoing activities following the conclusion of their market intervention activities.
Resilience begins in the field
If Ethiopia is going to be ready for the next disastrous drought, sustenance-level farms must diversify their production. They can do this by learning how to grow crops not only during the rainy season (their traditional method) but also during the dry months. This will provide an increase in income, not in one large sum, but spread throughout the year. These farmers also need assistance in connecting to markets that enable them to buy seed for new crops and sell their new production. In particular, assisting those farmers living far from roads and market infrastructures who’ve never had the opportunity before to realize the power of technology and business to increase their production is vitally important.
The Ethiopian Famine of 2016 didn’t happen for a number of reasons. Nearly three decades of peace, a forward-looking government, a new food distribution system, and new agricultural practices. But it’s going to take a lot more progress to avoid famine caused by the inevitable droughts to come in 2020, 2025 and beyond.
Why are there fewer people globally with access to safe water now than last year according to the official numbers of the World Health Organization and UNICEF’s Joint Monitoring Programme (JMP)? Is the world going backward?
Absolutely not. The reality is that we’re becoming increasingly aware of the dismal shape of the world regarding providing adequate water and sanitation services — and it’s even worse than most people thought. Yes, we are still living in the midst of a global water and sanitation crisis.
It makes our work at Water For People — to ensure Everyone has access to safe water and sanitation services, Forever — more important than ever.
Until July 11, 2017, we at Water For People stated that the drivers for our work were to provide sustainable services to 1.8 billion people for safe water and 2.4 billion people for sanitation. These were referenced global baseline data points on the state of the world from the University of North Carolina and the JMP before they issued the first ever global assessment on “safely managed” drinking water and sanitation services on July 12, 2017. This thorough assessment changed the global baseline from 1.8 to 2.1 billion for safe water and 2.4 to 4.5 billion for sanitation. This means that the situation is far worse than previous global estimates, specifically, 30% worse for water and 75% worse for sanitation. But more specifically, the baseline data is more accurate.
This is a big deal.
But before despairing and thinking that we can’t solve this crisis, we ought to reflect and think about where we are and how far we have come.
We know how to solve the global water and sanitation crisis. It takes national and local leadership, investment, and political will. Let’s not forget that the UN member nations have made great strides since the Millennium Development Goals (MDGs) were initiated in 2000. In 2015, the JMP found that the MDG global target for drinking water was met five years ahead of schedule, and significant progress was made toward the sanitation target, despite falling short of the stated goal. This led to the development of the 2016 Sustainable Development Goals (SDGs), which set even more ambitious, yet absolutely correct, goals for 2030. Thankfully water and sanitation now have a dedicated goal — SDG 6 — available and sustainable management of water and sanitation for all.
The global water and sanitation crisis is not in search of a solution. We have the solution — we need the human and financial resources to implement it.
Water is the basis of sustainable development. Safe water improves health, allows for access to education, pushes economic development, and enhances the quality of life for every family on earth. This is true social progress, and we have proof of its returns. We know that for every $1 invested in water and sanitation infrastructure we get at least a $4–5 return on economic productivity. The reasons to invest in this infrastructure seem obvious.
If this is the case, why wouldn’t every government make this investment? We know there is no simple answer. Government funding is complicated and there are competing needs for the limited financial, human, and natural resources needed to solve this crisis. Still, we can turn the tide and close the gap towards SDG 6 faster if we educate, build, and invest more.
These were my three calls to action in my TEDx talk, and they haven’t changed:
· Educate people in the global North that there is a water and sanitation crisis, and in the global South educate people to demand WASH services (and then change people’s behaviors to actually use these services).
· Build the missing infrastructure and (equally important) the human capacity, water utilities, and businesses to operate and maintain the infrastructure.
· Invest in infrastructure, institutions, policy development, and education. Luckily there are some presidents and national governments leading the way in promoting water and sanitation for their entire countries, which is why we have prioritized our national programs in Rwanda, Uganda, Bolivia, and Honduras as part of our global strategic plan.
What is Water For People doing about the new JMP baseline numbers? Continuing our work with an even greater urgency and commitment than before.
The revised, more accurate JMP baseline makes SDG 6 more challenging to reach by 2030, for sure. Thankfully, at Water For People, it actually confirms what we already knew. More people lack access to services than the previous JMP numbers had stated, especially in rural areas. Our own baseline numbers have not changed in the districts where we work. We do extensive data collection and we know (in much greater detail than the JMP) the existing levels of services. We built our district workplans to reach services for Everyone Forever with the starting point based on our actual data, not JMP or other estimates. We are also working with our partners in Agenda For Change on changing the systems in which we work to ensure high service levels can continue once established. This is done by helping national governments create the policies, secure the financing, and build the businesses and institutions needed to provide sustainable services.
SDG 6 will be reviewed in depth in 2018 at the UN High Level Political Forum on Transformation Towards Sustainable and Resilient Societies. It will be interesting to see what progress the UN member nations have made on prioritizing financing for water and sanitation services globally. At Water for People, the revised baseline numbers from the JMP give us a sense of even greater urgency to achieve our mission.