63793 Sanitation Marketing April 2011 At Scale Field Note Sanitation and Hygiene Series Experiences from Rural Benin Sanitation Marketing At Scale This field note presents the Benin story and its development of a successful national sanitation marketing program adapted to the rural African context. It provides valuable learning, lessons and innovations for other African countries seeking to develop rural sanitation marketing programs that stimulate household demand at scale and harness the potential and capacity of the local informal private sector market to supply products that respond to consumer needs. 1 Summary Map of Benin Sanitation marketing is a sustainable approach to household sanitation uptake at scale. While efforts in Africa to use marketing are underway in several countries, success stories have yet to be shared. In Benin, the Directorate for Hygiene and Basic Sanitation within the Ministry of Health has championed the development and operation of a highly innovative rural sanitation marketing programme. Within the first one-and-a-half years promotion cycle under national roll-out launched in 2005, the programme has resulted in a 10 percentage point increase in improved sanitation coverage from a baseline of 6.2% across 80,000 monitored households. Besides the one in ten households in enrolled communities that has completed construction, a further 2 to 3 out of every ten households is either planning or in the process of building an improved family latrine by accessing market-supplied materials and services. While already impressive these figures likely underestimate the full impact of this marketing intervention for reasons which are explained. This field note presents the Benin story and its development of a successful national sanitation marketing program adapted to the rural African context. It provides valuable learning, lessons and innovations for other African countries seeking to develop rural sanitation marketing programs that stimulate household demand at scale and harness the potential and capacity of the local informal private sector market to supply products that respond to consumer needs. Source: CIA Factbook Introduction Sanitation marketing is an approach to local sanitation industry. In sanitation and desires (see Table 1 for a summary household sanitation promotion that marketing, there is no subsidy for of key elements). The approach is aims to create sustained and effective hardware (e.g. cement, slabs and/or potentially one of the most promising sanitation by stimulating household superstructure). It is an approach that sustainable approaches to dealing demand for sanitation products and builds upon strong understanding of with the sanitation crisis and leading services. At the same time private sector consumer motivations and preferences to the attainment of the Millennium provision of products and services is as well as constraints to latrine adoption. Development Goals for Sanitation. developed and enhanced, with both The key aim is to develop promotional activities acting together to result in and private-sector supply-chain Sanitation marketing has been the establishment of a sustainable interventions that reflect consumer needs successfully applied in Vietnam (Frias 2 Sanitation Marketing At Scale Table 1: Key precursors and elements of a successful sanitation marketing approach Create a supportive policy & Stimulate demand for Develop private sector supply Facilitate linkages between enabling environment sanitation of desirable and affordable demand and supply technologies - Include supportive language - Understand consumer - Identify and standardise a - Link consumers with service in key policy documents behaviour and drivers of range of low cost desirable providers demand technology options (r&d) - Encourage donors to - Improve flow of information promote market-based - Develop, test and deliver - Increase no. Of trained/skilled between consumers and approaches marketing messages using local providers suppliers effective communications - Encourage local-level channels - Build marketing & business - Quality assurance/product government support for capacity of local providers warrantee sanitation marketing - Mobilise community for behaviour change - Endorse/certify service - Increase value for money - Enact legislation to provide providers through increased market for necessary dedicated - Understand what household competition financing for sanitation expenditures compete with - Support extension of supply- investments in sanitation chains for construction materials and components - Educate & inform consumers about technologies Adapted from Outlaw, Jenkins, and Scott, 2007. Opportunities for Sanitation Marketing in Uganda. USAID HIP, AED, Washington, D.C. 2005) and elements of the approach construction of improved latrines in Development of the Rural Water and [behaviour change communications, no 25,000 households across 9 of 12 Sanitation Sector’). Under PADEAR, hardware subsidy, and development of departments of the country by the end of the government began testing a new the small-scale private sector to supply 2009. approach to rural sanitation promotion household sanitation] were largely utilising social marketing to motivate responsible for Lesotho’s successful Origins of sanitation marketing in Benin household demand coupled with government-led urban sanitation program Benin’s national rural sanitation marketing sanitation delivery by small-scale private which began in the 1980’s (Pearson and hygiene promotion programme sector providers (local masons) via the 2002). Benin provides the first example (hereafter referred to as the PHA from its market. of a fully developed and tested national full French title Promotion de l’hygiene rural sanitation program that adapts et de l’assainissement –translated as PADEAR (1996-1999) was a government sanitation marketing to the rural African ‘hygiene and basic sanitation promotion’) programme initiated with World Bank and development context. is operated by the Directorate for Danish funding to put into practice the Hygiene and Basic Sanitation (DHAB) new (1992) National Water Supply and This field note shares the story of the within the Ministry of Health, with Sanitation Sector Development Strategy development of Benin’s highly innovative substantial Danish, Dutch and German (NWSSSDS). The NWSSDS called for marketing-based rural sanitation donor investments. Its beginnings can demand-led, efficient and sustainable promotion program currently on track be traced to 1996 and the PADEAR water and sanitation development across to result in the subsidy-free household programme (‘Project Support to the rural Benin via four key policy principles: 3 1. Decentralisation of the decision- in order to generate local competition and used PHAST (participatory hygiene and making process to the community keep latrine prices competitive, while the sanitation transformation) approach level (allowing households to make inclusion of not just construction training were combined to develop an image- informed decisions about their water but the impartment of basic marketing based participatory communications and sanitation infrastructure) and sales techniques allowed masons to package to address essential hygiene 2. Community contribution to initial effectively find their own new customers education and awareness along with capital investment and full contribution and market their services. The availability social marketing of improved latrines to cost recovery of infrastructure, with of masons’ services was also promoted for household or compound settings. households responsible for the full through the above-mentioned social Four target behaviours were included costs of their sanitation facilities marketing communications campaign. in the communications package (this field note focuses only on the sanitation 3. Prioritisation of efforts to reduce the The PADEAR1 pilot was fully operated component): costs of technologies, both capital for about 2 years and worked particularly 1. Building a sanitary latrine investment and maintenance costs well when the social marketing messages 4. Development of the national and 2. Safe hygienic transport, storage effectively reached households in local local private sector as primary actor and use of improved drinking water areas with an active trained mason responsible for supplying water and supplies marketing his services. sanitation goods and services 3. General domestic hygiene Scaling up 4. Handwashing with soap at key times The strategy also highlighted the need for Following key lessons and successes systematic hygiene promotion in all rural from the PADEAR-supported rural Box 1 highlights the programme water supply and sanitation programmes. sanitation marketing pilot, other donors adaptation and development process. began to experiment with a market-based The PADEAR social marketing approach by initiating pilots in other communications campaign utilised Departments including, Alibori, Borgou, mass media (radio and billboards) and Mono, Oueme and Atacora. Meanwhile direct consumer contact (DCC) activities Danida, between 2000 and 2004, financed (games, competitions, give-aways) the testing of a number of adaptations to disseminate consumer-focused to improve and refine the approach. motivational messages based upon non- Improvements were designed to bring health benefits of latrines reflecting rural the promotional activities in systematic communities’ own perceptions of the direct face-to-face contact with individual usefulness and value of latrines. households, coordinate access to the network of trained local latrine providers, A network of local masons was trained offer independent technical advice and to build a variety of low-cost latrine oversight to households, and refine the IEC models. In order to make latrines more (information-education-communications) affordable for rural households, the and marketing communications materials. Sanplat latrine technology was tested Refinements to the IEC materials were and introduced as a cheaper alternative, needed to support the new system of along with design standardizations to door-to-door promotion and scale-up the existing VIP single and double-cabin communications effectively across the wider populations of Atlantique and Zou. A newly constructed latrine. latrine to provide technology choice at lower cost. Training of multiple masons Marketing messages used in PADEAR and in each District (Commune) was essential streamlined elements of the previously 4 Sanitation Marketing At Scale Box 1: PHA intermediate phase development phases Nov 2001 – Mar 2002: Social study b. Low cost latrine designs c. Sanplat latrine construction steps Recognising the need to better understand the rural reality in order to d. Latrine maintenance and cleaning drive the key behaviours promoted within the programme a social study was commissioned to: To ensure these images were understood and effective, the materials were tested with rural populations before finalization for reproduction and 1. Explore attitudes relating to hygiene, water, defecation and basic use. Such testing is essential to ensure the success of any promotion hygiene campaign. 2. Define participative ways to improve and promote the health of rural October – December 2002: Hygiene agent training and training populations guide development 3. Identify motivating and constraining factors to promote and sustain With the completion of communications materials, cascade training good behaviours began with the training of Government District-level Hygiene Agents and contracted NGO animators who would in turn train the village health 4. Identify channels of communications in villages volunteers under their supervision through the use of a training manual developed and tested simultaneously. 5. Identify appropriate criteria for the selection of volunteer health promoters Early 2003: PHA pilot test volunteer hygiene promoter training Methods used to conduct the study included the use of environmental Once the Hygiene Agents were trained to execute the program, they walks, structured observations, structured individual interviews and under took the recruitment and training of Volunteer Hygiene Promoters focus group discussions carried out in local languages. across pilot communities. The outcomes of this research allowed the development of clear 2003 to Mid-2004: Volunteers and hygiene agents implement pha motivational image-based messages for delivery via a social marketing cycle activities in pilot test villages approach utilising appropriate channels of communication and strong volunteer health promoters. The 18 month cycle is implemented in pilot villages in Zou, and Atlantique Departments including a baseline survey of behaviors and July – November 2002: Communications materials development sanitation coverage undertaken as part of the PHA cycle of actvities. Following the conduct of research and message development 4 sets Nov 2004: External evaluation of pha pilot experience and impacts of motivational and educational images, based on the participatory communications method of serial images, for use in house-to-house The Project contracted with an agency in Benin, CEDA, to undertake promotion and with community groups were developed by a professional an rigorous evaluation of impacts. The evaluation documented a 20 creative agency. These related to: percentage point increase in family latrine coverage across pilot areas, among other improvements in hygiene and water handling practices 1. The faecal-oral transmission of water-related diseases and the ‘peril’ among households in comparison to the baseline survey, and highlighted of faeces, adapted from the PHAST tool on this topic the very high value and effectiveness of the visual image materials and the door-to-door promotional and communications activities in 2. The promotion of safe water for drinking stimulating and encouraging households to build latrines without any outside financing. In particular, volunteer hygiene promoters and agents 3. The promotion of handwashing with soap noted the high level of effectiveness of the set of five images expressing inconveniences and advantages of having a latrine in motivating 4. The promotion of family latrines (focus of this field note) with households to decide they wanted to build a latrine. included four different image sets: a. Motivational messages focussing on the inconveniences of open defaecation and the advantages of having a latrine (see fig 4 for final images) 5 Full scaling-up of the PHA using the operates within a strong policy in delivering the overall Hygiene and newly refined and tested materials and environment and combines learnings Sanitation Promotion Programme (PHA): approaches began in 2005, with the from PADEAR and PHAST to deliver a 1. National Government (DHAB): programme launching operations in the combination of hygiene and sanitation Leadership and strategic direction, Departments of Atlantique, Zou, Alibori, educational, motivational and supply- development and provision of Borgou, and Collines between 2005 and chain development approaches to drive promotional and training materials, 2007. Expansion aims to cover a further 4 rural household sanitation adoption and monitoring, evaluation, reporting Departments with aim of reaching a total via market-based supply. Table 2 and budgeting of 64 of the 77 Districts across 9 of 12 summarises Benin’s fulfilment of the 2. Regional Government (SHAB): Hygiene Departments of Benin by the end of 2009. basic essential activities necessary for a Agents (2 per commune, overseeing successful sanitation programme (as laid promotional activities over 1.5 years in The current sanitation marketing out in table 1). 20 localities at a time) to provide local component of the PHA (2005-2009) Five key sets of players are involved level leadership and support, train the Table 2: Key elements of Benin’s rural sanitation approach Creation of a Supportive Policy Demand Stimulation Supply of Desirable and Linkages Between Demand and and Enabling Environment Affordable Technologies Supply - National Strategy and Policy promoting private sector - Combination of educational - Sanplat recognised as - Hygiene Promotion delivery and increasingly and motivational messages cheaper and desirable Volunteers (relais) and local explicit about a zero alternative to the currently government Hygiene Agents hardware subsidy approach - Hygiene Education: PHAST available double-cabin latrine able to link households and (hardware subsidies to be faecal transmission routes masons phased out among all except and barriers tool - Masons’ training provided to the very poorest households develop a local network of - Hygiene Agents aid by end 2008; NGOs to also - Motivational Messages: providers household in siting of latrine follow this) - Avoid Snakes - Avoid Discomforts of - Trained masons’ certificated - Hygiene Agents and - Major donors (e.g. Dutch, Bush and equipped with moulds Promotion Volunteers monitor Germans, Danish) supporting - Privacy quality of mason’s work the program and pushing - Pride/Status - Catalogue of latrines models for zero hardware subsidy - Avoid Flies on Food developed and reproduced - Hygiene Agents and approach (the donors have Promotion Volunteers been key drivers influencing - Consumer latrine technology provide technical advise to sanitation policy) information materials households (catalogue of options, - Ministry of Finance and construction steps pictures, Health allocating budget and prices) revising job descriptions to support the program - Messages delivered at multiple levels: - New government position - Door-to-door and role of Hygiene Agents - Community Meetings created to drive the - Radio programme locally - Simple picture materials Adapted from Outlaw, Jenkins & Scott 2007 6 Sanitation Marketing At Scale village volunteer hygiene promoters and local masons, gather programme Figure 1: The PHA approach to hygiene and sanitation promotion in Benin monitoring and impact data, assure latrine construction quality; Supported by Ministry of Health supervisory Establishment of list of localities/villages to receive PHA intervention SHAB-level personnel 3. Volunteer Hygiene Promoters (Relais Stage 1 Formation and training of intervention team: Hygiene Agents, NGO Animators, Technical Services from Mayor’s office, Relais, Masons Communautaire): Community-based latrine education and promotion; monitoring of latrine construction, Situation Analysis/Baseline Study (conducted by Relais and HAs) hygiene behaviour changes, and cycle progress (2 Relais, one male and one PHA Campaign: Behaviour Change Promotion female, per community) 4. Masons: Construction of new Drinking Water Hygiene (collection, 18-month hygiene and Cycle 1 storage and treatment) standardized latrine designs; door-to- sanitation promotional Stage 2 cycle: education and door promotion of services social marketing by Cycle 2 Latrine Construction and Maintenance 5. NGOs and Hired Animators: Relais, masons, Has and contracted NGO Contracted to supplement the Cycle 3 Domestic and Food Hygiene animators program where Government capacity (N.B Cycles can be is insufficient by carrying out the same delivered in any order) Cycle 4 Hand Washing with Soap work as a Hygiene Agent in places where Agents are unavailable. Stage 3 Evaluation Study (conducted by Relais and HA) A brief overview of the approach is illustrated in Figure 1 and the sanitation component is now described in more detail. The strategy utilises a community-based volunteer system Directorate for Hygiene and Basic Before the promotion activities begin (hygiene promotion volunteer system) Sanitation who train two government- in a community, the volunteer hygiene to reach out to households within their employed ‘Hygiene Agents’ per District promoters produce a community map communities with an 18-month hygiene whose responsibility it is to train and showing the position of each household and sanitation promotion cycle which monitor local masons in improved in their locality and location of any latrines incorporates a sanitation promotion latrine construction designs and two either completed or under construction module and involves both community hygiene promotion volunteers per (sample shown in Fig 2). These maps, meetings and, critically, house-to- Locality (a community of about 80-90 alongside an initial baseline survey (which house visits. The sanitation module households on average) to carry-out the utilises pictures for each question to aid targets households directly with advice, 18-month community-level and door- data collection by volunteers with low technical information and motivational to-door promotion cycles within their literacy), give a baseline latrine coverage messages to encourage and promote the communities; such promotional activity and allow for simple yet effective monitoring construction of household latrines in the is further supported through local radio and evaluation. Each time a new latrine absence of hardware subsidies. announcements and advertisements. construction is started or finished the Each Hygiene Agent manages the cycle hygiene promotion volunteer adds this to To date the strategy has been led in 10 localities at a time, rotating to a new their map, along with marks to keep track centrally by the Ministry of Health, group of 10 localities every 18 months. of household visits. At the end of the 7 18-month cycle, an evaluation survey is conducted to measure changes in latrine Figure 2: Community map for PHA baseline, monitoring, and evaluation coverage and other target behaviours within the intervention zone during the course of the programme, thus providing a simple indicator of impact when collated by the Hygiene Agents at the District level. Each volunteer hygiene promotor is given a T-Shirt and a pack of promotional image cards both to incentivise and aid them in their promotion duties. Reflecting the failure of health messages to motivate latrine uptake, these materials use expressive visual images that highlight important household perceived benefits (see Figure 3) of latrine ownership revealed during in-depth formative research conducted among rural households in the Department of Zou (Jenkins 2004): - Avoiding the threats of the bush (primarily snakes) - Avoiding exposure to the weather (primarily rain) - Avoiding the embarrassment of being seen defaecating in the bush (privacy) - Preventing contamination of food from flies attracted to faeces in the yard - The pride afforded by having a latrine Further, building on the successful use of images without words in the PHAST approach, the promotional materials rely on pictures alone, thus avoiding the development of messages inappropriate for the illiterate. To ensure correct understanding and interpretation of the messages and that they were salient, early versions of them were extensively tested with the target rural audience and adapted before final production. Some Hygiene promotion volunteers and mason outside a homestesd. 8 Sanitation Marketing At Scale examples of the final print materials are Figure 3: Five Latrine promotion images expressing non-health benefits illustrated in Figures 3 and 4. Following a community-based latrine promotion launch meeting, hygiene promotion volunteers begin house- to-house visits to engage extended families living together directly in hygiene awareness activities. One PHAST tool (fecal-oral transmission pathways and barriers) is used first, followed by discussions of the inconveniences of defecating in the bush and other non- health benefits of latrines using the images in Figure 4. Then, those interested in considering building a household latrine are recorded on a list. Hygiene Agents report that these household visits are critical to the success of the programme, and provide the basis for follow-up visits to support the household through the process of planning and building their latrine. Local-level promotion is complemented through (Courtesy: DHAB/Unicef) the airing of local radio commercials. Where households are interested in be trained to ensure an effective local latrine technology and superstructure latrine construction, the PHA catalogue latrine supply and given basic marketing combinations are presented, alongside of options and prices is shared with the techniques to support the promotional some of the advantages of and the price household by the volunteer hygiene work. range for each. promoters along with picture cards showing construction steps and materials In training, masons are given technical During and again at the end of latrine needed to build the most low-cost option guidance in choosing the correct site for construction, Hygiene Agents and (see Figure 4). Once the household latrine positioning and the construction of the volunteer hygiene promoters pay declares they are ready to begin traditional latrines from local materials, as household visits to conduct quality construction planning, arrangements well as the Sanplat Latrine (un-reinforced assurance tests, providing households are made for the representative Hygiene dome slab) introduced under the PADEAR with protection against poor latrine Agent to pay a visit to the household program as the cheapest durable craftmanship. At this time they will also to discuss where to cite the latrine and alternative to the more commonly known, reinforce the importance of cleaning and provide any needed technical guidance. but more expensive, rectangular single or maintaining the latrine, using images Masons are put in touch with households double-cabin VIP styles. Thus, masons specifically developed to support this to begin negotiations on design are able to provide the range of these communications task. preferences and price. technology options. They are further trained to offer a range of superstructure This combination of latrine promotion, In addition to volunteer hygiene options and provided with a ‘latrine technical facilitation, masons’ training, promoters’ training, masons continue to catalogue’ within which various different and quality assurance is essential in order 9 Figure 4: Images used to portray the stages involved in latrine construction 1. Materials necessary for construction of dome 2. Head of household digging slab collar 3. After the mason finishes the slab collar, slab and foundation collar with mason instructions head of household continues digging pit 4. After casting the slab, mason instructs 5. 6 people on the cured slab to test its strength household on curing the concrete for 21 days before posing on the pit, supervised by the promoter Grass matt superstructure Cement superstructure Mud superstructure (Source: PHA Training Manual, DHAB) 10 Sanitation Marketing At Scale to reach households at varying stages BOX 2: Traditional healer, Adjatokpa locality, Kpomasse commune in the process of deciding to install a latrine. In some cases households have not considered installing a latrine This man decided 3 years ago that he wanted to build a latrine – he had many clients visiting him from urban areas and when they asked to visit the toilet he was embarrassed to show before and thus must be persuaded to them to the bush. Some clients did not return to him after this experience. While he knew consider it, while in other cases there he wanted a latrine he did not know what latrine to construct or how to go about getting it may be a desire to construct a latrine constructed. Then in 2006 the PHA began in his village and he was able to gain information but inadequate knowledge of technology about the different types of latrines, their costs and how to go about the construction process. Even then however he was initially cautious, as the un-reinforced dome slab design options or of good local opportunity to did not look strong, so he waited. After some time two other households in the village built a do so, as illustrated by the case of the latrine and he was able to see that they were good, so at last he decided to get the mason to traditional healer described in Box 2. build one for him. Once he had decided to build the whole process took just seven days and the Hygiene Agent was able to assure him the quality of his slab was good. Programme Impact By the end of 2007, the PHA national program was operational in 877 communities (known as Localities in Figure 5. Improved family latrines newly built during the first phase of national scale-up in 877 PHA communities across 5 departments. Benin), in 34 out of a total of 77 Districts, across five Departments, covering 8,000 approximately 372,000 people equivalent Cumulative Number of New Family to about 10% of each department’s 7,000 rural population. A total of 7,148 new 6,000 Latrines Constructed unsubsidized improved family latrines 5,000 had been built in enrolled communities between the beginning of 2006 when 4,000 activities began on the ground and 3,000 the end of 2007. The pace of uptake 2,000 increased steadily each semester over this period, as seen in Figure 6, 1,000 registering a 60% increase in the number 0 of improved latrines constructed in 2007 Baseline 2005 Jan-Jun 2006 Jul-Dec 2006 Jan-Jun 2007 Jul-Dec 2007 compared to 2006. Over the period, an 2005 through 2007 additional 177 informal sector masons in Atlantique Alibon Rorgu Collines Zou PHA Districts were trained and certified in the construction of Sanplat, VIP, and Source: DHAB PHA quarterly program monitoring and supervision reports. double-vault improved latrines, and equipped with low cost light-weight coverage from 6.2% at baseline to 16.2% The minimum private investment by mould kits for on-site construction of by the end of 2007. Thus, by the end of households in building their latrine was unreinforced dome slabs at customers 2007, within durations ranging from as estimated to be US $60. Another 2 to 3 homes. little as 0.5 up to 1.5 years of marketing out of every 10 households by the end of promotion activities, on average 1 in 10 2007 were registered as having plans to An analysis of detailed monitoring data households across enrolled communities build or with construction underway. available for three Departments shows had completed the construction of an that the rate of new latrine construction improved permanent family latrine using These results confirm the ability of PHA in PHA enrolled communities represented locally available mason providers trained program to replicate across a large an increase in household latrine by the program and fully self-financed. national scale, similar high levels of 11 uptake that were achieving during small Figure 6. PHA program rates of new family latrine construction achieved scale pilot testing of the promotion across PHA departments and overall for 2006-2007 period package and new approach in 2003-2004 (see Box 1). In the case of Atlantique and New latrines built per community Population per new latrine built Alibori, where detailed data was available to examine coverage changes, the PHA 14.0 80 Rate of New Latrine Construction per community Latrine Density: Population per New Latrine Built program achieved up to a 15% increase 70 12.0 in permanent latrine coverage in under 1.5 yrs in the absence of any hardware 60 10.0 subsidy. This impact compares well to 50 the 10-20% increase achievement of the 8.0 pilot test phase (2003-2004) of the PHA 40 approach. 6.0 30 As seen in Figure 6, the PHA program 4.0 20 has achieved solid successes in the national roll-out with the strongest pace 2.0 10 of latrine uptake occurring in Collines, Alibori, and Atlantique Departments, 0.0 0 Collines Alibori Atlantique Borgou Zou Average at an average pace of 12.1, 11.2, and 10.6 new improved family latrines built in each enrolled PHA community, respectively, over the 2006-2007 period. comprising 10% of the Department’s same localities as the PHA programme As indicated above, many more are 2006 rural population. By the end of resulted in offers to subsidise family under construction or being planned by 2007, 1,606 new family latrines had been latrine construction directly alongside households in these communities. built, translating to a 328% increase in the PHA zero hardware subsidy the number of latrines and an estimated approach in some villages. Detailed data for the Department of rise in household latrine coverage from - The geologically difficult terrain (high Atlantique and Alibori, where the PHA 6.7% to 22%. water table, collapsing soils) occurring programme has been particularly in some areas, for which DHAB has successful, illustrate this to be no trivial In Zou Department, while activities were not yet identified and/or developed achievement (Table 3). In Atlantique, the scheduled to begin at the same time as good low-cost latrine designs. PHA cycle began in 194 communities in Atlantique (early 2006) start-up was - A lack of dynamism of some field staff (18,240 households; population 84,947), delayed and activities did not commence and gaps in departmental supervision comprising 9% of the Department’s in most of the 225 targeted communities and leadership during the roll-out. 2006 rural population. By the end of (comprising 17,327 households, and 2007 2,047 new family latrines had been approximately 11% of Zou’s rural In Zou, 937 new latrines were constructed built within the 194 localities without population) until as late as the second by the end of 2007, translating to an any hardware subsidy, equivalent to a half of 2007. This and other factors increase in household latrine coverage 363% increase in the number of latrines listed below contributed to lower, but from 7.9% to 13.4% across PHA on the ground in just 1.5 years, and still positive rates of latrine uptake in Zou communities, and the average number of an estimated rise in household latrine Department. people per latrine down from 51 to 30. coverage from 4.2% to 15.5%. In Albiori, - The multiplicity of existing the PHA began with 143 communities organisations promoting latrines using The above official data from initial roll-out (10,511 households; population 59,316), conflicting approaches within the are promising and impressive but under- 12 Sanitation Marketing At Scale represent the total impact of the PHA Table 3: Changes in latrine coverage within PHA localities in Atlantique, programme. In the first instance they do Alibori, and Zou between 2006 and 2007 not include those households that have PHA - Atlantique department 2005 2006 2007 started to construct a latrine but have latrine coverage indicator not yet completed construction. This number may be higher than the number Total number of latrines 777 1414 2824 of completed latrines given the extended % Households w latrine* 4.2 7.7 15.5 duration of time it can take a household to plan, organize and construct a latrine. % Concessions w latrine* 15.3 27.8 55.4 In rural Benin, many households dig the latrine pit after one harvest, wait until People per latrine 108 59 30 more money is available after the next % Increase in number of latrines from Baseline 182% 363% harvest before having the slab installed baseline and may even wait until after another harvest to construct the superstructure PHA - Alibori department 2005 2006 2007 – thus a household may take 3 years latrine coverage indicator to complete latrine construction once Total number of latrines 705 1236 2311 started. In this way it is important to collect data measuring not just completed % Households w latrine 6.7 12.5 22.0 latrines but those under construction and % Concessions w latrine 11.2 19.6 36.7 changes in desire for a latrine. Such data is in fact collected by PHA staff (though People per latrine 84 46 26 not presented in impact evaluations) through the community mapping process % Increase in number of latrines from Baseline 175% 328% baseline described above. For example, in the District of Kpomasse in Atlantique, PHA – Zou department 2005 2006 2007 the promotion cycle started in 10 latrine coverage indicator communities in March 2006 and another 10 in May 2006. Six hundred households Total number of latrines 1377 1607 2314 were targeted across these communities % Households w latrine 7.9 11.1 13.4 and by January 2007: % Concessions w latrine 44.5 51.9 74.8 new (improved) latrines without People per latrine 51 38 30 hardware subsidy % Increase in number of latrines from Baseline 117% 168% baseline (though not completed) latrine construction (as indicated by dug pits and/or completed concrete slabs) * Both % households and % compounds with latrines are provided as typically extended families composed of multiple related households live within a single concession (compound) in rural Benin. The number of households living to construct a latrine and were either in a single compound varies greatly from just one to over 13, thus while in the case of smaller family compounds with awaiting Hygiene Agent visits to help several related households, one latrine per concession might count as ‘access’ it is unlikely to constitute ‘adequate with citing of the latrine or saving the access’ in the case of large occupancies. Household coverage under-represents latrine access while concession necessary funds coverage over-represents it. 13 This suggests that the total percentage seeing and trusting other people’s toilets, not only from the strengths of the Benin of households constructing latrines in more start to construct them (as the programme but from understanding some these communities as a result of the traditional healer described in Box 2 did). of the current weaknesses that need PHA promotional cycle will likely reach Over time, as more people build latrines further development to achieve a more a minimum of 26% (combining latrines in an area, installation becomes a less rapid uptake. completed and under construction risky, more acceptable and desirable percentages) and probably higher reality and a contagion sets in leading Supply (as indicated by expressed demand), to the ownership of a toilet becoming While the PHA programme has however those latrines not completed a social norm. This means that as the created a very strong package of local within the cycle duration are not currently percentage latrine coverage in an area communications materials and model measured in impact evaluations. goes up the ongoing rate of latrine for promotion delivery (the hygiene installation should also increase resulting promotion volunteer model), and has Two other considerations further indicate in an exponential growth rate (see Jenkins identified affordable and desirable latrine that the presented data under-represents 2004). Thus while doubling and tripling options and trained masons in their the impact of the PHA programme. of latrine numbers are impressive in construction, there are still supply-side Firstly, the volunteer hygiene promoters’ themselves, further increases in sanitation constraints which clearly block latrine maps only cover the targeted PHA coverage are likely to take place outside construction for some households. In intervention community they work in, so the PHA communities and to continue Benin, cement is expensive (about US$8- data they collect does not cover latrines after the cessation of the intervention as 10/bag and 2-4 bags are needed in latrine build outside of monitored programme those households already constructing construction, depending on the model) communities. However, successfully latrines complete them and as increased and in rural areas is often inaccessible trained local masons are constructing rates of coverage push those without – where it is available there may be an latrines both outside and within them. toilets to seek to install them through the additional US$1 transport fee to get it to Some may even be building more latrines development of a social norm. the home. This problem of expense and outside the PHA intervention communities unavailability need to be addressed so than within them as illustrated by the Given the success of the programme to that consumers and cement providers community of Lo Kossa in Kpomasse. date, it is no surprise then that the DHAB might be better linked (see Table 1) Here two masons were trained. Within Lo now intend to scale-up their intervention through new or improved supply chains Kossa they had built 16 latrines between further with a goal to reach 25,000 to maximise the PHA impact in the future. March 2006 and the end of 2007, households across 64 District within 9 Further, new affordable latrine designs however, they had also constructed a of Benin’s 11 Departments, aiming for a are needed to address the challenges of further 45 latrines outside this community. 10 percentage point increase in latrine difficult geologic conditions. Thus, they had built three times as many coverage within the PHA monitored latrines outside Lo Kossa as in it. If this areas, a target that should be met and Targeting communities pattern is being replicated elsewhere indeed be exceeded through multiplier The programme impact has also been many more latrines are being built as a effects beyond the PHA programme’s variable across locations and a strategic result of the PHA programme than are implementation cycle and directly approach to targeting communities being captured in direct monitoring. monitored communities. in scale-up needs to be developed so that, in the interest of reaching the This phenomenon relates to Diffusion Future challenges: looking back and Millennium Development Goals, ‘easy of Innovations Theory and specifically moving on win’ communities - those ripe for local to what is known as the multiplier effect Rural marketing in Benin presents an opportunities to build where uptake whereby initially only a few innovative effective sanitation promotion model from is likely to be greatest and most rapid and risk-taking people (known as ‘early which other countries can gain many are identified and targeted ahead of adopters’) build latrines but over time, lessons and inspirations. These come those where the challenge is likely to 14 Sanitation Marketing At Scale be greater. In particular, communities selected for intervention should not be in close proximity to areas with a recent history of latrine construction hardware subsidies. Past evaluations show clearly that where people know about hardware subsidies, willingness to pay for latrines is suppressed due to the expectation of waiting to receive a free, or highly reduced-cost one. This has been one of the major challenges experienced in some of the communities in Zou, responsible for its lower rate of latrine uptake compared to Atlantique, Alibori, and Collines, where no such problems have been encountered. Despite room for further enhancements to increase programme impact, Benin’s rural sanitation model still represents one of the most promising sanitation programmes currently under operation in Africa, and Trained mason building casting slab on-site for new customer. offers valuable lessons and inspiration for rural sanitation programmes across the continent and beyond. Key lessons The Benin story illustrates clearly that sanitation marketing can really work particularly in areas without a history of hardware subsidies. Central elements were key to Benin’s success: - Political Leadership and Drive - In-Depth Formative Research to Understand Indigenous Motivations for and Existing Constraints to Latrine Acquisition - Emphasis on non-health, image-based promotional materials - Importance of house-to-house promotion - Private Sector Development for Latrine Delivery and Promotion - Zero Hardware Subsidies A newly-constructed slab. 15 Key References: Cairncross S (2004) The Case for Marketing Sanitation. WSP-AF Field Note Frais J & Mukherjee N (2005) Harnessing Market Power for Sanitation: Private WSP Sector Sanitation Delivery in Vietnam. WSP-EAP Field Note. The World Bank Hill Park Building Heieleri U (2000) Poverty Alleviation as a Business. Swiss Agency for Development Upper Hill Road PO Box 30577 - 00100 and Cooperation. Nairobi, Kenya Jenkins MW (2004) Who Buys Latrines, Where and Why? WSP-AF Field Note. Phone: +254 20 322-6334 Fax: +254 20 322-6386 Pearson, I (2002) The National Sanitation Programme in Lesotho: How Political E-mail: wspaf@worldbank.org Leadership Achieved Long-Term Results. WSP-AF Field Note. Web site: www.wsp.org Reiff S & Clegbeza G (1999) L’experience PADEAR au Benin des latrines familiales non-subventionees. ‘Le marketing social et la promotion du petit secteur prive’. WSP-AF Field Note. 1 Further information on the development, implementation and impact of this first phase of PADEAR (1996-1999) in pilot communities in Atlantique and Zou/Collines Departments can be found in a previous WSP Field Note (Reiff & Clegbeza, 1999). April 2011 About the authors WSP MISSION: To support poor people in obtaining affordable, safe, and sustainable access to Beth Scott is Public Health Behavior Change Specialist who trained at the London School water and sanitation services. of Hygiene and Tropical Medicine and works as independent consultant on hygiene, sanitation and related health behavior change communications and market-based promotion WSP FUNDING PARTNERS: development. WSP’s donors include Australia, Austria, Canada, Denmark, Finland, France, the Mimi (Marion) Jenkins is a Research Scientist in the Department of Civil and Environmental Bill & Melinda Gates Foundation, Ireland, Engineering at the University of California at Davis and an Honorary Lecturer in Environmental Luxembourg, Netherlands, Norway, Sweden, Health at the Hygiene Centre at LSHTM who focuses on adoption and consumer demand Switzerland, United Kingdom, United States, behavior and market-based approaches to delivery of improved products and services. and the World Bank. Gabriel Kpinsoton works with the Ministry of Health, Government of Benin, and has been leading the development and scale up of PHA program in Benin. PREPARED BY: Prepared by Beth Scott, Mimi Jenkins & Gabriel Kpinsoton. Disclaimer PEER REVIEW: By Isabel Blackett, Jaqueline Devine, Yolande Coombes, Nat Paynter. Water and Sanitation Program (WSP) reports are published to communicate the results of WSP’s work to the development community. Some sources cited may be informal documents that are not readily available. The findings, interpretations, and conclusions expressed herein PHOTO CREDITS: are entirely those of the author and should not be attributed to the World Bank or its affiliated Mimi Jenkins, Beth Scott and Sadok Hidri. organizations, or to members of the Board of Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information Design and Layout by Catherine Njeri. shown on any map in this work do not imply any judgment on the part of the World Bank Group concerning the legal status of any territory or the endorsement or acceptance of such boundaries. The material in this publication is copyrighted. Requests for permission to reproduce portions of it should be sent to wsp@worldbank.org . WSP encourages the dissemination of its work and will normally grant permission promptly. For more information, please visit www.wsp.org . 16