Our sustainable water, sanitation and hygiene at scale programme – or SusWASH – was a five-year initiative aimed at addressing the long-term challenges of sustaining water and sanitation services and hygiene behaviours. Funded by the H&M Foundation, the programme also worked to ensure water, sanitation and hygiene (WASH) services can be provided to everyone in society.

The programme generated lessons and evidence that helped to inform our 2022–32 Global Strategy, and the design of future programmes. SusWASH helped to lay the foundations for improved inclusive WASH sustainability, ultimately contributing towards Sustainable Development Goal (SDG) 6 – water and sanitation for all.


Implemented in Cambodia, Ethiopia, Pakistan and Uganda, SusWASH applied a systems strengthening way of working that tackled some of the barriers to WASH sustainability and inclusion. This involved working with local and national governments, communities, civil society, local private sector and research institutes. UN-DESA recognised our systems strengthening approach as good practice for reaching the SDGs.  

In practical terms, systems strengthening in this project meant working across all levels to improve WASH governance, coordination, planning, monitoring, financing, accountability, water resource management and social and gender dynamics.

The SusWASH Programme had five outcome areas, which covered national and sub-national levels: 

  1. Service and behaviour change models demonstrated to inform planning, investment and policy. 
  2. Improved capacity to plan, monitor, budget and coordinate​ WASH services. 
  3. Effective accountability mechanisms​.  
  4. Clearly defined institutional arrangements​. 
  5. Learning and best practice shared.
WaterAid’s conceptualisation of the WASH system showing actors (people and institutions), factors (social, economic, political, environmental, technological) and interlinkages that influence the achievement of inclusive, sustainable, universal access to WASH.
WaterAid’s conceptualisation of the WASH system showing actors (people and institutions), factors (social, economic, political, environmental, technological) and interlinkages that influence the achievement of inclusive, sustainable, universal access to WASH.
Image: WaterAid

Participatory programme design process

SusWASH was based on a participatory programme design process, which helps to identify barriers to WASH sustainability and the activities required to address them. Issues of gender, equity and inclusion, and corruption are also considered.

WaterAid Ethiopia held the first Wereda Level Contextual Analysis Workshop with Gololcha Wereda Sector Office experts and managers. Jara, Gololcha, Bale, Oromia, Ethiopia, November 2017.
Image: WaterAid/ Behailu Shiferaw

The SusWASH programme looked different in each country because it was adapted to respond to challenges specific to local contexts. The identification and prioritisation process was carried out in consultation with governments, the local private sector, civil society and communities, and took into account government priorities, other initiatives already underway in a specific area, and what meaningful outcomes the programme could achieve.  

Click on the titles below to discover our work in the four countries.

We worked predominantly with provincial and local governments to support their increased responsibilities in WASH service provision, as part of the ongoing decentralisation process in Cambodia. 

More specifically, this involved supporting provincial, district and commune authorities in Kampong Chhnang to assume new roles and responsibilities for the operation and maintenance of water supply services and sanitation promotion. Together with provincial and district officials, we worked to strengthen their capacity and leadership and to address key gaps, including: 

  • Improving provincial and district-level WASH coordination mechanisms 
  • Integrating SDG indicators into existing monitoring and planning systems, and strengthening the national Monitoring Information System 
  • Introducing the principles of lifecycle costing for district investment planning 
  • Supporting the development of the new national Hygiene Behaviour Change Communication campaign 
  • Assessing the market for safely managed water supply options and making recommendations for their scale up 
  • Strengthening the market for sanitation and hygiene products 
  • Establishing systems to operate, maintain and rehabilitate existing water supply infrastructure using the local private sector 
  • Strengthening accountability mechanisms between service providers and users 

We also worked with healthcare centres in Kampong Chhnang to upgrade their WASH facilities. Marginalised groups were supported to identify barriers to their WASH access and share their experience with authorities and on social media platforms. 

At the national level, we supported a review of the Ministry of Rural Development’s National Action Plan for Rural Water Supply, Sanitation and Hygiene.

Below, Sokkung Sou, SusWASH Programme Manager at WaterAid Cambodia, presents an overview of how we have been strengthening the WASH system in Cambodia. He describes the components of the system we are working on, how we are tackling the systemic barriers to WASH sustainability and inclusion, and what we have learned during the programme so far.

In Ethiopia we worked with the Government to implement the One WASH National Plan (OWNP) at district level in Gololcha woreda (equivalent to a district), Oromia Region by: 

  • Improving sector coordination, planning and monitoring of WASH services 
  • Mentoring the newly established woreda WASH teams to fulfil their roles and responsibilities 
  • Assessing the status of infrastructure and WASH service levels, with the aim of generating accurate data for targeting of investments 
  • Supporting the enhancement of district-level plans and budgets to include provision for post-implementation support, not just the costs of providing first-time access 
  • Using improved district plans to advocate the increased finance required to sustain WASH services and behaviours, and attract finance to extend services to unserved areas 
  • Working with civil society to strengthen community representation and voice through establishment of community platforms such as customer forums 
  • Advocating integration of community voice platforms into the existing OWNP 

We also supported a small-town utility to extend and enhance its water supply service delivery to meet current and future demand. We also worked with the district to deliver training to the utility and other water supply management structures on asset management, financial planning and operations and maintenance. In parallel, we conducted research into barriers to achieving and sustaining Open Defecation Free status, applied the national school WASH strategy, and supported review of the national Government’s hygiene behaviour change strategy. We also conducted research on gendered barriers to WASH access and used the findings to develop WASH and gender programme guidance. We fed lessons and research findings into the national Government’s plans, strategies and campaigns, such as the second phase of the OWNP.

We worked with local, district and provincial government in Sindh Province to:  

  • Strengthen coordination and planning processes via the District WASH Forum for improved resource allocation 
  • Build capacity in WASH service-level monitoring and mapping of government-installed WASH facilities for coordinated planning and budget allocation at district and provincial levels 
  • Integrate additional sustainability indicators into the Sindh Education Monitoring Information System to improve WASH performance monitoring in schools 
  • Assess suitable management arrangements for government-installed piped water supply schemes, and gain buy-in for an assessment of their full lifecycle costs 
  • Assess the causes of poor functionality and abandonment of communal hand pumps 
  • Implement a community-managed plus model for communal flood-resilient hand pumps 
  • Train relevant government staff on an improved community-led total sanitation approach and support its roll-out in Thatta district 
  • Understand the potential for establishing a follow-up mechanism to monitor open defecation free status over time 
  • Develop a provincial-wide behaviour change communication strategy 
  • Assess the effectiveness of existing community feedback mechanisms and the feasibility of using the District WASH Forum as an accountability platform 
  • Assess the effectiveness and support the application of the Sindh sanitation and drinking water policies at local levels 

We also worked with relevant ministries at the national level to integrate WASH and menstrual health and hygiene into the national school curriculum and teacher training. 

We worked with Kampala Capital City Authority (KCCA), relevant line ministries and civil society organisation partners to:  

  • Strengthen sector coordination, monitoring, planning and budgeting 
  • Support KCCA directorates for health, education and strategic planning to include elements that strengthen the sustainability of WASH services within their current plans 
  • Assess the effectiveness of existing community feedback and accountability mechanisms, with the aim of making recommendations on how they could be strengthened 
  • Promote the value of strong leadership and good governance with elected political representatives 
  • Demonstrate WASH service and behaviour change models in schools and healthcare facilities across the five divisions of Kampala 
  • Support the integration of SDG6 indicators into the existing national-level sector performance measurement framework 
  • Advocate long-term institutional commitment to finance the full cost of sustaining WASH services and behaviours 
  • Develop national guidelines for WASH in healthcare facilities 

We used the learning and evidence generated from the SusWASH programme in Uganda to support the Urban WASH reform process, led by the Ministry of Water and Environment, and to inform ongoing sector research into regulation and capacity development initiatives. 

Publications and resources

Watch our films for an inside view of SusWASH

The Kampala WASH Governance Forum (WASH Mayors Forum)

The Lord Mayor of Kampala City and municipal mayors from the Greater Kampala Metropolitan Area share their insights around tackling city-wide WASH blockages, and explain how they have come together to form the Kampala WASH Governance Forum. The forum aims to strengthen the planning, monitoring, coordination and regulation of WASH and solid waste management in the city, to ensure services reach everyone, are sustainable and have political commitment.

Following the forum’s creation in March 2018, an ordinance has been passed to improve the regulation of sewerage and faecal sludge management in Kampala.

Weyonje: grassroots campaigning for sustainable solutions

Kamwokya II in the centre of Kampala, Uganda, is home to more than 6,000 people in less than half a square kilometre of land. Here, Christopher Tumwine leads a community action group – Weyonje – supported by WaterAid and Kampala Capital City Authority.

Weyonje campaigns for sustainable solutions to protect the community’s health, safety and dignity from overflowing sewers, filthy water and disease. They go house to house, talking to people about how to use toilets properly and dispose of the waste safely. During the COVID-19 pandemic, worried that projects to protect people from COVID-19 were leaving behind informal settlements, Weyonje began to teach people about the importance of hygiene and handwashing to prevent the spread of the coronavirus.

In 2019, before the pandemic, we followed Weyonje and Chris to witness an exciting moment for Kamwokya.

WASH systems strengthening in practice: experiences from WaterAid’s SusWASH programme

In this 90-minute panel discussion from November 2020, hear from country programme teams in Cambodia, Ethiopia, Pakistan and Uganda about how they are strengthening WASH systems for inclusive and sustainable WASH at scale as part of the SusWASH programme. The discussion includes insights from programme funders H&M Foundation and concludes in part two here.

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H&M Foundation

One of our key partners is the H&M Foundation.