Equity and Inclusion in Sanitation and Hygiene in Africa: A Regional Synthesis Paper

This 30-page working paper was drafted for the 3rd AfricaSan Conference in July 2011 in Kigali, Rwanda, to support the technical session "Reaching the Unserved: Equity and Inclusion in Africa". According to the authors, the desk review, consultations, and analysis behind this paper reinforced what was already known - that excluded populations are not only people who suffer from "asset poverty", but also those who are shut out for social reasons. They argue there is a need to recognise equity and inclusion issues in planning and programming for water and sanitation; otherwise, gains can be "quickly snapped up by the better informed, better connected, and better off, marginalising even further those who are left behind without services."

The report states that apart from ethical considerations, there is strong evidence of the huge economic costs associated with neglecting sanitation, specifically open defecation, and the resulting burden of disease. And so, while the case for action cannot be questioned, the action needs to be based on the principle of equity, which requires clear identification of and effective response around specific barriers in the following three categories:

• Attitudinal barriers arise essentially from a lack of respect, which results in isolation, prejudice, stigma, misinformation, and lack of self-confidence of those who are marginalised. Attitudinal barriers are responsible for much of the social exclusion experienced by people with disabilities or people living with HIV, as well as for the disproportionate burden placed on women and girls in the region. These barriers are also responsible for taboos that prevent people from talking about and then ensuring that sanitation facilities address the practical dimensions of washing and disposal needs linked to menstruation for women and girls.
• Environmental barriers impede physical accessibility to infrastructure and to communication; for example, toilet and squat pan designs which are difficult to use for people with disabilities, older people, and pregnant women; pans and traps that are improperly sized and the lack of suitable options for waterlogged areas, sandy soils, or flood-prone areas; and communication materials which cannot be deciphered by illiterate people or those who are blind or deaf.
• Institutional barriers cover a host of issues and acts of omission, such as lack of specific policies for the excluded including finance, knowledge, skills, and consultation mechanisms, and acts of commission such as administrative and financial corruption.

The report shares several case studies which point to a number of communication-related lessons learned. For example, constitutional guarantees on inclusion need to be displayed prominently through simple posters in local languages, telling children and adults about their rights, and at the same time about their responsibilities to other users regarding proper use and maintenance. The paper states that respect and non-discrimination for other users are simple, non-negotiable principles that we must be agreed and clearly communicated. In addition, in terms of the community-led total sanitation (CLTS) approach, the report states that explicit attention to voice, different needs in design, and monitoring of inclusion is needed in order to ensure sustainability and inclusion as these approaches scale up.

The report states that there is a role for all to play in ensuring inclusive access to water and sanitation:

People: to promote non-discrimination and active inclusion in sanitation and hygiene.
Government (local, state, and national): to play the role of regulator of quality and inclusion rather than that of providing services. The government is institutionally responsible as duty bearers for the entire framework and in ensuring that no one is excluded.
Non-governmental organisations (NGOs): to support the national effort through influencing, monitoring, capacity building, demand creation, and demonstration of best practice through delivery.
External Support Agencies: to support the national agenda, collaborate on strategies, offer relevant technical support and lessons from international best practice, and undertake joint monitoring.
Financing Institutions and Donors: to support the national agenda and commit to equity and inclusion in their financing and ensure aid effectiveness. These organisations support longer-term, cross-sectoral research on sustainability and inclusion.
Media: to promote awareness and advocacy for equitable and inclusive sanitation and hygiene, bring the voices of the unheard to the fore, and act as a watchdog - highlighting gaps and showcasing successes.
Academia: to contribute to collective influence through objective research and analysis, sensitivity and commitment to inclusion, and studies and analysis. For example, engineers can improve inclusive design; social scientists and statisticians can collect and disseminate evidence on different marginalised groups.
Elected representatives and Judiciary: to support the right to sanitation and hygiene through legislation, advocacy, and enforcement with a focus on the excluded and marginalised.
Private sector and small businesses: to recognise and promote inclusive sanitation and hygiene design and approaches.

The paper concludes by stating that the purpose of the paper is not to be prescriptive, but to highlight the issue of inclusion, invite new ideas, and encourage commitment and linked actions.