Achieving effective, city-wide inclusive sanitation service delivery requires coordination of diverse actors in the sanitation value chain as many factors constrain the efficiency and quality of faecal sludge management (FSM). In partnership with government, consumer, and private sector stakeholders in Bihar’s capital city, Patna, PSI India facilitated extensive market analysis, identified the market challenges, and co-developed a market-based urban FSM services ‘ecosystem’ which resulted in the safe collection, treatment, and disposal of over 7 million litres of faecal sludge from more than an estimated 1,500 households over two years, as part of bundled portable toilet cabins and FSM services. The FSM programme Praashadan, funded by the Bill & Melinda Gates Foundation, built trust, improved coordination, and brokered official agreements between tanker operators and government, tested a portable toilet cabin business model to subsidize operation of a faecal sludge treatment plant, and established a call centre and promotional activities to drive customers to the services of a newly formed tanker operators association. Moving forward there is a need to place the work with these market actors into a wider context of a financed, coordinated, city-wide sanitation planning to address technology, R&D, and other constraints that support better business models and allow regular quality FSM services.
One of the main blockages to advancing sanitation coverage – identified at Unclogging the Blockages (Kampala, Uganda, 18–20 February 2014) – is the lack of inter-sector coordination (among relevant sectors such as housing, energy, agriculture, and health, as well as public and private actors), particularly at district and municipal levels. The main challenges are: 1) uncertain leadership and silo approaches affecting collective impact; 2) not addressing districtwide or nationwide service delivery; and 3) lack of opportunities to learn from and contribute to other sectors outside sanitation, particularly on market-based solutions. A holistic sanitation strategy not only addresses technology, business models, and financing across the entire sanitation value chain, but also a cross-sector approach that leverages the resources, platforms, expertise, and experiences sectors such as agriculture, energy, and housing have already advanced. With significant gains in demand creation, the tasks are to connect an increasingly informed demand with appropriate and affordable supply options, and to build the capacity of local institutions. The articulation of local market actors is critical to sustainably enter and strengthen supply chains. This paper provides practical strategies for capacity building of sanitation as a business towards cityand district-wide sanitation coverage that brings health and wealth to all.