WATER AND SANITATION PROGRAM: TECHNICAL PAPER 56972 Global Scaling Up Sanitation Project Case Study on Sustainability of Rural Sanitation Marketing in Vietnam Christine Sijbesma, Truong Xuan Truong, and Jacqueline Devine April 2010 The Water and Sanitation Program is a multi-donor partnership administered by the World Bank to support poor people in obtaining affordable, safe, and sustainable access to water and sanitation services. Christine Sijbesma, IRC effort to meet the basic sanitation needs of the rural poor who Truong Xuan Truong, ADCOM do not currently have access to safe and hygienic sanitation. Jacqueline Devine, WSP The project is being implemented by local and national governments with technical support from WSP. For more The task manager for the study was Jacqueline Devine of information, please visit www.wsp.org/scalingupsanitation. the Water and Sanitation Program (WSP), who also reviewed This Technical Paper is one in a series of knowledge products this report. The study was executed by IRC International designed to showcase project findings, assessments, and Water and Sanitation Centre, The Hague, the Netherlands, lessons learned in the Global Scaling Up Sanitation Project. and ADCOM Consultants in Hanoi, Vietnam. The respective This paper is conceived as a work in progress to encourage international and national team were Dr. Christine Sijbesma the exchange of ideas about development issues. For of IRC and Dr. Truong Xuan Truong of ADCOM. ADCOM more information please email Christine Sijbesma, Truong team members were Dinh Ngoc Bich, Dr. Ha Viet Hung, Le Xuan Truong, and Jacqueline Devine at wsp@worldbank.org Duc Hanh, Nguyen Thi Hong Sam, Nguyen Kim Thai, Ho or visit our website at www.wsp.org. Thi Kim Uyen, Nguyen Nhu Trang, and Nguyen Tuan Minh. Joanna Rhodes of IRC edited the case study report and WSP is a multi-donor partnership created in 1978 and administered by Amy Grossman of WSP edited the study for publication, with the World Bank to support poor people in obtaining affordable, safe, and assistance from Kara Watkins. sustainable access to water and sanitation services. WSP's donors include Australia, Austria, Canada, Denmark, Finland, France, the Bill & Melinda Gates Foundation, Ireland, Luxembourg, Netherlands, Norway, Sweden, The authors wish to thank Nguyen Danh Soan, Coordinator Switzerland, United Kingdom, United States, and the World Bank. of the Rural Water Supply and Sanitation Partnership (RWSSP) in the Ministry of Agriculture and Rural WSP reports are published to communicate the results of WSP's work to the development community. Some sources cited may be informal Development (MARD), and Pham Bich Ngoc, also of the documents that are not readily available. RWSSP, for their continued guidance. Nghiem Thi Duc, IDE's manager of the pilot project, provided valuable documents The findings, interpretations, and conclusions expressed herein are and clarifications. Support from Vinh Thanh Nguyen of WSP entirely those of the author and should not be attributed to the World Bank or its affiliated organizations, or to members of the Board of is also gratefully acknowledged. Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data Peer-reviewers for this report included Eduardo A. Perez, included in this work. Craig Kullmann, and Christopher Trethewey of WSP, and Pete The map was produced by the Map Design Unit of the World Bank. Kolsky of the World Bank. Their comments were invaluable. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of the All photographs used by permission of team members. World Bank Group concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Global Scaling Up Sanitation is a WSP project focused The material in this publication is copyrighted. Requests for permission on learning how to combine the promising approaches of to reproduce portions of it should be sent to wsp@worldbank.org. Community-Led Total Sanitation and Sanitation Marketing WSP encourages the dissemination of its work and will normally grant to generate sanitation demand and strengthen the supply permission promptly. For more information, please visit www.wsp.org. of sanitation products and services at scale, leading to © 2010 Water and Sanitation Program improved health for people in rural areas. It is a large-scale R W S SP Executive Summary Background with the promoters, providers, and some local government From 2003 to 2006, a rural pilot project was conducted in authorities. Interviews were held with district and provin- Vietnam with technical support from the non-governmental cial authorities and at a national level with the NGOs, organization (NGO) International Development Enter- national authorities, and donors involved in rural sanita- prises (IDE) and funding from Danish International Devel- tion. With the help of participatory tools, focus group dis- opment Assistance (DANIDA). The project tested whether cussions were held with sixty-one householders who had a sanitation marketing approach could improve rural access built sanitary toilets or upgraded their unsanitary ones, and to sanitary toilets in 30 communes in six districts of the sixty householders who had either no toilet or a still unsani- coastal provinces of Thanh Hoa and Quang Nam. tary one. Finally, the study team visited a very small and non-random sample of installed toilets to observe the qual- The project trained promotion teams consisting of local ity of construction and hygiene as per the national stan- health workers, Vietnam Women's Union leaders, and village dards of the Ministry of Health. heads, as well as small providers (shopkeepers, producers, and masons). These teams, in turn, promoted sanitary Case Study Findings toilets and helped households to build the type of toilets The trend of increased access to sanitary toilets was sus- they wanted and could afford. The pilot project trained over tained. Average access which in the study sample was 15% 2,000 government staff, Women's Union leaders, small in 2003 (one percentage point lower than in the pilot area entrepreneurs, and trainers. After 3.5 years, over 15,000 as a whole) and grew to 44% in 2006 and to 59% by 2008. households had gained access to a sanitary toilet in the pilot The average annual growth rate of 7.5% equaled that of the area out of 32,000 households targeted. This number was pilot project as a whole, and in the study villages was even 2.5 times the increase achieved under a conventional one percentage point higher. sanitation program conducted in the three preceding years. Average access grew from 16% to 46%. Growth in three of the comparative communes was much lower. In one it was even negative, as the population grew Three years after the end of the pilot program, WSP con- more rapidly than sanitation access. In the fourth no statis- tracted IRC/ADCOM to design and carry out a case study tics could be obtained. to investigate the sustainability of the rural sanitation marketing approach. The main research question was At the end of the pilot project, 16% of the poor households whether the outputs and outcomes had been sustained had built a sanitary toilet, while their proportion in the after the external support had ended. Other research ques- pilot population was 19%. However, the poor-specific tions were used to determine if the approach had spread to monitoring was not sustained. In the case study it was neighboring communes ("spill-over effect"), if the districts impossible to get commune statistics specified for poor and had extended the approach district-wide ("scaling-up non-poor households. It was only possible to note that effect"), and if there were signs of spontaneous marketing overall, access to sanitary toilets increased steadily while the developments ( "parallel development"). The case study percentage of poor households remained the same or varied was conducted in a purposively selected sample of eight over time. communes in four districts of the two provinces. Four matched communes that did not participate in the pilot All but one promoter had continued to promote sanitation but were located in other parts of the same districts served along with their job duties, albeit at a lower intensity and as a comparative group. with fewer methods. The promoters had not received new promotional materials and two-thirds said they had run out Research for the case study took place between June and of pilot project brochures. Interest in toilets had reportedly August 2009. Local sanitation statistics were collected in all remained high, especially among women. However, the sus- study communes. Semi-structured interviews were held tainability of promotion may drop in the future because www.wsp.org iii Case Study on Sustainability of Rural Sanitation Marketing in Vietnam Executive Summary local women leaders and village heads change after three or They reported sharing a toilet with relatives or neighbors or four years and training for their successors was not practicing open defecation. However, many said that in the institutionalized. latter case they used the "cat method" (i.e., defecate in a small hole and then cover the excreta with soil). Local providers had continued to develop their services and customer base and other entrepreneurs had joined when Local authorities in the study communes, districts, and they saw the growing sanitation demand. All but one provinces varied in their willingness and actions to sustain provider had continued to expand their range of goods and rural sanitation marketing after the pilot. In some com- services. Septic tanks were the most popular option with munes, the authorities continued the sanitation steering both customers and providers, raising a concern for the committees, annual sanitation plans, toilet loans, etc. with- future as it is common practice for villagers to empty full out going back to subsidizing toilets. Other communes tanks directly into the environment. had accepted NGO projects with toilet subsidies since the pilot, but said that this was not a real solution as project Virtually all entrepreneurs gave some form of credit to cus- duration was short and the number of households that tomers and some shops also gave credit to masons. On aver- could be assisted was small. The supportive commune gov- age, one-third of the customers bought on credit. There ernments had been convinced by the good results of the were no agreements or collateral; the decision was based on pilot. The less supportive authorities were doubtful about acquaintance and trust. being able to convert the poor and hard-core open defeca- tors, or faced other more urgent constraints--no land Three-quarters of the providers said that they now had more title deeds, industrial solid waste problems, and absence of customers and over half reported a greater business volume. a proper cemetery. Two-thirds said that they made more profit and had higher incomes in the last three years. However, all also provided In three of the four study districts (no interview could be other goods and services and worked seasonally and often conducted in the fourth) the district authorities had sus- part-time in sanitation: the toilet business alone was not tained their positive attitudes. They praised the project enough to live on. strategy; the demand for district commitment; the organ- ization of the program; the professionalization of the Although trained in marketing as part of the pilot, only half communication approach; the increase in awareness, of the providers had continued this practice. None had knowledge and skills of promoters, providers, and con- developed their own leaflets or catalogs. To attract new sumers; the capacities developed in the private sector; the business, they relied on local relationships, networks, and lower cost and better cost-awareness; and the greater their reputation. As part of the pilot, IDE had encouraged access at higher speed that had resulted in less open defe- the formation of provider networks to cooperate on cation and better living environments. Nevertheless, the production, procurement, sales, transport, construction, districts had not continued their support to the study and after-sales services. These networks were sustained and communes after the pilot. They mentioned in particular new ones had been formed. the absence of funding for new promotion materials and training. However, as discussed below, two study districts Satisfaction with services and toilets had remained high had supported scaling up. among householders. The few dissatisfied householders reported clogging, allegedly due to using regular paper While provincial authorities had not been directly involved in instead of toilet paper, and poor quality construction. The the pilot, they praised the project and its good results in a small number of toilets observed and built either during or coastal environment, where poverty and open defecation hab- since the pilot all met the standards of Ministry of Health. its are serious constraints to improving sanitation. They saw two problems for strategy adoption and support province- Those householders without a toilet cited financial concerns wide. The first was paying an incentive for sanitation as the primary reasons they had not installed or upgraded. iv Global Scaling Up Sanitation Case Study on Sustainability of Rural Sanitation Marketing in Vietnam Executive Summary promotion to three promoters in all communes. The second similar coverage as the pilot study commune in a little over was promoting no-subsidy toilets and training local masons two years. The highest coverage achieved was 96%; the and shops in the mountainous areas with high rates of district-wide average was 49%. The two other study ethnic minorities. districts did not scale up. At the national level, authorities reported that Vietnam is Conclusions, Lessons, and currently not reaching its rural sanitation targets and that Recommendations adoption of sanitation marketing could help. The Vietnam The case study report includes a series of conclusions, les- Women's Union and donors cooperating in rural sanitation sons learned for replication of the approach in Vietnam and were ready to support with capacity development and fur- elsewhere, and recommendations. Some highlights: ther piloting. They also recommended the development of · Although sanitary toilet promotion by community improved monitoring of access for the poor, and combining health workers, women's leaders, and village heads sanitation marketing with Community-Led Total Sanita- had continued, the lack of budgeting for ongoing tion (CLTS) as piloted in other parts of the country. supply of promotional materials, the lack of training of new promoters and providers, the lack of market The providers reported that households in neighboring research, and the lack of development of a more spe- communes had begun to seek services from them and their cific marketing strategy for the poor may jeopardize networks after the pilot project. They also said that new future sustainability. providers and networks had emerged, which copied their · Service providers and demand for sanitary toilets example and now offered the same services and goods. continued to develop after the pilot project. As long However, without proper user information, training of pro- as this growth was limited, peer learning, instruc- viders and promoters, and toilet follow-up, the same quality tion manuals, and ongoing consumer information of service as in the studied pilot communes was not assured. could ensure an acceptable construction quality and In Nghi Son Economic Development Zone, for example, user satisfaction. An explosion in demand combined which included some of the pilot projects, the quality of with unguided and controlled supply meant that the construction of sanitary models and user satisfaction had good results from private sector involvement were both decreased. Reasons for the decline included: the rapid not sustained. demand increase, the absence of organization and training · The strategy to target especially women through the of the promoters and providers, and monitoring of con- women leaders and the heath workers has worked struction quality by the community health workers that was well in the two provinces. From the interviews with too little and too late without support from trained women the promoters, the providers, and the FGDs, it be- leaders and village heads. came clear that women were the most interested, but that the couple, and sometimes their children, The research of sustainability at institutional levels also re- made decisions jointly and harmoniously. However, vealed that after the pilot project, two of the four study dis- this may be different for other regions in Vietnam tricts had encouraged all other communes in their districts and elsewhere, where agreement on a toilet or bath- to adopt sanitation marketing. In Hau Loc district in Thanh room as an investment priority in rural households Hoa province, the District Steering Committee advocated is lower. the approach to the other communes through exposure · Sanitation marketing has enabled men who visits, but without providing training. The district of Nui worked part-time in sanitation to move out of Thanh in Quang Nam actually scaled up sanitation market- the agriculture and fishery sectors and obtain bet- ing to all 17 communes. The district encouraged the com- ter jobs with more career prospects in small-scale mune staff to promote sanitation and each commune was enterprise. Thus, rural sanitation marketing has able to send some providers for training to the district head- contributed to Vietnam's policy and strategy of quarters. As a result, the other 12 communes achieved rural poverty reduction, albeit without a specific www.wsp.org v Case Study on Sustainability of Rural Sanitation Marketing in Vietnam Executive Summary strategy for gender equity in capacity develop- environment, institutionalized capacity building for ment of the providers. promoters and providers, more regular consumer · Since there is not a formal recognition from the na- studies, further development of promotional mate- tional government and its integration in rural sanita- rials and communication channels, and the design tion strategies and programs is not institutionalized, and testing of a specific strategy enabling the poor to not all commune, district, and provincial govern- install unsubsidized sanitary toilets. ments were ready to replicate the approach and scale · A key lesson was the lack of a good, but sim- it up. Provincial governments, which are the imple- ple sanitation monitoring system. Missing were: menters of the national rural sanitation program, (i) poverty-specific monitoring of toilet access; were especially not ready to shift funds now used for (ii) the combination of data from all the local toilet subsidies in poor regions to building longer- sanitation projects of different government term local toilet promotion and supply capacities. departments and NGOs; (iii) the participation of · A financing strategy for the poor is missing. A more the people in assessing and monitoring the sanitation refined and comprehensive strategy than promoting coverage in their own locations to raise awareness, loans and savings--especially in light of the high motivate change, and enhance validity of the data inflation level, estimated at 8% for 2009--is needed. and transparency of program performance; and · In the long term, the approach used in the pilot study (iv) data aggregation and integration into a single, may not be sustained and expanded without further easy to use computerized and comparative database advocacy for a supportive political and administrative at commune, district, and provincial level. vi Global Scaling Up Sanitation