Multi-level sanitation governance: understanding and overcoming challenges in the sanitation sector in sub-Saharan Africa
Nelson Ekane | Björn Nykvist | Marianne Kjellén | Stacey Noel | Nina Weitz
The provision of sanitation facilities - a basic necessity for human health, well-being, dignity, and development - remains a mammoth challenge for developing countries where the vast majority of the 2.5 billion people without improved sanitation facilities reside. Sub-Saharan Africa (SSA) is one of the regions where decent, dignified, and functional toilet facilities remain largely inaccessible. Most of the countries in SSA will miss the Millennium Development Goal (MDG) for sanitation. There are sharp contradictions in the region between formal and informal sanitation institutions. There is also a disconnect between actors at the macro, meso, and micro governance levels. This paper shows how multi-level governance analysis, path dependency, and institutional inertia can be used to improve understanding of some challenges in the sanitation sector in SSA, and discusses approaches that can contribute to improving the sanitation situation in a sustainable way. In addition, the paper asserts that demand-driven strategies and private sector involvement in the sanitation sector is paramount for establishing new sanitation paradigms and sociotechnical regimes. We conclude that a good understanding of actors at all levels - their various roles, interactions, and the way they interpret and respond to policies - is key to accelerating progress in sustainable sanitation coverage in SSA.Achiro, B. (2012) Constraints and Prospects of Law Enforcement for Improved Sanitation in Kawempe Division, MSc dissertation, Kampala District, Uganda: Makerere University.
Amable, B. (2003) ‘Diversity of modern capitalism’, in I. Bache and M.V. Flinders (eds), Multi-level Governance, Oxford, UK: Oxford University Press.
Bache, I. and Flinders, M.V. (eds) (2004) Multi-level Governance, Oxford: Oxford University Press.
Bartram, J. and Cairncross, S. (2010) ‘Hygiene, sanitation, and water: forgotten foundations of health’, PLoS Med 7(11) e1000367 <http://dx.doi.org/10.1371/journal.pmed.1000367≯.
Bos, A. and Gijzen, H. (2005) ‘Health benefits versus costs of water supply and sanitation’, Water21 7(5): 1-72.
Boschi-Pinto, C., Lanata, C.F., Mendoza, W. and Habte, D. (2006) ‘Diarrheal diseases’, in D.T. Jamison, R.G. Feachem, M.W. Makgoba, E.R. Bos, F.K. Baingana, K.J. Hofman and K.O. Rogo (eds), Disease and Mortality in Sub-Saharan Africa, Washington, DC: World Bank.
Cairncross, S. and Feachem, R.G. (1993) Environmental Health Engineering in the Tropics: An Introductory Text, Chichester, UK: John Wiley & Sons.
Campbell, J. (2004) Institutional Change and Globalization, Princeton, NJ: Princeton University Press.
Cheng, J.J., Schuster-Wallace, C.J., Watt, S., Newbold, B.K. and Mente, A. (2012) ‘An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality’, Environmental Health 11(1): 1-8 <http://dx.doi.org/10.1186/1476-069X-11-4≯.
Department for International Development (DFID) (2012) Water, Sanitation and Hygiene Portfolio Review, March 2012, London: DFID.
Douglas, M. (2002) Purity and Danger: An Analysis of Concepts of Pollution and Taboo, London: Routledge.
Ekane, N., Noel, S., Kjellén, M. and Fogde, M. (2012) Sanitation and Hygiene: Policy, Stated Beliefs and Actual Practice: A Case Study in the Burera District in Rwanda [online], SEI working paper 2012-07, Stockholm: Stockholm Environment Institute <www.sei-international.org/publications?pid=2226≯ [accessed 8 July 2014]. www.sei-international.org/publications?pid=2226
Ekane, N. and Gill, T. (2013) Sanitation Policy and Practice in Rwanda: Tackling the Disconnect, SEI Policy Brief, Stockholm: Stockholm Environment Institute.
Esrey, S.A. (1996) ‘Water, waste and well-being: A multi-country study’, American Journal of Epidemiology 143: 608-23.
European Court of Auditors (ECA) (2012) European Union Development Assistance for Drinking Water Supply and Basic Sanitation in Sub-Saharan countries, Special report no. 13, Luxembourg: ECA.
Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water and sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi. org/10.1016/S1473-3099(04)01253-8≯.
Franks, T. and Cleaver, F. (2007) ‘Water governance and poverty: a framework for analysis’, Progress in Development Studies 7(4): 291-306 <http://dx.doi.org/10.1177/146499340700700402≯.
Genschel, P. (1995) ‘The dynamics of inertia: institutional persistence and institutional change in telecommunications and health care’, Governance 10(1): 43-66 <http://dx.doi.org/10.1111/0952-1895.281996028≯.
Geyer, N., Forster, M., Ludwig, A., Nahimana, V. and Ndayisaba, A. (2011) East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, March 2011.
Haimi, S., Ranta, L. and Hietaranta, J. (2008) ‘Challenges in dry sanitation: case from Swaziland and Zambia’, in L. Akatama (ed.), Experiences of Dry Sanitation in Southern Africa, Report 78, Finland: Turku University of Applied Sciences.
Harris, D., Kooy, M. and Jones, L. (2011) Analysing the Governance and Political Economy of Water and Sanitation Service Delivery, ODI Working Paper 334, London: ODI.
Hooghe, L. and Marks, G. (2001) ‘Types of multi-level governance’, European Integration online Papers (EIoP) 5(11).
Hooghe, L. and Marks, G. (2003) ‘Unraveling the central state, but how? Types of multi-level governance’, American Political Science Review 97(2): 233-43.
Höpner, M. (2005) ‘What connects industrial relations and corporate governance? Explaining institutional complementarity’, Socio-Economic Review 3: 331-58 <http://dx.doi.org/10.1093/SER/mwi014≯.
IISD (2013) ‘Summary of the third session of the UN General Assembly open working group on sustainable development goals, 22-23 May 2013’, Earth Negotiations Bulletin 32(3): 9.
Jain, N. (2011) Getting Africa to Meet the Sanitation MDG: Lessons from Rwanda, Washington, DC: Water and Sanitation Programme.
Kjellén, M. (2009) ‘Structural leakage in Dar es Salaam: the investment deficit in water distribution’, in I. Karlsson and K. Röing de Nowina (eds), Meeting Global Challenges in Research Cooperation, 27-29 May 2008, Uppsala, pp. 304-11, Uppsala: Centre for Sustainable Development, Uppsala University and Swedish University for Agricultural Sciences.
Kjellén, M. (2010) ‘Water vending in Dar es Salaam, Tanzania’, in B. Calas and C.A. Mumma Martinon (eds.), Shared Waters, Shared Opportunities: Hydropolitics in East Africa, Dar es Salaam: Mkuki na Nyota Publishers Ltd.
Kvarnström, E., McConville, J., Bracken, P., Johansson, M. and Fogde, M. (2011) ‘The sanitation ladder: a need for a revamp?’ Journal of Water, Sanitation and Hygiene for Development 1(1): 3 <http://dx.doi.org/10.2166/washdev.2011.014≯.
Massie, A. and Webster, J. (2013) ‘Towards understanding the water and sanitation hygiene beliefs and practices of the Twa of South-west Uganda’, Waterlines 32(1): 5-22 <http://dx.doi.org/10.3362/1756-3488.2013.002≯.
Morella, E., Foster, V. and Ghosh Banerjee, S. (2008) Climbing the Ladder: The State of Sanitation in Sub-Saharan Africa, Background Paper 13 (PHASE I), Washington, DC: International Bank for Reconstruction and Development/World Bank.
Movik, S. and Mehta, L. (2010) The Dynamics and Sustainability of CLTS: Mapping Challenges and Pathways, STEPS Working Paper 37, Brighton: STEPS Centre.
Nelson, R. (1994) ‘Evolutionary theorizing about economic change’, in N. Smelser and R. Swedberg (eds), The Handbook of Economic Sociology, pp. 108-36, Princeton, NJ: Princeton University Press.
North, D. (1990) Institutions, Institutional Change and Economic Performance, New York: Cambridge University Press.
Nyonyintono Lubaale, G. and Musembi Musyoki, S. (2011) ‘Pro-poor sanitation and hygiene in East Africa’, background paper presented at the East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, 29-31 March 2011.
ODI (2012) Rwanda: The Development of Sector Strategies, Country Learning Notes, Budget Strengthening Initiative, London: ODI.
Ostrom, E. (1990) Governing the Commons: The Evolution of Institutions for Collective Action, Cambridge: Cambridge University Press.
Pahl-Wostl, C. (1995) The Dynamic Nature of Ecosystems: Chaos and Order Entwined, Chichester, UK: Wiley.
Pahl-Wostl, C. (2008) ‘Requirements for adaptive water management’, in C. Pahl-Wostl, P. Kavat and J. Moltgen (eds), Adaptive and Integrated Water Management: Coping with Complexity and Uncertainty, Paris: Springer.
Pierson, P. (2000) ‘Increasing returns, path dependence, and the study of politics’, American Political Science Review 94(2): 251-67.
Prüss-üstün, A., Fewtrell, L. and Bartram, J. (2002) ‘Estimating the burden of disease from water, sanitation, and hygiene at a global level’, Environmental Health Perspectives 110: 537-42.
Prüss-üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: WHO.
Rip, A. and Kemp, R. (1998) ‘Technological change’, in S. Rayner and E. Malone (eds), Human Choice and Climate Change, Resources and Technology, Volume 2, Columbus, OH: Battelle Press.
Roe, M. (1996) ‘Chaos and evolution in law and economics’, Harvard Law Review 109(3): 641-68.
Rosemarin, A., Ekane, N., Caldwell, I., Kvarnström, E., McConville, J., Ruben, C. and Fogde, M. (2008) Pathways for Sustainable Sanitation: Achieving the Millennium Development Goals, Stockholm: Stockholm Environment Institute/London: IWA Publishing.
Rotmans, J., Kemp, R. and van Asselt, M. (2001) ‘More evolution than revolution: transition management in public policy’, Foresight 3(1): 15-31 <http://dx.doi.org/10.1108/14636680110803003≯.
Sano, J.C. (2007) Urban Environmental Infrastructure in Kigali City, Rwanda: The Challenges and Opportunities for Modernised Decentralised Sanitation Systems in Poor Neighbourhoods, Msc thesis, Wageningen, Netherlands: Wageningen University.
Shove, E. (2003) Comfort, Cleanliness and Convenience: The Social Organization of Normality, New Technology/New Cultures Series, Oxford: Berg Publishers.
Stenström, T-A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems, SEI report, EcoSanRes Series, 2011, Stockholm:
Stockholm Environment Institute. Stinchcombe, A. (1968) Constructing Social Theories, Chicago: University of Chicago Press.
Stubbs, P. (2005) ‘Stretching concepts too far? Multi-level governance, policy transfer and the politics of scale in South East Europe’, Southeast European Politics VI(2): 66-87.
Szántó, G.L., Letema, S.C., Tukahirwa, J.T., Mgana, S., Oosterveer, P.J.M. and van Buuren, J.C.L. (2012) ‘Analyzing sanitation characteristics in the urban slums of East Africa’, Water Policy 14: 613-24 <http://dx.doi.org/10.2166/wp.2012.093≯.
Thompson, R. (2004) ‘Overcoming barriers to ecologically sensitive land management: conservation subdivisions, green developments, and the development of a land ethic’, Journal of Planning Education and Research 24: 141-53 <http://dx.doi.org/10.1177/0739456X04269860≯.
UNDP (2006) Beyond Scarcity: Power, Poverty and the Global Water Crisis, Human Development Report, New York: UNDP.
UN-Water (2008) Sanitation is an Investment with High Economic Returns. Sanitation Generates Economic Benefits, Factsheet, Geneva: UN-Water.
UN-Water (2012) UN-Water Global Annual Assessment of Sanitation and Drinking-water (GLAAS) 2012 Report: The Challenge of Extending and Sustaining Services, Geneva: UN-Water and the World Health Organization (WHO).
WaterAid (2011) The Sanitation Problem: What Can and Should the Health Sector Do? WaterAid Report, May 2012, London: WaterAid.
WaterAid (2013a) Keeping Promises: Why African Leaders Need to Deliver on their Past Water and Sanitation Commitments, WaterAid Report, February 2013, London: WaterAid.
WaterAid (2013b) Everyone, Everywhere: A Vision for Water, Sanitation and Hygiene Post-2015, London: WaterAid.
WHO and UNICEF (2014) Progress on Sanitation and Drinking Water: 2014 Update, Geneva: WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation.
WSP (2012) ‘Africa: economics of sanitation initiative’ [website] <www.wsp.org/wsp/content/africa-economic-impacts-sanitation≯ [accessed 22 April 2013]. www.wsp.org/wsp/content/africa-economic-impacts-sanitation
Yardly, S. (2010) Joining the Dots: Why Better Water, Sanitation and Hygiene are Necessary for Progress on Maternal, Newborn and Child Health [pdf], Teddington, UK: Tearfund <http://tilz.tearfund.org/~/media/files/tilz/research/j20066%20wash%20report%20web.pdf≯ [accessed 8 July 2014]. http://tilz.tearfund.org/~/media/files/tilz/research/j20066%20wash%20report%20web.pdf
Achiro, B. (2012) Constraints and Prospects of Law Enforcement for Improved Sanitation in Kawempe Division, MSc dissertation, Kampala District, Uganda: Makerere University.
Amable, B. (2003) ‘Diversity of modern capitalism’, in I. Bache and M.V. Flinders (eds), Multi-level Governance, Oxford, UK: Oxford University Press.
Bache, I. and Flinders, M.V. (eds) (2004) Multi-level Governance, Oxford: Oxford University Press.
Bartram, J. and Cairncross, S. (2010) ‘Hygiene, sanitation, and water: forgotten foundations of health’, PLoS Med 7(11) e1000367 <http://dx.doi.org/10.1371/journal.pmed.1000367≯.
Bos, A. and Gijzen, H. (2005) ‘Health benefits versus costs of water supply and sanitation’, Water21 7(5): 1-72.
Boschi-Pinto, C., Lanata, C.F., Mendoza, W. and Habte, D. (2006) ‘Diarrheal diseases’, in D.T. Jamison, R.G. Feachem, M.W. Makgoba, E.R. Bos, F.K. Baingana, K.J. Hofman and K.O. Rogo (eds), Disease and Mortality in Sub-Saharan Africa, Washington, DC: World Bank.
Cairncross, S. and Feachem, R.G. (1993) Environmental Health Engineering in the Tropics: An Introductory Text, Chichester, UK: John Wiley & Sons.
Campbell, J. (2004) Institutional Change and Globalization, Princeton, NJ: Princeton University Press.
Cheng, J.J., Schuster-Wallace, C.J., Watt, S., Newbold, B.K. and Mente, A. (2012) ‘An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality’, Environmental Health 11(1): 1-8 <http://dx.doi.org/10.1186/1476-069X-11-4≯.
Department for International Development (DFID) (2012) Water, Sanitation and Hygiene Portfolio Review, March 2012, London: DFID.
Douglas, M. (2002) Purity and Danger: An Analysis of Concepts of Pollution and Taboo, London: Routledge.
Ekane, N., Noel, S., Kjellén, M. and Fogde, M. (2012) Sanitation and Hygiene: Policy, Stated Beliefs and Actual Practice: A Case Study in the Burera District in Rwanda [online], SEI working paper 2012-07, Stockholm: Stockholm Environment Institute <www.sei-international.org/publications?pid=2226≯ [accessed 8 July 2014]. www.sei-international.org/publications?pid=2226
Ekane, N. and Gill, T. (2013) Sanitation Policy and Practice in Rwanda: Tackling the Disconnect, SEI Policy Brief, Stockholm: Stockholm Environment Institute.
Esrey, S.A. (1996) ‘Water, waste and well-being: A multi-country study’, American Journal of Epidemiology 143: 608-23.
European Court of Auditors (ECA) (2012) European Union Development Assistance for Drinking Water Supply and Basic Sanitation in Sub-Saharan countries, Special report no. 13, Luxembourg: ECA.
Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water and sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi. org/10.1016/S1473-3099(04)01253-8≯.
Franks, T. and Cleaver, F. (2007) ‘Water governance and poverty: a framework for analysis’, Progress in Development Studies 7(4): 291-306 <http://dx.doi.org/10.1177/146499340700700402≯.
Genschel, P. (1995) ‘The dynamics of inertia: institutional persistence and institutional change in telecommunications and health care’, Governance 10(1): 43-66 <http://dx.doi.org/10.1111/0952-1895.281996028≯.
Geyer, N., Forster, M., Ludwig, A., Nahimana, V. and Ndayisaba, A. (2011) East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, March 2011.
Haimi, S., Ranta, L. and Hietaranta, J. (2008) ‘Challenges in dry sanitation: case from Swaziland and Zambia’, in L. Akatama (ed.), Experiences of Dry Sanitation in Southern Africa, Report 78, Finland: Turku University of Applied Sciences.
Harris, D., Kooy, M. and Jones, L. (2011) Analysing the Governance and Political Economy of Water and Sanitation Service Delivery, ODI Working Paper 334, London: ODI.
Hooghe, L. and Marks, G. (2001) ‘Types of multi-level governance’, European Integration online Papers (EIoP) 5(11).
Hooghe, L. and Marks, G. (2003) ‘Unraveling the central state, but how? Types of multi-level governance’, American Political Science Review 97(2): 233-43.
Höpner, M. (2005) ‘What connects industrial relations and corporate governance? Explaining institutional complementarity’, Socio-Economic Review 3: 331-58 <http://dx.doi.org/10.1093/SER/mwi014≯.
IISD (2013) ‘Summary of the third session of the UN General Assembly open working group on sustainable development goals, 22-23 May 2013’, Earth Negotiations Bulletin 32(3): 9.
Jain, N. (2011) Getting Africa to Meet the Sanitation MDG: Lessons from Rwanda, Washington, DC: Water and Sanitation Programme.
Kjellén, M. (2009) ‘Structural leakage in Dar es Salaam: the investment deficit in water distribution’, in I. Karlsson and K. Röing de Nowina (eds), Meeting Global Challenges in Research Cooperation, 27-29 May 2008, Uppsala, pp. 304-11, Uppsala: Centre for Sustainable Development, Uppsala University and Swedish University for Agricultural Sciences.
Kjellén, M. (2010) ‘Water vending in Dar es Salaam, Tanzania’, in B. Calas and C.A. Mumma Martinon (eds.), Shared Waters, Shared Opportunities: Hydropolitics in East Africa, Dar es Salaam: Mkuki na Nyota Publishers Ltd.
Kvarnström, E., McConville, J., Bracken, P., Johansson, M. and Fogde, M. (2011) ‘The sanitation ladder: a need for a revamp?’ Journal of Water, Sanitation and Hygiene for Development 1(1): 3 <http://dx.doi.org/10.2166/washdev.2011.014≯.
Massie, A. and Webster, J. (2013) ‘Towards understanding the water and sanitation hygiene beliefs and practices of the Twa of South-west Uganda’, Waterlines 32(1): 5-22 <http://dx.doi.org/10.3362/1756-3488.2013.002≯.
Morella, E., Foster, V. and Ghosh Banerjee, S. (2008) Climbing the Ladder: The State of Sanitation in Sub-Saharan Africa, Background Paper 13 (PHASE I), Washington, DC: International Bank for Reconstruction and Development/World Bank.
Movik, S. and Mehta, L. (2010) The Dynamics and Sustainability of CLTS: Mapping Challenges and Pathways, STEPS Working Paper 37, Brighton: STEPS Centre.
Nelson, R. (1994) ‘Evolutionary theorizing about economic change’, in N. Smelser and R. Swedberg (eds), The Handbook of Economic Sociology, pp. 108-36, Princeton, NJ: Princeton University Press.
North, D. (1990) Institutions, Institutional Change and Economic Performance, New York: Cambridge University Press.
Nyonyintono Lubaale, G. and Musembi Musyoki, S. (2011) ‘Pro-poor sanitation and hygiene in East Africa’, background paper presented at the East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, 29-31 March 2011.
ODI (2012) Rwanda: The Development of Sector Strategies, Country Learning Notes, Budget Strengthening Initiative, London: ODI.
Ostrom, E. (1990) Governing the Commons: The Evolution of Institutions for Collective Action, Cambridge: Cambridge University Press.
Pahl-Wostl, C. (1995) The Dynamic Nature of Ecosystems: Chaos and Order Entwined, Chichester, UK: Wiley.
Pahl-Wostl, C. (2008) ‘Requirements for adaptive water management’, in C. Pahl-Wostl, P. Kavat and J. Moltgen (eds), Adaptive and Integrated Water Management: Coping with Complexity and Uncertainty, Paris: Springer.
Pierson, P. (2000) ‘Increasing returns, path dependence, and the study of politics’, American Political Science Review 94(2): 251-67.
Prüss-üstün, A., Fewtrell, L. and Bartram, J. (2002) ‘Estimating the burden of disease from water, sanitation, and hygiene at a global level’, Environmental Health Perspectives 110: 537-42.
Prüss-üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: WHO.
Rip, A. and Kemp, R. (1998) ‘Technological change’, in S. Rayner and E. Malone (eds), Human Choice and Climate Change, Resources and Technology, Volume 2, Columbus, OH: Battelle Press.
Roe, M. (1996) ‘Chaos and evolution in law and economics’, Harvard Law Review 109(3): 641-68.
Rosemarin, A., Ekane, N., Caldwell, I., Kvarnström, E., McConville, J., Ruben, C. and Fogde, M. (2008) Pathways for Sustainable Sanitation: Achieving the Millennium Development Goals, Stockholm: Stockholm Environment Institute/London: IWA Publishing.
Rotmans, J., Kemp, R. and van Asselt, M. (2001) ‘More evolution than revolution: transition management in public policy’, Foresight 3(1): 15-31 <http://dx.doi.org/10.1108/14636680110803003≯.
Sano, J.C. (2007) Urban Environmental Infrastructure in Kigali City, Rwanda: The Challenges and Opportunities for Modernised Decentralised Sanitation Systems in Poor Neighbourhoods, Msc thesis, Wageningen, Netherlands: Wageningen University.
Shove, E. (2003) Comfort, Cleanliness and Convenience: The Social Organization of Normality, New Technology/New Cultures Series, Oxford: Berg Publishers.
Stenström, T-A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems, SEI report, EcoSanRes Series, 2011, Stockholm:
Stockholm Environment Institute. Stinchcombe, A. (1968) Constructing Social Theories, Chicago: University of Chicago Press.
Stubbs, P. (2005) ‘Stretching concepts too far? Multi-level governance, policy transfer and the politics of scale in South East Europe’, Southeast European Politics VI(2): 66-87.
Szántó, G.L., Letema, S.C., Tukahirwa, J.T., Mgana, S., Oosterveer, P.J.M. and van Buuren, J.C.L. (2012) ‘Analyzing sanitation characteristics in the urban slums of East Africa’, Water Policy 14: 613-24 <http://dx.doi.org/10.2166/wp.2012.093≯.
Thompson, R. (2004) ‘Overcoming barriers to ecologically sensitive land management: conservation subdivisions, green developments, and the development of a land ethic’, Journal of Planning Education and Research 24: 141-53 <http://dx.doi.org/10.1177/0739456X04269860≯.
UNDP (2006) Beyond Scarcity: Power, Poverty and the Global Water Crisis, Human Development Report, New York: UNDP.
UN-Water (2008) Sanitation is an Investment with High Economic Returns. Sanitation Generates Economic Benefits, Factsheet, Geneva: UN-Water.
UN-Water (2012) UN-Water Global Annual Assessment of Sanitation and Drinking-water (GLAAS) 2012 Report: The Challenge of Extending and Sustaining Services, Geneva: UN-Water and the World Health Organization (WHO).
WaterAid (2011) The Sanitation Problem: What Can and Should the Health Sector Do? WaterAid Report, May 2012, London: WaterAid.
WaterAid (2013a) Keeping Promises: Why African Leaders Need to Deliver on their Past Water and Sanitation Commitments, WaterAid Report, February 2013, London: WaterAid.
WaterAid (2013b) Everyone, Everywhere: A Vision for Water, Sanitation and Hygiene Post-2015, London: WaterAid.
WHO and UNICEF (2014) Progress on Sanitation and Drinking Water: 2014 Update, Geneva: WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation.
WSP (2012) ‘Africa: economics of sanitation initiative’ [website] <www.wsp.org/wsp/content/africa-economic-impacts-sanitation≯ [accessed 22 April 2013]. www.wsp.org/wsp/content/africa-economic-impacts-sanitation
Yardly, S. (2010) Joining the Dots: Why Better Water, Sanitation and Hygiene are Necessary for Progress on Maternal, Newborn and Child Health [pdf], Teddington, UK: Tearfund <http://tilz.tearfund.org/~/media/files/tilz/research/j20066%20wash%20report%20web.pdf≯ [accessed 8 July 2014]. http://tilz.tearfund.org/~/media/files/tilz/research/j20066%20wash%20report%20web.pdf
Achiro, B. (2012) Constraints and Prospects of Law Enforcement for Improved Sanitation in Kawempe Division, MSc dissertation, Kampala District, Uganda: Makerere University.
Amable, B. (2003) ‘Diversity of modern capitalism’, in I. Bache and M.V. Flinders (eds), Multi-level Governance, Oxford, UK: Oxford University Press.
Bache, I. and Flinders, M.V. (eds) (2004) Multi-level Governance, Oxford: Oxford University Press.
Bartram, J. and Cairncross, S. (2010) ‘Hygiene, sanitation, and water: forgotten foundations of health’, PLoS Med 7(11) e1000367 <http://dx.doi.org/10.1371/journal.pmed.1000367≯.
Bos, A. and Gijzen, H. (2005) ‘Health benefits versus costs of water supply and sanitation’, Water21 7(5): 1-72.
Boschi-Pinto, C., Lanata, C.F., Mendoza, W. and Habte, D. (2006) ‘Diarrheal diseases’, in D.T. Jamison, R.G. Feachem, M.W. Makgoba, E.R. Bos, F.K. Baingana, K.J. Hofman and K.O. Rogo (eds), Disease and Mortality in Sub-Saharan Africa, Washington, DC: World Bank.
Cairncross, S. and Feachem, R.G. (1993) Environmental Health Engineering in the Tropics: An Introductory Text, Chichester, UK: John Wiley & Sons.
Campbell, J. (2004) Institutional Change and Globalization, Princeton, NJ: Princeton University Press.
Cheng, J.J., Schuster-Wallace, C.J., Watt, S., Newbold, B.K. and Mente, A. (2012) ‘An ecological quantification of the relationships between water, sanitation and infant, child, and maternal mortality’, Environmental Health 11(1): 1-8 <http://dx.doi.org/10.1186/1476-069X-11-4≯.
Department for International Development (DFID) (2012) Water, Sanitation and Hygiene Portfolio Review, March 2012, London: DFID.
Douglas, M. (2002) Purity and Danger: An Analysis of Concepts of Pollution and Taboo, London: Routledge.
Ekane, N., Noel, S., Kjellén, M. and Fogde, M. (2012) Sanitation and Hygiene: Policy, Stated Beliefs and Actual Practice: A Case Study in the Burera District in Rwanda [online], SEI working paper 2012-07, Stockholm: Stockholm Environment Institute <www.sei-international.org/publications?pid=2226≯ [accessed 8 July 2014]. www.sei-international.org/publications?pid=2226
Ekane, N. and Gill, T. (2013) Sanitation Policy and Practice in Rwanda: Tackling the Disconnect, SEI Policy Brief, Stockholm: Stockholm Environment Institute.
Esrey, S.A. (1996) ‘Water, waste and well-being: A multi-country study’, American Journal of Epidemiology 143: 608-23.
European Court of Auditors (ECA) (2012) European Union Development Assistance for Drinking Water Supply and Basic Sanitation in Sub-Saharan countries, Special report no. 13, Luxembourg: ECA.
Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water and sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi. org/10.1016/S1473-3099(04)01253-8≯.
Franks, T. and Cleaver, F. (2007) ‘Water governance and poverty: a framework for analysis’, Progress in Development Studies 7(4): 291-306 <http://dx.doi.org/10.1177/146499340700700402≯.
Genschel, P. (1995) ‘The dynamics of inertia: institutional persistence and institutional change in telecommunications and health care’, Governance 10(1): 43-66 <http://dx.doi.org/10.1111/0952-1895.281996028≯.
Geyer, N., Forster, M., Ludwig, A., Nahimana, V. and Ndayisaba, A. (2011) East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, March 2011.
Haimi, S., Ranta, L. and Hietaranta, J. (2008) ‘Challenges in dry sanitation: case from Swaziland and Zambia’, in L. Akatama (ed.), Experiences of Dry Sanitation in Southern Africa, Report 78, Finland: Turku University of Applied Sciences.
Harris, D., Kooy, M. and Jones, L. (2011) Analysing the Governance and Political Economy of Water and Sanitation Service Delivery, ODI Working Paper 334, London: ODI.
Hooghe, L. and Marks, G. (2001) ‘Types of multi-level governance’, European Integration online Papers (EIoP) 5(11).
Hooghe, L. and Marks, G. (2003) ‘Unraveling the central state, but how? Types of multi-level governance’, American Political Science Review 97(2): 233-43.
Höpner, M. (2005) ‘What connects industrial relations and corporate governance? Explaining institutional complementarity’, Socio-Economic Review 3: 331-58 <http://dx.doi.org/10.1093/SER/mwi014≯.
IISD (2013) ‘Summary of the third session of the UN General Assembly open working group on sustainable development goals, 22-23 May 2013’, Earth Negotiations Bulletin 32(3): 9.
Jain, N. (2011) Getting Africa to Meet the Sanitation MDG: Lessons from Rwanda, Washington, DC: Water and Sanitation Programme.
Kjellén, M. (2009) ‘Structural leakage in Dar es Salaam: the investment deficit in water distribution’, in I. Karlsson and K. Röing de Nowina (eds), Meeting Global Challenges in Research Cooperation, 27-29 May 2008, Uppsala, pp. 304-11, Uppsala: Centre for Sustainable Development, Uppsala University and Swedish University for Agricultural Sciences.
Kjellén, M. (2010) ‘Water vending in Dar es Salaam, Tanzania’, in B. Calas and C.A. Mumma Martinon (eds.), Shared Waters, Shared Opportunities: Hydropolitics in East Africa, Dar es Salaam: Mkuki na Nyota Publishers Ltd.
Kvarnström, E., McConville, J., Bracken, P., Johansson, M. and Fogde, M. (2011) ‘The sanitation ladder: a need for a revamp?’ Journal of Water, Sanitation and Hygiene for Development 1(1): 3 <http://dx.doi.org/10.2166/washdev.2011.014≯.
Massie, A. and Webster, J. (2013) ‘Towards understanding the water and sanitation hygiene beliefs and practices of the Twa of South-west Uganda’, Waterlines 32(1): 5-22 <http://dx.doi.org/10.3362/1756-3488.2013.002≯.
Morella, E., Foster, V. and Ghosh Banerjee, S. (2008) Climbing the Ladder: The State of Sanitation in Sub-Saharan Africa, Background Paper 13 (PHASE I), Washington, DC: International Bank for Reconstruction and Development/World Bank.
Movik, S. and Mehta, L. (2010) The Dynamics and Sustainability of CLTS: Mapping Challenges and Pathways, STEPS Working Paper 37, Brighton: STEPS Centre.
Nelson, R. (1994) ‘Evolutionary theorizing about economic change’, in N. Smelser and R. Swedberg (eds), The Handbook of Economic Sociology, pp. 108-36, Princeton, NJ: Princeton University Press.
North, D. (1990) Institutions, Institutional Change and Economic Performance, New York: Cambridge University Press.
Nyonyintono Lubaale, G. and Musembi Musyoki, S. (2011) ‘Pro-poor sanitation and hygiene in East Africa’, background paper presented at the East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, 29-31 March 2011.
ODI (2012) Rwanda: The Development of Sector Strategies, Country Learning Notes, Budget Strengthening Initiative, London: ODI.
Ostrom, E. (1990) Governing the Commons: The Evolution of Institutions for Collective Action, Cambridge: Cambridge University Press.
Pahl-Wostl, C. (1995) The Dynamic Nature of Ecosystems: Chaos and Order Entwined, Chichester, UK: Wiley.
Pahl-Wostl, C. (2008) ‘Requirements for adaptive water management’, in C. Pahl-Wostl, P. Kavat and J. Moltgen (eds), Adaptive and Integrated Water Management: Coping with Complexity and Uncertainty, Paris: Springer.
Pierson, P. (2000) ‘Increasing returns, path dependence, and the study of politics’, American Political Science Review 94(2): 251-67.
Prüss-üstün, A., Fewtrell, L. and Bartram, J. (2002) ‘Estimating the burden of disease from water, sanitation, and hygiene at a global level’, Environmental Health Perspectives 110: 537-42.
Prüss-üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: WHO.
Rip, A. and Kemp, R. (1998) ‘Technological change’, in S. Rayner and E. Malone (eds), Human Choice and Climate Change, Resources and Technology, Volume 2, Columbus, OH: Battelle Press.
Roe, M. (1996) ‘Chaos and evolution in law and economics’, Harvard Law Review 109(3): 641-68.
Rosemarin, A., Ekane, N., Caldwell, I., Kvarnström, E., McConville, J., Ruben, C. and Fogde, M. (2008) Pathways for Sustainable Sanitation: Achieving the Millennium Development Goals, Stockholm: Stockholm Environment Institute/London: IWA Publishing.
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Shove, E. (2003) Comfort, Cleanliness and Convenience: The Social Organization of Normality, New Technology/New Cultures Series, Oxford: Berg Publishers.
Stenström, T-A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems, SEI report, EcoSanRes Series, 2011, Stockholm:
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Fewtrell, L., Kaufmann, R.B., Kay, D., Enanoria, W., Haller, L. and Colford, J.M. (2005) ‘Water and sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis’, Lancet Infectious Diseases 5: 42-52 <http://dx.doi. org/10.1016/S1473-3099(04)01253-8≯.
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Genschel, P. (1995) ‘The dynamics of inertia: institutional persistence and institutional change in telecommunications and health care’, Governance 10(1): 43-66 <http://dx.doi.org/10.1111/0952-1895.281996028≯.
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Harris, D., Kooy, M. and Jones, L. (2011) Analysing the Governance and Political Economy of Water and Sanitation Service Delivery, ODI Working Paper 334, London: ODI.
Hooghe, L. and Marks, G. (2001) ‘Types of multi-level governance’, European Integration online Papers (EIoP) 5(11).
Hooghe, L. and Marks, G. (2003) ‘Unraveling the central state, but how? Types of multi-level governance’, American Political Science Review 97(2): 233-43.
Höpner, M. (2005) ‘What connects industrial relations and corporate governance? Explaining institutional complementarity’, Socio-Economic Review 3: 331-58 <http://dx.doi.org/10.1093/SER/mwi014≯.
IISD (2013) ‘Summary of the third session of the UN General Assembly open working group on sustainable development goals, 22-23 May 2013’, Earth Negotiations Bulletin 32(3): 9.
Jain, N. (2011) Getting Africa to Meet the Sanitation MDG: Lessons from Rwanda, Washington, DC: Water and Sanitation Programme.
Kjellén, M. (2009) ‘Structural leakage in Dar es Salaam: the investment deficit in water distribution’, in I. Karlsson and K. Röing de Nowina (eds), Meeting Global Challenges in Research Cooperation, 27-29 May 2008, Uppsala, pp. 304-11, Uppsala: Centre for Sustainable Development, Uppsala University and Swedish University for Agricultural Sciences.
Kjellén, M. (2010) ‘Water vending in Dar es Salaam, Tanzania’, in B. Calas and C.A. Mumma Martinon (eds.), Shared Waters, Shared Opportunities: Hydropolitics in East Africa, Dar es Salaam: Mkuki na Nyota Publishers Ltd.
Kvarnström, E., McConville, J., Bracken, P., Johansson, M. and Fogde, M. (2011) ‘The sanitation ladder: a need for a revamp?’ Journal of Water, Sanitation and Hygiene for Development 1(1): 3 <http://dx.doi.org/10.2166/washdev.2011.014≯.
Massie, A. and Webster, J. (2013) ‘Towards understanding the water and sanitation hygiene beliefs and practices of the Twa of South-west Uganda’, Waterlines 32(1): 5-22 <http://dx.doi.org/10.3362/1756-3488.2013.002≯.
Morella, E., Foster, V. and Ghosh Banerjee, S. (2008) Climbing the Ladder: The State of Sanitation in Sub-Saharan Africa, Background Paper 13 (PHASE I), Washington, DC: International Bank for Reconstruction and Development/World Bank.
Movik, S. and Mehta, L. (2010) The Dynamics and Sustainability of CLTS: Mapping Challenges and Pathways, STEPS Working Paper 37, Brighton: STEPS Centre.
Nelson, R. (1994) ‘Evolutionary theorizing about economic change’, in N. Smelser and R. Swedberg (eds), The Handbook of Economic Sociology, pp. 108-36, Princeton, NJ: Princeton University Press.
North, D. (1990) Institutions, Institutional Change and Economic Performance, New York: Cambridge University Press.
Nyonyintono Lubaale, G. and Musembi Musyoki, S. (2011) ‘Pro-poor sanitation and hygiene in East Africa’, background paper presented at the East Africa Practitioners Workshop on Pro Poor Urban Sanitation and Hygiene, LAICO Umubano Hotel, Kigali, Rwanda, 29-31 March 2011.
ODI (2012) Rwanda: The Development of Sector Strategies, Country Learning Notes, Budget Strengthening Initiative, London: ODI.
Ostrom, E. (1990) Governing the Commons: The Evolution of Institutions for Collective Action, Cambridge: Cambridge University Press.
Pahl-Wostl, C. (1995) The Dynamic Nature of Ecosystems: Chaos and Order Entwined, Chichester, UK: Wiley.
Pahl-Wostl, C. (2008) ‘Requirements for adaptive water management’, in C. Pahl-Wostl, P. Kavat and J. Moltgen (eds), Adaptive and Integrated Water Management: Coping with Complexity and Uncertainty, Paris: Springer.
Pierson, P. (2000) ‘Increasing returns, path dependence, and the study of politics’, American Political Science Review 94(2): 251-67.
Prüss-üstün, A., Fewtrell, L. and Bartram, J. (2002) ‘Estimating the burden of disease from water, sanitation, and hygiene at a global level’, Environmental Health Perspectives 110: 537-42.
Prüss-üstün, A., Bos, R., Gore, F. and Bartram, J. (2008) Safer Water, Better Health: Costs, Benefits and Sustainability of Interventions to Protect and Promote Health, Geneva: WHO.
Rip, A. and Kemp, R. (1998) ‘Technological change’, in S. Rayner and E. Malone (eds), Human Choice and Climate Change, Resources and Technology, Volume 2, Columbus, OH: Battelle Press.
Roe, M. (1996) ‘Chaos and evolution in law and economics’, Harvard Law Review 109(3): 641-68.
Rosemarin, A., Ekane, N., Caldwell, I., Kvarnström, E., McConville, J., Ruben, C. and Fogde, M. (2008) Pathways for Sustainable Sanitation: Achieving the Millennium Development Goals, Stockholm: Stockholm Environment Institute/London: IWA Publishing.
Rotmans, J., Kemp, R. and van Asselt, M. (2001) ‘More evolution than revolution: transition management in public policy’, Foresight 3(1): 15-31 <http://dx.doi.org/10.1108/14636680110803003≯.
Sano, J.C. (2007) Urban Environmental Infrastructure in Kigali City, Rwanda: The Challenges and Opportunities for Modernised Decentralised Sanitation Systems in Poor Neighbourhoods, Msc thesis, Wageningen, Netherlands: Wageningen University.
Shove, E. (2003) Comfort, Cleanliness and Convenience: The Social Organization of Normality, New Technology/New Cultures Series, Oxford: Berg Publishers.
Stenström, T-A., Seidu, R., Ekane, N. and Zurbrügg, C. (2011) Microbial Exposure and Health Assessments in Sanitation Technologies and Systems, SEI report, EcoSanRes Series, 2011, Stockholm:
Stockholm Environment Institute. Stinchcombe, A. (1968) Constructing Social Theories, Chicago: University of Chicago Press.
Stubbs, P. (2005) ‘Stretching concepts too far? Multi-level governance, policy transfer and the politics of scale in South East Europe’, Southeast European Politics VI(2): 66-87.
Szántó, G.L., Letema, S.C., Tukahirwa, J.T., Mgana, S., Oosterveer, P.J.M. and van Buuren, J.C.L. (2012) ‘Analyzing sanitation characteristics in the urban slums of East Africa’, Water Policy 14: 613-24 <http://dx.doi.org/10.2166/wp.2012.093≯.
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UNDP (2006) Beyond Scarcity: Power, Poverty and the Global Water Crisis, Human Development Report, New York: UNDP.
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WaterAid (2011) The Sanitation Problem: What Can and Should the Health Sector Do? WaterAid Report, May 2012, London: WaterAid.
WaterAid (2013a) Keeping Promises: Why African Leaders Need to Deliver on their Past Water and Sanitation Commitments, WaterAid Report, February 2013, London: WaterAid.
WaterAid (2013b) Everyone, Everywhere: A Vision for Water, Sanitation and Hygiene Post-2015, London: WaterAid.
WHO and UNICEF (2014) Progress on Sanitation and Drinking Water: 2014 Update, Geneva: WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation.
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