Sanitation in Rwanda and Bangladesh: Successes, Challenges, and Policy Insights

This article is part of our collaboration with International Policy Review at IE University. Photo Credits: The Japan Times.

Abstract

An important aspect of the sixth sustainable development goal (“ensure availability and sustainable management of water and sanitation for all”) is the steps that governments take to improve the quality of life for its citizens. To this extent many strategies fail due to a multitude of factors, ranging from a lack of motivation to implement policies to a lack of funding and personnel. However, recent successes in Bangladesh (84% of whose population has access to sanitation) and Rwanda (72% has access to sanitation services) provide hope for many developing countries and inform researchers about what works and what doesn’t. Henceforth, this article aims to analyse the successes and failures of the Bangladeshi and Rwandan sanitation programmes. Through a thorough examination of the tools used, scope involved, and actors present, we can weigh their successes and failures, both of which are important lessons for the ultimate goal of this paper, a comprehensive model that can be used by similar developing countries to improve their respective levels of sanitation. All of this in the effort of making an effective exercise in creating universal protocols that bridge the gap between the challenges individuals face towards self actualization and their ability to fulfill their capabilities.  

Literature review

Literature surrounding water and sanitation in Bangladesh and Rwanda mainly focus on the methods employed by each country specifically, never comparing the two, thus making literature on the issue varied and rather vague. For example, “The Bangladesh Sanitation Miracle: How the Nation Achieved Near-Universal Access” by Peter Harvey and Rifat Hossain focuses solely on the issues of sanitation in Bangladesh, and thus excludes any other example of success. “Rwanda’s Success in Sanitation: How Political Will and Innovation Led to Rapid Progress” by the world bank group does the same with Rwanda. The state of  SDG6 research thus fails to include a cross structural analysis which is something this paper tries to change. Furthermore, much of the research in this area is descriptive rather than constructive, a fact that inspired me to create a model that might aid in access to water and sanitation.    

1. Introduction

The United Nations General Assembly (UNGA) adopted the Sustainable Development Goals (SDGs) in lieu of the Millennium Development Goals (MDGs), recognizing that the latter were unfeasible in their aspirations. This newly created 2030 Agenda revolutionized the way we viewed the world, emphasizing global action to solve global problems, and highlighting that individual action is only sufficient as part of a broader effort. On September 23, 2015, 193 countries of the UNGA formally adopted the 2030 Agenda. One of the 17 goals mentioned in this program, and of most relevance to this article, is SDG No. 6, which concerns access to clean water and sanitation.

A human being can survive only three days without water. Thus, access to clean water is a basic human right. Yet as of 2022, at least 2.2 billion people lacked safely managed drinking water, handwashing facilities, or lived in water-stressed countries. Over 3.5 billion people, or 40% of the world’s population, lacked proper and safe sanitation. With the demand for water far exceeding rates of replenishment in freshwater sources—comprising only 0.5% of all water on Earth—it is clear that this is a grossly overlooked issue. However, this perspective on the issue of water is extremely flat; in fact, it is a multidimensional issue that affects sectors as broad as education and even peace. Children cannot attend school because they are busy fetching water, many lose their lives fighting over access to rivers and lakes, and women are particularly marginalized in these areas. Despite the severity of this issue, with our current rate of progress, we need to accelerate efforts six-fold  to meet our drinking water goals, five times for sanitation, and four times for hygiene. Naturally, there is a need to find unique solutions to the problem of sanitation. Fortunately, the countries of Rwanda and Bangladesh have made significant progress in this department.

Bangladesh has a population exceeding 170 million, making it the eighth most populous country and one of the most densely populated. 42.6% of the population is urban; most importantly, however, Bangladesh enjoys near-universal access to drinking water, with nearly 98% of the population having access. Open defecation dropped from 34% to 1% in just 25 years, and 74.8% of the country has a handwashing station.

Rwanda, in contrast, has a much smaller population of nearly 13 million, with an urban population of 17.89%. The country has a growing but fragile economic base, especially since the Rwandan genocide of 1994. Despite these adversities, Rwanda has increased sanitation services, with 72% of households having access to basic sanitation services, and government spending on this sector increasing by nearly 28.6% within the last year. 

The ultimate goal of this research paper is to perform a comparative analysis between the two countries, identifying important similarities and differences in their approaches. More importantly, this study aims to analyze and identify which aspects have been the most successful and which have fallen short of their goals. To this extent, I have used a wide variety of secondary data, including research papers, government policies, laws, and statistical data. Consequently, creating a model with two levels of analysis, with each outlining a respective policy approach. With the bottom-up approach focused on non-state, individual actors, and the top-down approach analysing government/state behaviour.   This two-pronged analysis indicates that the model extracted from this analysis should be applicable to other countries as well.

2. The Bangladeshi Model: Examining the Balance Between Growth and Governance

The Bangladeshi model has a  sectoral approach in order to have the most impact possible, in doing so the government improves their scope and effectiveness of policy. In collaboration with the United Nations International Children’s Emergency Fund, (UNICEF), the Bangladesh Department of Public Health Engineering (DPHE) launched the SHEWA-B program to more than 20 million people between 2007 and 2013. It focused on the rural population of the country, citing them as the most vulnerable victims of preventable disease, dysentery, and other infections resulting from a lack of infrastructure.

As a part of the SHEWA‐B, the Bangladeshi government educated and established Community Hygiene Promoters (CHPs) over the course of 5 years. According to a 2017 survey nearly 47% of all households met with a promoter. Each CHP was given 27 days to become familiar with germ theory, communication tools and  WASH Water, sanitation and hygiene services technology like latrine construction and handwashing techniques. Between 2007 and 2010, efforts focused on handwashing after defecation and before consumption of food, for both children and parents. Between 2010 and 2012, it further involved a focus on menstrual hygiene, safe disposal of child excrement and arsenic-free water use. Newcomers were taught through the Assessment, Analysis, Action, or AAA, method and systems thinking tools like flashcards, charts and mind maps. However, promoters received only $42 a month for their efforts, which was 50% of what unskilled labourers would earn, and their workload was overbearing as they consulted  2,000 people every 2 months, resulting in high dropout rates. Thus, their impact was negligible, as there was only a 1.4% decrease in diarrhoea prevalence in control areas.

Yet, Bangladesh can also teach us a useful solution to issues with community engagement. The Building Resources Across Communities (BRAC) model of CHW was effective in providing aid precisely because it learned from the mistakes of SHEWA-B. It focused on intensive household engagement as opposed to extensive coverage, selling subsidized products like soap and menstrual pads. Workers, mostly  women, earned a liveable wage of $100-$150 a month, covering 150 households a month and undergoing a 3-6 month training program. The organization had over 50,000 CHWs working in the country by 2020. Their efforts led to a reduction of diarrhoea by 27% in monitored areas over a course of 5 years. Hence, it is extremely important to reduce a reliance on government funding (which SHEWA-B utilized) and take advantage of private efforts as well to create a mutually beneficial and substantive approach to issues of hygiene, but, most important of all, workers that are being used to campaign for hygiene need to be well paid and their workload manageable for real improvements to be seen and for efforts to be as productive and meaningful as possible.

Strong government commitments to the cause of sanitation and clean water are crucial in redirecting efforts to ensure success in all areas. To this extent the Bangladeshi government has implemented numerous programmes including the National Strategy for Water Supply and Sanitation, in effect since 2014, and the Institutional & Regulatory Framework for Faecal Sludge Management implemented in 2017. The National Action Plan and Revised National Pro-Poor Strategy implemented in 2020, and very recently the National Menstrual Hygiene Management Strategy (2021) revised the National Water and Sanitation Policy (1998) which is now realigned to fit the SDG. They have an $814 million budget for wash efforts as of 2017, an increase from $492 million in 2007, indicating a persisting and strong commitment to the SDG. These policies’ combined efforts have led to many innovations like the Arsenic Risk Reduction Program in risk-prone regions like Chandpur and Comilla, which consisted in drilling 150-200m deep tubes that resulted in a 95% safe water yield for over 150 communities. In addition, by 2020 they installed over 20,000 rainwater harvesting systems working at an 80% functionality rate. To improve capacity, they installed 2,000-liter tanks in coastal areas like Satkhira. In 37 districts like Barisal Pond, Sand Filters reduced salinity intrusion efficiency by 30%. Aiming to improve the sewage system in populated areas like Dhaka and Chittagong, Water Supply And Sewage Authority (WASA) programs are present. In Dhaka, they want to improve sewer coverage by 50% by 2030. In Chittagong, the $144 million project aims to expand piped networks to over 150,000 residents. Ultra-poor households (families that eat 20% below necessity but spend more than 80% of their income on food) form 13% of the population,  and receive  a $50 subsidy for latrines.

However, campaigns and public service advertisements seem to have a high success rate. The Clean Hands, Safe Life campaign airing on BTV and Radio Bangladesh resulted in an increase of soap availability at handwashing stations from 27% to 47%. The COVID-19 Hygiene Drive included 30-second ads featuring celebrities like cricketer Shakib Al Hasan, with UNICEF reporting in 2021 that over 85% of households recalled the messages. School campaigns had over 50,000 schools train students as “hygiene ambassadors”, with over 22% of schools having sanitary pad disposal bins by 2018. The government also works with intergovernmental organizations which can use foreign money and investment to boost local programmes, which is another important aspect to improving conditions and making up for a lack of domestic resources. The World Bank’s rural water supply and sanitation project involves over $40 million for the establishment of 11,900 safe water points. The Dhaka Sanitation Improvement Project allocates over $72 million for drainage upgrades.

To conclude, when wanting to engage communities into sanitation efforts, it is much better to use a bottom-up approach where action is induced by the population itself, supporting NGOs and other local efforts yields much greater results when compared to government established programmes aimed at the community. This is most likely because, as grassroots actors, they have a more accurate idea of what motivates individuals and the incentives needed to spur action. On the other hand, national-scale action that does not require community participation to work but rather public awareness through a distinctly governmental lens can also prove successful as states have greater resources to make tangible infrastructure changes that improve the physical capabilities of areas. In fact, the government might be the only actor capable of such action. Thus, their top-down approach works when considering local and national scale initiatives. In fact, their usage of foreign investment might serve as an additional advantage to their efforts.

3. The Rwandan model

Rwanda’s response to sanitation and clean drinking water concerns began with a national-scale, top-down approach. The government, in 2010, pledged to guarantee universal access to safely managed sanitation services by 2024, as enforced by the Water and Sanitation Sector Strategic Plan. To achieve this, they have implemented a variety of national policies. The National Sanitation Policy established in 2016 focused on integrated waste management, hygiene promotion and decentralized implementation. The Economic Development and Poverty Reduction Strategy prioritized sanitation as a key element in the poverty alleviation effort. While these plans have not quite achieved their ambitious goals, there have been significant improvements. In 2000, 42.31% of the population used basic sanitation, yet as of 2020, over 72% use unshared toilets, and facilities have improved by 92% in quality since 2000. With regard to access to clean water, over 72% of the urban population and 56% of the rural population have access to basic water services, resulting in a general 82.3%  increase in the amount of sources of clean drinking water—A clear indicator that these policies were working and the circumstances in the country have improved rapidly. Many credit the structure of their implementation as a huge asset to efficiency as it covers a wide variety of services, with over six different departments working towards SDG 6. 

The MININFRA (ministry of infrastructure), closely overlooks sectoral planning, effectively mobilizing resources for national policy. It coordinates the nearly 60% of sector funding that goes into access to clean water and sanitation, along with donations from intergovernmental organizations like the World Bank, African Development Bank, and UNICEF. The Ministry of Health promotes a decentralized governance model implementing the Community-Based Environmental Health Promotion Program, or CBEHPP, effectively installing pit latrines with slabs in over 84.3% of all rural households. It further realizes the Community-Led Total Sanitation (CLTS) program, that mobilizes villages to eliminate open defecation, successfully reducing their occurrence to 1% across Rwanda. The WASC (Water and Sanitation Corporation), manages urban water supply, sewerage and treatment plants. However, sewage systems are limited to high-density areas, namely parts of Kigali, using affordable condominial sewerage methods. Public-Private Partnerships (PPPs)  are crucial for sludge management and water purification efforts. The MININFRA issues permits and standards that control the activities of enterprises, while the WASC oversees compliance with environmental standards. Coordination with private enterprises like Nduba to increase the efficiency at which fecal sludge management occurs as their trucks take care of extraction and transportation and their treatment facilitates the disposal of fecal sludge. Additionally, community-focused government-backed programs appear to be some of the most successful: for example, the Umuganda service, which is mandatory service on the last Saturday of each month from 8.00 am to 11.00 am, involves community clean-up drives in highly polluted areas. Failure to participate might result in a fine. Microfinance from banks like Urwego Bank aids low-income households with investments in sanitation with small, low-interest loans ranging from $234 to $391 to build or upgrade latrines. They have tailored repayment schedules that align with household income cycles, making the shift towards cleaner sanitation much less daunting. This comes in tandem with polluter pays strategies and further subsidies for low-income households. The government has also invested in expanding its water supply efforts, with at least 1,937 km of water pipelines in urban areas and 1,852 km in rural areas reportedly being extended, constructed or rehabilitated. The aim of these efforts is to reach every household by 2030. To this extent, nearly 96% of the urban population has access to drinking water through public taps and protected sources. In addition, nearly 87% of the population gets water from government-protected sources like springs and boreholes; these sources are sustainably managed and constantly monitored for signs of contamination and pollution to ensure safety of water, further using filtration and solar disinfection processes to remove contaminants.

Despite the Rwandan government’s steady and admirable efforts in combination with tangible progress in increases in sanitation and access to clean and safe drinking water, an issue of huge concern presents itself: the divide between the rural and urban households. There is nearly an 11% difference in access to safe and clean drinking water and a 41% difference in households using piped and supplied water. Only 16 % of rural households have access to water within 200 meters of their home, and 34% have access within 500 meters; in comparison, 60% of urban households have water within 200 meters and 75% within 500 meters. Nearly 44% of rural households still use standpipes, and 15% still rely on unimproved water sources. It is obvious therefore that the progress that Rwanda has made has left its most vulnerable population increasingly thirsty. Hence, it can be concluded that even though government support is an amazing method to rally support and coordinate efforts to improve sanitation in a way that is both effective and methodological, its unequal focus can widen the disparities among its population. A reason for this could be that major constituencies and populations are urban, coupled with their proximity to the center of governance, which might make it crucial to take action, not to mention the existence of technical infrastructure that makes achieving goals much easier. Nonetheless, this means that the rural population is unjustly neglected.

This entire process teaches us some crucial things. The presence of the PPPs model is extremely effective in mitigating the inefficiencies of public systems, though it needs to be monitored to ensure support given to rural populations as well. Additionally, the benefits of decentralized planning and infrastructure coordination are quite evident, especially in mobilizing civil society to help rural populations.

4. My proprietary model

When tackling the creation of my own model, especially one that could work in a variety of economically developing countries, a two-level approach would be the most effective. By this, I mean a top-down approach level that deals with government action catered towards the citizenry and influencing citizen action through laws, regulations, and legislation, ensuring that all actors can take joint action to combat issues of clean water and sanitation. However, most importantly, this level deals with infrastructure and development along with civil engineering, possible only with the help of governments to enforce and approve of changes that might make sanitation facilities easier to access and clean drinking water available to all. Here the primary actors are governments (institutions and officials), enterprises that work closely with governments, and foreign aid. The second level is a bottom-up approach, which, as the name implies, involves how the citizenry takes grassroots-level actions to help themselves and aid one another in a larger community. Here, local agents take issues into their own hands, gauging what the community and individuals need and making efforts themselves on ways to improve. This action therefore is so strikingly effective because it targets the people that need help, justifying its separation on its own level. Another very important factor at play here is how governments interact with these local actors. Facilitating them and helping them grow is an essential dynamic at this level. Here the primary actors are local leaders, NGOs, and individual families.

Figure 1. Top-down approach 

The PPPs model used by Rwanda is particularly striking, as it ensures innovation, private and public gains, and accelerates infrastructure development. It reduced the burden that the government has, all while increasing the autonomy of local actors, and reducing bureaucratic barriers. Preventing the influence of these actors from overreaching and potentially harming progress through pollution or unequal distribution of resources. Where I would defer in the use of this method from that seen in Rwanda is a focus away from urban areas and instead rural communities to bridge the urban-rural gap.

Laws, regulations, and legislation are crucial to ensure compliance towards sanitation progress across the entire population; they act as a fundamental basis through which individuals can take actions and set rules for the game. Most importantly, they limit the ability of corporations and other institutions to exploit the people and, in doing so, establish fundamental duties to the people and determine what the people have a right to. Thus, by creating a complex system of rewards and incentives progress is more likely to occur. 

Infrastructure like latrines, sewage systems, and pipelines are crucial for the advancement of SDG 6 and are unlikely to happen solely through community action; they need government planning and action. Thus, commitments from the government to implement changes as well as coordinate civil engineering are essential. This section also extends to foreign aid, which the government receives from international institutions like the World Bank, the International Monetary Fund and countries like China and the US. Besides providing monetary support in the form of aid, they also provide strategic civil service plans and help lay out cities and urban development.

Most effective of all, however, are campaigning efforts. They have extremely high penetration rates, especially in urban populations; they are relatively easy to make, and increased technological innovation makes the dissemination of this tool extremely easy. Furthermore, a change in behavior of an individual is the ultimate goal of this method, and as seen in Bangladeshi campaigns, it is increasingly viable.

Figure 2. The bottom-up approach model

In regard to community engagement, microfinance is a solution present in both Rwanda and in Bangladesh. Here, financial services would be provided to low income families to create household infrastructure like filtration systems and handwashing stations. These financing systems target those often ignored by centralized systems, and thus cover individuals that the top-down approach might ignore. In other words, covering many crucial blind spots. 

A major learning from the Bangladeshi model comes in the form of the Community Health Worker model that shows the benefits not only of local organizations, but also the credence in providing proper financial support for volunteers and incentivizing sanitation efforts. Thus, volunteers at this level of approach should be provided a livable wage and a manageable workload, though this should vary between countries and not be a standardized approach. In the same vein of thought, non-profit organizations play a huge role; they are frequently created with a specialized goal and are crucial in, like the PPPs, removing burdens from the government and working more efficiently. The only difference is that as non-profits, they are more likely to use humanitarian resources to provide much more than physical capabilities to individuals. However, a crucial suggestion in this model is the light support from governments, which is essential to the longevity of non-profit organizations and can help them increase their legitimacy while providing tangible impacts that create a symbiotic and mutually beneficial relationship.

However, to ensure that this down-up approach works, decentralized planning should be implemented by governments. Here, decision-making is distributed amongst various individual or localized agents. For issues like sanitation, especially, which might seem trivial to policymakers in urban areas, a strategic approach where decision-making authority about these issues is distributed to various sectors within the country rather than a centralized forum. This therefore brings us to the last module here with the importance of individual action and the crucial role of community leaders in engaging citizens and relying on support towards achieving sanitation and water growth, along with the importance of individual sanitation habits.

5. Conclusion

This research paper’s ultimate objective is to conduct a comparative analysis between two nations, highlighting significant parallels and divergences in their methodologies. More significantly, this study seeks to evaluate and determine which elements have achieved the greatest success and which have not met their objectives. Water is a complex subject that impacts many areas, including education and even peace. Women are especially marginalised in these locations, many people die battling for access to rivers and lakes, and children are unable to attend school because they are too busy gathering water. Despite how serious this problem is, the UN suggests that we must accelerate our efforts by six times to fulfil our drinking water targets, five times for sanitation, and four times for hygiene at our current rate of advancement. Naturally, the demand for innovative solutions to the sanitation issue is greater than ever, and in response to this need I believe the model laid out could be an important stepping stone for many developing countries around the world to catalyze action in the area.

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