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

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?

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3 Responses to “What can historical success teach us about tackling sanitation and hygiene?”
  1. Al-hassan Adam

    Good Report by Henry and Tim! It would be interesting to show at what point Ghana, Zambia and co fell behind the curve. There are important questions raised here in terms of the role of Big State. Some good lessons for advocates of slim state.

  2. Henry Northover

    Duncan, Thanks for the blog piece on our paper. Thoughts by way of response.

    On your point about the paper not pulling out the necessary conditions for developmental politics, I think it’s fair to say we could have been clearer that the analysis presented only sets out the public policy drivers of successful reform efforts. In the paper’s defence, it does point to the pursuit of the common good and notions of ‘modernity’ in newly independent states as some of the political context.

    I guess my challenge back on your summary is to ask whether, in the urgent rethink prompted by Agenda 2030, it’s worth going into the country specificities that went towards making up the “politics behind the policies”. Isn’t one left telling Tanzania or Ghana: “do give up now because political history tells us you need intra-peninsular and Cold War rivalries, or recent independence with which to fashion a nation-building project, or ethnic cleavages that can only be overridden by a leadership that…. (cont’d P.74)”

    It might be the stuff of the history of development politics or exercises setting out interesting parallels between Rwanda and Singapore etc but not a useful route map for policy-makers desperate to deliver the step change in the performance of the basic services’ sectors .

    For me, one of the many interesting findings to emerge and one that challenges INGO advocacy is the nature of ‘political will’. As you point out, the politics of exhortation and declarations of worthy intent were insufficient. Rather, it was a fine balance between subsidiarity in policy implementation backed up by an administrative culture of ‘breakers of bottlenecks’. The best quote from the Malaysian Deputy Prime Minister to health workers:

    “Your function, first and foremost, is a function of a ‘breaker of bottlenecks’. You must get out and around to every district, looking for frustrations, looking for departmental disagreements, looking for delays, and, when you have found them, you must diagnose them and then: (a) try on your own behalf to solve them; (b) if you cannot solve them yourself then report to the officers of my Ministry and ask them to solve them; and (c) when all else has failed then they will be brought to me and I will try and solve them.”

    So, INGO advocacy efforts that aim to tweak text in declarations miss the point. What’s needed is a methodical engagement by elites insistent in progress-chasing delivery, in freeing up bottlenecks, cyclical monitoring and pursuing progressive reforms. It’s that that is decisive and not paper plans or stand-alone declarations. In modern parlance, it’s ‘adaptive management’.

    It would be interesting to hear if there are parallel models in other basic service sectors

  3. Indrani Ganguly

    A good report, also the note that would this work in more democratic countries.The Indian Prime Minister has committed to Swaccha Bharat (clean India) but given the diversity and levels of dissension within the political parties and the general population that will take a while to achieve.