Take, for example, sanitation and hygiene in Vietnam and Cambodia. A shocking number of households – 50 percent in Vietnam and nearly 80 percent in Cambodia – lack proper sanitation. Every year, water-borne illnesses and infections lead to 17,000 deaths annually and burden families with the high cost of health care and lost wages. But ending the practice of open defecation, building proper sanitation systems and ensuring the adoption of good hygiene practices is not as simple as it may sound. In rural areas, many families in these countries live on less than $2 a day. Even a simple toilet is a significant investment that is often viewed as an unrealistic, unnecessary cost. Added to that is the widespread acceptance of the status-quo – these are, after all, conditions that even the oldest members of the community grew up with.
However, it is clear that the need in these countries outweighs the challenges. That’s why East Meets West has invested in bringing proper sanitation to 344,000 of these very same households and is helping ensure that these systems are being used. A focus on the community, a great deal of teamwork and a results-based reward serve as the catalyst behind this unique approach.
Community investment is critical
A good foundation starts with the community, making sure that both the households and community leadership understand the importance of sanitation systems and are willing to make the investment. We believe that having families invest in the systems themselves is critical to the long-term adoption and use of those systems. After all, when it’s your investment, you care more about getting your money’s worth.
Of course, families need help to overcome their hesitation and the serious cost barriers and ensure that there is access to education, financing, installation, maintenance and verification. So it’s important to bring everyone to the table – including credible lenders, local governments and community leaders with extensive networks and the ability to reach rural communities.
Active partner engagement will ensure the implementation of the key elements of the program, which are to:
Educate – through community meetings, materials and events – about why sanitation is crucial to ensure a community’s clean water, good health and economic productivity;
Connect families to financing and loans, and teach local masons and builders how to construct safe, low-cost and effective latrines;
Train community volunteers who can educate their neighbors about how the latrine works and what hygienic practices they should follow; and
Ensure that the use of latrines can be verified and the rewards granted.
Which brings us to the results-based reward. This is more than just a way to help offset the cost of the latrines. The rewards – offered to households, to community volunteers promoting the program, and to communes themselves that reach target adoption rates – serve as a catalyst. Households are not merely motivated to act, they are motivated to act quickly. And when communities are investing as a group in sanitation systems, change is noticeable – and sustainable. Cultural norms shift, the spread of disease is curbed, and the entire community sees positive changes in their health and productivity. Finally, by rewarding results rather than intentions, we make sure that the adoption of sanitation and hygiene has gone that one step further.
Creating sustainable change
This is a tried and true approach, one that East Meets West has pioneered to improve access to education and clean water in Vietnam, and that is now making an impact in health and sanitation. An officer from one of our partner organizations, the Tien Giang Women’s Union, had a first-hand perspective – and critical role – in ensuring the installation of 2,812 household latrines using this system. Faced with a short window of time, an ambitious goal and limited resources, Ms. Tuyet Hong decided to focus on the families, identifying the barriers they faced and helping overcome them. And with the buy-in and support of local governments, suppliers, the Vietnam Bank for Social Policies and others, she was able to surpass the original target.
There’s one more stakeholder that is crucial to the change – donors. Recently, our program received an important boost from the Bill & Melinda Gates Foundation, in the form of a $10.9 million grant. Donations, whether from foundations or individuals, are what allow organizations like ours to roll out these programs and scale them to provide more help to an ever-expanding network of families. We are grateful for all of the support we have received, and we hope that East Meets West’s approach can serve as a model for others and a reminder that, with a little innovative thinking and a community-based approach, even the seemingly impossible can become reality.
John Anner is president of East Meets West Foundation, an international development agency working to transform health, education and sanitation systems for disadvantaged communities in Asia. The organization has invested more than US $105 million in development solutions in Asia, and currently operates programs in Vietnam, Cambodia, India, Laos, Myanmar, Philippines and Timor Leste.