Expanding Access to Improved Sanitation for the Poor INSIGHTS FROM THE PHILIPPINES IN PARTNERSHIP WITH Context Findings Recommendations Annex CONTEXT income urban households in the Philippines still do not have improved sanitation facilities and to test possible sanitation solutions that enable these households to improve their THE CHALLENGE: sanitation conditions. The study is part of IFC’s ongoing efforts to partner with the private and public sectors to The Philippines is home to around twenty five million of promote inclusive and sustainable growth through market- the 2.3 billion people worldwide who lack access to a basic based solutions for the poor and underserved. sanitation service. Poor sanitation has enormous economic 1 and human costs.2 The spread of water-borne diseases, for OBJECTIVES AND METHODOLOGY: instance, results in billions of dollars in costs to the government and poor quality of life for many citizens.  The objectives of this study are to provide context for the sanitation conditions of low-income communities in the In the Philippines, only 12 percent of households have Philippines and to identify the opportunities and barriers to connections to sewage systems or septic tanks that are improving sanitation systems. The study results are intended serviced regularly with proper sludge treatment and to help key stakeholders — such as businesses, governments, disposal. As a result, 82 million people have sanitation and nongovernmental organizations — to develop feasible systems or practices that could endanger the environment approaches to expanding access to improved sanitation for and public health, including five million people who still low-income communities and to create new markets for practice open defecation.3 The total cost of all this poor sanitation for these underserved segments. The study sanitation is estimated to be $1.4 billion per year, primarily targeted low-income urban or peri-urban communities of due to its health impact.4 Metro Manila and neighboring provinces that are predominantly not yet served by existing sewerage and The government of the Philippines has recognized the septage management services. This study established an costs and, with various water service providers, has taken analytical framework to assess a number of potential great strides towards improving sanitation for its citizens, sanitation models, taking into account existing conditions, including helping to accelerate investments in the household preferences and needs, and willingness to pay. sanitation sector. However, investments have focused on major civil infrastructure rather than on improvements to The study included: individual households. Such a narrow focus has left efforts 1. Quantitative surveys of 800 households that would have an immediate effect on household sanitation practices, such as building toilets, solely in the 2. Six focus group discussions with a total of 64 hands of those households, who often face substantial participants barriers to improving their sanitation. 3. In-depth interviews with 14 government officers across four provinces (Metro Manila, Rizal, Laguna, Ensuring universal access to improved sanitation is complex and Pampanga) and 12 municipalities and challenging. While improved sanitation is a basic expense for most people in developed urban areas, the country’s The quantitative surveys included the assessment of poorest households find such an investment challenging due socioeconomic conditions, physical characteristics of to a lack of adequate resources or proper information. dwelling places, and preferences and willingness to pay for Moreover, underserved groups in the Philippines can be proposed sanitation models. The survey targeted difficult for outside parties to reach, as they can easily fall households belonging to the lowest income class and through the cracks between the competing priorities of included households with private (400 respondents) as well multiple institutions responsible for sanitation. as those without private toilets (400 respondents). The 18 percent of total respondents living below the poverty line5 IFC’s Inclusive Business team partnered with the Manila had a per capita income of USD 811 (37,928 Philippine Water Foundation, which is Manila Water Company’s social pesos).6 Detailed information on the profile of the responsibility arm established in 2005, to undertake a respondents and assumptions underlying the analysis is three-part study that would assess the reasons why low- available in the annex (page 25). 2 Context Findings Recommendations Annex Pampanga IMPUTED PER CAPITA FIGURE 1: GEOGRAPHIC INCOME SCOPE OF STUDY 815 USD (38,094 Php) IMPUTED POVERTY RATE 16.2% POVERTY LINE 421 USD (19,670 Php) Rizal IMPUTED PER CAPITA INCOME 796 USD (37,200 Php) IMPUTED POVERTY RATE 20.5% Pampanga POVERTY LINE 444 USD (20,742 Php) Laguna IMPUTED PER CAPITA INCOME 753 USD (35,216 Php) IMPUTED POVERTY RATE 22.9% POVERTY LINE Rizal 432 USD (20,175 Php) Metropolitan Manila Metro Manila IMPUTED PER CAPITA INCOME 887 USD (41,452 Php) IMPUTED POVERTY RATE 12.5% POVERTY LINE 435 USD (20,344 Php) Laguna POPULATION DATA OF STUDY AREA Average Population Region, Population Total Growth Province, And Area Density Population Rate Highly (km2) (pop/ km2) 2015 (per year) Urbanized City 2015 2000 – 2015 Philippines 300,000 337 100,981,437 1.84% Metro Manila 639 20,166 12,877,253 1.72% Imputed poverty rate: % shows proportion of household below the poverty line to the total Rizal 1,191 2,422 2,884,227 3.50% population Source: Philippine Statistical Authority (PSA). Laguna 1,917 1,583 3,035,081 2.89% SWIFT Poverty Estimation Methodology calculation conducted by World Bank, Pampanga 2,062 1,266 2,609,744 2.04% September, 2016 Source: Philippine Statistical Authority. 2015 3 Context Findings Recommendations Annex FIGURE 2: REPRESENTATION OF THE SANITATION TECHNOLOGY “LADDER” Cost per household with appropriate excreta management or reuse Water Quality Intangibles Health Status Access Time Benefits per household Economic Assessment of Sanitation Interventions SANITATION MODELS TARGETING 3. Private toilets that connect to a low-cost septic tank THE POOR a. Septic tank only for those who already have toilets and toilet bowls, but discharge directly to drains This study looked at the sanitation situation of low-income or waterways Filipino households in view of viable alternatives, potential b. Septic tank including the toilet structure barriers, and benefits of expanding access to improved 4. Communal septic tanks sanitation systems. Alternative sanitation facilities form a ladder in which increasing benefits and level of service The options were selected to reflect different conditions correlate with increasing costs, as in the figure above from found in poor households, which tend to have little or no the Water and Sanitation Program’s 2011 Economic space and lack land rights. In addition to social, financial, Assessment of Sanitation Interventions in Philippines.7 and technical aspects of each model, the study also investigated the present strategies and plans of local The socioeconomic condition of the households, as well as governments to identify potential location-specific the limitations or opportunities set by their dwelling places recommendations for the models. and locations, make certain rungs of the “sanitation ladder” more applicable to them. Additionally, the study also The figure on page 5 presents a summary of alternative investigated how the physical design and pricing of typical options with their corresponding technical description, sanitation options could be tailored to the specific needs of identified barriers, strengths, operational requirements, and low-income Filipino households. assessed appropriateness. Recommendations are based on the particular conditions and needs of various groups. Instead of looking at every possible sanitation option, the Unfortunately, uncertainty still exists about what subsidies study focused on four models: or funding mechanisms would be leveraged. 1. Public or community toilets 2. Portable toilets for home use 4 Context Findings Recommendations Annex FIGURE 3: PRESENTED SANITATION OPTIONS 4. COMMUNAL TREATMENT Communal treatment  OW COST TOILET 3. L facility built on WITH SEPTIC TANK common space Pour flush toilet with Network of sewer PORTABLE TOILET 2.  (plastic) septic tank pipes connecting up to SOLUTIONS for household use 50 households Plastic portable unit 4 USD (180 Php)/month Requires an operator placed inside the for 24 months for to perform O&M of house (coupled with toilet & septic tank, or treatment plant collection and contain 3 USD (140 Php)/ 4 US (190 Php)/month waste) month for 24 months for 24 months 1. COMMUNITY for septic tank only 6 USD (275 Php)/month TOILET for 24 months; 1 USD Shared toilet built on (40 Php)/month after common land .1 USD (5 Php) per use + Private facility Private facility + No septic tank + Simple and low + + No permanent space required at household maintenance required Can be located + + No upfront cost to Privacy, convenience, + + Low upfront cost underground user durability Easy implementation + No land required at + house Requires community - land and collective Labor intensive - Upfront and - investment to build emptying Shared facility/not - emptying costs and maintain Short term solution - treatment plant improved Requires land at house - only - Pay per use Upfront and emptying - Risks of misuse and - costs Shared responsibility - concerns around safety for maintenance and smell Preferred by Preferred by 3% IMPROVED TREATMENT Preferred by Preferred by 3% 10% 73% of households of households of households of households with toilets without toilets without toilets without toilets SUITABLE FOR HOUSEHOLDS BEST FOR HOUSEHOLDS BEST FOR RENTAL BEST FOR HOUSEHOLDS WITH NO SPACE FOR A WITH LIMITED LAND PROPERTIES, INFORMAL WITH LAND TENURE AND PRIVATE WHERE COMMUNITY AVAILABILITY OR NO LAND SETTLEMENTS OR INDOOR/OUTDOOR SPACE LAND IS AVAILABLE OR WHEN TENURE PROPERTIES WITH SPACE REQUIREMENTS SEPTIC TANKS AREN’T CONSTRAINTS REGULARLY EMPTIED INCREASED COST 5 Context Findings Recommendations Annex Findings KEY FINDING 2: Open defecation or other unsafe practices for disposing of waste in the environment pose significant risks to KEY FINDING 1: Current sanitation health and the environment. conditions for low-income households are substandard. Contaminated waterways are a health risk for everyone, especially people in areas prone to poor drainage and Households with private toilets predominantly use a exposed to polluted water. A majority of respondents seated, pour flush toilet that discharges typically to unsealed, reported having open drainage in their community with single pit. About 91 percent of households with private toilets stagnant waters blocked by solid waste. Among households have facilities that discharge to a septic tank. However, the that practice open defecation, 36 percent do not have quality and function of the septic tank need to be assessed to proper plumbing inside the house. determine whether it can be safely improved. About 39 percent of septic tanks have an unsealed base, 49 percent Contaminated waterways are also a huge issue for people have no outlet, and only 22 percent have concrete walls, who rely on wells for water supply. Almost half, or 46 suggesting that a high number of on-site systems are leaking percent, of the households are less than 50 meters away into the groundwater or nearby surface waters. from a well that people use, with even higher rates among households in Pampanga and Laguna. These wells serve as Most septic tanks are designed to be desludged every three common sources of water supply. In Pampanga and Laguna, to five years to allow for the efficient breakdown of waste for example, 18 percent of respondents still use wells as their by bacterial activity. The study found, however, that only 13 drinking water source, while another 50 percent use wells percent of septic tanks have ever been desludged. With for non-drinking purposes. more than 50 percent of systems having operated for longer than five years and a mean age of nine years, many of these Flooding from nearby rivers only heightens these risks as it septic tanks are leaching pollution into the environment. can bring polluted waters in direct contact with people or contaminate water supply. For 27 percent of respondents, Among those surveyed, about 80 percent of households rivers near their home flood after every rainfall with a without a private toilet rely on their neighbors’ toilets, higher proportion of flooding in areas where people do not which face the issue of poor septic tank maintenance and have a private toilet. For 22 percent of respondents, flooding improper design. Even though the quality of existing reaches inside their houses. sanitation systems is generally low, the majority of the households who use their neighbors’ toilets are satisfied Contamination is not only a problem for those practicing with the practice. There are a minority of households that open defecation or improperly disposing of feces. It is also use other alternatives. Around 8 percent of households an issue for those with an operating toilet in a home with a without a private toilet use communal toilets, which are mostly local government facilities. Some concerns raised by respondents, include distance from home, waiting times, Shifting norms around safety and health for safety concerns especially for female users, and bad smell, women and children are making it less which suggests poor conditions. Moreover, respondents acceptable for women and girls to practice open reported feeling “hiya,” a Filipino term that means defecation, thereby increasing the perceived embarrassment or shame, for using communal toilets. need for sanitation solutions that provide greater privacy. Respondents cited a desire to Finally, some households without a private toilet reported reduce health risks, particularly for children, as defecating in chamber pots or a plastic bag and then a driver for improving sanitation, suggesting disposing of waste on vacant lots, with the garbage, into increased understanding of the impact of poor waterways or into the drainage system. Around 9 percent of sanitation practices on community health. households practice open defecation directly defecating on the ground or waterways. 6 Context Findings Recommendations Annex sanitation system that allows seepage and contamination. KEY FINDING 3: Demand for improved Among those households surveyed who have a toilet, there sanitation, particularly for private toilet was a high number, 37 percent, of on-site systems. solutions, is high among the urban poor. Therefore, sanitation projects should consider addressing this issue by developing a piped water supply and Almost all households surveyed wanted their communities discouraging the use of shallow wells. to improve sanitation conditions, and unsurprisingly 90 percent of households without private toilets indicated a Households recognize the connection between poor desire and aspiration to improve from their present sanitation practices and health risks. In fact, a primary conditions. Presented with four sanitation models, 73 motivation reported by respondents for improving percent of these households showed interest in private sanitation was concern for health, especially for the health toilet solutions, 10 percent in portable solutions, and 3 of children. However, they tend to associate health risks and percent in community-based solutions. However, it is disease more with water quality and garbage disposal. important to note that there is a gap between respondents’ Among those surveyed, water quality was reported as a aspiration and their reality. Households face a number of major cause of illness by 27 percent of households. Poor barriers to improvement including their status of tenure, hygiene followed with 14 percent of households and then space availability, and financial ability. With land tenure and sanitation, cited by 11 percent of households. Households space taken into consideration, only 13 percent of the cite several ways to reduce illness — 44 percent cited households without private toilet would be able to cleanliness and garbage reduction, 20 percent cited treating implement the desired private toilet solutions such as a water, and 19 percent said regular bathing. Only 3 percent, low-cost toilet with septic tank. however, mentioned sanitation. Households with private toilets were less interested in Further, local government officials and health officers improving their sanitation conditions. Two-thirds of interviewed seem to rank the issue of sanitation-related individuals with private toilets indicated they wanted to diseases such as diarrhea as lower priority because the keep the status quo. However, these households overall cases of diarrhea were perceived to be less severe underestimated the risks associated with their current when compared to other health issues, such as dengue. sanitation system. Lacking understanding of needed Moreover, with rapid improvement of water services since maintenance and information about the risks of leakage, the entry of utilities such as Manila Water, water-borne they did not perceive a need to upgrade from their existing diseases have generally declined, except in the poorest tank. When presented with specific sanitation households lacking access to service improvements. Local improvements, almost half did not want any of the options government officials and health officers may also provided, though 49 percent did show interest in a low-cost underemphasize sanitation because of their lack of septic tank that would complement their existing toilet understanding about its importance. Two such cases are system. Very few were interested in communal treatment that of health officers in Laguna and Rizal, who did report options, likely due to a lack of understanding of the benefits recent cases of diarrhea but linked it to poor water quality, of such systems. hygiene, and food rather than sanitation. Contrary to the perceptions of health officers, however, water and sanitation-related diseases still seem to be widely prevalent, particularly among children. The households surveyed reported that, in the previous four weeks, among children under the age of five, 36 percent had Low-income households diarrhea, 33 percent had stomach aches, 14 percent had parasitic worms, and 1 percent had typhoid or cholera. show significant demand Children who discharged feces on the ground, along with those who used a neighbor’s or friend’s toilet, were most for private, in-home toilet affected by these sicknesses. systems. 7 Context Findings Recommendations Annex FIGURE 4: PREFERRED SANITATION MODEL: FIGURE 5: PREFERRED SANITATION MODEL: HOUSEHOLDS WITHOUT PRIVATE TOILETS HOUSEHOLDS WITH PRIVATE TOILETS n=400 respondents n=400 respondents 14% nL ow-cost toilet with nL ow-cost septic tank septic tank nC ommunal treatment/ 10% n Community toilet septic tank nP ortable toilet 48% 49% n None 3% solutions 73% n None 3% KEY FINDING 4: COST IS AN IMPORTANT toilet, septic tank, and portable option. Their responses CONSIDERATION AMONG POOR are summarized in figure 6. The larger and darker words below were reported more frequently by respondents. HOUSEHOLDS, BUT DESIRE FOR PRIVACY, CONVENIENCE, AND SAFETY Households opting for a portable toilet solution also value ALSO DRIVE PREFERENCES. privacy and convenience highly, but placed more weight on spatial considerations in choosing their preferred model. Household preferences and aspirations around new About 21 percent of those who wanted a portable option sanitation solutions are simple. People surveyed value indicated that this was the primary reason for their choice. privacy, convenience, and safety, and they recognized the health and safety benefits that would come from Individuals see a number of disadvantages in communal new systems, particularly for women and children. As facilities. They do not provide the same privacy, convenience such, there is a strong preference for private toilets over and safety that home-based solutions offer. However, a few other alternatives. households did prefer a community toilet, particularly because of concerns about the availability of land. An option that is “simple,” “private,” “comfortable,” and “cheap” was commonly emphasized. In addition, participants actively discussed having a bowl, pour flush FIGURE 6: PREFERRED FEATURES FOR IMPROVING SANITATION FOR HOUSEHOLDS WITHOUT TOILETS Privacy was cited as the main reason for 58 percent of households who chose a private toilet, followed by convenience and safety. 8 Context Findings Recommendations Annex Focus Group Discussions: Benefits and Concerns of Sanitation Models Focus group respondents reflected on the benefits and concerns of different sanitation improvements. They felt that community toilets were better than their current conditions and they liked that they had no upfront costs, had water, looked clean, had fewer health risks, and would be used by women. Respondents were concerned that they might not have the money to use it, that there would be little privacy, that it would be difficult to maintain, and that there would be vandalism and other security concerns. Some compared it to a truck stop. They liked that portable toilet solutions were low-cost, looked like an improved chamber pot, were sanitary, private, could be used indoors, did not require piping, and were good for small houses. They were worried that they would fill quickly and smell if not collected frequently, and they thought people would dump waste into river or garbage to save money. They also worried that portable toilets were not a long-term solution, might break, could be used mistakenly by children as water pails, and that they would not be suitable for remote homes. They liked that the low-cost private toilet and septic tank was a long-term solution that was clean, sanitary, safe, private, comfortable, independent, and did not require lengthy piping. But they were worried about the cost and size of such an option, as well as the challenges of emptying and building it. They felt that it might be difficult to maintain a communal facility and were worried that it would fill quickly and that pipes would clog. Finally, they were worried that they were expensive and that the community did not have the space for such an option. KEY FINDING 5: While poor households Many families in the Philippines face the reality of an want improved sanitation solutions, extremely limited budget. Among the households surveyed in this study, the mean estimated annual per capita income costs, technical barriers, land rights, is 811 USD (37,928 Php) and the mean annual self-reported and other issues stand in their way of income is 592 USD (27,689 Php).8 The overall poverty rate of upgrading. survey respondents was 18 percent. 5.1 The biggest barrier to the adoption of In addition to having limited incomes, households have very improved sanitation systems is cost. little in savings. Only 17 percent of respondents surveyed indicated they were able to save regularly, and those The high interest in improving sanitation and the high households saved an average of 22 USD (1,028 Php) per demand for improved sanitation systems do not month. They also have poor access to financing. 78 percent translate into the ability to pay. of households reported that they do not have any channel for borrowing money. The majority of those with some Half of households were not willing to pay for a solution, with access cite informal sources such as family, friends, or two-thirds citing lack of funds as the primary reason. Almost money lenders as their primary channel. half of households without a toilet indicated that cost was the main reason they did not have a toilet. Even for Households with some disposable income have competing households who said they were willing to pay, the estimated needs which may be prioritized above sanitation cost of each option was too high for their income. This gap is improvements. Among those surveyed, 24 percent driven by fluctuation in income and expenditures, budget prioritized home repairs and 17 percent school or college pressures, the inability to save, lack of financing, and poor fees; only 13 percent prioritized sanitation improvements. credit options for home improvement, among other aspects. 9 Context Findings Recommendations Annex Confidence interval P=0.05 FIGURE 7: CALCULATED MONTHLY MEAN 1 Maximum AFFORDABILITY PER SANITATION OPTION 2 Mean PRICES (PhP) 3 P.446 (10 USD) Minimum 450 P.378 (8 USD) P.340 (7 USD) 400 1 1 1 1 1 P.309 (7 USD) P.324 (7 USD) P.377 (8 USD) 350 P.362 (8 USD) 300 P.310 (7 USD) P.292 (6 USD) 2 P.347 (7 USD) 2 P.277 (6 USD) 250 2 2 2 P.295 (6 USD) P.307 (7 USD) 200 P.244 (5 USD) 150 P.244 (5 USD) 100 3 3 3 3 3 50 0 Community Toilet Portable Toilet Low-cost toilet with Low-cost septic Communal septic n = 13 Solutions septic tank tank tank n = 39 n = 292 n = 197 n = 10 Unit=households who have chosen a sanitation option While households do have experience with paying for However, the limited and sporadic cash flow of low-income access to basic utilities, there is a significant gap households makes it difficult for them to spend a significant between what households are willing or able to pay and part of their budget on sanitation. Such households often the cost of constructing or upgrading such systems. cannot afford the large upfront investment required to construct or purchase an improved sanitation system. Household spending behaviors suggest that people do have some experience with paying for access to other basic Respondents were asked how much they would be willing utilities such as water and electricity. About 86 percent to pay for their preferred facility. On average, households of those without a toilet pay an average of 8 USD (352 Php) were willing to pay 53 USD (2,468 Php) for all the solutions a month for water, while 88 percent of those with including portable toilet solutions, low-cost toilets with a toilet pay an average of 9 USD (432 Php) a month. septic tank, low-cost septic tanks, and communal septic tanks. FIGURE 8: PERCENT CURRENTLY PAYING FOR WATER Acceptable price ranges for sanitation investments were derived using households’ declarations as to minimum and Those Those maximum acceptable amounts. On average, the price range n Yes with without n Yes between 68 USD (3,200 Php) and 86 USD (4,000 Php) was n No toilets toilets n No most deemed acceptable for a low-cost toilet with septic tank and low-cost septic tank alone. Only 39 percent of households accepted this price range, suggesting that there is a significant percentage of households for whom this range is not acceptable and the consensus about a preferred 88% 86% price is low among the surveyed households. There were sizeable differences between regions and paid paid between people with differing income levels. A higher 9 USD (432 Php) 8 USD (352 Php) willingness to pay was found in Metro Manila and Laguna per month per month 10 Context Findings Recommendations Annex than in Rizal and Pampanga.9 Households in the non-poor 5.2 The biggest technical challenge for feasible group expressed, on average, greater willingness to pay for sanitation options is a lack of space in the home improved sanitation facilities than those considered poor.10 for toilets and around the home for septic tanks. The study also found that the amount households were Other geographical considerations include soil willing to pay for a sanitation option does not necessarily conditions, proximity to waterways, and match the amount of savings they have declared. unavailability of access-ways. Surprisingly, even households who declared they had no savings were willing to pay on average 52 USD (2,426 Php) Space Is The Biggest Technical Challenge for improved sanitation options. From the perspective of the household, space emerged as The study used a benchmark of 2.5 percent of household the biggest barrier in the ability of some households to income to assess the maximum amount households could upgrade sanitation facilities. The average size of dwellings, pay for sanitation.11 Using this benchmark, the mean combined floor area, without toilets was 16.5 square meters affordable amount per household is 7 USD (327 Php) a for the entire study area. These small sizes make building a month. Households willing to pay for the option that they toilet or septic tank difficult. have chosen accept to pay 7 USD (332 Php) a month. This amount is much higher than the amounts that were tested Interviewers were instructed to measure the space inside in the study. Prices tend to be higher for those opting for a and around the house. They found that 30 percent of low-cost septic tank or communal septic tank because households had insufficient space inside the house for a households with toilets tend to have higher incomes. toilet, while 45 percent had enough space for a separate Conversely, the affordable prices are lowest for community bathroom. Therefore, the plans given to households for toilets and portable toilet solutions, as households opting adopting new sanitation systems will have to take into for those solutions tend to have lower incomes. account the space constraints and make effective use of the limited space. These findings show the necessity of bridging the gap between the amounts households are able or willing to pay Availability of land outside the house for septic tanks was and the actual costs of sanitation improvements. Most of also limited. Only 56 percent of households had the 1.5 the respondents indicated a need to pay in small square meters around the house needed to build a septic installments rather than up-front, due to their low levels of tank. Even community land, which could be used as an savings and difficulty in accessing financing. Therefore, alternative for private land around the house to build interventions will need to include the establishment of communal septic tanks, was highly limited. 78 percent of financing, as well as payment terms that reflect the flow of households were situated in communities where there was irregular income patterns among low-income households. insufficient community land. Willingness to pay: Defined as a declaration by households of the amount they would pay for a certain service. Accurate information about willingness to pay is critical for assessing the economic viability of projects, evaluating policy alternatives, setting affordable tariffs, assessing financial sustainability, and designing socially equitable subsidies. Acceptable price range for sanitation improvements: Defined as the range between the minimum and the maximum amounts each household declared they would be willing to pay. Affordability: Defined as the share of monthly household income that households have the capacity to pay for utility services. Unlike willingness to pay, it is not based on a declared amount that households would want to pay; rather it is an amount calculated based on a ratio to the household’s income, which is 2.5 percent of income in this study. 11 Context Findings Recommendations Annex Type Of Property Influences What Can Be Constructed mistaken assumption that they would never need to be emptied. The type of property also influences the ability of a • Road accessibility: Emptying a septic tank is typically household to build a toilet or septic tank. About 48 percent done by a vacuum truck, but the process is a challenge in of respondents lived in studios or one-bedroom dwellings. dense urban areas where roadways to houses are often In Metro Manila the figure reaches 69 percent, compared too narrow to accommodate these trucks. About 18 with only 33 percent in Rizal. Another 20 percent of percent of respondents’ toilets were located more than respondents live in multi-story buildings, which present 20 meters from a main road where a truck could park. additional challenges for toilet construction. In addition, Additionally, in the majority of cases the width of the non-robust housing materials such as bamboo make it access path to the house is too small for an emptying difficult to build a toilet out of the traditional ceramic and vehicle to pass. Only in 19 percent of the cases was it big concrete desired by some respondents. Alternatives that are enough for a car, while in 71 percent of the cases the lightweight and suitable for such conditions will have to be access path to the house was big enough only for a explored. person or a motorbike. The limited width adds complexity Access To Septic Tank For Desludging to constructing a sewer as well, since roads will need to be completely closed for construction. A simple sanitation improvement option would be to ensure that current septic systems are desludged, while also Terrain And Soil Conditions Need To Be Addressed At The creating desludging requirements for new systems. In Design Stage addition to social and financial reasons for not desludging, Sanitation solutions must address technical considerations there are pragmatic issues that make accessing septic tanks raised by the physical environments of households. The for desludging very difficult: areas in the survey mostly had sandy soil, which is fast • Location of septic tanks: About 70 percent of draining and suitable for septic tanks emptying into soak households surveyed have a septic tank or pit located pits. However, Rizal and Laguna have slower-draining soil, under the house, which means that the flooring would which makes it difficult for septic tanks to discharge to soak need to be broken in order to access it. There is often no pits or to leach fields as typically required by standard lid or easily accessible opening through which to empty designs. In these areas, systems must be designed so that the septic tank because many systems were built on the discharge is redirected to covered drains or to an additional 12 Context Findings Recommendations Annex Another issue is the influence of culture on sanitation Informal settlements face very poor sanitation practices. This is particularly true for those people living in conditions. In Metro Manila, the relocation of Tabun, Pampanga where there is a community of migrant informal settler families to private lands can Badjaos who view open defecation as a safe and accepted take two or more years. In the meantime, these sanitation approach. The city health official reported that families do not have sufficient residency rights some Badjao residents continue to practice open defecation to receive sanitation support, and the local despite the construction of a communal toilet for them. government does not implement sanitation 5.4 Institutional fragmentation and poor projects on-site due to the lack of land ownership. The city health officer in Taguig, coordination among local governments is Manila suggested that informal settler families another barrier to sanitation improvements. could form associations and get accredited to The institutional setup of national government agencies is help with applications for water, electricity, and fragmented, and supporting agencies are weak, posing a other basic services. challenge for improving sanitation services throughout the country, as such an effort requires cross-sector engagement. The multiple government agencies involved in chamber with filter media. Further, 19 percent of the sanitation services often have unclear and overlapping surveyed households’ dwellings are below street level, mandates, hampering sector development. Local making desludging even more challenging. government units (LGUs), which oversee the sectors, have varying capacities. LGUs also have difficulty coordinating 5.3 Effectively expanding access to sanitation to the efforts of departments, such as those managing health, the underserved lacking land rights and those in environment, or community issues. So, while officials in the informal settlements is another key challenge. in-depth interviews were clear on their roles, they often operated in silos. Other key large players such as the Local Lack of land ownership is a major obstacle to improving Water Utilities Administration have the technical capacity sanitation systems. Among households that currently do to support sector development, but operate under a difficult not have a toilet, land ownership was, after cost, the most governance framework and have financially underperformed. frequently cited reason for not improving sanitation. About 76 percent of households without private toilets did not Informal settlements in particular fall through the cracks of own the land they lived on, but instead rented, squatted, or this fragmented framework. Ongoing plans to relocate occupied the land for free. Respondents indicated that that households living in informal settlements prevent sanitation the landlord refused to build a septic tank or that they could improvements, since they lead officials and government not build one since they did not own the land. Additionally, employees to downplay the extent of sanitation issues, many worried that asking the landlord to build a toilet could lead to an increase in their rent, affecting their ability to afford housing. Focus Group Discussions: Role of Community Leaders Land ownership is a particularly difficult issue for those Participants in focus groups discussed how setting living in informal settlements. Even though many an example for others to follow and educating government officials recognize the need to protect informal people through informal and formal campaigns settlers living on waterways, the lack of land rights and would influence them to upgrade their sanitation plans to relocate these households make carrying out conditions. While regulations were seen as sanitation upgrades extremely difficult. In one province, an important to force people to act, most people official said that he was instructed to defer the thought that local leadership from a barangay implementation of a sanitation project for an informal leader was more effective at changing people’s settlement area because the project could encourage the behavior. settlers to resist relocation efforts. 13 Context Findings Recommendations Annex saying that they would later disappear when the residents KEY FINDING 6: Community engagement moved or were resettled. Even when the government does can play a positive role in influencing recognize that informal settlement families need proper households about sanitation practices, sanitation facilities and that those people living on waterways need to be protected, officials feel that there is and ensure project sustainability. little they can do to help. Barangay leaders are viewed as an effective and often a preferred source of information on sanitation practices. Limited budgets and competing public priorities make They are strong influencers and motivators in the sanitation a low priority for the government. Government community. The research also showed that community institutions that are working to support the poorest action can be effective when there is wide agreement in the households have limited financial resources and therefore community and among community leaders. Community limited ability to address sanitation, especially as they focus engagement in water and sanitation service delivery has on “more immediate” issues, such as mosquito-borne been effective in facilitating a change in behavior and diseases. Even though a considerable number of people in the ensuring project sustainability and accountability. Philippines still lack improved sanitation facilities, local government employees and ministry officials minimized the Many communities have instituted education campaigns to importance of sanitation during the in-depth interviews. inform and engage community members with health and These government officials commonly believed that hygiene issues. Such campaigns have been successful in sanitation is not a major problem and that water-borne communicating the importance of handwashing and of diseases are rare, and they had other priorities. Limited clean drinking water. Another example is the “Green Clean” budgets mean that local government units tend to instead campaign, which raised awareness and community prioritize diseases that are perceived to be more life- engagement on issues related to water and sanitation and threatening such as dengue (which was a priority for many created a sense of shared responsibility between health and environment departments) and other mosquito- government and individuals around community borne diseases. Many environmental officers reported being improvement. In Metro Manila, where communal services primarily focused on the sanitation permits of commercial include water pumps and toilets, respondents reported that establishments, which generate revenues for the local each household takes part in shared responsibilities such as government units and therefore attract greater attention. cleaning the communal toilet. The effectiveness of Officers tend to focus on septic tank improvement for community campaigns has varied by geography, with more businesses rather than residences, and on management of success in Metro Manila, where there seems to be stronger water and garbage. Local government units that do have “community spirit” and cooperation, than other regions sanitation programs have focused mainly on personal such as Pampanga. Still, education campaigns can be hygiene practices. Unsanitary practices or lack of toilet effective in informing people and changing behaviors, which facilities rarely emerge as immediate causes of concern. can be used in the effort to improve toilet facilities. Recent Success at Community Engagement Many interviewees mentioned that it has become more common for households to buy purified drinking water and that education campaigns around handwashing have been successful in reducing risks of water-borne illnesses. Though improvements to the drinking water supply have helped decrease water-borne illnesses, they may also have inadvertently contributed to a lowering of concern about sanitation. Nonetheless, a number of interviewees cited community-level engagement as the best option for promoting and improving sanitation. Such engagement could leverage the network of local barangay health workers, who usually reside in the barangay itself, visiting households and personally talking to residents. Additionally, representatives from a couple of local government units mentioned that these health workers also issue tickets against offenders who violate environmental or sanitation ordinances. 14 Context Findings Recommendations Annex The Philippines has a number of laws and policies governing sanitation and water supply. While there are no lack of laws designed to support the water and sanitation sector in the Philippines, translating them into projects and programs still remains a challenge. Several agencies play key roles in the sanitation sector in the Philippines. FIGURE 9: NATIONAL GOVERNMENT AGENCIES: ROLES AND RESPONSIBILITIES Agency Roles and Responsibilities National Economic and Leads the formulation and implementation of national policies Development Authority (NEDA) Oversees Local Water Utilities Administration (LWUA) and Metropolitan Department of Public Works Waterworks and Sewerage System (MWSS) and Highways (DPWH) Manages major infrastructure projects Implements programs related to public health aspects of sanitation Operationalizes the Sanitation Code, including regulating the operations of Department of Health (DOH) regional and provincial sanitation providers (desludging, septage hauling, wastewater treatment) Advocates for sanitation efforts by local government units (LGUs) Implements programs aimed at lessening environmental pollution resulting Department of the Environment from sanitation and Natural Resources (DENR) Leads the operationalization of the Clean Water Act Promotes and oversees development of water supply systems through local Local Water Utilities water districts in areas outside Metro Manila Administration (LWUA) Provides capacity building support to water districts Metropolitan Waterworks and Serves Metro Manila through two concessionaires, the Manila Water Company Sewerage System (MWSS) and Maynilad Water Services Utilities agencies in charge of the sanitation sector in the Philippines are highly fragmented, with different standards, priorities, and implementation timelines FIGURE 10: UTILITIES / SERVICE PROVIDER: ROLES AND RESPONSIBILITIES Provider Roles and Responsibilities Metropolitan Waterworks Two private companies (Manila Water Company, and Maynilad Water Services) and Sewerage System operate under contract to the public MWSS to serve the mega-Manila area, (MWSS) which extends beyond Manila’s center into the neighboring provinces. Autonomous utilities created under Presidential Decree 198, water districts have traditionally been financed and technically supported by the Local Water Utilities Water Districts Administration and serve nearly 19 million people. There are 844 Water Districts, of which around 514 are operational. Local Government Utilities Anywhere from 660 to 3,900 utilities operate as part of Local Government Units. (LGU) Other public-private Three large companies, Manila Water, Balibago Water services, and PrimeWater partnerships and private Infrastructure, and several smaller ones operate around 360 systems outside utilities mega-Manila. There may be around 7,950 small community utilities organized in various forms, Community providers including Community-Based Organizations, Rural Water Supply Associations, Barangay Water Supply Associations, and Co-operatives. 15 Context Findings Recommendations Annex RECOMMENDATIONS these activities, starting with research and development on the left hand side of the spectrum and ending with Operation and Maintenance (O&M) and after-sales support on the This study focused on the ways that solution providers right hand side. can help develop a market for low-cost, quality sanitation products for low-income households in the Philippines. This section goes into each of these phases of the value chain It also considers what needs to be done to establish an in more detail, providing recommendations on actions that environment that would enable such a market to grow. solution providers could take. Given that success will require collaboration with other entities it also provides some further Progress in creating universal access to sanitation will considerations on areas where solution providers could work require a range of activities and innovations along all parts together with other parties throughout the value chain. of the value chain. FIgure 11 below provides a synopsis of FIGURE 11: RECOMMENDATIONS Sales and Marketing Research & Product / Service Distribution / Value and After-Sales Development Development Service Delivery Chain Support • Help generate • Prototype products • Provide/facilitate • Conduct education demand for toilets and test models and access to finance awareness and and lead value chain prices for BOP through innovative effective community development payment campaign Solution • Lead technical • Leverage community Provider design support for maintenance • Conduct product • Conduct capacity • Help connect • Help conduct design and facilitate training for masons customers with awareness training process financial assistance/ and generate • Monitor quality subsidies demand construction NGO • Provide ongoing operation and maintenance and after sales support for customers • Provide sanitation • Raise awareness of loans for customers solutions • Help generate MFI demand • Gather inputs for • Facilitate financing • Provide guideline • Help provide product design for for private sector to for customers ongoing operation BOP support technical to access to financial and maintenance design and pilot assistance for and after sales Government testing sanitation support for customers 16 Context Findings Recommendations Annex Sales and Marketing Research & Product / Service Distribution / Value and After-Sales Development Development Service Delivery Chain Support FOR SOLUTION PROVIDERS Design a product that low-income households can afford: i. When engaging with partners to design sanitation 1. Research & Development: develop quality and models, consider affordability and willingness to cost-effective solutions targeting low-income pay of low-income households. Partnerships with households nongovernmental organizations and with the public sector can support the development of low-cost Design product tailored to the needs and profiles of target latrines and the creation of sanitation entrepreneurs households: through training and sanitation marketing in the i. Providers should consider design and engineering Philippines. Innovations, particularly in the design and alternatives that reduce the footprint and cost of pilot testing of low-cost options, may also grow out of private toilets so that low-income households that the process known as Human Centered Design, in aspire to have them can afford and accommodate which the perspectives and experiences of end users them. Solution providers also need to make sure to are included in the design process to make sure elicit feedback from the targeted communities and solutions are suitable and relevant to their needs. even seek community involvement in the design of ii. Explore additional possibilities for developing sanitation products. innovative sanitation models in the area of reuse ii. For each customer segment, options should address of human waste and recycling of sanitation physical and socioeconomic considerations, such as products. Types of sanitation businesses are emerging available space, physical geography, and land tenure that use raw waste or the outputs of waste water along with personal preferences, aspirations, and treatment for productive and profitable purposes. willingness to pay. Because waste has a potential monetary value that iii. Consider how all proposed sanitation models, can be tapped, and waste reuse has a broader including community toilets or portable toilets, will environmental benefit, there may be a possibility that maximize the qualities most highly valued — safety, these approaches may increase the financial and convenience, and privacy. physical demand for waste which can help incentivize and even help pay for alternatives to such unregulated discharge. Potential exists in this area, though very little progress has been demonstrated thus far in the Philippines. 17 Context Findings Recommendations Annex Sales and Marketing Research & Product / Service Distribution / Value and After-Sales Development Development Service Delivery Chain Support 2. Product / Service Development: Incubate value ii. Develop an initial business model which details chain players and explore holistic market-based product design parameters, value chain players and business models their roles, and volume projection and economics over the project’s life cycle, along with key success factors, Consider formulating market-based business models for risks, and concerns. Then, pilot potential market-based sanitation that capitalize on household needs and “end-to-end” solutions based on a pilot design constraints together with the detailed supply side including an overall plan to reach potential value chain information to understand what models are available and players, pilot locations identified, and potential feasible for different conditions. performance metrics for pilots. i. First, conduct a product landscaping analysis to find available products, paying attention to options, features, and price. Second, identify gaps in the local market in which technologies are not present and identify suitable product solutions. Then, gather inputs from a range of stakeholders, including experts and institutions, value chain participants, and potential customers. 18 Context Findings Recommendations Annex FIGURE 12: APPLICABILITY OF SANITATION OPTION BASED ON PHYSICAL CONSIDERATIONS Have space/ Have existing Have space Have space in Option access for toilet facility inside housea communal area pipe-laying Community Toilet No No Yes No Portable Toilet Solutions No No No No Shared Toilet No No Yesb No Private Toilet with low-cost septic tank No Yes N/A N/A Low-cost septic tank only Yes Yes N/A N/A Private Toilet w/ communal facility No Yes Yes Yes Communal facility only Yes Yes Yes Yes a Area requirement pertains to space among numerous individual houses b Communal area in this instance refers to a neighbor’s house FIGURE 13: SOCIOECONOMIC FACTORS Overall Requirement for requirement for Option Level of servicea community Relative costc tenure and participation spaceb Community Toilet Medium Medium Very high Low Portable Toilet Solutions Low Low Low Low Shared Toilet Medium Medium High Low Private Toilet w/ low-cost septic tank High High Low Medium Low-cost septic tank only High High Low Medium Private Toilet w/ communal facility Very high Very high d Very high High Communal facility only Very high Very high Very high High a Level of service is a positive attribute and so is color-coded opposite the other negative attributes b Based on totals of Table 1 c Values shown are based on the absolute cost of construction of the option. However, subsidies and payment schemes can make costlier alternatives more affordable, especially if they are found to be most feasible and sustainable for the specific area. d Rated as very high due to opportunity for higher level of treatment ex. primary to secondary treatment 19 Context Findings Recommendations Annex Sales and Marketing Research & Product / Service Distribution / Value and After-Sales Development Development Service Delivery Chain Support 3. Distribution / Service Delivery: facilitate 4. Distribution / Service Delivery: design access to financing to help break down adequate payment methods and help facilitate affordability barriers and reduce upfront costs payment for low-income households for sanitation systems i. Work with financial institutions to design adequate Facilitating access to financing will be critical for any of the payment methods and to make sure monthly payments options to succeed, as it will help with affordability and are affordable for low-income households based on their reduce the upfront costs of sanitation systems for low- affordability benchmark. Research shows that most income households. low-income households prefer paying their contribution or fees in monthly installments, though some households i. Public and private sector partnerships should be will pay upfront for installing or improving a sanitation leveraged to implement innovative and suitable facility if the cost is reasonable. financing solutions that increase access and maximize affordability for low-income households. Partnerships ii. The monthly contribution should be affordable, and with financial institutions, such as microfinance ideally it will be below the affordability benchmark of 2.5 institutions, can help with financing, providing percent of a household’s monthly consumption, which is, subsidies, or disbursing loans to make sanitation on average 7 USD (327 Php) a month. Lastly, it is improvements possible for low-income households. important to ensure payment for products by arranging ii. Blended finance could be used in a way that does not appropriate payment channels for customers. distort the markets but instead directs more commercial finance toward water and sanitation infrastructure. Approaches such as grants, concessional lending, and various forms of credit enhancements can help address financing constraints that households face. iii. Types of funding that base financial incentives on People in most households tangible outcomes, such as result-based financing,12 can be successfully leveraged, for example subsidies prefer to pay at a local level: that boost access for underserved households to sanitation or “Output Based Aid.” 44 percent preferred to pay at a barangay or payment center, 35 percent preferred a barangay authorized representative, and 14 percent preferred a service provider. 20 Context Findings Recommendations Annex Sales and Marketing Research & Product / Service Distribution / Value and After-Sales Development Development Service Delivery Chain Support 5. Sales & Marketing and After-Sales Support: populations, attract private investment, and create an build awareness and create demand for solutions environment that will enable the market to grow. Develop a targeted, community-based approach, and While the research shows that the local government conduct education and marketing campaigns to build officials often underemphasize the importance of sanitation understanding of the importance of improved and are unaware of concrete actions to take, they are rich in sanitation and of available sanitation options. Only 10 political capital and can mobilize people and push projects percent of surveyed households have ever received quite effectively, so long as they are given technical information about sanitation, and this information was assistance, especially in planning and engineering. limited to instructions on hand-washing with soap or To push further sanitation efforts on the national level, disposal of solid waste. Most surveyed households have solution providers can engage national government leaders little awareness of sanitation options, do not know how to broadly, or they can do so in the context of specific projects. construct toilets, and do not know where to find masons or Relevant government agencies include the Department of other community members that could construct them. Health, the Department of Environment and Natural i. Leverage the influence of barangay leaders by Resources, and Congress. Government officials should be involving them in any promotion and education involved from the earliest stages of development in order to campaigns, communicate to them the benefits of increase buy-in. improved sanitation through quality products, and help them to provide accurate information to the Solution providers should seek the assistance of the whole community. government in reducing the occurrence of unsanitary ii. With leadership of a proactive community leader, practices as well as increasing demand for sanitary coordinate projects and targeted socialization with the alternatives. Direct discharge of feces into waterways could community, leveraging lessons learned from other be policed or, alternatively, improvements could be successful community activities. Information should be rewarded. Defecation by children near the roadside or into based on community views and should show the creeks should be curbed. Local government units could also benefits of improved sanitation, the options for campaign more strongly against throwing away feces along improvement, the estimated cost of each option, and with garbage. Providers can encourage governments to get the options for payment. Any solution will initially need involved by pointing to negative effects on public health and strong community support while the market is built the environment — the same issues that led to a Supreme and until it becomes large enough to be self-sustaining. Court mandate to clean up Manila Bay. Effective Collaboration and Partnerships: work with All actors in the value chain should work together to drive the government to push a comprehensive sanitation- demand for sanitation solutions and to ensure that the right for-the-poor agenda products are provided at affordable prices. Solution providers, the government, microfinance institutions, non-governmental organizations, and the private sector can develop a market for underserved 21 Context Findings Recommendations Annex Because improving sanitation in underserved communities is a challenge of such great magnitude, partnerships among various stakeholders are likely to be very important. Solutions providers can benefit from partnering with non-governmental organizations, microfinance institutions, and governments. Below are some examples of ways that solutions providers can partner with others and foster an environment in which universal access to sanitation can be achieved. NON-GOVERNMENTAL ORGANIZATIONS GOVERNMENT (NGOs) Governments, with their knowledge of and ability to affect NGOs have a solid presence, strong networks and relevant local conditions, can help solutions providers design local knowledge in many localities (or communities). By sanitation options that are feasible in particular communities. partnering with solutions providers, NGOs can widen the More significantly, governments can help create demand for impact of their efforts while staying consistent with their sanitation solutions among low income households by social mission. Solutions providers can leverage NGOs’ creating education and marketing campaigns that build an strengths to build awareness, generate demand, train local understanding of the importance of improved sanitation manufacturers, monitor the quality of construction, endorse and awareness of available options. trustworthy and quality providers, and provide long-term customer support. Some NGOs will have experience in Solutions providers can also work with governments to bringing the perspectives and experiences of potential ensure that sanitation solutions are affordable. They can customers into product development and design, ensuring work with local government units to facilitate creation of that solutions are feasible and relevant to the needs of the financial assistance programs and to help customers learn people who will use them. Some NGOs may also be able to about current options for financial assistance. Governments help customers find appropriate subsidies to help pay for can even develop new financing instruments for potential sanitation solutions. providers, such as viability gap financing or output-based aid and subsidies. Such financing will encourage providers MICROFINANCE INSTITUTIONS (MFIs) to work on technical design, pilot concepts, build awareness, and roll out business models. Solutions providers can partner with MFIs to help people pay for water and sanitation services. MFIs can leverage existing funding by disbursing it through loans to people in need. Water.org, for instance, provides funding to various MFIs in the Philippines for capacity building and technical assistance. Through its Water Credit program, it offers grants to MFIs (or affiliated NGOs) for operational expenses while providing water and sanitation loans.13 MFIs, together with local NGOs, can also help raise awareness and drive demand for specific products. 22 Context Findings Recommendations Annex Annex RESEARCH METHODOLOGY Provided below is background on data collection methodology, on sanitation models, and more information on the analytical framework used to assess the optimal conditions for implementation of each of these models. Focus Group Discussions: Led by In-depth Interviews: Semi- Household Quantitative Surveys: TNS Philippines and MWF structured interviews with From June to July 2016, with guidance and 14 government officials surveys were conducted supervision from IFC were conducted by MWF, with 800 households (400 technical team members, with guidance from IFC technical households with private toilets and discussions were conducted from team members, between April and 400 households without private January 2016 to March 2016 in the June 2016. Interviewees included toilets) by local survey firm TNS same areas as the household barangay leaders, barangay health Philippines, whose surveyors were surveys. The aim was to understand workers and officials, city health trained and supervised by IFC. The the drivers, barriers, and officers, sanitation inspectors, and survey focused exclusively on preferences of low-income sanitation heads of local residential buildings and excluded households for improving sanitation governments. The aim of these dormitories and buildings that were systems. Two focus groups, each interviews was to understand the used for commercial, service, with four to six residents, were status of ongoing government business, or industrial purposes. conducted per province, with a efforts concerning sanitation. total of 64 participants. For the household quantitative surveys, target respondents These three parameters were used to assess the barriers were the heads of households or their partners, between and drivers for changing sanitation practices, and to the ages of 20 to 60 years old, and within the lowest income ultimately to test the feasibility of different models and economic class. For detailed survey methodology and sample the potential tradeoffs. The next page presents an overview design, refer to contact information on the last page. of the analytical framework used in this exercise. This framework captures both existing conditions and variables The household survey included more than a hundred that influence selection of sanitation options. questions, or about 470 variables. Many of the variables were derived from a framework based on three parameters: This was combined with testing with households social, financial and technical. willingness to improve, interest among a proposed set of sanitation models, and their ability and willingness to pay for improved models. 23 Context Findings Recommendations Annex FIGURE 14: ANALYTICAL FRAMEWORK Social Financial Technical Understanding of need for Current financial situation and Details of design in comparison to sanitation, impact of poor affordability standards sanitation on health and Costs of current sanitation Configuration and operation of Understanding environment current system and its current existing Perception of sanitation and potential impact on health sanitation performance and environment Socio-economic data that may Operation and maintenance influence needs and decisions Needs/requirements Motivations for improvement and Anticipated costs for upgrading Suitability of upgrading existing factors that influence decision- system Income, affordability, and making willingness to pay Land for building new system Satisfaction with existing Access to finance and preferred Elevation and gradient sanitation options payment schemes Soil conditions and groundwater Role of stakeholders including Role of other public or use Improving community leaders in influencing nongovernmental institutions in change Access to emptying and street options financing width Perception of individual versus collective or government responsibility Ongoing sanitation programs or projects 24 Context Findings Recommendations Annex PROFILES OF SURVEY RESPONDENTS Respondent Profiles: About 82 percent of respondents were females, although only 16 percent of females were heads of households. Half of all heads of households were unskilled workers or worked in agriculture, 22 percent worked in services or sports, and 19 percent were skilled workers. The average age of respondents was 39 years, with males slightly older than females. On average, households have 5.11 members: 3 adults, 1.3 children aged between five and 14 years old, and 0.8 young children below the age of five years old. Nearly all households surveyed live in small quarters: 48 percent live in studio-type or one-room dwellings and 42 percent live in single-detached houses. Nearly half of the households in the survey owned their homes. On average, 40 percent of households own their plots or land and 39 percent occupy land for free. A larger number of land owners is found among private toilet owners and those who use a neighbor or friend’s toilet. SWIFT (Survey of Well-being via Instant and Frequent Tracking) — key findings by province: The project employed the SWIFT Tool, or the Survey of Well-being via Instant and Frequent Tracking, which is a quick and low-cost way to gauge the consumption levels of households. Consumption can be used as a proxy for income or poverty levels. The Poverty Global Practice at the World Bank has developed this tool as part of its efforts to reduce absolute poverty. Using the SWIFT tool, the team estimated 100% – 3% 5% 3% 3% consumption levels for the overall sample and 17% 35% 18% 26% segmented the responses to other questions 80% – according to income or poverty levels. The 60% – average consumption levels provide an idea of 47% 57% the average income levels of the households in 51% 46% 40% – the survey areas. The mean estimated annual per capita income through SWIFT is 811 USD 20% – 29% (37,928 Php), whereas the mean annual self- 18% 24% 11% reported income is 592 USD (27,689 Php). The 0% – 4% 2% 5% general poverty rate of survey respondents was Metro Rizal Pampanga Laguna Manila 18 percent, compared with 25 percent for typical households in the same region. The poverty line n Wealthiest Quintile n2 changes based on province, the highest line n4 n Poorest Quintile n3 being found in Rizal and the lowest in Pampanga. But Laguna had the highest share of those in the lowest quintile in terms of income, with 29 percent of respondents in the second-lowest quintile, and 5 percent in the lowest income bracket. Metro Manila had no respondents in the lowest income level and 11 percent in the second-lowest. 25 Context Findings Recommendations Annex SANITATION OPTIONS • Flush toilet uses a cistern or holding tank for flushing water, and a water seal (which is a U-shaped pipe There are four general categories of sanitation facilities: below the seat or squatting pan) that prevents the 1. Open defecation when human excreta is disposed of passage of flies and odors. A pour flush toilet uses a in fields, forests, bushes, open bodies of water, beaches, water seal, but unlike a flush toilet, a pour flush toilet or other open spaces or disposed with solid waste uses water poured by hand for flushing (no cistern is used). This can discharge to: 2. Unimproved sanitation facilities do not ensure hygienic separation of human excreta from human, — Piped sewer system is a system of sewer pipes, animal, or insect contact. They include the following: also called sewerage, that is designed to collect human excreta (feces and urine) and wastewater • Flush/pour flush to elsewhere refers to excreta being and remove them from the household deposited in or nearby the household environment environment. Sewerage systems consist of (not into a pit, septic tank, or sewer). Excreta may be facilities for collection, pumping, treating, and flushed to the street, yard or plot, open sewer, a disposing of human excreta and wastewater. ditch, a drainage way, or other location. — Septic tank is an excreta collection system • Pit latrine without slab uses a hole in the ground for consisting of a water-tight settling tank, which is excreta collection and does not have a squatting slab, normally located underground. The treated platform, or seat. An open pit is a rudimentary hole. effluent of a septic tank is designed to seep into the ground through a leaching pit. It can also be • Bucket refers to the use of a bucket, chamber pot, or discharged into a sewerage system. other container for the retention of feces (and sometimes urine and anal cleaning material), which is • Pit latrine refers to a system that flushes excreta to a periodically removed for treatment, disposal, or used hole in the ground or leaching pit (protected, as fertilizer. covered). Dry improved toilets are less common in urban areas of Philippines, where water based • Hanging toilet or hanging latrine is a toilet built over sanitation is typical, but can include: the sea, a river, or other body of water, into which excreta drops directly into the water. — Ventilated improved pit latrine (VIP) is a dry pit 3. Shared improved sanitation facilities are facilities latrine ventilated by a pipe that extends above the of an otherwise acceptable type (see description of latrine roof. The open end of the vent pipe is improved sanitation facilities below), shared between covered with gauze mesh or fly-proof netting and two or more households. This is distinguished from the the inside of the superstructure is kept dark. original JMP definition which only classified facilities that are not shared, or not public, as improved. Shared — Dry pit latrine with the pit fully covered by a slab or sanitation facilities, especially those constructed platform that is fitted either with a squatting hole properly, can provide drastically better service to users or seat. The platform should be solid and can be of unimproved sanitation facilities, but still do not made of any type of material (concrete, logs with provide the level of privacy, security, and reliability of a earth or mud, cement, etc.) as long as it adequately private improved sanitation facility. covers the pit without exposing the pit content other than through the squatting hole or seat. 4. Improved sanitation facilities are likely to ensure hygienic separation of human excreta from human, — Composting toilet is a dry toilet into which animal, or insect contact. They include the following, carbon-rich material (vegetable wastes, straw, relevant to the likely conditions in the Philippines: grass, sawdust, ash) is added to the excreta and special conditions are maintained to produce inoffensive compost. A composting latrine may or may not have a urine separation device. 26 Context Findings Recommendations Annex TESTED SANITATION MODELS PRIVATE TOILET WITH SEPTIC TANKS AND SEPTIC TANKS ONLY In order to better understand attitudes toward different sanitation improvement features, a limited set of sanitation Private toilets with septic tanks are the options, selected from the list discussed in the previous most prevalent sanitation facility in the section, was presented to study participants. The selection Philippines, though the quality of their was based on current sanitation systems, available design and construction varies widely. The cost of a technologies, and early, ongoing piloting of certain options, standard/improved septic tank, which is typically an such as the portable toilet solutions. underground two-chambered reinforced-concrete tank, is prohibitive for many poor households. Innovations in septic COMMUNITY TOILET tank design include small-footprint septic tanks made of plastic or fiberglass that can be installed faster and more Community toilets have been built primarily by cheaply than conventional concrete tanks. The study local governments, typically in public spaces, like presented two options: a low-cost private toilet with septic barangay or neighborhood halls. Community tank for households without toilet, and, for households that toilets, unlike the public toilets found in parks or malls, are had an existing toilet or an unimproved pit, a low-cost made for everyday use by communities that lack private septic tank only. The costs as presented included the sanitation. These toilets are installed within the community concrete floor, septic tank, and — for the first option — the itself unless issues with land acquisition make that toilet bowl.15 Households were informed that these systems infeasible, as in informal settlements. To be truly viable, a require emptying every three to five years and require land community toilet needs to be appropriately sized, be around the house to be built. located close to the community, have a secure water supply, be well maintained, and have user fees that are manageable COMMUNAL TREATMENT for members of the community. Private toilets with communal treatment, often PORTABLE TOILET SOLUTIONS referred to as decentralized wastewater treatment systems, exist in some new private- The concept of a portable toilet solution is sector developments, small commercial areas, and in other somewhat new. It has been tested in Ghana and developments such as old government housing projects. In Haiti and is being considered for use in Laguna, a the Philippines, these have been built in the Quezon and La province in the Philippines.14 The toilet itself is similar in Union Province, Dumaguete, San Fernando.16 In Indonesia, concept to a chamber pot kept inside the house and they are common in dense low-income urban areas that emptied after use. The difference is that the portable toilet have little space for individual septic tanks. There are 14,000 system is designed to reduce smell and to help individuals community-scale sanitation systems built by government avoid direct contact with feces. The system includes regular and donor funded programs.17 Typically, household toilets collection and subsequent treatment of the waste by an are connected to a network of sewer pipes that discharge external service provider. The portable toilet solution unit into small treatment facilities, which can be improved septic tested in the study, following a proprietary design of a toilet tanks, anaerobic baffle reactors, or simple decentralized manufacturer, is a plastic receptacle specially designed to wastewater treatment systems sized to treat a number of minimize odor. It is designed to have sufficient volume for households. Since the facilities are usually managed by the usage by a typical family for three days, after which it is community rather than a wastewater authority, the collected by service providers and discharged in proposed community needs to work together to support their local acceptance facilities. The waste from these acceptance operation and to fund minor costs, such as regular facilities will be periodically desludged by vacuum trucks desludging. and transported to a wastewater treatment facility. 27 Endnotes 9. Willingness to pay was measured by a household’s response to three questions: 1) What is the maximum acceptable amount beyond which respondents would consider the service to be too expensive to be acceptable? 2) What is the minimum acceptable amount below which respondents would consider the service to be too cheap and 1. “Progress on Drinking Water, Sanitation and Hygiene, 2017 Update and SDG Baseline,” quality questionable? 3) What is the standard amount or normal amount that World Health Organization and the United Nations Children’s Fund, 2017, Geneva. Available respondents would consider reasonable or fair? at: http://www.who.int/mediacentre/news/releases/2017/launch-version-report-jmp- water-sanitation-hygiene.pdf 10. A household is defined as poor if household income is less than the poverty line set per province. 2. Rodriguez UE., Jamora N., and Hutton G, Economic Impacts of Sanitation in the Philippines. World Bank, Water and Sanitation Program, 2008, Washington D.C. The World Bank Water 11. Frankhauser S. and Tepic S., “Can poor consumers pay for energy and water? An Sanitation Program estimated the economic cost of poor sanitation and hygiene in affordability analysis for transition countries,” European Bank for Reconstruction and urban areas in the Philippines at $1.4 billion per year, with the impact on health the Development, 2005. largest source of quantified economic costs 12. An umbrella term for innovative mechanisms that disburse subsidies after results have 3. Philippines Unified Financing Framework for Water Supply and Sanitation been verified. Resources are disbursed not against individual expenditures or contracts on the input side, but against demonstrated and independently verified results that are 4. Rodriguez, Jamora, and Hutton. Economic Impacts of Sanitation in the Philippines. World largely within the control of the service provider. Risk is therefore transferred to the Bank, Water and Sanitation Program. service provider. 5. The Philippines Statistical Authority established the 2016 poverty level in different 13. Water.org. Available at https://water.org/our-impact/philippines/ provinces: Pampanga (19,670 Philippine pesos), Laguna (20,175 Philippine pesos), Metro Manila (20,344 Philippine pesos), and Rizal (20,742 Philippine pesos). 14. Program in Ghana and Laguna: http://www.toiletboard.org/our-impact. Trial in Haiti: https://www.oursoil.org/what-we-do/dignified-sanitation. 6. Imputed per capita income has been calculated through the SWIFT tool, which estimates consumption levels or imputed per capita income for the overall sample of 15. To manage costs, funds for the toilet walls and roofing were removed. Households 800 households based on poverty levels. The average consumption levels or imputed could then construct those two pieces in line with their budget. per capita income provides an idea of the average income levels of the households in 16. “East Asia and the Pacific Region Urban Sanitation Review: Philippines Country Study.” the survey. World Bank, 2013, Washington D.C. 7. “Economic Impacts of Sanitation in the Philippines. Economic Assessment of Sanitation 17. Mitchell C. and Ross K, “Findings and Recommendations: A Synthesis for Key Interventions in Indonesia,” World Bank, 2017. A six-country study conducted in Stakeholder Community Scale Sanitation in Indonesia,” Prepared by the Institute for Cambodia, China, Indonesia, Lao PDR, the Philippines, and Vietnam under the Sustainable Futures, University of Technology Sydney. Available at: http:// Economics of Sanitation Initiative (ESI) Water and Sanitation Program. communitysanitationgovernance.info/research-outputs/ 8. The Philippines Statistical Authority. The exchange rate used in this study is 1 USD=46.75 Philippines pesos — cited by the average IMF exchange rate from June to July 2016 Poverty line by province has been given by the Philippine Statistical Authority ABOUT IFC ACKNOWLEDGEMENTS IFC, a member of the World Bank Group, is the largest global The preparation of this report was led by Shino Saruta, Alexis development institution focused on the private sector in emerging Geaneotes, Gilles Roger, Ronald R. Muaña, and Freya Mills, with markets. Working with more than 2,000 businesses worldwide, we guidance from Toshiya Masuoka of International Finance Corporation. use our capital, expertise, and influence to create markets and Groff Creative provided the design and Renuka Rayasam provided opportunities in the toughest areas of the world. In FY17, we delivered copywriting and editorial support. a record $19.3 billion in long-term financing for developing countries, The study team would like to acknowledge the significant assistance leveraging the power of the private sector to help end poverty and and cooperation, and the invaluable contribution of: Ferdinand M. boost shared prosperity. For more information, visit www.ifc.org. dela Cruz, Carla May Beriña-Kim, Carmela B. Rosal, Janie Rose Alfonso, and Arvee Joy Galman of Manila Water Foundation. The study team ABOUT MANILA WATER FOUNDATION (MWF) would also like to acknowledge the significant assistance of Laguna Manila Water Foundation (MWF) was established in 2005 by Manila Water and Manila Water Company — Pasig, San Juan Mandaluyong, Water Company (MWC), Inc. as an avenue to serve beyond the given and Taguig Business Areas. mandate to provide water and used water services in the East Zone The study team would like to thank all of the management team of of Metro Manila. MWF is guided by the vision to become the enabler the Manila Water Company who attended the workshop in October of change that will uplift the quality of life of Base of the Pyramid 2016 and who reviewed the findings for their thoughtful comments (BOP) communities, which are the poorest of the poor, through and for their contribution to study recommendations. the provision of sustainable water and used water services. As the corporate social responsibility arm of the Manila Water group of Finally, this report has benefited greatly from the world-class companies in the Philippines, it is in a unique position to establish expertise, in-depth industry and country knowledge, and programs that provide water, the vital source of life, to those who contributions from Christopher C. Ancheta and Karl Galing of the do not have access to this basic need; educate people on water, World Bank. sanitation and hygiene issues; and provide sustainable livelihood opportunities to community groups, with the support and This report was made possible by financial support from the Japanese commitment of MWC and its subsidiaries. Ministry of Finance through Comprehensive Japan IFC Trust Fund. RIGHTS AND PERMISSIONS/DISCLAIMER PHOTO CREDITS Ronald R. Muaña, Manila Water Foundation © International Finance Corporation 2017. All rights reserved. The material in this work is copyrighted. 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