What can historical success teach us about tackling sanitation and hygiene?

April 1, 2016

     By Duncan Green     

Ooh good, another ‘lessons of history’ research piece. Check out the excellent new WaterAid report: Achieving total wateraid logo resizesanitation and hygiene coverage within a generation – lessons from East Asia.

The paper summarizes the findings of four country case studies: Singapore, South Korea, Malaysia and Thailand, all of which produced ‘rapid and remarkable results in delivering total sanitation coverage in their formative stages as nation states’. I can certainly vouch for Singapore – I spent 3 years there as a child in the late 60s. Whenever the rains came, the main roads flooded, turning the city into an insanitary swamp. Not any longer.

South Korea then and nowThe paper concludes: ‘Although their initial conditions were very different from those currently found in ‘fragile’ and ‘least-developed’ countries in Africa and South Asia, some useful conclusions can be used to inform discussions on development of strategic approaches to delivering sanitation for all:

  • High-level political leadership was crucial and did not stem from community-driven demand.
  • That leadership did not restrict itself to high-level exhortation, but was marked by an ongoing engagement in the implementation agenda.
  • Some element of subsidy was included, but alongside demand creation, and was often indirect (e.g. through housing subsidy).
  • ‘Course correction’ mechanisms were devised at all levels so that obstacles to implementation were quickly identified and addressed with remedial policy reforms.
  • Hygiene, cleanliness and public health aims drove sanitation improvements.
  • A well-coordinated multi-sector approach was a necessary condition for rapid sanitation improvements.
  • Capacity building happened alongside sanitation improvements.
  • The vision of total sanitation coverage came before attainment of levels of national wealth.
  • Reaching a threshold of per capita GDP was not decisive in the strategic choice to set the course to deliver total sanitation coverage.
  • Monitoring was continuous and standards raised as goals were achieved.’

I would underline a couple of things emerging from the summary: firstly, stuff that you might expect to be important,

Sanitation v GDP

Sanitation v GDP

but wasn’t – leaders did good things to build the nation, even though there was no bottom-up pressure. Activists who routinely say nothing happens without pressure from below please take note.

Second, lot of elements of systems thinking/how change happens here: course corrections, multi-sector approaches, ratchet mechanisms to continuously raise goals as progress was achieved.

Third that they didn’t have to wait to get rich – you can start long before then.

But there’s  a big question that the report doesn’t answer (and in that it resembles many other attempts to raid history for policy ideas): what were the politics that allowed this to happen? Here we have dirigiste one party states in Singapore and Malaysia, and military governments in the early years of take-offs in South Korea and Thailand. It’s no good just focussing on their policies while ignoring the politics – would such policies have been possible with more inclusive, democratic governments and if so, how? Need to get onto the democratic developmental state discussion if this is to be genuinely useful.

So while I applaud the attempt to oxygenate today’s policy debates with a sense of what has worked in the past, ignoring the power and politics discussion in here seems to paint a very partial picture.

My collection of useful ‘developmental lessons of history’ work now comprises

To which I still intend to add something on the history of successful redistribution. Any other candidates?

April 1, 2016
Duncan Green