As part of the Dgroup discussion Universal access and use of sanitation and hygiene services, what works?, during the second week we looked at tools and approaches for reaching the last mile. Should these be different for different stages of sanitation progress in an area? Are they biased towards households and communities, at the expense of responding to inequalities between people? Read up on what professionals from the Africa and Asia regions as well as the Netherlands, the US and Australia, had to say.
Placing the vulnerable groups first
While there are many moral and needs-based arguments to state that vulnerable groups should not become the last mile in a rural sanitation programme, but rather should be the first to practice safe sanitation, this may not be realistic. Though contributions covered a range of perspectives, the majority was against an imperative of avoiding this at all costs.
Those ‘against’ focused on efficiency and pragmatism. Developing delivery mechanisms for these groups requires time and additional insight, and it is more efficient to put the effort in the sanitation market and in a good performance of the local government. Also, it can be argued that as high coverage thresholds of community-level sanitation are achieved, health benefits are conferred across the entire community through herd protection. As sanitation is one of many competing priorities for vulnerable households, once momentum is flowing, it would involve inevitably making a trade-off for them.
Those in support of avoiding at all cost that vulnerable groups become the last mile, argued that there are additional benefits. If everyone is on board from the start this would mobilize community support mechanisms. Furthermore, since vulnerable groups often have higher morbidity, interventions that focus on them ‘disproportionately’ could lead to meaningful improvements in their health.
When reflecting on the ‘how’, several participants focused on the need to look for and understand existing social support mechanisms and proactively engage with these from the start, rather than thinking about externally introduced tools.
Different tools or approaches for reaching the last mile
The contributions to this topic reaffirmed the first weeks discussion on the importance of context (and context shaping the approaches) and the need to understand the “who” within the last mile and the many different barriers to uptake of services, beyond poverty alone. None of the participants argued that one size fits all, but rather they each focused on the importance of being iterative, in tailoring, reviewing and adjusting different tools or approaches to different groups and at different stages. Many contributions reasoned this was needed as vulnerable groups and their barriers are not homogenous, therefore it is logical that a differentiated approach be done. Others argued that as uptake is not homogenous, approaches also require reviewing and adjusting. As one of the participants commented: “It might take as much effort to reach the last 20% as it takes to reach the initial 80%.”
Interested? Read up on the first week's discussions and stay tuned for the final topic of this Dgroup discussion on exploring the effectiveness of tools to target and service the last mile, and the integration of these into service delivery models.