A conversation with the Gates Foundation (Water, Sanitation & Hygiene) on September 18, 2012


Note: This set of notes gives an overview of the major points made by Sara Rogge and Alix Zwane.

The WSH program started as a special initiative, with the goal of broadly exploring water, sanitation and hygiene. Over time we have come to believe that the sanitation subsector is highly neglected. (The relevant Millennium Development Goal is far off track; 2.6 billion people use unsafe toilets or practice open defecation; there isn't sustainability in terms of access to sanitation services.) It gets less attention than water. So over time we've focused in on this area as something that is more neglected than water and as an area where we can have maximal impact.

Around 2009, we decided that sanitation would be the focus of our WSH strategy. In mid-2011 we formally launched a strategy with the tagline of "Reinvent the Toilet." There hasn't been a lot of innovation in sanitation. What we use in this country is what's considered the gold standard, but the sewer system you see in the West isn't possible in a lot of countries. The traditional approach is a pit latrine, but then the question is how you deal with the waste once it fills up. We're looking for a new approach--something that can eventually be affordable and works off the grid, i.e. without relying on sewers, and can turn waste into something usable.

The amount that we give out each year for sanitation has grown over time. About 60% goes to R&D, 5-10% policy & advocacy, and the remainder of it goes to thinking about business models and platforms on which one might deploy these innovations, though there's a lot of overlap between categories.

There are lots of underfunded opportunities within R&D. On the business model side, there are opportunities to invest in projects that explore how to make this profitable, how to encourage entrepreneurship in sanitation services, etc.

To give a practical example on the business model side, we've asked folks at the Jameel Poverty Action Lab (J-PAL) to partner with municipalities and other partners in India and sub-Saharan Africa to do experiments to better study the industrial organization of urban service provision. In India we definitely have more good ideas than we can fund.

There's also an investment we made in the water sector that we're really happy with: chlorine dispensers for water treatment at the point of collection. We've seen incredibly high take-up rates of chlorine due to this method. It's a project we think has the potential to be one of those "millions saved" type of stories, but it's not in our strategy anymore; it's something that we actively hope others fund. The relevant grant is to the scale-up arm of Innovations for Poverty Action (IPA).

Re: funding opportunities that might offer good short-term learning opportunities, we have several opportunities to collaborate to test and develop new business models.

An example of a project that tests a business model – though it’s not an opportunity for co-funding — is one that looks at shared sanitation by 2-5 families (as opposed to 35 families) that could serve 800,000 to 1 million people directly. In all cases, our investment in delivery is in service of the larger goal — to understand the mechanism we'd need to scale up in order to roll out an innovation in sanitation.

Re: rigorous studies on the impact of clean water interventions, a few years ago there were few of these, but there have been recent improvements, as you can see in two recent reviews. One is Ahuja, Kremer and Zwane 2010. The other is a new working paper that 3ie just published.

We’ve made some significant investments in understanding the epidemiology of water, hygiene and sanitation and how they interact with nutrition interventions in particular. That’s been transformative to how we think about the cost-benefit analysis of water/hygiene interventions.