Humanosphere

The Gates Foundation recently awarded a $10.9 million grant to the Oakland-based East Meets West (EMW) Foundation to support the NGO’s sanitation and hygiene work in Cambodia and Vietnam.

While the Gates Foundation is well known for supporting technology-based poverty solutions, the programming by EMW is remarkably tech-free. Rather than focus on new innovations and technologies, EMW puts a high emphasis on evidenced-based solutions that have a built in accountability mechanism.

“What stands out is our business model,” said John Anner, President of EMW. “The Gates Foundation gave us this grant because of our results-based mechanism which helps drive down costs of an intervention.”

Sanitation and hygiene are areas where simple interventions can save lives. The WHO estimates that some 2.7 billion people will not have access to basic sanitation by 2015 if current trends persist. That accounts for more than 1 out of every 3 people globally. It is particularly a problem in southern Asia where sanitation coverage is pegged at 36%.

Poor sanitation increases the risk of diarrhea, the leading killer of children under the age of 5. For these reasons EMW has made it a priority to develop programs that improve sanitation. Their community-based program starts with education and ends with the installation of clean latrines.

To do so, EMW must train masons to build the latrines, connect households with financing and provide the right set of incentives for households to pay for a latrine to be built. EMW pays a rebate to families upon the successful completion of the latrine which serves the dual purpose of encouraging people to see the project through and hold all involved accountable. To get the rebate, an independent evaluator must come and inspect the new latrine.

“A lot of the poor have to be risk averse due to the challenges they face. It is not just about the cash incentive. It has to be done right. Meaning it functions right, does not smell and works in the future,” said Anner. He stressed the importance of the latrines working beyond the date of completion.

Vietnam is a country rife with water project failures. To Anner and other water advocates, a part of the problem is attention given to the inauguration of a program. Evidence is an important part of program design, but just as important for ensuring its sustainability.

The most important aspects of sanitation and hygiene are often the least interesting to donors. Anner gave an example, “I have never come across a funder who looks to improve electrical panels for water systems. It is a major failing point of the water sector. ” EMW made it a priority to find solutions to improve the problem of delivering power to the solar panels so that they can cope with voltage changes and are not harmed by flooding.

One way to evaluate programs and gather results that has become popular is the randomized control trial. However, Anner has found that the cost and lack of donor interest to fund the trials as a barrier to using them for EMW. Because of that, they have turned to business case studies as a model for informing both decision makers and donors by providing information about how to apply solutions in the real world.

Ultimately, outputs tied to impact stand above all else for Anner and EMW. “For us output means that the financial transition happens only after the impact happens,” said Anner.  The cholera outbreak that is spreading throughout Freetown, Sierra Leone is an example of how poor sanitation can suddenly wreck havoc on a community. The constant toll runs deeper for Cambodia and Vietnam where poor hygiene and sanitation practices are responsible for an estimated  17,000 deaths and $1.2 billion in economic losses.