5 Key Insights to Achieving Improved Citywide Sanitation

Emptying a vacuum tanker at a sewer discharge point in Visakhapatnam, India. Photo credit: Water & Sanitation for the Urban Poor.

Share on:           


Change management, effective public–private partnership, and regulation are crucial to the success of citywide inclusive sanitation programs.


With less than 10 years to meet the targets of Sustainable Development Goal 6, citywide approaches are urgently needed to achieve affordable water, sanitation and hygiene facilities for all. While progress has been made, there is still much to be done.  

The citywide inclusive sanitation framework advocates for the equitable provision of safe and sustainable sanitation services for everyone, from high-quality toilets to well-maintained treatment sites.

Over the past decade, not-for-profit Water & Sanitation for the Urban Poor (WSUP) has supported cities in providing low-income people with better water and sanitation. This piece presents five key insights from past and current projects about the practical application of the framework.

1. Citywide inclusive sanitation requires transformation

Citywide inclusive sanitation is not just a technological, operational or financial challenge but it also requires all institutional players to work in new and unfamiliar ways, and develop new, often entirely different, skills.

The approach requires leaders and managers to develop skills in change management and transformation, such as:

  1. providing strategic vision and strong leadership as demonstrated in Lusaka, Zambia, where the citys water and sanitation utility and the national regulator collaborated to improve on-site sanitation in peri-urban areas, promoting context-appropriate toilet designs and developing guidelines for safely emptying and transporting waste from toilets;
  2. setting realistic timeframes since change can take much longer than typical project cycles as demonstrated by Nairobi City Water & Sanitation Companys decade-long journey of transformation to build an operating division dedicated to informal settlements; and
  3. building momentum through tangible short-term wins as shown in Maputo, Mozambique where community sanitation blocks (toilets and hygiene points shared and maintained by communities) built political will and momentum for sustainable sanitation in low-income areas.

2. Leverage urban structures, especially in larger cities

A well-designed citywide inclusive sanitation program should build on the administrative and political structures of the city including areas of future growth. Engaging relevant officials, such as ward-level public health inspectors, ward councilors and traditional leaders, with their counterparts at the city level means that they can take on essential activities so that citywide inclusive sanitation does not create parallel structures. Involving the community develops ownership and creates communication and influence channels. The administrative structure is a basis for breaking down the city into manageable sub-units; public officials can inspect and enforce more easily if service provision is based on their administrative areas.    

For example, the city of Visakhapatnam in India rapidly eliminated open defecation, promoted improved household and public toilets, and developed a bottom-up citywide sanitation plan by creating partnerships between womens self-help groups and sanitation inspectors in every ward. In Lusaka, community-owned water service providers in peri-urban areas began offering sanitation services as well, which improved customer acceptance and saved money.

3. Sanitation solutions must take a customer-centric approach

It is difficult to achieve citywide inclusive sanitation through a “push” approach that relies just on enforcement, particularly in low-income/informal areas. It’s important to recognize that most people in cities already have some form of sanitation—even if it’s an unsatisfactory option like open defecation. This means that improved sanitation solutions must win over customers with ingrained habits by offering better service at a competitive price.

A “one size fits all” approach cannot deliver citywide sanitation: different solutions must be developed for different types of customers. This remains a challenge for public organizations, engineers, and funders. In Lusaka, for example, lower-than-expected uptake of sewerage connections resulted in low flows that compromised system performance. Similarly, in Accra, Ghana, the slow adoption of improved but expensive toilets by customers has led to unsustainable subsidies.

By contrast, specialized low-income units within many Kenyan utilities support safe fecal sludge management services at lower prices and with different payment terms to attract customers away from traditional, unsafe pit emptying services.

4. Private sector needs a competent public partner

The diversity of sanitation services and customer types, the need for efficiency, and the obligation to meet demand mean that mandate holders must engage private service providers. In WSUP’s experience, public–private partnerships in sanitation can fail to attract good businesses or achieve scale because the public party is unable to procure or fairly administer partnership contracts.

Building the competence and credibility of the public sector is a crucial step for CWIS programs. In Freetown, Sierra Leone, a new fecal sludge management unit was established in the city council, alongside a management strategy, work plan, and operating procedures. In Bangladesh, WSUP provides support to both private and public actors engaged in the SWEEP business model, which uses the guarantee of public sector support offered by a public–private arrangement to incentivize equitable service delivery.

5. Regulation is core to effective citywide inclusive sanitation governance

Regulation is a practical governance tool that guarantees efficient, safe, and equitable sanitation while balancing the interests of government, customers, and service providers. However, in some cities, regulation only covers sewerage delivered by one service provider, while institutional responsibility for on-site sanitation may be unclear. Regulating sanitation across a whole city is a significant and necessary shift: citywide inclusive sanitation requires multiple services to be delivered by public and private players in a competitive market. Comprehensive and wide-ranging regulation based on a clear legal and policy framework is required—either through an independent regulator or through service contracts.

The Kenyan national regulator, Water Services Regulatory Board, has developed a regulatory mechanism to promote pro-poor service delivery in low-income urban areas. In Zambia, the National Water Supply and Sanitation Council provides a way for utilities to set efficient sanitation tariffs that recover some costs without precluding access for the poorest.

Moving Forward

With the deadline to meet SDG 6 targets fast approaching, cities adopting citywide inclusive sanitation approaches with tight timeframes can incorporate the following lessons:  

1. Gain policy makers’ commitment to the program during project preparation. Focus on the realities of the city’s sanitation and explicitly address these issues, aligning the project with existing urban structures.

2. Build the clarification of sanitation mandates, regulation, and accountability into the project’s design and results framework so these foundational elements are evaluated. 

3. Approach project design strategically. Address the long-term nature of change early and include change management in the project results framework. Take a programmatic view while considering upcoming projects.

4. Incorporate a commercial perspective in project designs. Consider business model viability, market risk, and customer-centric, value-for-money thinking in project design. Citywide inclusive sanitation requires different solutions for "customers'' rather than "users” and these solutions have distinctive characteristics. A utility’s experience with piped water systems may not prepare them for what is required.

5. Rethink capacity building from a citywide inclusive sanitation perspective. Prioritize the business, commercial, and management skills that mandate holders and service providers will need. Support regulators to develop regulatory instruments that enable and drive urban sanitation.


Eastern and Southern Africa Water and Sanitation. 2020. Guidelines for Citywide Inclusive Sanitation (CWIS) Planning.  

M. Gambrill, R.J. Gilsdorf, and N. Kotwal. 2020. Citywide Inclusive Sanitation—Business as Unusual: Shifting the Paradigm by Shifting Minds. Frontiers in Environmental Science. 11 February.

N. Jeffery. 2018. How to Improve Sanitation Across An Entire City: The Case of Visakhapatnam. Water & Sanitation for the Urban Poor. 4 September.

R. Franceys. 2020. Referee! Responsibilities, Regulations and Regulating for Urban Sanitation. UK. Eastern and Southern Africa Water and Sanitation and Water & Sanitation for the Urban Poor.

Swiss Federal Institute of Aquatic Science and Technology (Eawag). Towards Citywide Inclusive Sanitation.

Water & Sanitation for the Urban Poor. 2020. A Journey of Institutional Change: Extending Water Services to Nairobi’s Informal Settlements. UK.

Yaver Abidi
Managing Director, Water & Sanitation for the Urban Poor Advisory

Yaver Abidi specializes in supporting utilities, municipalities, and service providers to improve water and sanitation for low-income customers in cities in Africa and Asia.

Rosie Renouf
Consultant, Water & Sanitation for the Urban Poor Advisory

Rosie Renouf specializes in applied urban sanitation research.

Sam Drabble
Head of Evaluation, Research and Learning, Water & Sanitation for the Urban Poor

Sam Drabble has been leading research and learning in WSUP for six years.

Leave your question or comment in the section below:

The views expressed on this website are those of the authors and do not necessarily reflect the views and policies of the Asian Development Bank (ADB) or its Board of Governors or the governments they represent. ADB does not guarantee the accuracy of the data included in this publication and accepts no responsibility for any consequence of their use. By making any designation of or reference to a particular territory or geographic area, or by using the term “country” in this document, ADB does not intend to make any judgments as to the legal or other status of any territory or area.