Delivery of safe and affordable water and sanitation services in rural locations, particularly where there are large distances between households or where water is scarce: The distance to urban centres where the local administration offices are based, and from where supplies can be sourced for hardware, can also be an impediment to maintaining services. People living in rural areas often have limited income, or rely on a trading economy and do not have sufficient income to pay for services. A protected well may be relatively straight-forward and inexpensive to construct, but there are often issues of quality and sustainability in terms of financial, management and technical needs, particularly where technical capacity and access to spare parts for hand pumps installed on protected wells for example is limited. In rural areas, there is frequently a lack of management or financial capacity necessary for maintaining hand pumps or other protected sources among small communities.

Poor people bear a disproportionate share of the impact of inefficient water and sanitation services: Fewer poor people are connected to a network and when they do have access, the installation has to be shared among many more people. Construction costs, as well as the operation and maintenance of non-networked services will often be financed by households themselves, rather than by government contributions. This can expose them to fluctuations in the prices charged by the private sector, as well as in terms of sustainability, when financing is not planned for operation and maintenance costs. The absence of sufficient financing for maintenance leads to intermittent or failing services, with the poorest overpaying to informal service providers, while the higher-income consumers have to invest in coping strategies, such as water storage or pumps to extract water from the network.

Demand for services:

• For access to sanitation to be sustainable, investments in software, including awareness raising programmes, are usually necessary to stimulate demand. Some countries have been shifting toward “complete sanitation”—focusing on community and household behavior and sanitation practices.This involves encouraging households to change behavior—shifting away from open defecation, washing hands, keeping food and water covered, using safe water, focusing on children’s hygiene behavior and maintaining a clean environment.
• Where demand is low, providing sanitation hardware or subsidies to purchase the sanitation hardware risks that the facility will not be used, i.e., latrinisation not sanitation.
• Supply-driven interventions (often based on a subsidy provided to households to pay for the construction of the services) have been painfully slow and inefficient in bringing sustainable sanitation in developing countries, particularly in rural areas. A demand-led approach, which depends on individuals and groups making a specific request for services, works on the principle of participation. For these approaches, it is assumed that the greater engagement of individuals in the process of delivery will ensure better use and sustainability of services, both in technical and financial terms. However, this can lead to services being provided only to those people who are able to make this request and can afford the services, or who have the resources to engage, or who are specifically targeted by the State through promotional campaigns. There can also be difficulties in taking this approach to scale, to reach all residents, due to the different contexts and different technologies demanded by households and communities. One solution can therefore be a combination of these approaches, whereby States provide some level of bulk services, so that facilitation and promotion of individual and household level provision can be provided more easily by the individuals and households themselves.

Targeting:

• It can be difficult to target cross-subsidies effectively to those living in poverty, because those groups may not be connected to the networked service. Therefore the not-so-poor households with connections will often appropriate the benefit of the lower tariff. In some cities or countries, cross-subsidies are targeted on the basis of the type of service delivery, such as kiosks or yard taps having lower tariffs than household connections.
• A common problem found in subsidy schemes is ensuring that the subsidies reach those most in need rather than middle, or even high-income populations, as is often the case. One approach to ensure that all those in need receive a particular benefit or subsidy is by making this subsidy universally available, automatically and with minimal bureaucracy. An alternative approach is to target benefits or subsidies at particular individuals or groups, and apply conditions that need to be met to receive this benefit – whether based on income, geography or other criteria. This is a more expensive and bureaucratic approach, as it requires resources to regulate who receives the benefit and inform households and communities of their rights to the benefit.
• The embarrassment of requesting a subsidy and admitting to be living in a situation of economic deprivation can also, depending on the culture or cultural norms prevalent in the country, prevent those most in need from benefiting from the subsidies they are entitled to.

Progressive tariff systems: One of the problems with this approach is the assumption that all households will use the same amount of water, regardless of household size, or need. Large households, households sharing a connection and those households requiring larger quantities of water for health reasons, could be at a risk of moving into the second block, and therefore having to pay more per litre. Alternatively, households have to limit their per capita water consumption to levels that may not be sufficient for the realisation of the human right to water. It is difficult to set the tariff blocks at a rate that both ensure that households have sufficient quantities of water and at the same time act as a deterrent for the excessive use of water. Often the first block is made so large to satisfy political demands that few households have to pay the second block rate. The benefit of the cross-subsidising nature of IbT is then lost, and economic sustainability put at risk.

Lack of human and financial resources to implement policies and plans, develop and establish national standards for safe use of wastewater or faecal sludge, or oversee sanitation standards and undertake the necessary surveillance and enforcement. This lack of commitment of resources may be explained by the fact that in many cultures sanitation is a taboo subject, and is not popular with either politicians or planners. As a result, there is often not enough information on who does not have adequate access to sanitation and why, making planning and budgeting difficult.

Financing for sanitation: Requirements for the financing of sanitation are often more complex than for water, and will include the purchase or construction of a latrine or toilet, storage, removal or transport of the waste matter (a sewerage system or pit/septic tank emptying system) and treatment, disposal and/or reuse of waste matter. To ensure the hygienic use of sanitation facilities, the costs to governments also include hygiene promotion and awareness-raising campaigns. The costs for institutions and households include the cost of purchasing soap, and water, for both hygiene and in some cases for flushing toilets. This range of services generally requires a number of different service providers, which are not often coordinated, either in terms of management or in terms of securing the necessary financing.

Focus on network consumers:

• Governments and donors in developing countries tend not to target sanitation spending on those living in poverty, more often focusing on massively subsidised networked sewerage systems that are used by a small percentage of the urban population. The faecal sludge from latrines used by the majority of the population is generally not factored into the design of wastewater treatment systems.Conventional sewerage solutions may not only be capital intensive to construct and operate, but are costly in terms of the amount of water required to operate them effectively, increasing water bills of individuals and households.
• Household contributions for water and sanitation services in rural areas and in informal settlements can differ quite substantially from household contributions for standard piped water and sewerage provision. In these cases, user costs can range from the construction of communal or individual household provision (a well, and communal or household toilets) for storing water (buckets, jerry cans and tanks) and for treating water (boiling, chlorine, filters, etc.), and for cleaning, maintaining and emptying latrines or septic tanks, and disposing of excreta. The availability of hardware and spare parts, particularly for those technologies that do not require the regular replacement of parts, can be a considerable barrier to maintaining services, particularly in rural areas.

Deprived urban areas: There are technical reasons – often over-emphasised – which explain why these urban informal settlements lack formal access to water and sanitation services, such as poor planning, narrow streets or a hazardous environment, making the provision of services more complex. However, often the real reason why people living in informal settlements do not have access to water and sanitation is their insecure tenure status and a lack of acceptance of slums and recognition of the human rights of the people who live within them, which prevents services from being delivered effectively and affordably. Often households are not permitted by landlords or by the State to build their own latrines. National and municipal authorities do not want to accept the existence of informal settlements, and fear that allowing services to be delivered will legitimise settlements and encourage further settlements to be created.

Taboo regarding women and girls' hygiene: During menstruation, women and girls require access to water, sanitation and hygiene services, including clean water for washing cloths used to absorb menstrual blood and a place to dry them, somewhere private to change cloths or disposable sanitary pads, facilities to dispose of used cloths and pads, and access to information to understand the menstrual cycle and how to manage menstruation hygienically. As well as addressing practical needs like this, it is also necessary to promote better awareness amongst women and men to overcome the embarrassment, cultural practices and taboos around menstruation that impact negatively on women’s and girls’ lives, and reinforce gender inequities and exclusion. Development workers and community members alike have found this a difficult topic to discuss, due to its sensitive nature and the sometimes discriminatory practices that surround menstruation.