The Role of Shared Sanitation in Child Development, with Ed Mitchell, CEO of Water and Sanitation for Urban Populations (WSUP)

[00:00:00] Piers Clark: Welcome to the Exec Exchange, 15 minute podcast in which a leader from the water sector shares a story to inspire, inform, and educate other water sector leaders from around the globe.
[00:00:10] Piers Clark: My name is Piers Clark and my guest today is Ed Mitchell, the Chief Executive of WSUP, Water and Sanitation for Urban Populations. And on this special year end Christmas broadcast, we are going to be talking about an incredibly important topic all around how shared sanitation and the positive impact that can have on child health.
[00:00:32] Piers Clark: Ed, wonderful to have you with us today.
[00:00:35] Ed Mitchell: Thank you very much, Piers.
[00:00:37] Piers Clark: The way we do this is we always start by learning a little bit about our interviewee. So, walk me through your history. How did you get to the role of Chief Executive of WSUP?
[00:00:48] Ed Mitchell: So I've been working in and around water and sustainable development for 35 years now. I've had a stint with two British water companies, the environment agency, some time in government, and also in the third sector.
[00:01:03] Ed Mitchell: As an undergrad, I was particularly interested in sustainable development and also international development. Much helped the latter by being lucky enough to have the opportunity to do my dissertation halfway up Mount Kilimanjaro in Tanzania. I spent two summers in Africa, fell in love with the place, but then, you know, like everybody else came to the end of my degree and needed a job and discovered that there was this sector called environmental consultancy. And I've been in corporate social responsibility, what you might more recently call ESG.
[00:01:38] Ed Mitchell: And then three years ago I got the opportunity to follow my other great passion around international development. And so here I am as Chief Executive of WSUP.
[00:01:46] Piers Clark: You were number two at the Environment Agency, you were the acting head of the Environment Agency.
[00:01:52] Ed Mitchell: That's right, yes.
[00:01:53] Piers Clark: I mean, that's a pretty awesome claim to fame. That's where I first came across you.
[00:01:59] Ed Mitchell: I think the experience of working in heavily regulated industry really helped me be an effective regulator.
[00:02:07] Piers Clark: Brilliant. Now, let's talk about WSUP, Water and Sanitation for Urban Populations. Just describe, so people in the audience who've never heard of this charity, what it does.
[00:02:17] Ed Mitchell: We call ourselves Water and Sanitation for Urban Populations, and we do very much what it says on the tin. We drive inclusive and resilient urban water and sanitation systems by helping utilities serve their low income customers and strengthening the enabling environment in which they operate.
[00:02:34] Ed Mitchell: Earlier this year we celebrated our 20th anniversary, and in that time we've helped over 43 million people which is an incredible achievement for a small organization like ours. We have seven long-term program, six in Africa, and also one in South Asia in Bangladesh. And through our consulting arm, WSUP advisory, we've worked in another 20 or so countries.
[00:02:56] Ed Mitchell: We raise money from governments, from companies, from philanthropists to enable us to support utilities on issues as diverse as customer service network extensions, leakage and losses, fecal sludge management, financial management, whatever, really they need to be able to extend their services into the fast growing low income communities.
[00:03:20] Piers Clark: Thanks for that overview, Ed. One of the key questions I always like to ask any charitable organization is the efficiency of their funding, how much of the donor's money actually gets deployed in the field, and how much is used doing the necessary admin work.
[00:03:35] Piers Clark: Do you know those numbers?
[00:03:36] Ed Mitchell: We're actually not a charity, we're a not-for-profit company. We have a very efficient model, but primarily because we don't, on the whole, raise money from individuals. Most of the household name charities in the UK they spend a lot of money in order to raise money from people on the street corners or through Christmas campaigns or whatever.
[00:03:58] Ed Mitchell: Most charities will spend 20 to 23% of their income raising money. We spend two or 3% because we focus on funders who have an interest in the water and sanitation sector, and we raise money in big chunks rather than in, five or 10 pounds here and there.
[00:04:18] Piers Clark: Excellent. Now, the thing that we want to talk about today is all around the impact of shared sanitation on child development. I'd like to come at this problem from a bit of a distance really, and first start talking about the millennium goals and why those were set and what those goals have been set around sanitation services, and just talk me through what we've been shooting for and what your work has subsequently revealed.
[00:04:45] Ed Mitchell: If you again, look at the global south, the current level of access to decent quality sanitation is something less than a quarter. And there's a bit of a variation between urban areas and rural areas, but consistently it's been one of the least well achieved of the Millennium development goals that then became the Sustainable Development Goals.
[00:05:11] Ed Mitchell: There are two SDGs, as they're known, relevant in this space. There's one about access to clean safe water, and the other one is about access to safely managed sanitation.
[00:05:22] Ed Mitchell: And the progress against that is judged according to different tiers of provision of sanitation from the very worst open defecation through to safely managed individual household sanitation. And there are five or six different levels. The country's progress is judged under a framework called the joint monitoring program. And there has been progress, but that progress suggest that we're way off track achieving universal coverage by 2030.
[00:05:52] Ed Mitchell: Now, the bit of research and work that I want to talk about today adds a bit of a nuance to that because in addition to showing a way that we can more effectively progress up that ladder towards safely managed sanitation, it also shows the crossover between that sustainable development goal and the one on child health, nutrition, and development.
[00:06:16] Ed Mitchell: The two are very closely aligned and we have some very, very exciting research carried out by the University of North Carolina Chapel Hill in North Carolina and the London School of Hygiene Tropical Medicine, along with the Institute of Public Health in Mozambique, examining the impact of some shared sanitation facilities that we constructed in 2013, 14, and 15 in the suburbs of Maputo in Mozambique.
[00:06:45] Piers Clark: And just to be clear, the Millennium Goals and the Sustainable Development Goals weren't shooting for shared sanitation. Those were moving from open defecation to people having individual toilets within their households. The shared sanitation wasn't on that tiering of very bad to very good.
[00:07:04] Ed Mitchell: That's correct. And of course there are two components to sanitation. There's the user interface, the toilet, and then there's what happens to the fecal sludge. You have to realize that in most of the global south, the number of people who are connected to a sewer is very, very small. So, the predominant toilet type is a pit latrine.
[00:07:24] Ed Mitchell: And to achieve safely managed sanitation, you've both gotta have a clean, dignified toilet, and you've gotta have the mechanisms that empty that toilet and dispose of the fecal sludge in a manner that isn't harmful to the environment. You only score at the top of that tier at that ladder, if the sanitation is provided on a individual household basis.
[00:07:49] Piers Clark: Let's just make sure we've brought the audience with us on this journey. Huge sways of the population haven't got access to good sanitation, 75%. you said. Millennium goals and then the sustainable development goals were set to improve that situation, but one of the steps in there wasn't around shared sanitation and shared sanitation of course, is much cheaper to build the infrastructure and also to service the infrastructure to be able to empty the pit latrines under a community toilet block, as opposed to going individually house to house. It is much easier to do.
[00:08:21] Ed Mitchell: Absolutely. And the logistics of providing individual household sanitation are extraordinarily difficult in what are usually incredibly densely populated environments with very little access, house to house other than on foot.
[00:08:39] Ed Mitchell: The system has almost set up to fail in that the likelihood of being able to provide household level sanitation in low income communities in fast growing slums, for want of a better word is an almost undoable task. So, it's not just about cost, although cost is an important factor. It's also simply about the logistics of how do you access these toilets, how do you build them?
[00:09:03] Piers Clark: Yeah. And if anyone who's been in a favela, or a slum or a shanty community will know that the houses are built so close together that actually just getting vehicles in there to remove the sludge is a logistical nightmare.
[00:09:15] Piers Clark: Okay, so we've understood the problem, we've teased that the answer is that shared sanitation provides as much developmental benefit as individual toilets will get for children. Now, talk me through that actual piece of research and the findings you've got and the confidence you have around that data.
[00:09:32] Ed Mitchell: The project that underlies this is called MAP-San, which stands for Maputo Sanitation trial, and we installed two variants of shared sanitation blocks in the burrows the poor suburbs of Maputo in the 2013 to '16 period. And we connected about 300 households to two different types of toilet blocks.
[00:09:57] Ed Mitchell: One was a toilet shared by two to three households with maybe 15 to 20 people using that. And the other is a larger community toilet block. They're kind of modular in design so you have anything from kind of two seats upwards and you could be serving upwards of 40 to 60 to 80 people per toilet blocks.
[00:10:20] Ed Mitchell: Now, very importantly, these are high quality, clean, safe, well-managed sanitation blocks. In the case of the community sanitation blocks, they have washing facilities, both showers and hand washing facilities, et cetera, et cetera.
[00:10:36] Ed Mitchell: Our work was very much engaging with the communities, because often challenge is not building these things, but keeping them running for 5, 10, 15, 20 years. You have to enable the community to self-manage, self-organize and maintain these toilet blocks on an ongoing basis otherwise, it's just a vanity project that last two or three years.
[00:10:59] Ed Mitchell: The University of North Carolina and the London School of Hygiene got funding from the USAID, the US Development Agency, and also from the Bill and Melinda Gates Foundation to study the impact on child health in particular of access to these toilets. So as well as the toilets that we put in place, they also carry out the same study in compounds which haven't had the improved toilets put in place.
[00:11:25] Piers Clark: They've got a baseline that they can measure against.
[00:11:28] Ed Mitchell: Exactly. They carried out this study soon after completion of the toilets and in common with all previous studies, they did not find categoric evidence that this was a solution where you could identify cause and effects between providing the toilets and having an impact on child health and development, which is what's always been found in the past, it's always been assumed that good sanitation must be a contributing factor, but nobody's been able to isolate that contributing factor in a meaningful way.
[00:11:58] Ed Mitchell: They then went back five years later and did a 60 month follow up study, and that's where the really, really interesting results come in because what they've shown is that children born into compounds with access to these improved shared sanitation facilities had showed 31% less stunting than children born into the control compounds without the improved sanitation.
[00:12:23] Ed Mitchell: Stunting is a key development measure, which is not just about height. So this isn't about whether you are tall or short, it's that malnutrition and growth particularly in those first thousand days, have lifelong implications for health and development in all aspects. Whether that is cognitive development, whether it's physical development, et cetera, et cetera.
[00:12:45] Piers Clark: It's absolutely fascinating. A 31% improvement is not incremental. This is a step change improvement. How confident are you that these findings that you've got in this particular area will translate to other areas around the world?
[00:12:58] Ed Mitchell: Well, that's a really good question, and we would like to replicate the interventions and then demonstrate that it will be applicable elsewhere. The underlying research and the cause and effect that the researchers have shown gives me every confidence that this will be widely applicable.
[00:13:15] Piers Clark: Now you mentioned that the work was funded by USAID and we should acknowledge and thank them for that contribution as well as the Bill and Melinda Gates Foundation. USAID very publicly, their funding has been pulled. What are the implications of that for the work you do?
[00:13:32] Ed Mitchell: The US is not alone in reducing overseas development aids. The UK government has made reductions and announced further reductions across Europe. Most countries are reducing their development aid. So this is a global phenomenon.
[00:13:46] Ed Mitchell: And within that, the amount spent on water sanitation and hygiene is shrinking as well. So the situation is fairly bleak for those of us that are passionate about this area.
[00:13:56] Ed Mitchell: But what WSUP is doing is we're focusing on the good water sanitation and hygiene. And so whilst those that are WASH specialist funds and funders might be shrinking, there are lots of opportunities in climate change, in child health as we're talking about today, where people are still spending a lot of money on development objectives, and we're spending a proportion of that money on, in this case, high quality shared sanitation. So in effect, we, like many others, are trying to diversify our funding base beyond pure development aid and beyond WASH specific development aid.
[00:14:33] Piers Clark: It is an incredible story you are telling and the things that you are doing to demonstrate that shared sanitation can improve the welfare and development opportunities for the next generation are incredible.
[00:14:48] Piers Clark: And of course, this doesn't take it away from the fact that we do still need to be moving to a wider improvement of individual household sanitation. But this is such an important step. And Ed, I thank you for sharing it and the brilliant work that wasp's been doing here.
[00:15:04] Piers Clark: If this is something you want to learn more about, there is information that can be provided and I'm sure that Ed would love to have any voices of support from around the world.
[00:15:13] Piers Clark: Now we normally finish with a conversation around what advice would you give your younger self, but actually I wanna ask you a different question. I wanna ask you a question about resilience, your personal resilience, and how you have stayed resilient when you are working inside an organization doing such fundamentally important work, yet on a budget that is constantly at risk or running out of funding, how do you deal with that challenge?
[00:15:36] Ed Mitchell: It's a great question, Piers. I must say that since starting this role, I do feel the pressure of keeping the organization funded, keeping our brilliant experts employed, but also the enormous pressure of wanting to help people who deserve decent services and facilities and who just don't have them at the moment.
[00:15:55] Ed Mitchell: The thing for me that makes an enormous difference is when I go and visit and see our work on the ground and meet the people that we are helping and supporting, everything else pales into insignificance.
[00:16:09] Ed Mitchell: So long as I get out to see our work on the ground, two or three times a year, then that gives me all the resilience I need to keep focusing on the job in hand and is so worth it when you see the faces and you talk to the people that we've had the privilege of being able to help.
[00:16:27] Piers Clark: You have been listening to the Exec Exchange with me, Piers Clark, and my guest today has been Ed Mitchell, Chief Executive for Water and Sanitation for Urban Populations, WSUP, and we've been talking about how shared sanitation can have such an enormous benefit on childhood development.
[00:16:45] Piers Clark: Hope you can join us next time. Thank you.