There appears to be a set of recurrent institutional and attitudinal problems within the sanitation sector that are preventing substantive progress being made towards achieving MDG 7.

Unsustainable supply driven approaches Supply driven projects can coerce, entice or persuade householders to build latrines through the use of generous subsidy, normally in the form of free hardware and/or labour . Such projects are driven by the desire to construct large numbers of latrines, with project management concentrating on ensuring that cement supplies, slabs and masons etc arrive on time. When project funding ends, as it always does, the delivery and support mechanisms dissolve and the community members are left, as they started, with a lack of latrine component supply chains, few technology options, nowhere to turn to for support and the same cost constraints. A ‘sticking plaster’ solution rather than a sustainable solution.

Mis-use of subsidies Subsidizing excreta management can be justified on public health grounds but an incorrectly applied subsidy can have the following negative effects:

• creating dependency
• buying participation
• being impossibly expensive
• being a poor use of public money
• ignoring latrine affordability and replication issues
• not reaching the poor
• slowing latrine adoption rates

Not understanding people’s real needs and desires The private verses public dimension of sanitation demand shows that both households and the public sector (government) clearly have good but different reasons for wanting sanitation improvements. Unfortunately, the needs and desires of the householders are rarely taken into account during project design. This, and standard latrine designs are used together with what, to the householder, must be uninspiring motivation messages based on public health needs ie death doctors and diarrhoea.

Confused national ministerial leadership The Ministries of Water, Health, Local Government and Rural Development are usually given some form of mandate over sanitation. Effective co-ordination within a single ministry can be a difficult process and across different ministries it can be impossible. Adding layers of central, regional, district, and city responsibilities plus the Ministries of the Environment (which are becoming increasingly aware of the potential pollution problems caused to groundwater by on-site sanitation) and the net result is a tangled web of overlapping, uncoordinated, unworkable policies, low budget allocations, low prioritisation and lack of accountability.

Disconnected policies and regulations In many developing countries sanitation policy development occurs at central ministerial level with implementation responsibility being based at district government. Under these circumstances even well written and well thought out sanitation policy documents can be consigned to the water supply officer’s desk draw and allowed to slowly gather dust if they are not developed in an inclusive and participatory manner. In the absence of an appropriate policy, local government enforcement officers in many ex-British colony countries still use outdated legislation first drafted in 1936.

Weak political will and leadership Excreta disposal is simply not a political issue and is destined to remain in the political backwater for many years. The elevation of sanitation to an MDG target has had a significant impact on political will for sanitation change in the global development sector and it is slowly beginning to gain political credence at national level, but it would be a brave politician who would attempt to be elected on a “latrines for all” policy rather than “clean water for all”, or “free health care for all”.