Five lessons we learned from our Sustainable WASH programme

5 min read
Mary, 17, student, holding up her clean hands after washing them with soap and water at a newly installed sink in the girls’ toilet block, Ntinda Primary School, Kampala, Uganda, February, 2019.
Image: WaterAid/ James Kiyimba

In the third year of the SusWASH (Sustainable WASH) Programme, Vincent Casey and Hannah Crichton-Smith look back at what we’ve learned about what makes a systems strengthening and empowerment approach effective at achieving inclusive, lasting universal access to water, sanitation and hygiene (WASH).

To make a lasting difference, access to clean water, decent sanitation and good hygiene must continue long after it is introduced. Globally, millions more people now have access to these three essentials, but the current rate of progress is still too slow. It is also a reality that pumps break down, toilet pits fill up and good hygiene habits are forgotten if no effort is made to maintain or sustain them. This means people who we think have access might be experiencing a poor level of service.

Sustainable services need strong systems.

Addressing these challenges requires much more than just building more taps and toilets and delivering one-off training exercises. That’s why we are focusing on building strong WASH systems that ensure access lasts and reaches everyone.

A strong WASH system includes all the policies, processes, resources, behaviours, infrastructure and institutions necessary for delivery of inclusive, lasting WASH. People, communities, civil society, and informal and formal institutions play vital roles in bringing about changes in the system.

Strengthening the WASH system means understanding that WASH is delivered and used in complex settings, with many component parts, which must be understood and strengthened to deliver improvements. There is no one-size-fits-all solution. The design of WASH interventions must be informed by detailed context analyses and respond to issues that affect sustainability or access for marginalised groups. They must combine efforts at multiple levels to strengthen government leadership, institutional processes and policies, and community empowerment, and demonstrate inclusive, sustainable service delivery models that governments can scale up.

What our initiative has taught us

In 2017 we began a joint initiative with our partner the H&M Foundation, aimed at addressing the root causes of poor WASH sustainability and inclusion, applying a systems strengthening approach through a human rights lens. Now in our third year of the programme, here are some of our SusWASH achievements and lessons learned so far.


• In Cambodia, district local government staff in WASH committees have increased confidence, initiative and capacity to fulfil their roles. They independently meet regularly, prioritising WASH in their meetings, developing and implementing WASH plans, assigning focal points for WASH, promoting access to WASH among their communities and considering service provision to the most marginalised groups.

• In Pakistan, the Public Health and Engineering Department (PHED) has committed to scaling up asset mapping in the entire district. The Secretary of the PHED in Thatta district has committed to training district government engineers to scale up asset mapping in the whole of Thatta. Asset mapping will help the PHED to understand where and when to target finance in developing new and rehabilitating existing water supply services. This commitment follows WaterAid Pakistan’s demonstration of asset mapping in seven union councils in the district.

• In Uganda, Kampala Capital City Authority (KCCA) has committed to integrating life cycle costing components into their minimum standards for sanitation in Kampala. Following training on life cycle costing, KCCA has demonstrated its understanding of the utility of assessing the full life cycle costs for sanitation by agreeing to integrate them into the next edition of their minimum standards for sanitation in Kampala. The standards regulate on-site technological options and are used by all institutions working on sanitation in the capital. Integrating life cycle costing into the standards will help implementers make informed decisions about the appropriateness of different sanitation service options for greater sustainability.

• In Ethiopia, district government are demonstrating greater responsibility for improving inclusive WASH services. Following Making Rights Real training, and support to strengthen customer forums, district officials in Gololcha district have increased awareness of their responsibility for the delivery and improvement of WASH services in the district. They also have greater awareness of issues of equity and inclusion, which they are starting to integrate into their planning and monitoring processes.

Collins Taremwa, quality control officer, at his work station inside the laboratory at the National Water and Sewage Corporation, Gaba Water Works, Kampala, Uganda.
Collins Taremwa, quality control officer, at his work station inside the laboratory at the National Water and Sewage Corporation, Gaba Water Works, Kampala, Uganda.
Image: WaterAid/ James Kiyimba

  1. Identify your entry point, your lever of change. Despite links between the WASH system building blocks, it is important to identify the most critical building block that is most likely to trigger broader changes in the system. Focusing our efforts on strengthening accountability in Kampala has strengthened community ownership and empowerment, while also strengthening leadership and government accountability structures.
  2. Understanding motivations and incentives of individuals and groups is crucial to achieving systems change. In Ethiopia, the local government and utility staff explained that having better communication between them and the community/service users gave them greater understanding of the challenges the community face and more motivation to fulfil their roles and responsibilities for improving WASH.
  3. Collective action takes time, requires focal points and is not for perfectionists. In Cambodia, the team supported the development of the Government-led national WASH Monitoring Information System (MIS). It took two years from the first meeting in 2017 to produce the final report, which captures the methodology, data analysis and lessons learned. Focal points in each institution (NGOs, development partners and especially the Department of Rural Health Care), ensured consistency of knowledge and accountability throughout the process. It’s better to have good data about the status of rural WASH services in time for investment decision making than perfect data after investment decisions have been made.
  4. Timeframes to achieve the desired systems change are difficult to predict. Systems change depends on external factors such as government willingness and commitment to working together and making the system work. Efforts to change the mindset of decision makers, especially political leaders, to appreciate the need for a systems strengthening approach as a driver for improving service delivery and sustainability are essential.
  5. Measuring change in the system requires a culture of reflection and learning within the implementing organisation and government. Tools that assess the strength of WASH system building blocks can mask small, incremental changes. Such tools need to be contextualised and complemented by more regular qualitative reflections. At WaterAid, we are taking lessons from SusWASH to develop an organisation-wide framework for measuring WASH systems change.

Find out more about our the SusWASH programme at