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Cleaning up our act: Scalable actions and effective aid

Time (GMT +00) 09:30 13:00

Session 1. Sanitation perspectives: taking stock of the International Year of Sanitation (IYS)

Jon Lane started by emphasising that the IYS had achieved a great deal:

·         Messages about sanitation have reached new places. Increasing political and media interest is occurring in many countries in Africa and Asia, and at the global level major philanthropic organisations are interested

·         The IYS has unified the sanitation community behind one set of messages, and achieved unity within the UN – a notable achievement.

·         It has been demonstrated that demand-led, people-centred approaches to sanitation get results, not hardware subsidies.

·         Sanitation has been placed in the wider development context: sanitation is now talking to the health, social development, economic growth and environment sectors in their own terms, using positive messages.

Jon Lane emphasised that the IYS is a springboard for further effort, which will be further supported by the Global Framework for Action on Water and Sanitation agreed last year. Where next?

·         There is a need to work more with the medical/health profession.

·         Economic growth arguments will be key to convincing Ministries of Finance to spend money on sanitation. 1 dollar of spending on sanitation generates 9 dollars of economic activity.

·         Sanitation is being transformed from a neglected development sector to a dynamic area of human economic activity. This means a complete change of mindset: once demand is built, then local entrepreneurs will provide services.

·         Community-Led Total Sanitation will be a major tool going forward.

Finally Jon Lane identified 4 knowledge gaps:

·         Working at scale is not the same as scaling up, and we have to understand better the processes involved with working at scale. He gave the example of mobile phones, which did not start in a single village.

·         How to serve people in crowded slums: we do not know the best way, although shared or public facilities are probably needed.

·         Which advocacy approaches have succeeded or failed

·         Engaging with Ministries of Finance: we need to learn the best approaches.

Robert Chambers presented the latest achievements of Community-Led Total Sanitation (CLTS), and its future prospects.

·         CLTS is mainly relevant for rural sanitation.

·         It does not involve hardware subsidy, but community members help each other.

·         Facilitators help communities to analyse the pathways by which human waste ends up in their food or drinking water, rather than lecturing.

·         Although the paradigm shift was hard for some to accept, CLTS has now reached 20 countries. It is particularly significant in Bangladesh, India, Indonesia, Ethiopia, Kenya and Tanzania.

·         The total impact is hard to assess and probably small against the 2bn people affected by open defecation in rural areas, but CLTS is spreading exponentially.

He then highlighted lessons learned from the CLTS experience.

·         Disgust, self-respect and convenience motivate change more than health, especially for women.

·         Certain environments are more favourable than others: where there is a policy for latrine subsidies this makes CLTS difficult (e.g. India); when sanitation sits in the Ministry of Health prospects seem to be better for CLTS; CLTS is more successful in smaller communities.

·         Approaches to reaching the MDGs which focus on costing solutions and pumping in money are dangerous for CLTS; budgets are needed for training and capacity development but not for hardware.

·         Efforts to develop markets to meet the demand for sanitation facilities, as well as supportive policies, are needed.

·         Triggering change is not enough: follow-up is needed, particularly on maintenance of hardware.

Robert Chambers then identified significant knowledge gaps remaining on CLTS.

·         The processes taking place in communities and different ways to achieve “triggering”

·         The issues involved in going to scale, including trade-offs in terms of the quality of facilitation (existing health workers can not necessarily do it easily and so far training has only been successful when carried out intensively with communities).

·         The best approaches for policy change and advocacy, for example how to engage with India on the question of latrine subsidies.

·         How to create and support champions (passionate individuals make the difference).

·         How to avoid abuses of CLTS (the risk that other less effective approaches label themselves CLTS because of its popularity)

He concluded that there is a huge potential impact from CLTS. It may not be realised, but the next few years will be critical. CLTS could explode and become self-spreading. Everyone is invited to share insights on CLTS via the dedicated website.

Sandy Cairncross, as discussant, focused on four knowledge gaps:

·         The health impacts of sanitation. How do health benefits relate to coverage (and is 100% coverage needed)? What are the health benefits of on-site sanitation vs sewerage in urban areas? What are the usage patterns of facilities, particularly by and for children, and their implications? How are sanitation facilities maintained and what are the risks of inadequate maintenance to or to those maintaining (e.g. pit emptiers).

·         The link to education. How can effective sanitation and hygiene education be achieved in all schools, not only those with a dynamic committed headteacher? How far are the messages children learn in school taken home, and how do they affect household hygiene behaviour? What is the impact of segregated school toilets on girls’ education?

·         Adapting approaches to local conditions. Can CLTS be adapted to urban areas or are other approaches such as commercial marketing more effective? Can municipalities take on a quality control role? Do sanitation programmes stimulate uptake in other communities? How can supply chains be supported at the same time as boosting demand for sanitation? How sustainable is the market? Is there a living to be made in the sanitation business, or will latrine-building only provide enough income to be a sideline/part-time job?

·         Economic issues. What is being spent on sanitation vs. the cost of disease? What are the per capita costs of sewerage vs. on-site sanitation? Are figures showing higher growth rates in countries which have invested in sanitation robust? If so we should trumpet them loudly!

A floor discussion followed the speakers. Questions and comments included:

·         Urban sanitation: what are the next steps? Robert Chambers replied that CLTS has worked in some small urban communities, but depended on exceptional political leadership. However the CLTS approach can be used successfully for urban solid waste management. Jon Lane acknowledged that historically most attention has gone to rural sanitation, but this is changing as urban populations increase. For on-site sanitation tackling land tenure is essential (a legal process), and at the same time better links need to be made between municipalities who have the responsibility for sanitation and civil society who often have the ideas (a political process). The transformation of sanitation into a dynamic economic activity will come from big cities – there are even cases of people being paid to use public toilets! Sandy Cairncross shared his experience from Mozambique where a simple latrine design has been taken up, adapted and marketed by the local private sector leading to coverage of 90% of areas outside the sewerage network. He compared this with Tanzania, where subsidies were provided for a specific latrine model and only 200 were taken up.

·         How can we ensure that finance reaches the local level where it is needed?

·         In Ethiopia one region has developed a strong sanitation policy and is making efforts to take it to scale. This could be a good study case. Jon Lane mentioned Burkina Faso and South Africa as other interesting cases.

·         Why did the IYS focus only on household sanitation? Sanitation is also about sludge treatment and disposal, pollution control and urban planning. The speakers agreed with the need for an integrated approach to sanitation, but Jon Lane explained that the IYS focused on household sanitation in order to have clear, simple messages.

·         The current financial situation may mean that subsidies become less popular, which could be a good opportunity to advocate for CLTS.

·         A meeting is planned this year between finance ministers of developing countries and development ministers of donor countries. What should we aim to achieve from this? Jon Lane responded (1) every country knowing which Ministry sanitation falls under, and (2) Ministers of Finance making a commitment (not just an aspiration) to allocate money to sanitation.

·         Is there a connection between education being dominated by men (teachers and policymakers) and the lack of separate toilet facilities in schools? In one district of Rwanda, only the school with a female headteacher has separate facilities and the drop-out rate among adolescent girls is high.

·         Municipalities are key for leading changes in sanitation, so research should look more at the politics and democratic functioning of urban areas and advocacy should be targeted at municipalities as well as the national level.

·         Radio is a very cheap and effective way to reach lots of people. Sandy Cairncross agreed and highlighted a study in Kenya which found a strong association between access to radio and levels of handwashing following a radio campaign.

Giving final remarks, Robert Chambers said that understanding lateral spread of sanitation and finding ways to support it using a “light touch” will be critical. Jon Lane emphasised that every one of us can make a difference to the future of sanitation, and called on participants to play their part. Sandy Cairncross stressed the need to listen to consumers and respond to their choice of sanitation facilities – not to assume that any one technology holds the answer.

Session 2. The role of aid in achieving the MDGs: a sector perspective

Armand Rioust de Largentaye presented a recent study on aid effectiveness (AE) on infrastructure, one of the inputs into Roundtable 8 (on sector AE) at the Accra High Level Forum.

·         The study is not yet published but main findings were that the Paris Principles do apply in infrastructure sectors, particularly ownership and alignment: capacity building and use of local systems are key.

·         A project approach was found to be more appropriate than budget support for large infrastructure investments.

He then explored some issues which arose at Accra in relation to sector AE.

·         Many sectors are considered not ready for budget support – but will they ever be? When is it appropriate to start budget support and what are the risks?

·         Leadership from Ministries of Finance, not sector ministries alone, may be important for AE at sector level. This is illustrated by the experience of Uganda.

·         Donors need to take more risks and be prepared to use country systems: “the leaks only appear when water is fed into the pipes”.

·         Growth was said to be necessary for strong ownership.

Maurice Bernard then discussed some specific water and sanitation sector issues in relation to the Paris Principles.

·         The water sector is complex and fragmented. The allocation of responsibilities and regulatory frameworks to govern how actors operate, are therefore very important. Finance is necessary but not sufficient to achieve the MDGs: governance is central.

·         The water sector has three sources of revenue: charity, taxes and tariffs. The balance must be right in order to leverage further financing. The water sector needs stable, predictable financing because it involves large investments with long return periods.

·         There are hard policy choices to be made in the sector in terms of: trade-offs and priorities in coverage levels and standards of service provided; the mix of revenue sources to be adopted; technologies for water and sanitation; and prioritising among subsectors (water and sanitation, rural and urban).

·         Using budget support requires that these hard policy choices are already made, with adequate capacity in place at all levels and good governance. We are not there yet, but in the meantime there are steps that can be taken, for example:

o        Focus on one subsector first – it is hard to tackle the whole sector at once

o        Support ownership and accountability by capacity building

o        Support and leverage sector policies

o        Harmonise and prepare for alignment, including through using basket funding. He said that AFD are using output-based basket support at subsector level, which ensures ownership as the programmes are defined and implemented by government and not micro-managed by donors.

o        Make efforts to increase the reliability and predictability of finance flows (but he argued that ODA currently provides only around 5% of the sector’s financing needs, so it remains critical to get the tariffs and taxes right and to engage Ministries of Finance effectively).

Maurice Bernard concluded by setting out some examples of recent European Initiatives. These include the EU Neighbourhood Investment Facility, which aims to catalyse co-financing for water and other sectors. So far it has been put in place in Egypt and Tunisia.

Brian Baldwin then made a presentation in four sections: (1) AE issues in the agriculture sector; (2) changes since Accra; (3) issues of results and accountability; (4) next steps. He first identified specific characteristics of the agriculture sector, which are shared to some extent by water and sanitation, and their implications for AE:

·         Agriculture is private-sector led, with the state setting the broad policy environment. (He noted that OECD were initially not interested in applying AE principles in agriculture for this reason, seeing the Paris Principles as applying to the public sector only.)

·         A wide range of stakeholders are involved.

·         It is cross-ministerial and heterogeneous.

·         There is often a lack of integration of sectoral or local strategies for agriculture with national policy, creating a challenge in terms of ownership.

·         Alignment and harmonisation are improving, but mutual accountability and managing for results require more work.

He then discussed changes since Accra.

·         Concrete steps have been taken to increase transparency, predictability, the use of country systems, untying of aid and division of labour among donors.

·         Some progress has been made on fragile states and conditionality.

·         A significant change was achieved in donor-partner relationships with increasing accountability and trust. He reported that developing countries emphasised two main concerns: “you don’t use our systems and you don’t trust us”.

·         These steps were reflected in the Accra Agenda for Action, which also emphasised capacity building (with governments to decide where it is needed), commitment to civil society, and the further work needed on mutual accountability and managing for results.

·         A major step was the agreement on country reviews of results, involving parliaments, civil society and the private sector.

Brian Baldwin then talked about the challenges involved in effective management for results.

·         He gave an example from Sri Lanka where a results-focused policy has driven the development of an innovative results management framework in the last year, including the use of scorecards and a country level community of practice.

·         Managing for results requires a country system.

·         He suggested that Ministries of Finance should not be our target: what is key is to make sure sector ministries have the right messages to argue for resources.

He concluded by identifying some important next steps to enhance sector AE:

·         Support increased ownership, and broaden it by supporting advocacy for the inclusion of rural stakeholders, farmer organisations and the private sector.

·         Capacity building is critical.

·         Support coherent policy frameworks

·         Support the development of cost-effective results management systems, and appropriate indicators.

Katharina Welle then raised three points as discussant:

  1. We should be careful to distinguish between the spirit and the mechanics of AE. A project modality might be appropriate for large infrastructure, but does that mean that it cannot adhere to the spirit of the Paris Principles? Maurice Bernard responded that large infrastructure uses project financing in developed countries, and that projects can still allow ownership, harmonisation and the spirit of AE.

  1. Governance is central. One of the key messages from Roundtable 8 was the importance of the political economy of countries and sectors for progress in AE, a finding borne out by a recent ODI study on AE in water, health and education. Katharina Welle proposed three building blocks for understanding governance:

·         Actors and ideologies. Who is involved, and what is their development ideology?

·         Accountability and decision-making. Are formal or informal processes important? How are decisions made in reality and how can we engage with them?

·         Incentives and constraints. What determines the way actors in the sector behave?

She argued that understanding these will enable us to deal better with risks.

3. Managing for results faces particular challenges. There is a danger of confusing monitoring progress in AE with progress in development outcomes. It is also difficult to make comparisons in AE between sectors, as data is often incomparable with no common indicators. Katharina Welle suggested greater learning across sectors is needed, for example from the Sri Lankan model for managing for results. Finally she emphasised the need to include civil society and parliaments in managing for results, and asked whether tools such as scorecards are easy to implement in practice. Brian Baldwin responded that the Sri Lankan model works across sectors, and is informing other South Asian countries although it is very new.

A floor discussion followed the speakers. Questions and comments included:

·         How should we work towards AE in low governance situations, where trust is often lacking and it is hard for outsiders to penetrate the system? Maurice Bernard replied that few countries are ready for budget support, and that ownership must mean more than having a policy in place, but implies real commitment, accountability and dialogue. Guy Howard reacted that general budget support is not a high proportion of ODA and is only used in some countries. He emphasised that AE is a philosophy of doing business, not just budget support.

·         Is there room for models to channel finance directly to the private sector or local government, with government’s approval? Brian Baldwin replied that donors are not yet good at engaging the private sector, and don’t know who to engage with. He said that sometimes the private sector does not want to work with government, because of the risk of changing policies.

·         Sri Lanka should not be held up as a model, because of the ongoing conflict which aid has done little to address.

·         How can donors address land rights? Brian Baldwin agreed that the issue is critical, but said that donors can only tinker at the edges because of the primacy of national sovereignty. Donors can support local groups pushing for land reform. Guy Howard mentioned examples of water and sanitation services being brought to people in spite of lack of tenure rights in Dhaka.

·         How do donors cope with giving up their control over money put into basket funds, entrusting monitoring to others and accepting different environmental standards? Armand Rioust de Largentaye replied that untying of aid was a huge revolution, and agreed that these are challenging for donors.

·         Agriculture and water are both historically neglected sectors. Agriculture has won high level political commitment: can water learn from this experience? Only with political commitment will mutual accountability be achieved.

·         Decentralisation and devolution are linked to trust and whether resources reach local implementers. AE debates are often too centralised.

·         Sector integration can work effectively on the ground – so why not at higher levels?

·         The development community does not give enough information to voters to hold governments to account, in donor or developing countries. Armand Rioust de Largentaye responded that building accountability requires engaging the public: sector results must therefore be made public in a form that everyone can understand.

·         Many development projects do not conduct adequate impact evaluation and methodologies for this should be explored, in particular ways to involve users in setting indicators.

The speakers then gave final remarks. Katharina Welle emphasised that the indicators we use for monitoring are key, and more thinking is needed on how to do this well. Brian Baldwin highlighted the primacy of ownership. He concluded that good progress has been made but challenges remain in defining results, developing accountability mechanisms, supporting champions and fostering political will. Maurice Bernard stated that channelling aid to the private sector has often been taboo to donors even when it acts as an implementer of government policy, which should be rethought. Armand Rioust de Largentaye highlighted the importance of getting incentives right for the private sector, and said that the specific advantage donors have is in capacity building. Guy Howard wrapped up by noting that building ownership and accountability are crucial for achieving development outcomes. He said that “country-led development” is challenging as even a democratic country does not have a single view, but the development community is trying to move forward.


This event comprised two sessions, the first focused on the progress made during the International Year of Sanitation and the second debated the challenges and opportunities resulting from Accra for measuring progress towards aid effectiveness.

9.30 – 11am

Session 1. Sanitation perspectives: taking stock of the IYS

The Sanitation target under Goal 7 of the Millennium Development Goals (MDGs) is under threat. The 2008 Joint Monitoring Programme report of the WHO/UNICEF (JMP) notes that “the world is not on track to meet the sanitation target”. Between 1990 and 2006 the proportion of people, globally, without improved sanitation decreased by only 8 percent. At that rate, says the JMP, the world will not achieve even half the MDG sanitation target by 2015, with progress in sub-Saharan Africa particularly poor. “We need to greatly accelerate progress in sanitation.” The International Year of Sanitation has succeeded in raising the profile of sanitation, but, as the ‘IYS’ nears its close, what is to be done to reach the c.700 million persons which the JMP says risk being missed? At this session, speakers and participants will take stock of achievements during the IYS, and then move on to consider responses to the main challenges to increasing access to sanitation and hygiene. Key questions which the session will address  include: 

    • How far has the IYS helped to overcome the sanitation stigma and place sanitation in wider development debates?
    • What needs to happen to translate funding into effective approaches on the ground, and how can new approaches be taken to scale?
    • Where does ‘Community-led Total Sanitation’ sit within the sanitation debate, and where is it going?
    • What are the knowledge gaps? 


Jon Lane - Water Supply and Sanitation Collaborative Council

Robert Chambers - Institute of Development Studies


Professor Sandy Cairncross - London School of Hygiene and Tropical Medicine


Peter Newborne - Research Associate, ODI

11 – 11.30am - Refreshments

11.30am – 1pm

Session 2.  The role of aid in achieving the MDGs: a sector perspective

In September 2008 the aid community met at the third High Level Forum on Aid Effectiveness in Accra. For the first time, one of the roundtables at Accra focused on applying the Paris Declaration at sector level. Measuring the effectiveness of aid at sector level is particularly relevant as donor-government dialogues and aid instruments are more firmly established within sectors. Moreover, at sector level it is easier to establish clear links to development outcomes, for example through improved access to sanitation and hygiene, or decreased maternity mortality.   

Drawing on evidence from two recent studies of aid effectiveness in basic services and infrastructure sectors, the meeting will debate the challenges and opportunities resulting from Accra for measuring progress towards aid effectiveness at sector level, and discuss how the link between aid effectiveness and development outputs could be strengthened. Particular attention will be paid to instruments that allow us to better understand the governance challenges to aid effectiveness at sector level, and to identifying lessons for the water sector from other sectors as diverse as health, education, agriculture and roads.  

  • How do the challenges and opportunities for progress in aid effectiveness differ between sectors (e.g. water, health, education, roads)?
  • What progress was made on ways to measure sector aid effectiveness at the Accra High Level Forum?
  • How should the links between aid effectiveness and development outcomes be made clearer?


Brian Baldwin - IFAD / Platform Chair, Global Donor Platform for Rural Development

Armand Rioust de Largentaye - Agence Française de Développement

Maurice Bernard - Agence Française de Développement


Katharina Welle  - Institute of Development Studies, University of Sussex


Guy Howard - Water & Environment Adviser, Department for International Development