Rural Water Supply and Sanitation in Africa Global ...€¦ · national level, both in urban and...

The Water and Sanitation Programis an international partnership forimproving water and sanitation sectorpolicies, practices, and capacitiesto serve poor people

June 2004

Rural Water Supply and Sanitation in Africa

Global Learning Process onScaling Up Poverty ReductionShanghai Conference, May 25-27, 2004

This case study contributes to the learning process on scaling up poverty reduction by describing andanalysing three programmes in rural water and sanitation in Africa.

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The main current challenges are to increase the pace of sanitation, toensure the poorest people are served and to improve the capacity of localgovernment to manage the work.

Executive Summary

Water, sanitation and hygieneare essential for achieving all theMillennium Development Goals(MDGs)1 and hence for contributing

to poverty eradication globally. Thiscase study contributes to the learningprocess on scaling up povertyreduction by describing and analysingthree programmes in rural water andsanitation in Africa: the national ruralwater sector reform in Ghana,the national water and sanitationprogramme in South Africa and thenational sanitation programme inLesotho. These three programmeshave achieved, or have the potential toachieve, development results at anational scale exceeding the averagerates of progress for Sub-SaharanAfrica. The lessons from theseprogrammes, and from other nationalprogrammes in Africa that are notdescribed in detail in this case study,are useful for other people aroundthe world. None of them is perfect,but they all demonstrate good workat a large scale.

Over the past decade, the rural waterand sanitation sector in Ghana has beentransformed from a centralised supply-driven model to a system in which localgovernment and communities plantogether, communities operate andmaintain their own water services, andthe private sector is active in providinggoods and services. This reform startedwith an extended dialogue with the

major stakeholders in the sector, whichled to a new rural water, sanitation andhygiene education policy. The policywas then implemented in several largepilot projects and finally the lessons fromthose projects were incorporated intothe national programme itself.This reform has accelerated Ghana’sprogress towards achieving the MDGs,especially for water. The main currentchallenges are to increase the pace ofsanitation, to ensure the poorest peopleare served, and to improve the capacityof local government to manage the work.

South Africa’s national water andsanitation programme, which is one ofthe largest in Africa, aims to fulfil thehuman right to water and to achieve fullsanitation and water supply coveragewell in advance of the MDGs. The keyelements of the national water andsanitation programme include a clearpolicy and legislative framework; animplementation programme which hasprovided water infrastructure for over9 million people in less than 10 years; apolicy of free basic water, which aims toensure that affordability is not a barrierto access to safe water; and thedevolution of responsibility from nationalto local government. The governmentbelieves that the programme is oncourse to achieve full coverage of watersupply and sanitation by 2010, well in

advance of the MDGs, although otherobservers are less optimistic. The mainpoints of concern in moving forward arethe capacity of local government toimplement the work and the financialsustainability of the free basic water policy.

Lesotho is one of the few countries thathave put sound principles for sanitationinto practice at a national scale. Itsnational sanitation programme datesback 20 years but is not well knownoutside the country. The programme is apermanent and budgeted part of thegovernment’s work, independent ofexternal support agencies. Its financingrules are clear, including zero directsubsidies for building individualhousehold latrines; instead, householdersemploy private-sector latrine builders,while the government concentrates onpromotion and training. The Lesothoprogramme has been successful inaddressing sanitation holistically at anational level, both in urban and ruralareas. Rural sanitation coverage hasincreased very significantly and shouldeasily exceed the sanitation MDG. Themain problems ahead are targeting thepoorest people and solving the problemof emptying filled latrine pits.

The key message from thisthree-country study is that strongand sustained political leadership

1 Strictly speaking, drinking water is the subject of one of the MDGswhile sanitation is the subject of a goal set by the World Summit onSustainable Development (WSSD). However, this paper followsnormal custom in describing both as MDGs.

This case study was presented by Dr. Charles Yaw Brempong-Yeboah, DeputyMinister of Works and Housing, Republic of Ghana, at the ‘Scaling Up PovertyReduction: A Global Learning Process, and Conference’ in Shanghai, May 25-27,2004. This conference allowed key development actors to share their experiencesand policy lessons learned from poverty reduction initiatives around the world.A series of case studies, multi-country interactive videoconferences, onlinedialogues, and field visits culminated in this conference in Shanghai. The activitieswere sponsored by the World Bank in cooperation with other multilateral and bilateraldonors, with the Government of China hosting the conference in Shanghai.

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Rural Water Supplyand Sanitation in Africa:Global Learning Process onScaling Up Poverty Reduction

augmented by clear legislation,devolution of authority allied tocommunity empowerment, and carefullytargeted donor support can achievepoverty reduction at a significant scalethrough rural water and sanitation.

Backgroundand ContextAfrican rural water andsanitation in the early 1980s

The status of water supply andsanitation in rural areas in Africa in theearly 1980s was very poor. Coveragerates were typically 20 to 40 percentfor water and 10 to 30 percent forsanitation. Most African societies wereagrarian in character, yet rural servicesof all sorts were underdeveloped.Their political leaders tended to see theprovision of basic services, such aswater and sanitation, as the duty of thegovernment. So they had establishedlarge, centrally managed water supplyprogrammes. These programmes usedconventional engineering solutions thatresulted in infrastructure that wasbeyond the people’s capability tomaintain. This did not seem to be aproblem at the time as the governmentsfunded and undertook maintenancecentrally, normally providing the waterfree of charge to those peopleconnected to the service. However, aseconomic decline affected many Africancountries, budgets were reduced, watersupplies fell into disrepair, and the userswere unable or unwilling to maintainthem. New projects were delayed, andsanitation neglected. Concepts ofcommunity management, humandevelopment, human rights andempowerment of the poorest people

(Box 1) were not commonly appliedwithin the water sector.

Ghana: a parastatalthat was not coping

The rural water sector in Ghana wastypical of that in many African countries.The Ghana Water and SewerageCorporation (GWSC), a parastatalorganisation under the Ministry ofWorks and Housing, was responsiblefor both urban and rural water supplyand sewerage for a population of

approximately 15 million people.Most of GWSC’s staff and resources,however, were devoted to the urbansector, with just two or three staffworking on rural supplies.

So external support agencies andNGOs wanting to work in rural waterand sanitation found themselves settingup large regional projects that werealmost independent of the governmentboth in their policies and implementation.

Through community managementcommunity managementcommunity managementcommunity managementcommunity management, poor people own and manage theirresources and services, including drinking water and sanitation.Development practitioners around the world are increasingly acceptingcommunity management as a broadly applicable and large-scaleprocess, not a simple small-scale project method.

Human developmentHuman developmentHuman developmentHuman developmentHuman development entails people taking their own decisions abouttheir lives, rather than being the passive objects of choices made byothers about them. It relates closely to the exercise of people’srights and responsibilities.

The recognition of water as a human righthuman righthuman righthuman righthuman right, rather than only a technicalor economic issue, is increasingly enshrined in declarations andconventions on human rights. Most recently, the U.N. Committee onEconomic, Cultural and Social Rights stated that ‘The human right towater entitles everyone to sufficient, affordable, physically accessible,safe and acceptable water for personal and domestic uses.’ 2

EmpowermentEmpowermentEmpowermentEmpowermentEmpowerment of the poorest people enables them to make social,political and economic decisions. This is achieved through listening to thepeople and respecting their existing knowledge, social structures,institutions and leadership; paying special attention to the needs ofwomen and of marginalised, indigenous and the poorest people; andensuring that governments and support agencies participate in thepeople’s agendas and are accountable to the people, not vice versa.

Box 1: Community Management, Human Development,Human Rights and Empowerment

2 General Comment 15, November 2002.

This combination of health and physical factors motivated the governmentand external support agencies to take interest in improving sanitation.

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GWSC was responsible for maintainingover 8,000 rural point sources, mostlyhandpumps, and over 200 small-townpiped schemes. In theory, GWSC sentout staff to maintain and repair thesupplies. In practice, this was beyondGWSC’s capacity — partly because itfocused its attention on urban ratherthan rural supplies, and partly because itcollected only enough revenue fromrural users to cover a fraction of themaintenance costs. Consequently, bothhandpumps and piped systemssuffered frequent breakdowns andsupply interruptions. As these problemsworsened, the Ghanaian politiciansbecame increasingly concerned aboutthe water and sanitation sector.

South Africa: raciallydivided services

In South Africa, a country of some 40million people in 1994, the situation wascomplex. Until that year, the countrywas governed in accordance with racistapartheid principles. Responsibility forwater supply and sanitation wasfragmented and allocated to localgovernments in four provinces and to10 nominally autonomous homelands,resulting in very different levels ofservice. The overall statistics maskedextreme contrasts between the differentsectors of society. Most of thewhite-ruled local government areasoffered standards equal to those inindustrialised countries. In the ruralareas where black people lived therewere often no services, while in blackurban areas the situation was mixed.This situation was exacerbated by theabsence of any coherent nationalpolicies, guidelines or support structures.In the years leading up to the democratic

change in 1994, some preparatory workhad started in anticipation of the people’sexpectations of change in many areas,including water and sanitation.

Lesotho: asanitation problem

Lesotho is a much smaller countrythan Ghana or South Africa, witha population of approximately 2 millionpeople, 90 percent of whom live in ruralareas. In the early 1980s Lesotho hadmany water- and sanitation-relatedhealth problems. Rural water supplywas being addressed, but sanitationwork had hardly started: only 15percent of the rural population hadany sort of sanitation, the remainderusing open defecation. The increasingpopulation density and decreasingnumber of trees led, as would beexpected, to a potentially highdemand for latrines. This combinationof health and physical factorsmotivated the government and externalsupport agencies to take interest inimproving sanitation.

Overview ofthe Cases

These three cases have beenchosen for this study because theirpolitical and professional leaderstook decisive action to improve

water and sanitation, which addressedpoverty reduction on a significant scaleand generated lessons that areapplicable elsewhere.

The three national programmes aredescribed here in turn, followed bybrief reference to other similarprogrammes in Africa.

Ghana: a major change inboth policy and structure

By the mid-1980s the government ofGhana was in a dilemma regardingwater. On the one hand it regardedwater as a social good so it did notwant to impose cost recovery onconsumers. On the other hand it couldnot afford either the capital or operatingcosts necessary for equitable provisionof water and sanitation to all. Theunintended consequence of thissituation was that poor people hadno water, while rich people enjoyedcheap water.

In 1986, prompted by GWSC’sconcerns on operating costs, thegovernment made a one-off increase inwater tariffs. The tariffs rose tenfold andpeople complained but paid them; thisstarted to give a cross-subsidy fromrich to poor. Meanwhile the governmentwas monitoring the innovationsassociated with the InternationalDrinking Water Supply and SanitationDecade (1981-1990), and established astakeholder group to adopt the bestpractice from the Decade. This led to abroad, consultative process of policydevelopment during the early 1990s(Box 2). In this process, many issueswere raised by Ghanaian people andagencies and debated and resolvedwith support from external supportagencies, notably the World Bank andthe Water and Sanitation Program(WSP). This process produced a draftsector strategy that was discussed andrefined by representatives from lineministries, local government, the privatesector, external support agencies andcivil society. This broad participationgave all the groups a voice in the reform

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process. The policy discussions alsodrew on the experiences of pilotprojects that were already under way.For example, WSP worked with thegovernment to test community-managed handpumps, the internationalNGO WaterAid tested communitymanagement of whole projects, andCatholic organisations experimentedwith community cash contributions.

Once the national policy for rural watersupply, sanitation and hygiene educationwas finalised, it was implemented at apilot scale in a project in Volta Regionsupported by the United NationsDevelopment Programme (UNDP) andthe Dutch government. Then it wasscaled up in the form of the World Bank-supported First Community Water andSanitation Project (CWSP-1), a US$20million programme managed by thenewly formed Community Water andSanitation Division of GWSC. CWSP-1implemented the new policy in 26 out ofGhana’s 110 districts. When it ended in1999, the national policy was enactedacross the whole country.

The Community Water and SanitationAgency was created out of GWSC in

stages. First, the functions related torural community water supplies wereplaced in a separate division withinGWSC; this enabled donors’ grants forwater and sanitation for poor people tobe monitored more clearly. Later, in1998, that division was made into anindependent agency and renamed theCommunity Water and SanitationAgency (CWSA). It had a fundamentallydifferent approach from that of GWSC:to be a coordinator and facilitator ofcommunity-managed water supplies,not an implementer. Whereas GWSChad had a poor reputation among thecommunities, CWSA immediatelystarted to gain a good reputation as itencouraged their sense of ownership.

At the same time that CWSA was beingcreated, the government was alsodevolving certain core responsibilitiesfrom the national level to districts andcommunities. The district assemblies,an important tier of elected localgovernment, were made responsible forprocessing and prioritising communityapplications for water supplies,awarding contracts for hand-dug wellsand latrine construction, and running a

latrine subsidy programme.Communities, in order to be eligible forassistance, had to establish gender-balanced water and sanitationcommittees, complete plans detailinghow they would manage their systems,and contribute cash equivalent to5 percent of the capital costs.In line with the new national policy,communities also had to pay for alloperation and maintenance costs.The final element of the strategy wasprivate-sector provision of goods andservices to an unprecedented extent,covering not only borehole drilling,operation and maintenance and latrineconstruction but even communitymobilisation (which is carried out bypartner organisations that aresometimes described as NGOs butactually function as commercialorganisations, working to precisecontracts and timescales).

By 2000, the reforms were completeand CWSA had settled into its allottedrole. This is principally to support thedistrict assemblies to implement thenational community water and sanitationprogramme. It also formulatesstrategies, standards and guidelines forthe sector, coordinates the work ofNGOs and external support agenciesand encourages private-sector activityin the sector. The communitiesthemselves have primary responsibilityfor managing their water and sanitationservices, while the small-scale privatesector is active in such areas as repairsand spare parts supply.

Regarding sanitation, the districtassemblies start by subcontractinghygiene promotion to the same partnerorganisations as the community

1965 Water Act governing role of GWSC1982 Decentralisation Act1986 Tariff increases1991-92 National water policy being drafted1992-93 Policy refined through series of strategy planning workshops1994 CWSP-1 started1998 Act created CWSA1999 CWSP-1 ended2000 Reforms and decentralisation completed

Box 2: The Chronology of Rural Water Sector Reform in Ghana


The complete change in rural water and sanitation in South Africa wastriggered by the political change from the apartheid era to the democraticera in 1994.

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mobilisation; demand is created,to which the district assemblies(with financial support from externaldonors through CWSA) respond byproviding subsidised latrine slabs, ventpipes and fly screens upon request.Meanwhile CWSA broadcastsadvertisements and jingles on localradio stations to complement thepromotional work. Traditionally,Ghanaian people do not talk to eachother about latrines, and behaviourchange takes a long time. It is hardlysurprising, therefore, that the progressof sanitation and hygiene promotion haslagged behind that of water supply inGhana. Until recently, the sanitationprogress was also allegedly hamperedby the World Bank’s stipulation thatover half the households in a community

must request latrines beforethe district assembly can startto supply any item, but thisguideline has now been relaxed.

The national government inGhana has a crucial role inpolicy but is not involved inimplementation. The Ministry ofWorks and Housing (the parentministry of CWSA) sets overallpolicy for the sector, and isindeed trying to change itsname to include Water toemphasise its importance.This ministry sees povertyreduction and the achievementof the water and sanitationMDGs as vital parts ofgovernment policy. TheMinistry of Local Governmentand Rural Developmentsupports district assemblies in

general, and water is a part of itsportfolio. It also tries to mediatebetween district assemblies and the lineministries such as Works and Housing.The Ministry of Finance does not yetgive water and sanitation sufficientpriority in the eyes of the line ministries,

as is indicated by the low percentageallocation to water and sanitation inthe Ghana Poverty ReductionStrategy Paper.

South Africa: turning theright to water into a reality

The complete change in rural water andsanitation in South Africa was triggeredby the political change from theapartheid era to the democratic era in1994. The country’s population wasthen just under 40 million people.Of these, an estimated 15 million(12 million of whom lived in rural areas)lacked access to basic watersupply and 20 million lackedbasic sanitation. Water – though notyet sanitation – was one of the people’stop concerns, and expectations werehigh that the new democraticgovernment would deliver equitablewater services quickly.

In 1994 the new government madethe Department of Water Affairs andForestry (DWAF) responsible forensuring that all South Africans hadequitable access to water supply andsanitation. DWAF had previously been atechnical organisation focused on water

1994 First democratic elections, water sector policy paper1995 Reconstruction and Development Programme1996 New Constitution of the Republic of South Africa1997 Water Services Act1998-2000 Various local government acts1999 Free basic water policy promulgated2003 Strategic framework for water

CWSA has achieved a measure of success in devolvingmanagement of water supplies to local communities in Ghana.

Box 3: The Chronology of the National Water SanitationProgramme in South Africa

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resources and forestry management. Itshistorically apolitical character was apositive asset in approaching its newtask, as was the involvement of anumber of progressive activists whomoved into this sector of government.DWAF consulted a range of interestedparties and produced a policy oncommunity water supply and sanitationin November 1994. This policy providedthe foundation for the legislative andregulatory framework (subsequentlyenacted in the Water Services Act of1997) governing the water sector, andfor the national water and sanitationprogramme (Box 3). The policyrecognised that local governmentswould eventually take responsibility forservice provision. It also referred to theright of access to basic water and to anenvironment not harmful to healthor well-being (Box 4). Both thisdecentralisation and the right to waterwere formally stated in the country’snew Constitution in 1996.

In 1994, the government knew that itmust quickly start work to meet thehigh demand for rural development,including water supply and sanitation.It launched a top-priority programmeentitled the Reconstruction andDevelopment Programme (RDP), fromwhich US$340 million was allocated toDWAF for water and sanitation. Sincethe decentralised institutional frameworkfor water and sanitation was not ready,DWAF itself took the lead to use theRDP funds to scale up its work rapidly.It involved all organisations that coulddo the work, mobilising water boards,NGOs (notably the Mvula Trust), sometransitional local government bodiesand private-sector companies aspartners in delivery. At the project level,

community-based project steeringcommittees were set up and providedwith guidelines by DWAF on theimplementation and maintenance of theirprojects. By these means, between 1994and 2003, new water services have beenconstructed for a design population of9 million people. This is one of thelargest and most rapid programmes ofservice provision in Africa.

During the late 1990s local governmentwas reformed, culminating in

Under the 1994 policy, the government funded the capital costs of water andsanitation infrastructure while the users covered operation and maintenancecosts – a financial division that applies in many other countries. Towards the endof the 1990s, however, it became clear that the high operation and maintenancecosts of many schemes meant that poorer people could not afford the chargesand so they were not benefiting from the new water and sanitation services. Inresponse, the government developed a free basic water policy. This policy, whichis a more sophisticated version of a concept followed by many other Africancountries in the early post-colonial era, encourages water services authorities toprovide the first 6,000 litres per household per month free of charge. Theoperation and maintenance costs are intended to be covered by a combinationof a rising block tariff above that consumption and a subsidy from the nationalbudget to the local government specifically for basic service provision.

The free basic water policy is controversial. On the one hand it has enacted apowerful political message and aims to ensure that people’s right of access tobasic water supply – and hence to the health and social benefits arising from it –is not limited by affordability. On the other hand its critics argue that it hasweakened poor people’s sense of ownership, increased their dependency on thegovernment, and reduced the accountability of the water services providers tothe users who do not pay. The impact of the free basic water policy on thenational economy is of particular interest. The subsidy needed from the nationalbudget is clearly identifiable, whereas the health and economic benefits of thewater are not immediately quantifiable but almost certainly much larger. So intheory it benefits the national economy, while in practice it may be vulnerable tothe economic policies of future governments.

Box 4: Equity of Access, and the Free Basic Water Policy

democratically elected localmunicipalities throughout the country.These municipalities are nowresponsible for implementing the ruralwater and sanitation services, and thelocal politicians are becoming activelyinvolved. So DWAF is changing its rolefrom an implementer to a facilitator andregulator. This will take some time, asmany municipalities are still weak, butthe Ministry of Finance has givenleadership by indicating budgets yearsahead to show DWAF’s reducing role


In South Africa the right to basic sanitation, and indeed to receivehygiene education, is constitutionally enshrined alongside that to water.

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and local government’s increasing role.As for the private sector, whoseinvolvement is a contentious topic inSouth Africa, it is deeply involved inresearch, design, manufacture and evensocial mobilisation and training,but scarcely involved at all as awater service provider.

In South Africa the right to basicsanitation, and indeed to receivehygiene education, is constitutionallyenshrined alongside that to water.However, as in many other countries,sanitation had lagged behind watersupply. This was partly because thecommunities themselves had alwaysstrongly prioritised water supply, andalso because there was not a goodsystem for promoting improvedsanitation at community level. In 2000,South Africa experienced a dangerousoutbreak of cholera, which provided ahuge stimulus to address the country’sslow rate of progress in sanitation. Inthe short term, latrine constructionprogrammes were given high priority. Toensure longer-term attention to sanitation,the government designated DWAF as thelead agency in sanitation. DWAF nowprovides strong political leadership forsanitation and hygiene promotion andhas created a dedicated sanitationprogramme to implement the work.

Lesotho: consistent policiesachieving long-term resultsin sanitation

The national sanitation programme inLesotho is much older than theprogrammes in Ghana or South Africa.By 1980, Lesotho already had anational water supply programme. Butthe professionals working in the sector

identified a gap in sanitation, initially inurban infrastructure and subsequently inrural areas. So, after a series of technicalstudies by various internationalorganisations, in the early 1980s thegovernment started a two-part nationalsanitation improvement programmecovering the urban and rural sectorsof Lesotho (Box 5).

From the beginning, the sanitationprogramme was carried out bygovernment organisations: specificallyby Urban and Rural SanitationImprovement Teams. These teamsworked within the government’s regularprogramme of public-sectordevelopment work. The two teamswere designed to create the minimumnecessary number of permanentgovernment posts, complemented by alarger number of short-term donor-funded posts to start the programmeand engage and train the private sector.This is exactly what has happened:donor funding has tapered out asplanned, and the local private sectororganisations have been active insanitation to the present day.

In both the urban and rural work, pilotprojects were launched before scalingthe work up to the full nationalprogramme. The pilot projects enabled

ideas to be tried locally before applyingthem nationally, and informed the designof the full-scale work that followed.

The rural sanitation programmeadopted a consistent set of principles.It ensured proper institutionalarrangements at national and districtlevel, involved the communities inplanning and management, andprioritised the government’s efforts oneducation and promotion. It insisted onfull cost recovery from the users – thegovernment did not subsidise latrinecosts. It promoted use of the small-scale private sector to build latrines anditself trained the builders. Each of theseprinciples is well known to professionalsin the sanitation sector. The importantpoint about Lesotho is that they have allbeen put into practice together,consistently and for a long time; thismay be unique in Africa.

Regarding technology, from the startthe Lesotho sanitation programmeadopted the ventilated improved pit(VIP) latrine, suitably adapted to localconditions, construction techniques andpreferences. This decision had animportant effect on the whole nature ofthe programme. While sanitationprogrammes typically begin with astrong technical bias due to the need to

1980 Urban Sanitation Improvement Team started work on a project basis1983 Rural Sanitation Improvement Team started pilot phase1984 Urban Sanitation Improvement Team became a permanent

government department within the Ministry of the Interior1987 Rural pilot phase ended, national rural sanitation programme

started within the Ministry of Health

Box 5: The Chronology of the Rural Sanitation Programme in Lesotho

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test a range of technologies and selectone or more to use, the Lesothoprogramme was always moreconcerned with broader social issuessuch as community participation, healthand hygiene promotion, and finance.

The government put most of its owneffort into promoting sanitation andtraining sanitation professionals.The media used for promotion includeprinted matter, radio, tape-slidepresentations and videos. Most of thisis targeted at potential latrine owners.The use of radio has been particularlystrong and has resulted in a significanttake-up of improved sanitation in termsof behaviour and construction oflatrines. The use of two key messages(improved health and improved status)in the promotion programme appearsto have increased the impact.

From the beginning, the design of theprogramme deliberately avoided thepossible stigma of a VIP latrine beingperceived as a poor person’s latrine.Middle-income people were targeted inpromotions as they could easily buylatrines without direct subsidies.

The private sector, in the form of smallcontractors who build latrines, has beeninvolved in the programme since thebeginning. These contractors weretrained by the Rural SanitationImprovement Team and make a livingfrom building unsubsidised latrines forhouseholders, which is a benchmark ofsustainability for which many sanitationprogrammes strive (Box 6).

Other African examples

Ghana, South Africa and Lesotho arenot isolated successes. Several othercountries in Africa have made notableprogress in their national rural waterand sanitation programmes.

A leading example is Uganda, whosewater and sanitation sector has beenreformed in accordance with its overallpoverty eradication plans. The reformprocess has been actively led bythe government itself, with wideparticipation from external supportagencies and other stakeholders.The reforms include decentralisation,increased local private-sector

A quarter of the trained latrine builders in Lesotho are women, includingMrs Monnanyane of Tsime, Butha-Buthe District. She pursues latrine buildingfull-time, actively marketing her skills by travelling from house-to-house or visitinglocal traditional leaders in neighbouring towns and villages. She explains topeople the importance of having a latrine, and finds that the resulting demand isso great that she has trained five other people, four of them women, as latrinebuilders in the same area.

Mrs Monnanyane’s background as a village health worker was a logical startingpoint to becoming a latrine builder. She works for everyone’s health, especiallythat of children. “I want to make an impression on the village,” she says. “There iscompetition when I go to other villages, but people request me [to build theirlatrines] because I have a good reputation. That is my work.”

Box 6: A Latrine Builder’s Story3

3 From Evans, Pollard and Narayan-Parker 1990.


The VIP latrine, depicted here in Mokhotlong District, has been the technology of choice from theinception of the Lesotho sanitation programme.

Better sanitation also provides greater privacy, convenience, safety anddignity; these aspects are particularly important for women.

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participation, recovery of operation andmaintenance costs, and no subsidy fordomestic latrines. A corresponding15-year investment plan, financed partlyby debt relief funds, is leading logicallytowards a sector-wide approach.

In Benin, the government and externalsupport agencies have adopted anational rural water and sanitationstrategy whose main features includecommunity management of waterservices, decentralisation from nationalto local government, variable levels ofservice in accordance with the people’sdemands and affordability, andprivate-sector provision of goods andservices. In Mozambique, a pioneeringprogramme of peri-urban sanitationserved more than 1.3 million people in acountry that was just emerging fromdecades of destructive civil war. InBurkina Faso, sanitation in both urbanand rural areas has been addressedsystematically using innovative ideas

such as cross-subsidies fromwater supply tariffs.

Analysis of ResultsAchievements ofthe three programmes

In all three cases the main achievementis poverty reduction through increasedprovision of water and sanitationservices to the rural poor (Box 7).

In Ghana, coverage in rural water andsanitation was, until recently, behind theaverage for Sub-Saharan Africa but isnow being extended at a rate ofapproximately 200,000 people (over 1percent of the population) per year andaccelerating. The government and othercommentators feel that good progressis being made. CWSA is now fullyestablished and functioning with theactive support of several bilateralsupport agencies, the European Unionand the World Bank. CWSA intends to

move to a sector-wide approach, inwhich all external support agencies pooltheir resources to support a singlenational programme rather thanseparate projects as at present.CWSA’s own projections, based on thecurrent level of work and the reformsdescribed above, indicate that the MDGfor water will be achieved, though it isdifficult to find coverage figures to verifythis yet. Attaining the MDG forsanitation will be more difficult.

In less than 10 years, the South Africannational programme has constructedwater supply schemes designed to serveover 9 million people (over 20 percentof the population). This has helped toredress the social inequity of the past.

The programme is continuing to extendrural water coverage at the rate of 1million people per year. Decentralisationis proceeding and DWAF is changingits function from implementation tosupport and regulation. Sanitation, whilestill lagging behind water, is receivingmuch more attention than before.DWAF expects to achieve its owntargets, in advance of the MDGs.

In Lesotho, tens of thousands of newVIP latrines have been built in the ruralareas and a similar number of ordinarypit latrines have been upgraded toVIP latrines. This corresponds to anincrease in sanitation coverage from15 percent to over 50 percent in ruralareas in 20 years. The rural sanitationprogramme remains fully active withinthe Ministry of Health. Lesotho is reapingthe benefits of its long engagement insanitation development, and is on trackto achieve the sanitation MDG (thewater MDG has already been achieved).

An independent financial operator in Uganda.

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The relevant Millennium Development and WSSD Goals are to halve the proportion of people who lack water andsanitation from the base year of 1990 to the target year of 2015. All three governments have signed up to these goals,and the South African government has gone further and set its own more ambitious goals to provide water for all by2008 and sanitation for all by 2010.

It is difficult to confirm what the coverage figures actually were in 1990, because some countries have changed theircriteria for measurement while others used different baseline years. Current best estimates, collated from various sourcesin-country and the WHO/UNICEF Joint Monitoring Program, are:

Ghana 30 35 41 – 68

South Africa – 39 63 100 100

Sub-SaharanAfrica average 35 40 45 – 70

Ghana – 15 28 – 68

South Africa – 24 44 100 100

Lesotho 15 – 55 – 66

Sub-SaharanAfrica average – 46 42 – 73

Note: – indicates data unavailable.

Country 1980 1990 2000 2008 target 2015 target

Country 1980 1990 2000 2008 target 2015 target

Rural water coverage (%)

Health and social impactof the programmes

Water-related diseases are the singlelargest cause of human sicknessand death in the world, anddisproportionately affect poor people.So the main impact of water and

sanitation on human development is byimproving health. For example, studiesfrom around the world have shown thatprovision of safe water and basicsanitation accompanied by hygienepromotion can reduce the incidence of

diarrhoeal diseases by as much as25 percent.4 Better sanitation alsoprovides greater privacy, convenience,safety and dignity; these aspects areparticularly important for women.

Considering the World DevelopmentReport pillar on social inclusion, rural

Box 7: Coverage Figures and Targets

Rural sanitation coverage (%)

4 From Evans, Pollard and Narayan-Parker 1990.


These economic factors make a strong case for governments to intervenein water and sanitation, either by regulation or investment.

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water and sanitation promote access toassets and services. They also advancesocial development through theircommunity management systems,which enable people to work togetherequitably for their own development.The water sector contains manyexamples of innovative and successfulcommunity management.

All these general health and socialimpacts of water and sanitation shouldapply in Ghana, South Africa andLesotho, although only a few specificstudies have been made there. Forexample, research in Lesotho suggesteda significant reduction in the incidence ofsanitation-related diseases in areaswhere water and sanitation projects hadbeen implemented. These findings aretypical of those from around the world,indicating that health impact derivesfrom the combination of improvedhygiene, sanitation and water supply.

Regarding social impact, empowermentand accountability to the poor havebeen extremely important featuresin both the Lesotho and Ghanaprogrammes. In South Africa, thenational programme has been centrallyled and the free basic water policyarguably reduces empowerment ofthe poorer people because the waterservice providers are more accountableto their paymaster (the nationalgovernment) than to their users. Thegovernment disputes this argument, butat least one independent survey5 seemsto confirm that the relationship betweenthe people and the water serviceprovider changes negatively whenthey cease to pay for the water.

So accountability must then beexercised through the ballot box.

Economic impactof the programmes

Around the world, poor peoplethemselves give a high priority todrinking water and, albeit to a lesserdegree, to sanitation. There isconsiderable evidence that improvedwater and sanitation generatesubstantial economic benefits, mainlythrough saving large amounts ofpeople’s time and energy. For example,fetching even a family’s basic waterrequirement can be both time-consuming and physically exhausting, aburden that falls disproportionately onwomen and children. Seeking privacyfor open defecation can also be time-consuming, typically causing manywomen to wake up an hour early every

day of their lives. Being ill with a water-related disease, or caring for an ill familymember, also consumes much time andmoney. The time and energy saved byimproved water supply and sanitationcan be used in many economicallyproductive or educational activities.Water and sanitation programmes alsocontribute to economic developmentby creating jobs, although this has arelatively modest impact as the numberof permanent jobs created is small atthe community level where thepeople are poorest.

These economic factors make a strongcase for governments to intervenein water and sanitation, either byregulation or investment. All thesefactors apply in Ghana, South Africa andLesotho, although few rigorous studiesof the economic impact of improved5 Palmer Development Group 2000.

Gender-sensitive community involvement can have a powerful positive impact on health; communityhealth club members celebrate the production of home-made soap in Zimbabwe.

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water and sanitation have been carriedout in these countries. In South Africa,job creation is an overt stated benefitof the national water and sanitationprogramme and DWAF monitors thenumber of jobs created by it. InLesotho, the latrines themselves are allbuilt by local private-sector builders;people with latrine construction skillshave a direct economic incentive topromote improved sanitation.

Costs of the programmes

In most countries, expenditures onwater and sanitation are usually includedunder other general headings such ashealth. It is thus difficult to give nationalfigures for money spent on water andsanitation,6 but it is possible to estimatecosts from individual programmes.

In Ghana, CWSP-1 supplied water forover 300,000 people at a direct costof US$26 per person. This unit costdoubles to $50 if the indirect costs ofinstitutional capacity-building areincluded. These costs are fairly typicalof other African countries.

The South African national programmeis well documented and supplies waterat an average cost per person ofapproximately US$90. This is regardedby some observers as high for ruralwater supply. Many of the schemes usecomparatively high, engineering-drivendesign standards and technologies thatmay be difficult for local governmentsto maintain and too expensive for theusers to fund. An alternative approachcould have been to involve the

communities in choosing service levelsand to build systems that thecommunities themselves could affordand maintain. But this has nothappened, mainly because theConstitution states that water must beavailable within 200 metres of everyperson’s house, which in scattered rural

populations dictates high-costtechnologies such as piped systemsrather than simpler and cheapertechnologies such as handpumps andwells as commonly used elsewhere inAfrica. When the civil servants raisedthis question, the politicians inParliament reaffirmed the policy.

The rural water and sanitation programme in Ghana has been implementedagainst a background of generally steady national economic growth. This hasnot benefited CWSA’s programme directly because the Ministry of Finance hasnot allocated more money to it from the government budget. However, CWSAhas benefited indirectly because external support agencies have put moremoney into the country, including CWSA. (Approximately 90 percent of CWSA’sinvestment, training and consultancy budget comes from external supportagencies, and only 10 percent from central government and from a small butinnovative cross-subsidy from urban water tariffs.)

The national economy of South Africa is inherently stronger than that of mostAfrican countries. Its GDP per person is an order of magnitude higher than thatof Ghana or Lesotho, for example. Using that context of economic strength, thepost-1994 government has chosen to construct water supply systems atcomparatively high capital and operating costs. This strategy relies on both thecontinuing strength of the national economy and the continuing willingness ofnational politicians, who have many other pressing needs to fund. In other Africancountries’ experience in the 1970s and 80s both these factors caused problemsand many water services collapsed. In South Africa in the 2000s, the currentgovernment is confident that they will not.

In Lesotho, the macroeconomic climate has always been difficult. So thesanitation programme was designed to minimise the drain on national economicresources through avoiding subsidies to household latrines, generating demandthrough promotional work, and encouraging the private sector to meet thedemand on a commercial basis. This strategy has worked well and successivegovernments have found the cost acceptable, as shown by the fact that theprogramme is still working as a part of the government system after 20 years.There is, however, one difficulty arising from mainstreaming the sanitation budgetinto the district health budgets. It now competes with curative work, and manyof the district-level decision-makers view the latter as a higher priority.

Box 8: National Economic Context of the Programmes

6 One study (WSP 2004) estimates expenditure on water andsanitation in Ethiopia, Kenya and Uganda as ranging from 0.5 to 1percent of GDP. South Africa has a policy of allocating 0.75 percentof its GDP to water and sanitation; the actual allocation hasreached the level of 0.4 to 0.5 percent.


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The Lesotho sanitation programmedoes not include any subsidy for latrineconstruction: each household pays forthe construction of its latrine by aprivate-sector builder. In rural areas alatrine costs approximately one month’ssalary, although people can reducecosts by collecting and using localmaterials for building.

Cost recovery policiesand practices

Recovering the costs of water andsanitation services is an important issuefor governments around the world thatwant to achieve the water and sanitationMDGs. While it is easy to argue thatinvestments in water and sanitationmore than pay for themselves inimproved health and saved time, thosebenefits are intangible and governmentswant to ensure that the actual costs willbe covered. Cost recovery is alsoimportant for the sustainability of thewater and sanitation services. For thepurpose of analysis, the costs aresubdivided into the capital costs andthe operation and maintenance costs.

Regarding capital costs, in Ghana theofficial policy specifies that thecommunity must pay 5 percent ofcapital costs and local governmentanother 5 percent (see Box 9 forGhanaians’ opinions on this and relatedmatters). The balance of 90 percent isprovided from CWSA’s (largely donor-funded) budget. In South Africa, thegovernment provides 100 percent ofthe capital costs for both water andsanitation. In Lesotho, for sanitation thehouseholders provide 100 percent of

the capital costs. These are markedlydifferent policies, and there is noabsolute right or wrong. The Ghanaianpolicy, in which the communitycontribution is intended to generate asense of ownership, is typical of manycountries. It seems sensible enough butdoes have some problems in practice:the rigid application of the policy isperceived by some observers as animposition by the World Bank; and thepolicy may discriminate against the

poorest people, so communities andlocal governments find ways tocircumvent the policy if the poorestpeople are to be served. The SouthAfrican policy is unusual among poorercountries but typical of middle-incomecountries. The Lesotho policy wasinnovative 20 years ago and remains atthe cutting edge even today, and itseems likely that many other countrieswill need to adopt this policy in order toachieve the sanitation MDG. However,

In 2000, the Community Water and Sanitation Agency commissioned abeneficiary assessment study in communities whose water facilities had beenimproved during CWSP-1. The study’s report7 describes the people’s own viewsabout their improved water and sanitation services.

● Over 90 percent of people were satisfied with the location, quantity andquality of the water.

● 97 percent of people used the improved water source and people did notfeel that poverty had constrained their access to improved water.

● 92 percent had contributed to the capital costs, and 85 percent were payingtowards the operation and maintenance costs. The vast majority felt that theprinciple of payment was fair, and intended to continue paying.

● Over 80 percent of people had adopted improved hygiene practices such askeeping water in a clean container, and washing their hands after using thelatrine and before cooking.

● However, people did not seem to prioritise their spending on latrines: onlysome 20 percent of people constructed new latrines, although almost70 percent were aware of the sanitation component of the programme.

● Over 90 percent of water and sanitation committees had received training,opened bank accounts, and held regular meetings. It was notable thatwomen played active and influential roles on these committees.

● Latrine builders, well diggers, mechanics and health workers all receivedtraining through the programme; however, 60 percent of latrine buildersdropped out due to lack of demand for latrines.

Box 9: People’s Opinions about Water and Sanitation in Ghana

7 Baah 2000.

In South Africa, the whole concept of the national water and sanitationprogramme is derived from the nation’s politics.

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even this policy is not faultless becausethe poorest households have beenunable or reluctant to construct latrines.Some NGOs have offered subsidies tosuch households in the rural areas, andthe government itself may soon do so.

Regarding operation and maintenancecosts, the policy in Ghana and Lesotho,which is typical of many poor countries,is that these must be paid by the users.In Ghana each community fixes the tariffbased on guidelines circulated fromCWSA through local government. Thedecisions of the communities areendorsed by the water and sanitationdevelopment boards of eachcommunity and approved by localgovernment. In South Africa, the basiclevel of water and sanitation service isfree to the users, while higher levelsshould be paid by the users and thebalance of operation and maintenancecosts is covered by a subsidy from thenational budget. In fact the applicationsof these policies are more flexible thanthe policies themselves appear. Forexample, in Ghana at the communitylevel the poor people are often identifiedand not required to pay (a form ofcommunity-managed cross-subsidy). InLesotho, the government subsidises thelatrine pit-emptying service. Meanwhilein South Africa, evidence is mountingthat many users are not paying even forhigher levels of service, and thereforeoperation and maintenance costs relywholly on the national subsidy. Only ina few richer and/or better-managedplaces8 do enough people pay thehigher tariffs to achieve full operationand maintenance cost recoveryfrom users overall.

Integration of hygiene,sanitation and water

In recent years it has become clear thathigher health benefits come from thecombination of improved hygiene,sanitation and water supply than fromwater alone. This integration of the threeactivities is therefore vital for achievingpoverty reduction through water andsanitation. In Lesotho especially, theprofessionals working on the nationalprogramme knew that this integrationmust underpin any national waterand sanitation programme. Hygienepromotion played a particularlyimportant role in generating the demandfor improved sanitation. Both in Ghanaand in South Africa, the lag of sanitationbehind water has been identified as anongoing problem that must be solved.

Learning and experimentation

Learning and experimentation have notbeen central features of these nationalwater and sanitation programmes;indeed it is arguable that innovation forits own sake is not appropriate in anationwide programme of basicservices. The main application oflearning and experimentation has beenthe use of pilot projects. In Lesotho andGhana, in particular, the new ideas werefirst implemented on a pilot scale, togain experience on which to base thenational programme. The nationalprogrammes then evolved step-by-stepfrom the pilot stages. The strength of allthree programmes has been in puttingsound principles into practiceconsistently. For example, the Lesothoprogramme put into practice acomplete set of policy ideas that werethemselves comparatively new in the

1980s, but its main characteristic hasbeen in the combined application ofthose ideas rather than in the innovationitself. The South Africa programme isalso based on a strongly articulated setof political beliefs, not on innovations fortheir own sake.

Analysis of KeyFactors forSuccessfulImplementationStrong political leadership

The commitment of political leaders hasbeen a strong factor in the success of allthree country programmes.

In Ghana, the national mood in the1980s favoured reform and innovation.The rural water sector reform fitted wellwith the other changes in the country’spolitical economy, although itsimmediate drivers were more pragmaticconsiderations. Rural water wasneglected, and the sector as a wholewas stuck in a downward spiral ofinadequate cost recovery and poorservice. The politicians made aconscious decision to reverse that trendby increasing tariffs, seeking grants andloans, and separating the rural from theurban sector. Successive governmentsof different parties have all seen waterand sanitation as an importantcontributor to social and economicdevelopment, and it has not been usedas a party political issue.

In South Africa, the whole concept ofthe national water and sanitationprogramme derived from the nation’spolitics. After the apartheid era ended,

8 The Mvula Trust estimates these to be 10 to 20 percent oflocal government muncipalities.


the new government was electeddemocratically in 1994 on the promiseof ‘a better life for all’. So there was astrong political commitment toprogrammes of service delivery;the national water and sanitationprogramme was part of a shared visionof a nation in which people would haveopportunities to develop their skills andto use them productively to work for anincome with which they could meet theirbasic needs. Successive ministers ofwater have given energetic anddetermined leadership to the sector(Box 10). The water programme is oneof the government’s most popularachievements, which naturally reinforces

Clear legislation

Legislation has played an important role.South Africa provides the best exampleof this. Its 1996 Constitutionencompassed extensive social,economic and environmental rights,including the right to basic water andsanitation. The national rural watersupply and sanitation programme thusbecame not just a short-term activity byDWAF but an integral element of thewhole nation’s legislated human rightsprogramme. An independentConstitutional Court holds thegovernment accountable for adherenceto the Constitution. The Constitution iscomplemented by successive acts ofParliament that have stated very clearlythe policies and their application. Soevery organisation involved in the waterprogramme knows its role.

In Ghana, there are also clear laws,notably various acts of Parliamentdating from 1988 to 1998 that definethe policies and the roles of most of thesector agencies. Local government isthe subject of a bill that will soonbecome law: by defining districtassemblies’ roles and responsibilities,it will help them to recruit better calibrestaff and hence to implement thenational water and sanitationprogramme more effectively.

In Lesotho, the legal framework evolvedas the sanitation programmeprogressed from the pilot stage to anationwide operation, notably throughthe formation of the national ruralsanitation programme in 1987.This evolving legal frameworkgave legitimacy to the sanitationprogramme’s position as a regular partof the public sector’s work.

the politicians’ enthusiasmfor it. Local politicalleaders also play an activerole, setting budgetpriorities and servicedelivery standards andapproving projects, andhave a positive influenceon the success ofthe programme.

In Lesotho, the politiciansplayed a different, thoughstill important, leadershiprole. The original impetusfor the sanitationprogramme came fromsector professionals andexternal agencies whichstressed the importanceof fitting their work intothe mainstreamgovernment structure.The politicians for theirpart recognised this, andfor many years haveallocated significant sums

to sanitation through the government’sregular budget.

In all three countries, the government’spriority to water and sanitation hasnot changed over time. Even whendifferent political parties have beenelected, as in Ghana, the impetus forwater and sanitation work has beenmaintained. This long-term commitmenthas underpinned the successof all three programmes. It is importantbecause water and sanitation,and especially hygiene promotion,are activities that must be sustainedover a long period in orderto achieve success.

Key factors contributing to successful implementation are strong politicalcommitment to water and sanitation service delivery programmes,decentralisation and clear legislation.

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Community members dig trenches to lay water pipes, South Africa.

Decentralisation tolocal government

The devolution of authority from nationalto local government is a governancetrend that has been widely adopted indeveloping countries in recent years,and applies much more broadly thanjust to the water sector. Its meritsinclude increased accountability tothe people and flexibility to tailordevelopment work to meet local needs.Other sectors, such as health, havepioneered this devolution. In the watersector all three countries studied herehave applied this devolution of authorityand recognise many positive benefits,although they have also encounteredproblems with it.

Professor Kader Asmal is a lawyer and educationalist by profession, and aveteran of the struggle against apartheid. Before the democratic change in SouthAfrica in 1994, he had been instrumental in drafting the Bill of Rights on which thenew Constitution was based, including the human right to water. PresidentNelson Mandela then appointed him Minister for Water Affairs and Forestry, apost that he held from 1994 until 1999.

Minister Asmal provided vigorous political leadership to the national waterand sanitation programme in South Africa. At a time when many other issuescompeted for attention, he championed the cause of water and sanitation atcabinet level within the government and he obtained substantial financialallocations for the water sector. He galvanised his own department and othersector players into action, driven by his passionate belief in the people’sright to water.

In 2000, Minister Asmal received the prestigious Stockholm Water Prize inrecognition of his leadership of the South African national programme. He himselfsaw the award as ‘a celebration of the democratic gains in South Africa whichhave enabled us to carry out the far-reaching changes to our body politic’.9

Box 10: A Politician’s Story

The two main problems have been thelong time needed to build up theexpertise of local governmentorganisations to fulfil their new role(which may in turn cause a temporaryreduction in coverage rates), and theirnatural inclination to revert to supply-driven centralised approaches andtechnologies. Both Ghana and SouthAfrica are experiencing these problems,and it is still too early to state how theywill be solved. In Ghana, for example,the devolution process has been wiselyslowed by the government to a paceslower than the external supportagencies would have liked, while CWSAstill has to implement water programmeson behalf of many local governments asa temporary measure. In South Africa,a significant proportion of localgovernments are not yet ready to take

on their legal obligations for water andsanitation, mainly because they lack thefinancial and operational capacity.

The corollary to the successful transferof power to local government is theexistence of a strong central agency tosupport local government. This isprecisely CWSA’s role in Ghana. While itwas the implementing agency in theearly stages, it is now principally helpingand supporting local government totake on this work. In South Africa DWAFis following a similar path, handing overresponsibility for implementation to localgovernments, and it will take on aregulatory and support role. In Lesotho,the devolution to local government tookplace at the start of the programme,with district sanitation teams taking themain role in implementing theprogramme, supported by the RuralSanitation Improvement Team.

Strong communities,civil society and media

This case study has consistentlyemphasised the leadership role of thenational governments. However, thecommunities themselves, local civilsociety organisations and the massmedia have also played important roles.

Community management principles havebeen important in Ghana and Lesotho,and in a few aspects (notably sanitation)of the South African programme. Theyare crucial to the sustainability of waterand sanitation services. One importantcorollary of community management isthat communities cannot manage theirwater and sanitation services in a vacuumbut need long-term technical andprofessional support from intermediaryorganisations. In Ghana and Lesotho, this9 Personal communication to the author, April 2000.

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Local governments need professional support from strongcentral public-sector organisations in order to implement their workprogrammes effectively.

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role is largely filled by small-scale privatesector companies, whose role has notbeen well documented or acknowledged.In South Africa, this support is providedby government agencies. Civil societyorganisations, on the other hand, areparticularly active in South Africa.For example, many human rightsorganisations were influential in thedebates that led to the constitutionalright to water and have even takencases of water disconnections to theConstitutional Court for decisions infavour of the users. South Africa alsohas NGOs that work in water servicedelivery, notably the Mvula Trust. TheTrust was influential both in policyand implementation of sanitation inparticular. The South African media havealso played an important role in ensuringpublic scrutiny and transparencyof the water programme.

In Ghana, the media provide livelycoverage of water issues, mainlyrelating to private-sector participationin urban water. In rural water they seesome progress, though less insanitation. They believe that their role isto communicate people’s views to thepoliticians – meanwhile the politiciansfeel that the media are often careless ornegative in their coverage. The GhanaianNGOs were initially helpful andconstructive in their contributions to thepolicy debate, but recently CWSA hasperceived them as more antagonisticin relation to possible private-sectorparticipation, apparently as a result ofinfluence from international social justiceand anti-globalisation organisations.

In Lesotho, the sanitation programmewas wholly implemented by thegovernment. NGOs played only a minor

role. The media were, however,important for the hygiene promotionthat generated people’s demandfor sanitation.

Active support fromexternal agencies

External support agencies haveplayed different supporting rolesin the three countries.

In Ghana, they have played a secondaryrole in policy-making but are vital infinancing the water and sanitation sectorand hence in Ghana’s ability to achievethe water and sanitation MDGs. Severalbilateral and multilateral donors hadbeen active in the water sector foryears, and had recognised theweaknesses of the centralisedgovernment-run implementation andmaintenance system. So the new policyprocess, while driven by Ghanaiansthemselves, was one with which mostof the external agencies felt empathy.These agencies continue to provide thevast majority of funds for CWSA’scapital investments, and thisdependence on external finance seemslikely to continue for many years. Thispattern is typical of a low-incomecountry. The role of the World Bank inthe Ghana programme attracts a rangeof comments. On the one hand, it hasmade loans available and supported thesector reforms and decentralisation. Onthe other hand, some sector players inGhana have the impression that theBank is stipulating certain conditions (forexample, fixed percentage contributionsto capital costs, minimum proportion ofpeople demanding latrines in a community,private-sector involvement) in order toaccess those loans. The Bank denies any

In Lesotho, water and sanitation options are discussed at an open community meeting.

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such conditionality, but there is still a feelingin Ghana that it has a disproportionateinfluence on sector policies.

In Lesotho, the external supportagencies were instrumental in startingthe national sanitation programme, butworked with the government to designthe whole programme specifically toavoid financial dependence on them inthe long term. Initially they suppliedexpert personnel who helped todevelop the programme in closecooperation with national staff withingovernment, and handed over allmanagement responsibilities to thegovernment staff. The external supportagencies also gave funds to develop thenational programme as a whole and inparticular to train private-sectorbuilders, but not to subsidise latrines.

In South Africa, the external supportagencies have had little influence on thepolicy process, and provide only a smallpercentage of the funding for thenational programme.

The South African governmentappreciates their support, but it is clearthat the programme is overwhelmingly aSouth African one and would haveprogressed almost as quickly withoutexternal support. This pattern is typicalof a middle-income country.

ConclusionsThese three national programmeshave achieved significant progresstowards poverty eliminationthrough improved water and

sanitation. Although they are alldifferent, there are several generalconclusions that can validly bedrawn from them:

● Top-level political commitment towater and sanitation, sustainedconsistently over a long time period,is critically important to the successof national sector programmes.

● Clear legislation is necessary to giveguidance and confidence to all theagencies working in the sector todetermine their own policies andplans and to advance their activitiesas quickly and as well as they can.

● Devolution of authority fromnational to local government andcommunities improves theaccountability of water andsanitation programmes. Localgovernments need professionalsupport from strong centralpublic-sector organisations inorder to implement theirwork programmes effectively.

● The involvement of a wide range oflocal institutions – social, economic,civil society, and media – empowerscommunities and stimulatesdevelopment at the local scale.

● The sensitive, flexible andcountry-specific support of externalagencies can add significantmomentum to progress in the waterand sanitation sector.

In all three countries, there are stillproblems to be solved in order toachieve the water and sanitationMDGs and hence eliminate poverty:

● The main institutional concerns inboth Ghana and South Africa relateto local government. It is difficult todelegate operational responsibilityfor water services in the poorestareas of a country from a relatively

well-resourced national departmentto often weak local governments.Since this institutional change isregarded as a central feature in thenational programmes, it is vital that itis carried out successfully. Thesuccess of the process will only bemeasured by the sustainability ofservices over the long term.

● The main financial concerns aredifferent in each case. Ghana istypical of many low-income countriesin that the achievement of the MDGswill depend on continuing externalfinancial support. South Africa is aricher country and does not needexternal support, but there is aconcern about the financialsustainability of water supplies whoseusers do not pay for the service.This reliance on funding from generaltaxation depends on the strengthof the national economy and thecontinued commitment of politiciansto the programme.

● The biggest remaining technical andfinancial problem in Lesotho is latrinepit emptying. Any latrine pit willeventually become full, and it canonly be described as a genuinelysustainable sanitation system if thepit can be economically emptied. Todate, the only viable method still inuse is emptying by conventionalsuction tankers, which is relativelyexpensive and is subsidised out ofthe national budget. Many othercountries (including South Africa) arebeginning to encounter the sameproblem of pit emptying; Lesothohas already encountered it becauseits national sanitation programmeis comparatively old.

Water and Sanitation Program-AfricaPO Box 30577World Bank Hill Park BuildingUpper Hill RoadNairobiKenya

Phone: (254-20) 322-6306Fax: (254-20) 322-6386E-mail: [email protected]: www.wsp.org

June 2004

WSP MISSIONTo help the poor gain sustainedaccess to improved water andsanitation services.

WSP FUNDING PARTNERSThe Governments of Australia, Austria,Belgium, Canada, Denmark,Germany, Italy, Japan, Luxembourg,the Netherlands, Norway, Sweden,Switzerland, and the United Kingdom, theUnited Nations Development Programme,and the World Bank.

WRITTEN BYJon Lane

ACKNOWLEDGMENTSWith acknowledgement to ElizabethKleemeier, Mike Muller and Ian Pearson,who wrote the Water and SanitationProgram’s Blue Gold field notes that formthe principal sources for this paper, and toJohn Dawson for editorial help. On behalf ofthe World Bank, the task managers wereM. Louise Fox, Lead Specialist, AfricaPREM Front Office (AFTPM) andRobert B. Liebenthal, Consultant,Quality Assurance Group.

Photographs: CWSA-Ghana, ? Curt Carnemark, WSP-Africa,Juliet Waterkeyn, Ian Pearson, and Guy StubbsCreated by: Write MediaPrinted at: PS Press Services Pvt Ltd

Selected Bibliography ofUseful Further ReadingGhana

Baah, K. 2000. ‘Beneficiary Assessment Study of the First CommunityWater and Sanitation Project.’ Community Water and Sanitation Agency.Kleemeier, E. 2002. ‘Rural Water Sector Reform in Ghana: A Major Changein Policy and Structure.’ Blue Gold Field Note 2. Water andSanitation Program.Wakeman, W., and Hart, T. 2001. ‘Implementation Completion Report onthe [First] Community Water and Sanitation Project.’ World Bank ReportNo. 21785.

South Africa

Department of Water Affairs and Forestry. 2003. Water is Life, Sanitation isDignity: Strategic Framework for Water Services. Government of South Africa.Mphuthi, S., et al. 2003. ‘Mid-Term Review of the Water Services SectorSupport Programme.’ Department of Water Affairs and Forestry,Government of South Africa.Muller, M. 2002. ‘The National Water and Sanitation Programme in South Africa:Turning the Right to Water into Reality.’ Blue Gold Field Note 8. Water andSanitation Program.Palmer Development Group. 2000. ‘PPP and the Poor in Water andSanitation: Case Study on Durban.’ WEDC.

Lesotho

Evans, P., Pollard, R., and Narayan-Parker, D. 1990. ‘Rural Sanitation inLesotho: From Pilot Project to National Programme.’ UNDP/World BankWater and Sanitation Program and PROWWESS Discussion Paper 3.Feachem, R., et al. 1990. ‘A Case-Control Study of the Impact of ImprovedSanitation on Diarrhoea Morbidity in Lesotho.’ Bulletin of the World HealthOrganization, Vol. 68, No. 4.Pearson, I. 2002. ‘The National Sanitation Programme in Lesotho: HowPolitical Leadership Achieved Long-Term Results.’ Blue Gold Field Note 5.Water and Sanitation Program.

General

Water and Sanitation Program-Africa Region. 2004. ‘Water Supply andSanitation in Poverty Reduction Strategy Papers.’Cairncross, S. 1999. ‘Measuring the Health Impact of Water and Sanitation.’WELL Technical Brief 10.Esrey, S., et al. 1990. ‘Health Benefits from Improvements in Water Supplyand Sanitation: Survey and Analysis of the Literature on Selected Diseases.’WASH Technical Report 66.

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