These benefits include averted diseases (treatment and medication costs, lost productive time for the sick and their careers, and premature death); averted water pollution (obtaining water from more expensive sources, hauling costs and time, and treating water); and access time savings (time travelling to place of open defecation, queuing for shared facilities, and accompanying children to place of defecation). Other sanitation benefits not measured by WSP include the impact on the environment, tourism, business as well as intangibles such as comfort, prestige, privacy and safety. All these benefits are summarised in Figure 3.
In terms of just the health benefits, WSP found that “for rural households that initially practiced open defecation, the projected gain from an intervention that provides access to basic improved sanitation facilities was slightly more than 720,000 LAK (US$90) per household [per year]” (WSP 2013). On top of this, annual time losses in rural areas were estimated to be 31 days per household.
The Government of Lao PDR recognises the benefits of improved sanitation. The Lao PDR National Plan of Action for Rural Water Supply, Sanitation and Hygiene proposes targets which include:
By 2015, access to improved sanitation in rural areas increased to 60% (was 50% in 2012, see Table 1); and
By 2015, access to improved sanitation among poor populations (lowest quintile) in rural areas increased to 32% (lowest quintile was 12.6% in 2012, see Figure 2).
However, these targets will be difficult to achieve. “Nam Saat has responsibility for rural sanitation, but is reported to have few resources to meet them. Ministry of Health funding accounted for just 1% of total government spending in 2007-08 and within this sanitation wasn’t treated as a priority.” (WSP 2012a). Furthermore, “sanitation has received little attention from government and continues to take a low priority compared to water supply” (WSP 2013). Limited funding combined with unclear responsibilities and poor coordination contributes to these institutional weaknesses.
The World Bank’s Water and Sanitation Program (WSP), UNICEF, SNV and Plan International support the Government in improving rural sanitation access. To that end two studies are being undertaken: one on consumer behavior and practices; and this analysis of the sanitation supply chain. Some data from the consumer behavior study is used to in this report (cited as “WSP – Sanitation Consumer Behavior Study”), but has not as yet been published.
WSP, UNICEF, Plan International and SNV are facilitating a collaborative process among Government, development partners and NGOs to create synergies and efficiencies in program methodologies, combining CLTS, Behavior Change Communications and Sanitation Marketing. As a result, WSP, UNICEF, Plan International and SNV have joined forces to fund this national supply chain study. The Department of Hygiene and Health Promotion and the Center for Environmental Health and Water Supply (“Nam Saat Central”) within the Lao PDR Ministry of Health provided overall leadership for this study.
WSP 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. WSP provides technical assistance, facilitates knowledge exchange, and promotes evidence-based advancements in sector dialogue. WSP is supporting the Government of Lao PDR in scaling up rural sanitation and hygiene through a five-year program, based on a two-pronged approach:
Supporting the enabling environment (sector coordination, policy and program guideline development and advocacy efforts), and
Supporting the development of at-scale program implementation models, using Community-Led Total Sanitation (CLTS), Sanitation Marketing, and Behavior Change Communications (BCC).
UNICEF’s Water, Sanitation and Hygiene (WASH) Program supports Lao PDR to achieve Millennium Development Goal 7, which specifically targets children’s right to survival and development through increased, equity and sustainable access to safe water and basic sanitation services and improved hygiene.
The Water Sanitation and Hygiene Program will address the challenge of wide disparities in access to and use of safe drinking water and basic sanitation facilities. It will support the national strategy for rural water supply and environmental health that places emphasis on the off-road, rural communities. It will operate within government schemes and seek to leverage these and other resources to scale up decentralized WASH approaches.
Areas of cooperation through Multi-Year Work Plan (2014-2015) include:
Continuation of upstream advocacy and dialogue for overarching WASH Sector Policy, Policy Implementation Guidelines and National Sanitation Strategy to materialize the National Plans of Action (NPA) and Lao PDR’s Sanitation and Water for All High Level Meeting.
Scaling up Rural Sanitation and Hygiene Promotion through demand driven (CATS) approach in select provinces to contribute to reduction of stunting and malnutrition.
Sustainable water supply facilities in the target communities of selected provinces
Sustained behavior change through the provision of WASH facilities in schools including daily group hand washing, toilet use and maintenance etc.
Continuation of support for WASH in emergency including the sector coordination and building community resilience through CBDRR.
Capacity building at national and sub national level, and
Evidence generation through survey studies and best practices to support to informed decision making
Plan International in Laos’s chief aim is to help Lao children realize their rights and assist them through programs in early childhood development and education, primary education and child protection, health and nutrition, and water, sanitation and hygiene promotion (WASH). As part of its country strategic plan, Plan’s WASH Program aims to contribute to improved health standards in communities (starting with their schools) by eliminating open defecation practices, encouraging proper hygiene behaviour and supporting water and sanitation infrastructure and management. Plan has been promoting the CLTS approach locally in its target areas and nationally along with other key partners including Nam Saat, SNV, WSP and UNICEF.
Currently, Plan’s WASH program is working with Lao government authorities and key stakeholders to contribute to improved health conditions in 90 villages in Bokeo and Oudomxay through CLTS and associated school triggering. In mid-2014, Plan began working with UNICEF to implement CLTS and water supply interventions in Ta-Oy and Salavan districts in Salavan Province targeting 70 villages over the next two years.
SNV currently operates across Africa, Asia and Latin America, working in three main sectors: Agriculture, Renewable Energy and Water and Sanitation (WASH). SNV first came to Laos in 1993 and established a full office as an independent organisation in 2004. SNV’s WASH programs are based upon the belief that access to water and sanitation is a human right, and that local government is the duty bearer of that right. Ensuring sustainable service delivery requires engagement from all sector stakeholders. Therefore, SNV engages both locally – building capacity among local government in Savannakhet, Champasak and Sekong, private sector and civil society for sustainable service delivery – and at national level – working with government officials and development partners to support sector reform.
Within its rural sanitation and hygiene work, SNV has integrated insights in CLTS promotion, sanitation marketing and value chain development, hygiene behavioural change communication and WASH governance to support local governments in developing a sustainable service delivery model. Particular attention is given to ensure equity and sustainability, finding service delivery solutions for vulnerable groups, and ensuring long term hygienic use and maintenance of sanitation facilities.
The National Center for Environmental Health and Water Supply (Nam Saat) has primary responsibility for rural water supply and the promotion of sanitation and hygiene for rural and urban areas. The Nam Saat was created in 1998 as one of six national centers under the Department for Hygiene and Disease Prevention within the Ministry of Public Health.
In this position, Nam Saat has been endorsing several projects with multiple stakeholders in order to improve access, use and sustainability of new and existing water supply and sanitation facilities in rural areas, as well as to maximize the health and socioeconomic impact of water and sanitation facilities in the context of rural development and water resources management.
Purpose and Objectives of Supply Chain Study
This national supply chain analysis aims to inform a future at-scale communications and marketing strategy and implementation plan to strengthen the market supply of affordable, accessible and desirable sanitation products and services to rural households, particularly those with lower incomes.
This supply chain study is a diagnostic of the rural sanitation supply and value chain in distinct physical and market environments. It focuses on the commonly found or most preferred products and services for improved sanitation in rural Laos PDR (including below-ground and above-ground sanitation facilities).
The Study analyzes the opportunities, issues, constraints (including market and non-market impediments) and potential risks with the current supply chain and its capabilities, particularly in reaching the base of the pyramid. It also maps existing actors and stakeholders, up and down the supply chain of sanitation goods and services and the relationships between them.
The Study aims to identify possible business models, interventions and support services which have the potential to improve the availability of affordable sanitation products and services to rural low-income households. The findings – along with the separate study of consumer behavior – will inform the Government’s national sanitation marketing and behavior change communication strategy and implementation plan.
The research team focused on seven provinces throughout the country, located in the Northern, Central and Southern regions (see Figure 4):
Northern Region: Bokeo, Luangnamtha;
Central Region: Borikhamxay, Savannakhet;
Southern Region: Sekong, Attapeu, Salavan.
Figure 4: Seven provinces for field work
Field work took place in 20 districts in these provinces, including regions with a variety of economic, social, and geographical conditions that can impact the sanitation supply chain (Table 2). These districts also include those that are Government focal districts for development.
According to available data (see Table 2), in some research districts as few as 15% of households have a latrine (Salavan and Ta-Oy in the south), while in others 70% or more have latrines (Houay Xai in the north and Khamkuet in the centre).