At the SNV-organised regional learning event on accessing hygiene and sanitation in Lampung, Indonesia last year, the eight country programme teams present were asked the question: “As districts progress in sanitation access, who do you see in your last mile?” Put differently, who is most likely to be last to gain access to sanitation? Of the groups identified as part of the ‘last mile’ single female-headed households appeared on almost all of the lists of the “potentially disadvantaged” .
The dilemma of single female-headed households
The ‘single female-headed household’ dilemma is not new in rural sanitation. Intersections between poverty, rural households and gender are well established. As part of an ongoing pre and post-assessment of SSH4A implementation in 11 countries , colleagues from the Emory University are analysing quantitative data generated through annual household surveys. Initial findings of Emory University show that whilst sanitation access, on average, has improved at a comparative rate for female-headed households – existing disparity persisted, and there was a lag in uptake of improved sanitation in comparison to male-headed households. See graph  by Garn, J., Apanga, P., and Freeman, M., (2018) below. (Viewing content on a mobile device? Click here to view full graph).
Field implementers point to the lack of labour as the primary barrier to increasing access. In promoting low-cost sanitation options, often, the type of ‘do-it-yourself (DIY)’ technologies introduced assume that labour is available within the household, or that resources can be easily mobilised. Design of these solutions need to take into account the myriad of gendered barriers at work, such as:
- outreach activities do not always reach all equitably, or women are excluded (un-) intentionally when they have less available time to participate in events, such as community-led total sanitation (CLTS), or attend community meetings - which is often the case when travel is involved, or if they are primary caregivers;
- gender-based discrimination and stigmatisation can put female-headed households in a position where they are the last to know and the last to receive support;
- linked to the above, women cannot always participate meaningfully in many decision making spaces, and their needs are less understood and represented in policy or approaches.
Can we bridge this gap?
How do we delink this last mile reality from single female-headed households and other potentially vulnerable groups to address this disparity? In SNV’s experience, it is important to have a clear understanding about who these potentially disadvantaged groups might be from the start; the specific barriers that they face; and how do existing market and local government address these barriers and respond at scale –there are more issues than affordability alone.
During 2017, the Institute for Sustainable Futures-University of Technology Sydney (ISF-UTS) conducted research on SNV’s SSH4A experience in rural sanitation and hygiene programming across five of the 11 countries where SSH4A is being implemented area wide. ISF-UTS findings in Bhutan, Nepal, Cambodia, Zambia and Tanzania have helped us to reflect on the strategies being used – including actions by government, private sector and communities – and importantly, their timing. (Read learning brief here).
It is becoming clear that there is no single solution. What seems to work well is a “toolkit” of tailored approaches for practitioners, and the capacity to adapt programming to respond to data and context. And, not only understanding what approaches to use, but also when approaches work best for different groups.
Tailoring a range of support mechanisms are likely to prove more sustainable and effective than a single solution. As we strive to realise the Human Rights to Water and Sanitation (HRTWS), and to meet the Sustainable Development Goals (SDGs), SSH4A findings of Emory University and ISF-UTS are once again reminding us now — more than ever — the importance of ensuring that sanitation and hygiene services meet the needs of all.
 While an approach to introduce a sanitation technology or practice may reach peak uptake for the majority and is therefore mainstreamed, after a period of time, there emerges a final group – the ‘last mile’ – that is last to adopt new technology or practice. Typically, the ‘last mile’ represents the final ten per cent, or less of a population. Concepts such as the ‘last mile’ have been adapted from Rogers’ Diffusion of innovations theory illustrated by the technology adoption bell curve.
 We refer to ‘disadvantaged individuals and groups’ as “potentially disadvantaged” following recommendations found in the Human Rights to Water and Sanitation Handbook by de Albuquerque (2014). By adding the word “potentially,” House, et al., (2017) suggest that we emphasise that not all individuals and groups who are likely to experience disadvantages, actually do.
 Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda and Zambia.
 Graph presented above is borrowed from Emory University’s Garn, J., Apanga, P., and Freeman, M., (2018) presentation titled “Assessing equity of an integrated sanitation approach in 11 countries.” Initial findings that show the success rate of SNV’s SSH4A approach vis-à-vis equity indicators will be shared during the WASH Futures Conference: Collaboration for Universal WASH in Brisbane, Australia (5-9 March 2018).