Why We Need to Reinvent the Toilet

Good morning ladies and gentlemen. I thank the organizers for giving me this opportunity to talk to you about our still newish water, sanitation and hygiene strategy at the Bill & Melinda Gates Foundation. You are probably aware that the foundation’s leadership approved a sanitation-focused approach to our grant making in 2009. In July, we formally launched this strategy at AfricaSan3 in Kigali, Rwanda, under a call to action to “Reinvent the Toilet.”

Our announcement was primarily focused on general audiences, and it worked out well. Our YouTube video generated more than 160,000 views. I know that’s small compared to something that really goes viral. Susan Boyle’s performance on “Britain’s Got Talent,” for example, generated 76 million views, probably including a good number of you here in the audience. But 160,000 set a new record for foundation videos, and it was picked up by dozens of influential social media outlets, including Mashable.

We were also very pleased by media pick-up from CNN, The New York Times, The Economist, and a raft of social media bloggers. According to our communications team, the launch announcement generated the most media coverage of any single announcement made by our Global Development program in recent years. It also prompted hundreds of emails from people around the world wanting to know more, and asking how they could help.

The popular interest and excitement produced by our July launch shows that we can get general audiences interested in toilets. But we also know that our messages and materials – and if you missed them, you can still find them on our website – probably didn’t satisfy hardcore water and sanitation enthusiasts like you. So today I would like to share more details on what we are aiming to achieve and planning to support. I’ll also try to answer some of the key questions that we have heard since our launch.

For this expert audience, I will skip the discussion of the sanitation crisis that has led us to adopt a sanitation-focused strategy. But one question that we have been asked whether we are still interested in water. And we have been asked whether the new sanitation focus really has changed what we fund. We have estimated that, through 2009, 54% of our funding went to water and the remaining 46% to sanitation and hygiene. Over the past two years, 90% of our funding has been invested in sanitation and the remaining 10% in water and hygiene.

That ratio is likely to remain the same in years to come. Clearly, it does not imply that we think water is no longer important. We will continue to invest significant resources in water. But because so many of you are already working on water, we want to help sanitation catch up. If we are investing in sanitation in a location where people don’t have access to safe water, we will not rule out supporting water-related activities as part of the project – or through collaboration with other partners that focus on water, such as the Hilton Foundation.

So let’s talk about sanitation. When addressing general audiences, I like to talk about toilets. But that doesn’t mean that we are only interested in commodes. With experts like you, I can talk about our deep interest in – and commitment to – sustainable sanitation services. I can take a whole value-chain approach, and I can discuss why we support WASHCost’s “lifecycle costing” approach rather than an oversimplified focus on initial capital expenditures. I can also discuss a sanitation ladder that is interested in the service levels experienced by the user, as opposed to a simple discussion of the steps related to toilet hardware. Yes, this is all insider jargon, and while it turns off 99.9% of the rest of the world, we know it means a lot to you – and I assure you that it means a lot to us as well.

The next question that I want to address – and this is already a touch more controversial – is to clarify that the only form of sanitation that we are really interested in is on-site sanitation, i.e., sanitation that is not connected to sewers. It is a wonderful ambition to provide entire populations with gold-standard flush toilets connected to sewer systems and wastewater treatment plants. Indeed, this still appears to be official policy in many places. But it is not the form of sanitation that serves the people we aim to serve.

We don’t think that sewers and wastewater treatment plants are going to be a solution that will be relevant for more than a few of the 2.6 billion people who currently don’t have access to improved sanitation. And we will not invest in sewers – not even the low-cost small-bore variations.

Note that this does not mean that we are only interested in straight-up “dry sanitation.” In a world where many are washers rather than wipers, a small amount of water for personal hygiene is likely to be part and parcel of any widely acceptable form of sanitation. We also recognize the need to find solutions for greywater from kitchens, and washing and drainage more generally.

Of the current crop of available technologies, we would include pour-flush latrines and septic tanks in the category of on-site sanitation. And decentralized wastewater treatment systems, or DEWATS, are about as close to sewer systems as we expect to come.

That does not mean, however, that we think that poor people, who can’t afford the flush toilets that you and I use, have to be satisfied with the outhouses that we happily left behind us sometime in the last century. I know that some of us are quite happy with the composting toilet at the mountain cabin we visit on the weekend. For the record, I personally don’t own such a toilet, though I did dig latrines with my dad on camping trips as a child, and I happily used them. But few, if any, of us in this audience choose to use an outhouse of the sort that we are currently trying to convince many millions of people to adopt. Nor can I imagine that too many of us would want to use a PeePooBag unless we truly had no other option.

Enter the Reinvented Toilet. Surely, in the more than two centuries since Alexander Cummings patented the S-bend – the revolutionary water seal that allowed the outhouse to be upgraded to an indoor water closet – we have learned a few things in science and engineering that can inspire smart inventors among us to come up with the “cellphone of sanitation.” Not a toilet that is only good enough for poor people, but an aspirational product that leapfrogs flush toilets. A product that all of us would want to use.

Frankly, how much sense does it make to clean water to drinking-water standards and then use a good portion of that precious resource to flush waste down an expensive pipe system – a pipe system that even the richest nations can barely afford to rehabilitate? And how much sense does it make to transport our waste to treatment plants that consume so much energy that many operators in Africa have simply flipped off the power switch? Wouldn’t you rather have a toilet in your house that directly recovers the energy, nutrients, and water that we currently throw away? Wouldn’t you like a toilet that helps you recycle waste in the same way that we now recycle paper, glass, and plastic? I bet you would.

So, yes, we think that the toilet should be reinvented.

But how crazy is it to go after such a reinvented toilet? Are we technology zealots? Have we put science fiction ahead of social science? Will poor people be able to afford some high-tech black box toilet that zaps shit into syngas using microwaves? Will people want to use them? Is technology even important? Don’t we already have plenty of wonderful toilet designs that too few people adopt? Shouldn’t we just focus on the politics of the human right to sanitation? Shouldn’t we just help empower communities to find their own solutions to their sanitation problems through community-led total sanitation (CLTS) approaches?

Our strategy pursues three key sanitation planks, or initiatives, as we call them. First is science and technology. Second is delivery at scale. And third is policy and advocacy. We are also investing significantly in a portfolio of work that supports monitoring, learning and evaluation. Finally we are keeping the option open to invest or re-invest in very promising water and hygiene related work.

Sanitation Science & Technology

Our science and technology initiative is investing in innovation to reinvent the toilet. This year we are funding a large number of small, one-year projects across a wide range of technical options. Next year we’ll see which options look like promising candidates for further investment.

Our long term goal is a household-scale reinvented toilet that safely removes pathogens and recovers resources. We also want it to be a convenience that everyone can afford and that everyone will want to use. An off-the-grid toilet that is not connected to water lines, sewer lines, or electricity lines. For affordability, we are assuming that the new toilet has to cost less than $0.05 per person per day, probably a lot less. And that sum has to include everything: from initial investment, to ongoing maintenance, and all other costs associated with use.

Following our launch in July, we received more than 400 spontaneous offers of assistance by email. These included pointers to waterless toilet designs that writers thought would meet our criteria. The recommendations on waterless toilets were, by and large, composting designs, including quite a few concepts from South Africa.

It is not that we don’t believe in the biological route. In fact, we have made a significant grant to the London School of Hygiene and Tropical Medicine (LSHTM) that explores a range of biological options to, in a way, reinvent the toilet. And quite a few of our Grand Challenges Explorations (GCE) grants pursue composting or digesting forms of toilets. But we want to underscore our contention that the reinvented toilet needs to go viral. Let me remind you that Africa now has more cell phones than toilets. And according to a recent survey, Britons think that cell phones rate higher as a life necessity than toilets.

Clearly we have work to do before we have a toilet that is a must-have for the average low-income consumer. We are emphasizing the chemical engineering route, rather than biology, because we see this as an under-explored, under-invested route compared to the biological option.

In addition to the reinvented toilet proper – which we would consider the definitive solution at the household level – we will also invest in intermediate solutions, particularly:

1. Reinvented toilets with resource recovery at the neighborhood or community level – which is probably easier to achieve from the standpoint of energy requirements and affordability. This approach could be combined with household-level forms of “cartridge toilets,” such as what Unilever is working on with its UniLoo / Clean Team project presented by Jeff Chapin of IDEO yesterday. Alternatively, it could be coupled with redesigned or improved shared plot or community toilets, or with effective emptying.
2. Improved latrine emptying technologies – such as reinvented vacuum trucks that actually work in low-income urban areas, are affordable for low-income customers, and can displace manual emptying.
3. Fecal sludge resource recovery of energy or nutrients – to remove human waste safely from the environment in a way that generates revenues. One idea worth testing, we think, is whether fecal sludge can be safely and profitably processed together with organic solid waste in urban areas – or with animal waste in rural areas. For the latter we would like to see what can be learned from China’s 40 million biogas digesters.
4. Improved sanitation services and business models – making a business out of sanitation along the lines of what we are exploring through our grant to Water for People in Malawi and Uganda, and through the baseline studies that we are currently funding of emptying services in five Asian and five African countries.

If that is too far out for you – and we do recognize that this is a radical vision – our more immediate goal is to provide improved services to the users of the more two billion latrines and septic tanks that are operating today. That means toilets, or user interfaces, that are clean, safe, and do not smell bad – even for community toilets. Mechanical emptying services that are safe, and that everyone can afford. And community-scale waste processing that recovers resources and generates revenues.

Delivery Models at Scale

Of course we are not just investing in innovation, even though that will be the largest initiative going forward. Our second initiative focuses on delivery models that help end open defecation at scale. In essence, this means that we are supporting large scale programs that are based on forms of Community Led Total Sanitation – or CLTS++ as we refer to them collectively.

These include our grants to the Water and Sanitation Program’s (WSP) Total Sanitation and Sanitation Marketing programs in Indonesia, India, and Tanzania, as well as ongoing discussions with most organizations that have the ability to deliver large-scale programs cost-effectively and sustainably, from UNICEF, PLAN, WaterAid, and BRAC, to iDE.

When we say “at scale” we mean reaching millions of people, with our key outcome metric being the number of people in communities who become and remain Open Defecation Free. Examples of such efforts include the Dutch-funded WASH1, implemented by BRAC in Bangladesh, which has reached more than 25 million people according to its external evaluation.

We are very interested in driving down the costs of such programs for two reasons. First, we can reach more people faster if the same intervention costs less – delivering more impact per dollar and higher value for money. Second, scaling up and reaching hundreds of millions of people will ultimately have to involve governments, and the effort will have to be affordable over time.

There are, of course, a number of different costs involved in CLTS++. There is the program cost that foundations like ours fund, or co-fund, with governments. And there are the costs borne by the community, typically involving the initial investment in building a latrine and the subsequent costs of emptying.

Program costs are, on average, as high as $10 per person. We would like to bring these down to $5 or less. The initial investments in latrines range from $20 to $60 or more per household, depending on the type of latrine involved. We have also seen cases where large families, or households that share toilets, pay more for emptying their latrines or septic tank than their initial investment.

In our portfolio of projects currently in the pipeline the key questions that we are looking to answer are:

1. What is the effectiveness and cost of the initial program that supports ending open defecation for millions of people?
2. What is the sustainability of such programs? Are communities still ODF 12 or 24 months later?
3. What is the sustainability of such programs in terms of emptying the latrines when they are full – even in rural areas?
4. What is the most effective way of combining supply-side measures, such as sanimarts, with CLTS-style demand creation?
5. What is the degree to which subsidies are necessary to reach the poorest of the poor?
6. What is the most effective way to engage to engage with, or hand over, CLTS efforts to governments?

As WSP, our long-standing partner in this area, knows all too well, we don’t shy away from asking difficult questions. We like to push for evidence, and we like to do business based on quantitative approaches wherever possible. We also have many other colleagues in the foundation who use other approaches to address some of the same health issues that we aim to prevent through improved water and sanitation. These include colleagues who work on cholera vaccines, or on the new rotavirus vaccine. We collaborate with them on a number of projects that test the effectiveness of cholera vaccine side by side with water and sanitation interventions in Bangladesh, for example. We also work closely with colleagues to test the hypothesis that chronic diarrhea in young children can damage gut health to such an extent that it has long term health impacts that may outweigh the direct health impacts of diarrhea.

In Bihar, we collaborate closely with our colleagues in family health who follow a community-based approach to improved maternal and child health that has important parallels with CLTS, notably a strong reliance on village health workers or midwives. In other words, in Bihar we test, through a set of grants, the hypothesis that delivery of CLTS can be effectively integrated with delivery of maternal and child health programs.

All in all, the CLTS++ grants that we have made, together with those we plan to make this year and early next year, aim to move up to close to 30 million people out of Open Defecation over the life of the projects, i.e., by 2015/16. Our goal is to expand that to 70 million people by about 2020. Over time, we expect to see innovations developed through our investments included in programs that take delivery to scale. We know, for example, that BRAC’s Babar Kabir worries that the millions of latrines they are helping to install will need emptying, and that there are currently no effective solutions to accomplish that task.

Policy and Advocacy

Reaching 70 million people through our partners and grantees will probably keep our small team at the foundation pretty busy. But we recognize that that is still only a small drop in the bucket of the 2.6 billion people who need better sanitation services. Getting to the next level of scale – reaching hundreds of millions of people – will have to involve governments. Governments that either implement large-scale programs, or governments that enable an effective private sector to provide sanitation services – or both. For that reason our third sanitation initiative, last but not least, focuses on policy and advocacy.

Effective policy and advocacy for sanitation will require good coordination among all stakeholders: civil society, donor agencies and particularly developing country governments. For that reason, we have joined the Sanitation and Water for All (SWA) partnership, recognizing it as the key forum to engage with developing country government representatives from the water and sanitation sector and from ministries of finance. We look forward to the next high-level meeting in the spring of 2012.

We also have supported regional sanitation conferences in South Asia and Africa this year, and we have joined the African Ministers Council on Water (AMCOW) African Water Facility with support that enabled the facility to issue a sanitation-focused call for proposals that closed just last week.

In addition to such “insider” policymaker-focused advocacy, we also believe there is value in advocacy that engages a large number of people in areas with poor access to improved sanitation with key messages. Work such as what WASH United is doing with its sports-based sanitation advocacy, and the World Toilet Organization is doing around World Toilet Day. For the foundation’s programs, we think we may be able to reach more than 50 million people with campaign-based advocacy programs around core sanitation messages in the next five years.

So far I have attempted to explain to you in more detail what it is we have in mind with our strategy. But it should be very clear to you that all we have is a small team, some bright ideas, and a pot of money. Most of the action that I have been describing will not come to pass without our current and prospective partners – partners that include many of you here in the audience.

So I also want to spend a few minutes here to discuss how we want to work with you. How we aim to be effective partners. Through a grantee perception survey that the foundation carried out in 2009, we learned that many of our partners think we can do a whole lot more to support them. And we have quite a few ambitious plans on this front too. Let me explain a few points.

First, I would like to discuss how we partner with others and how we develop relationships. Second, I would like to briefly discuss a somewhat innovative approach to grant-making that I refer to as “outcome contracting.” Third, I would like to raise the concept of “value for money” with you.

The Bill & Melinda Gates Foundation does not accept unsolicited proposals, but we do solicit proposals quite actively. Sometimes we do so through completely open calls for proposals, such as the Grand Challenges Explorations contest, or through semi-open calls where we invite a list of organizations, as we did this year for the Reinvent the Toilet Challenge. Most often, though, we extend direct invitations to one or several organizations on specific subjects.

Our small team of program officers drives this process. They attend meetings such as this, they travel to the areas where we work to visit projects and organizations in the field, and they organize small workshops or convenings of experts to get advice or brainstorm ideas. It is clear that the small size of our team is a limiting factor in the quantity and quality of relationships that we can effectively maintain, particularly because we don’t have a large number of field offices.

This past year we have more than doubled our team of program officers. As a result, we have rapidly increased our capacity to develop and maintain partnerships. One thing that our expanded staffing allows us to do is to engage more grantees closer to the ground, i.e., more developing country grantees. For universities in this country or in Europe, or for international NGOs, what this means is that, in the future, they will more likely operate as sub-grantees, working in partnership with a grantee in a developing country, as opposed to working directly with us. We think that, over time, this approach will support capacity-building in the global South. And it will increase the chance that our investments will have sustainable impact.

Which brings me to outcome contracting. Our interest in maximizing measurable outcomes for each dollar invested is not new to you, of course, as it is a refrain sung by many donors these days. Nor do we claim that we are doing something completely innovative. When you google Outcome Contracting, the top result is a Knol, a knowledge site on outcome contracting maintained by Paul Duignan, an outcomes and evaluation specialist. To my pleasant surprise, by the way, the third result last Sunday was a note I wrote a few years ago with colleagues when I was still with CGIAR. That note proposed “outcome contracting” when I was on the other side of the fence – as a grantee.

I will not go into every detail of outcome contracting as an approach to grant-making that my team is exploring at the foundation. But I did work with several grantees earlier this year, UNESCO-IHE in Delft and the Water Services Trust Fund in Kenya, for example, to develop and apply these ideas. Currently a handful of my colleagues are experimenting with the next wave: putting outcome contracts in place for a dozen or so new grants. What is the essence of this approach? Let me summarize it in a few simple steps:

First and foremost, it is about ensuring that the grantee and the foundation are very explicitly aligned around a common “vision of success” for a project – the impact that it seeks to have. This may sound obvious or trivial, but I argue that it is not an easy task, and it is far from common practice.

Second, it is about seeking to translate the impact that the project is expected to have into “outcomes” that are a proxy for impact – a step toward impact beyond outputs. When it is possible to find successful, mutually acceptable outcomes (and this is not always the case) these outcomes meet the following criteria:

• They are an acceptable (imaginable) proxy for impact from the side of the foundation, i.e., if we achieve the outcome, then we are confident that we will have made real progress toward impact; and
• They are close enough to the work of the grantee that the grantee can accept being held accountable for achieving them.

  Third, it is about agreeing on ways that outcomes attributable to the project can be measured in ideally quantifiable ways that are transparent, robust, and affordable – either by the grantee as part of routine monitoring, or through independent third-party verification, or both.

  Fourth, it is about managing risk by finding ways to link progress in achieving outcomes to the resources made available by the foundation. This can be done in several ways:

• Through “gated” subsequent payments that will only be made when there is pre-determined, measurable progress toward achieving outcomes (a form of orderly early termination for a non-performing project that puts part of the grant “at risk”); or
• Through reward payments for well-defined outcomes beyond a baseline, representing “excellent achievement,” that can be claimed and paid out if the outcomes are achieved to the satisfaction of the foundation. These are also referred to as “incentive payments” and can add as much as 50% to the baseline value of the grant for outperforming projected outcomes and doing so at lower-than-anticipated unit costs.

I promise you that you will hear more on this topic, both from me and from my colleagues, on future occasions. I realize that it may represent quite a different way of working for your organization, and it may require some adjustments.

On the other hand, my experience is that, as grantees, you will like this approach for at least two reasons. First it creates up-front clarity on mutual expectations – which tends to prevent a lot of trouble down the road. Second, if well done, it can significantly increase the flexibility grantees have in determining how best to reach pre-determined goals. And these goals can be stretch goals, with rewards matching achievements. In other words, once we as grant makers have confidence that we have clear agreement on what the outcomes are, and that you have committed to deliver on these goals, we can step back, get out of your business, and let you get on with it. My guess is that you might like that idea.

But of course, it is also a tool to hold both you and ourselves accountable. Whether you like that I don’t know, but I guess we will find out soon enough.

Finally let me say a few words about value for money. Value for money is one key outcome that we will likely discuss for every grant, even though it may be measured quite differently for different types of projects.

In the most generic sense, “value for money” means nothing more than that every grant should maximize value for money on its own, and its performance should be comparable to the broader portfolio of grants that it fits into. It is, in fact, the qualitative form of the economist’s Internal Rate of Return, recognizing that we cannot always express impacts or outcomes in monetary terms.

Practically, what this means is that if we can fund partners to implement CLTS++ programs at a scale of millions of people for a program cost of $5 per person, then that ratio becomes a benchmark of value for money for that type of grant. There may be reasons why costs would be higher in some cases, and why they would be lower in others. But in all cases, it would be a good conversation to have at the start of each project.

Similarly, we may be able to develop a benchmark that stipulates that effective grantees should be able implement awareness-raising campaigns that reach people with core messages at a cost of $0.1 per person. I do not think that we will easily develop a single benchmark to compare all projects across the sector, as our health colleagues have in $/DALY, but I do expect to have interesting conversations with at least a number of you on this topic.

That concludes my remarks today. Recapping, I want to say that we are open for business with our sanitation-focused strategy. Yes, we think the toilet should be reinvented, and we are looking for partners to help do that. We are also looking for partners to reduce the cost of effective mechanical emptying, and for partners to make money with resource recovery from human waste.

We want to make these innovations accessible to millions of people within ten years. We will continue our work with communities through key implementers of CLTS++ at scale, and we are reasonably confident that we are in the process of funding programs that will contribute to 30 million people living in Open Defecation Free environments. Finally we aim to be a partner with many of you here as advocates and champions for sustainable sanitation services for all. Your support and your commitment will be critical.

I thank you.