Market Based Programming for WASH in Humanitarian Situations

Market Based Programming (MBP) for WASH in Humanitarian Situations, December 2019

Case Studies/Country Reports

Water, sanitation, and hygiene access in southern Syria: analysis of survey data and recommendations for response. Conflict and Health, 2018.
Allowing market forces to manage WASH services and quantity, and targeting emergency response activities on increasing affordability with well-targeted subsidies and improving water quality and regulation via WSPs can be an effective, scalable, and cost-effective strategy to guarantee water and sanitation access in protracted emergencies with local markets. SWS

Strengthening market systems that provide water and hygiene items for cholera mitigation and emergency preparedness in Haiti. Waterlines, October 2018.
In the context of the cholera epidemics in Haiti, a pre-crisis market analysis (PCMA) was conducted in Artibonite to study the supply of and demand for various water- and hygiene-related items.

Pathways to professionalised community water services in a protracted crisis: a case from Juba. 41st WEDC Conference, 2018.
The paper depicts Oxfam South Sudan experience in professionalizing a community-based operating entity responsible for managing a water treatment plant in Juba, through WASH Market-based Programming. It describes how this was achieved by supporting the development of a business implementation plan and provision of tailored institutional support.

Refugees: The Most in Need of Zakat Funds. UNHCR, 2019.
Our cash assistance program is an innovative way to ensure that 100% of Zakat donations go to people most in need, to spend on what they need most, instead of providing them with truckloads of unwanted supplies.


WASH Market-Based Programming in Emergencies: Overview. Oxfam, 2018.
This overview, and the WASH and Markets in Crisis series linked to it, describes the impacts of crises on market systems, and introduces the benefits of market-based programming.

Using pre-crisis market analysis to strengthen emergency preparedness and resilience of WASH systems. 41st WEDC Conference, 2018.
This paper describes Oxfam’s experiences using pre-crisis market analysis in Bangladesh, Indonesia, South Sudan and Zimbabwe in order to support market-based programming to strengthen the resilience of market systems and prepare for reoccurring emergencies

Briefing note 2: Types of Market-Based Programming to Strengthen Emergency Responses. Oxfam, 2018.
This briefing note describes different types of WASH market-based programming used in pre-crisis, emergency or post-crisis contexts, giving examples from Oxfam’s experiences in Bangladesh, Indonesia and Zimbabwe.

Building evidence to inform the effective use of cash in emergency sanitation and hygiene programming. Save the Children; ODI, 2018.
An analysis of five case studies of utilization of cash/voucher assistance are presented and analyzed in the attempt of building evidence on their utilization in emergency WASH Sanitation and HP programming. Findings and recommendations are provided on coordination, situation and response analysis, program design, implementation, monitoring and evaluation.

Working with WASH market systems to improve emergency response and resilience in urban areas. HPN, 2018.
With funding from USAID’s Office of Foreign Disaster Assistance (OFDA), Oxfam set out to promote market-based responses to emergencies using pre-crisis market mapping and analysis in Bangladesh, Indonesia, South Sudan and Zimbabwe, focusing primarily in urban areas.

Measuring the benefits of using market based approaches to provide water and sanitation in humanitarian contexts. Journal of Environmental Management, June 2018. The results of the work revealed that CT/MBP can be used to support household, community and market level interventions to effectively reduce transmission of diseases. Efficiency, effectiveness, sustainability, appropriateness and equity were identified as useful parameters which correlated to widely accepted frameworks against which to evaluate humanitarian action.

Cash and Markets In the WASH Sector: A global WASH Cluster position paper. GWC, 2016. The proposed benefits of working through existing market systems include improvements to speed, efficiency and effectiveness of programming and increased beneficiary dignity and choice.

WASH and Cash and Voucher Assistance. Cash Learning Partnership.
In recent years the use of conditional Cash and Voucher Assistance to achieve WASH outcomes has steadily grown. CVA has been used to increase access to drinking water through water vendors or small shops, or through the use of kits for treating and storing water. Cash for work has been used for the repair and recovery of the piped water network.

Other Studies/Reports

Mobilising cash and voucher assistance programmes: The case for mobile money. GSMA, 2019.
Although the fastest means of disbursement at the immediate onset of a crisis is to deliver physical cash, digital options offer greater benefits longer term.

What does gender-sensitive cash and voucher assistance look like? CARE, 2019.
The study aimed at understanding the: Extent to which women, men, boys, and girls have been involved in the design of CVA and the implications of this involvement. Potential for CVA to foster positive and sustainable gender roles and relations that contribute to gender equity.

New financing partnerships for humanitarian impact. ODI, 2019.
Innovative finance applies to using market-based investments – which generate a financial return – rather than grants.

Cost-Effectiveness in Humanitarian Work: Cash-Based Programming. IDS, 2018.
The evidence reviewed also points to the limits of CBR; cash interventions are unable to tackle systemic issues around quality of service provision, education and largely also health (albeit they can help cover costs of dealing with small ailments, or channel some resources into the WASH sector

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IDS sanitation research | PEER research proposals | Recent WASH research


Who is being left behind in Swachh Bharat Mission? How do we include them? Immersive research report by WaterAid India with Institute of Development Studies, gives insight into who is missed in sanitation programming in areas of India and how to include them. podcast

‘More or less: A rapid review of ‘water for toilets’ in rural India’, examines both technical and behavioural aspects surrounding water collection, management and consumption related to toilet use in rural India. It provides recommendations for steps forward.

Retrofitting of toilets is a complex and challenging stream of work and is included as one of the main components of Open Defecation Free-Sustainability (ODF-S) plans under Swachh Bharat Mission- Gramin (SBM-G). This rapid topic review ‘Retrofitting: The Next Step for the Swachh Bharat Mission?’ aims to provide recent evidence and insights into the scale and nature of the challenges of retrofitting.


PEER Cycle 9 Call for Proposals Now Open – On behalf of PEER’s sponsors at USAID, the National Academies are happy to announce that this year’s cycle of PEER is now open and accepting proposals. There are several country-specific focus areas: urban WASH and transboundary water in Afghanistanclean energy in Bangladeshmultiple research sectors in Tunisia, and bioremediation of dioxins and furans in Vietnam.


School-based, blacklight handwashing program can improve handwashing quality and knowledge among pre-school aged children. Evaluation and Program Planning, February 2020. Authors: Deirdre Dingman, Jingwei Wub, Heather M.Murphy – Puzzles and structured handwashing observations can be used as handwashing evaluation tools. Use of a black light technology as an educational tool can help to improve handwashing quality among pre-school aged children.

Impact of the “BALatrine” Intervention on Soil-Transmitted Helminth Infections in Central Java, Indonesia: A Pilot Study. Trop. Med. Infect. Dis., Dec 2019. We tested a low-cost, locally designed and constructed all-weather latrine (the “BALatrine”), together with community education promoting appropriate hygiene-related behaviour, to determine whether this integrated intervention effectively controlled soil-transmitted helminth (STH) infections.

Relationship of sanitation, water boiling, and mosquito nets to health biomarkers in a rural subsistence population. Am Jnl Human Biology, Dec 2019. This suggests that relatively low cost and low maintenance public health interventions may wish to focus on latrine use, as there is unmet need and potential health benefits for those who use latrines. Additionally, while the cost is higher, public health organizations aimed at improving sanitation may be able to use minimally invasive field‐collected biomarkers as a diagnostic to objectively test the efficacy of interventions with greater specificity than anthropometric measurements.

Citywide Inclusive Sanitation through Scheduled Desludging Services: Emerging Experience from India. Front. Environ. Sci., 27 November 2019. This paper first reviews the need for regular desludging of septic tanks. It then outlines the emerging experience of design and implementation of scheduled desludging for inclusive, equitable, and sustainable sanitation to achieve social and environmental benefits in two Indian cities. In these cities, a performance-linked annuity payment framework is used to engage a private desludging enterprise. Payment is met through a sanitation tax and transfer from the general property taxes.


Kenya RAPID video shows impact in year 4. MWA, Dec 2019. See this above video for an update on Kenya RAPID as it nears its fifth and final year of implementation.


Water, Sanitation Can Systematically Prevent Antimicrobial Resistance in India. The Wire, Dec 2019. Limited access to water, sanitation and waste management services, increases risk of infections and leads to greater dependence on antibiotics which contributes to AMR.

By, for, and of the People: How Citizen Science Enhances Water Security. New Security Beat, Dec 2019. This article is part of ECSP’s Water Security for a Resilient World series, a partnership with USAID’s Sustainable Water Partnership and Winrock International to share stories about global water security.

WASH research on CLTS, latrines, menstrual hygiene, food hygiene, etc.

In addition to the studies and reports listed below, recent updates to include:


How does Community-Led Total Sanitation (CLTS) promote latrine construction, and can it be improved? A cluster-randomized controlled trial in Ghana. Social Science & Medicine, 2 December 2019. Authors: Miriam Harter, Jennifer Inauen, Hans-JoachimMosler – CLTS increased latrine coverage by 67.6%. CLTS achieved changes in psychosocial determinants based on a psychosocial model.

Costs and Willingness to Pay for Pit Latrine Emptying Services in Kigali, Rwanda. Int. J. Environ. Res. Public Health, November 2019. Authors: Zachary Burt, Rachel Sklar and Ashley Murray – Our results show that households had strong preferences for fecal sludge (FS) treatment, formalized services (which include worker protections), and distant disposal.

Infant Food Hygiene and Childcare Practices in Context: Findings from an Urban Informal Settlement in Kenya. The American Society of Tropical Medicine and Hygiene, November 18, 2019. Authors: Jane Awiti, Odhiambo Mumma, Oliver Cumming, Sheillah Simiyu, Alexandra Czerniewska, Rose Evalyne Aseyo, Damaris Nelima Muganda, Emily Davis, Kelly K. Baker and Robert Dreibelbis – Our findings demonstrate that behaviors associated with food contamination, such as hand feeding and storing food for extended periods, are determined largely by the larger social and economic realities of primary caretakers. Data also show how caregiving within an informal settlement is highly dynamic and involves multiple individuals and locations throughout the day.

Economic cost analysis of low-cost sanitation technology options in informal settlement areas (case study: Soweto, Johannesburg). International Journal of Hygiene and Environmental Health, January 2020. Authors: Musa Manga, Jamie Bartram, Barbara E.Evans – The study revealed that simplified sewerage is the cheapest option for Soweto informal settlement, even when the costs of pumping and treatment are included.

Gendered Water Insecurity: A Structural Equation Approach for Female Headed Households in South Africa. Water, November 2019. Authors: Saul Ngarava, Leocadia Zhou, Nomakhaya Monde – The study concludes that there are dynamic relationships in water insecurity (exposure, sensitivity and adaptive capacity) for female-headed households in South Africa.

Resilience by design: A deep uncertainty approach for water systems in a changing world. Water Security, April 2020. Resilience by Design is a generalizable approach offering important new methods of planning and managing for the resilience of critical infrastructure.


Health, Safety and Dignity of Sanitation Workers: An Initial Assessment. World Bank, November 2019.

Measurement in the study of menstrual health and hygiene: A systematic review and audit, November 2019. Authors: Julie Hennegan, Deborah Jordan, Brooks Kellogg, J. Schwab G.J. Melendez-Torres. Results of this audit indicate the need for the development and validation of new measures, and the evaluation of the performance of existing measures across contexts. In particular, the definition and measurement of menstrual practices, knowledge, attitudes, norms and restrictions should be addressed.


Channeling Financial Flows for Urban Water and Sanitation. CSIS Briefs. November 27, 2019. Through development agencies like USAID and OPIC, the United States can leverage additional private capital and increase the efficiency of existing water and sanitation programs.

Glass Half Full? Innovative Technologies Could Increase Global Water Security. New Security Beat, November 21, 2019. This article is part of ECSP’s Water Security for a Resilient World series, a partnership with USAID’s Sustainable Water Partnership and Winrock International to share stories about global water security.

New SHARE research on handwashing, food hygiene, position paper on the WASH Benefits and SHINE studies

Bruce Gordon and Oliver Subasinghe on the 2019 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report

In the latest USAID Global Waters Radio podcast, hear the World Health Organization’s Bruce Gordon, one of the creators of the 2019 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report, share key takeaways from this year’s data, collected from more than 100 countries. podcast

As we move closer to 2030, how are countries doing in their pursuit of the Sustainable Development Goals for water and sanitation?

Click below to give a listen to this important progress report, and feel free to share with interested colleagues.

Link to the podcast. updates | New WHO, WSUP reports | WASH research updates

Recent updates to

Bruce Gordon and Oliver Subasinghe on the 2019 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report – The latest podcast from Global Waters Radio features a conversation with Bruce Gordon, Coordinator for Water, Sanitation, Hygiene and Health at the World Health Organization (WHO), and Oliver Subasinghe, Communications and Data Advisor with the USAID Water Office.

Children wash their hands outside school in Samabogo, Mali.

Children wash their hands outside school in Samabogo, Mali.

DESIGNING VIABLE SANITATION ENTERPRISES – A MARKET BASED SANITATION GAME – USAID/WASHPaLS developed a game called Designing Viable Sanitation Enterprises to serve as a tool for MBS practitioners to understand and appreciate the interactions between the elements of a sanitation enterprise, the entrepreneur, and the broader context.

USAID Seeks Input on its Water and Development Research Agenda – To take advantage of the concentrated water, sanitation, and hygiene (WASH)–sector knowledge represented at the 2019 University of North Carolina Water and Health Conference, we held a consultation designed to share our process in developing a research agenda.

USAID in the News – Cambodia – Stone Family Foundation, IDE and USAID Launch Sanitation Development Impact Bond.


Watering the NDCs: National Climate Planning for 2020 and Beyond. AGWA, 2019. Watering the NDCs provides guiding principles and recommendations for national climate planners and decision-makers to help ensure they meet their goals set out in National Adaptation Plans and Nationally Determined Contributions.

Safer water, better health. WHO, 2019. This high disease burden could be largely prevented with existing interventions and prevention strategies, which are described in this report.

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Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper

Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper, November 2019. Children wash their hands outside school in Samabogo, Mali.

The WHO/UNICEF position paper summarizes the studies, contextualizes the findings within the wider body of evidence and distills the implications for future investments. The paper is accompanied by a recorded interview with the heads of WASH for WHO and UNICEF and the lead author of a consensus statement from leading researchers.

An excerpt – What are the implications for WASH programming?

The findings of WASH Benefits and SHINE are not a reason to do less on WASH. Conversely, the historical significance of WASH in disease control, the strong conceptual basis for WASH (Box 2) and the need for WASH to reduce the potential for outbreaks in addition to breaking endemic transmission all indicate that the WASH sector collectively needs to do more and better to reach the ambitious targets of the SDGs.

The findings also highlight blind spots in typical WASH programming – particularly the role of animal waste and fecal contamination of food during irrigation and food preparation that are often overlooked in WASH programme design.

Many have called for transformative WASH In response to the studies but with some ambiguity around what is meant. While the consensus is that this implies interventions that lead to a comprehensively clean environment (Box 1), the path to this result is not universally agreed.