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close this bookSanitation Promotion (SIDA - SDC - WSSCC - WHO, 1998, 292 p.)
close this folderGaining political will and partnership
close this folderPrinciples and guidelines
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View the documentAdvocacy for sanitation - Sara Wood1 and Mayling Simpson-Hébert2
View the documentMobilizing the media for sanitation promotion - WHO, Geneva, Switzerland
View the documentMobilizing partners for sanitation promotion - Sara Wood1 and Mayling Simpson-Hébert2
View the documentPrivate-sector involvement in promoting sanitation - Sara Wood1
View the documentSocial marketing for sanitation programmes - Sunil Mehra1

Advocacy for sanitation - Sara Wood1 and Mayling Simpson-Hébert2

1 WHO Consultant, Geneva, Switzerland.
2 WHO, Geneva, Switzerland.

There are few mysteries about why we need to have environmental sanitation. Lack of sanitation makes people ill and kills. More than three million people die every year from diarrhoeal diseases alone (1). It is said to be easier and cheaper to treat every patient with a sanitation-related disease, but is it wiser? What dignity is there living in filth and having chronic epidemics causing great suffering and death if all of this is totally preventable? What is development if it is not helping human beings to live in health and cleanliness with dignity?

Lack of environmental sanitation probably causes more illnesses and death than any other single factor in the world today. Human excreta is probably the world's number one pollutant. We are not only spoiling our water supplies, contaminating our food, and killing our children, but many countries are suffering economic loss from embargoes on their exported foods and loss of tourism owing to cholera outbreaks.

Half of the world's population lacks basic sanitation and within a few years it will be more than half (2). Yet it does not have to be this way. One of the main reasons for lack of investments in sanitation is lack of political will. Investments in sanitation lag far behind investments in water supply, even though the two should go hand-in-hand. Sanitation departments are under-staffed and under-paid, their workers often having the lowest status in public service. All of this must change. This is what advocating for sanitation is all about.

Advocacy is one of the main tools used to mobilize politicians and other partners for a cause. “Advocacy is speaking up, drawing attention to an issue, winning the support of key constituencies in order to influence policies and spending, and bring about change. Successful advocates usually start by identifying the people they need to influence and planning the best ways to communicate with them. They do their homework on an issue and build a persuasive case. They organize networks and coalitions to create a groundswell of support that can influence key decision-makers. They work with the media to help communicate the message”(3).

The future of sanitation and the incidence of sanitation-related diseases rests more on the behaviour of politicians than on sanitary engineers. If we are to have good sanitation programmes and technologies to meet the varying geographical, climatic and socio-cultural conditions found in the world today, we must have national policies on sanitation and funding for research and development.

There are at least two messages we need to get across to politicians and other key partners. Lack of sanitation is responsible for most of the diseases and death in developing countries today. Sanitation together with hygiene education will break the cycles of these diseases. Different messages may be needed for the general public based upon prestige, comfort, convenience and privacy. Whether health should also be a message for the general public will depend upon the outcome of the market research required to target the general public.

This article outlines four basic steps that are essential for effective advocacy.

Steps to effective advocacy

The objective of advocacy is to raise awareness and convince others of the need to take action. To do advocacy well, one must follow a series of time-proven steps.

1. Target audience identification

Successful advocacy begins with the identification of groups that need to be influenced and working out the best way to communicate with each group. For example, different ways to communicate could include personal contact, asking others more influential than yourself to carry your message, through the media (newspapers, television or radio), or through traditional channels of communication such as churches, temples or mosques, festivals or street theatre. The methods are numerous. The key is to work out which methods will be the most effective in reaching your target group.

2. Developing an information base

An effective advocacy campaign requires information that demonstrates the extent of the problem and the effectiveness of the proposed solution. To do this you will need facts and figures. Emotional pleas which are not substantiated will be put aside. Facts and figures provide evidence of the problem and are more difficult to ignore or refute. They also attract the interest of the news media which then gets the attention of the general public. Public attention can influence politicians to act, because if they don't, they risk losing their popular support.

If possible, try to gather location-specific or country data which will show:

- the significance of the problem and its future trend;

- current spending on treating people with diseases related to poor sanitary conditions;

- current spending on sanitation;

- the benefits of sanitation for health, education or other issues;

- that spending on sanitation makes economic sense and is feasible in your country;

- the impact of not taking action (such as on health costs, quality of life, the economy, attendance of girls at school).

Box 1. Some examples of information to have on sanitation

· Percentage of people in the country (or city, town, district or province) without sanitary facilities.

· Percentage of people predicted to be without sanitation by the year 2020.

· An estimate of the number of people (in your country, city or district) who die from diseases related to poor sanitation.

· An estimate of the number of children who die per year (in country, city, or district) from diseases related to poor sanitation

· An estimate of the percentage of children 5-15 infested with intestinal worms.

· An estimate of the number of school days lost per year from diseases related to poor sanitation.

· An estimate of the number of girls who do not attend school owing to lack of sanitation facilities at school.

3. Building a persuasive case

You will be competing with many others for attention. Therefore, you need to present your information or message in such a way that it stands out from the crowd and is so memorable that your target group cannot ignore it. The following are some practical suggestions for increasing the effectiveness of your messages.

· Choose only a few key messages. Multiple messages are not remembered. By keeping to a few messages, your messages will not be competing with each other for attention. You will be able to repeat a few messages more often, making people more familiar with them, more quickly. Your aim is to have your messages become part of local discussion on the subject.

· Keep messages simple. Messages which are easy to understand are much more likely to be remembered than those that require thinking about. You may have only a few seconds of time to put your message across, so it is important that its meaning is clear and easy to understand. Think of your message as something that can fit on a T-shirt.

· Make your messages relevant to your target audience. Information that is linked to a subject area that your target audience is already interested in will be much more relevant, persuasive, and interesting to them. For example, most politicians are concerned about maximising the economic productivity of the country. Therefore, one way to make sanitation messages relevant to them is to present the economic impact of ignoring the problem of sanitation.

Examples of economic messages:

12 000 worker days were lost last year due to diarrhoeal diseases.

Last year's outbreak of cholera cost the country one billion dollars in lost tourist trade.

You can maximise the relevance and interest of your messages simply by looking for ways to frame your sanitation messages in terms of how it might affect a particular target audience's area of specific interest.
· Time the release of messages. Your messages can be more effective if you time the release of them to coincide with another event likely to attract attention. To help achieve this, it is a good idea to make a list of the dates when other events are taking place so you plan your advocacy around them. Other events might include health conferences. World Health Day, World Water Day, International Labour Day, release of new statistics and new documents or reports.

· Say something new. There is a lot of competition for attention. One way to grab attention is to tell your target audience something new. This is often not as hard as it sounds. Sanitation is a specialized field. What may be common knowledge to you is unlikely to be widely known by others. Another way to say something new is to present information from a new angle. For example, sanitation information can be presented to show its impact not just on health, but on education, on equality for women, on earning tourist dollars, on generating business opportunities, and on increasing worker productivity. This can be particularly effective if you link it to issues which are currently attracting a lot of attention.

· Use powerful language. Messages must be strongly worded to be noticed and memorable. They should be a responsible presentation of the facts, suggest the response, and still convey a sense of urgency.

· Say what should be done. Messages should always be presented in a way that makes the audience feel they can do something, otherwise a sense of being overwhelmed and powerlessness to help is created. This has a paralysing effect. Instead your message should indicate that with any little bit of help, progress can be made. Make people feel that their contribution, in whatever form, counts.


An increase in public spending of just one-half per cent will result in expansion of sanitation services to 50 000 more families.

If every citizen gave 2 cents a month for the rest of the year to the sanitation fund, every school in our community could have water supply and toilets.

· Aim for impact. Messages which put a human face to the problem can touch people more deeply. Provide real-life stories, not just ones that show the negative effects but also ones which give hope and show that people, even with very little, can achieve great things. Inspire people into action. Excite them with the possibility of what they can achieve.

· Call for action. Include in your messages what action you would like to see taken. More often than not, your suggestions will be acted on. Community leaders often are busy and helping them with suggestions of appropriate actions enables them to act more quickly.

· Be creative. Doing things differently attracts attention. Study what others are doing in different sectors, in private business, and in other countries. Identify things that worked well and see if you can adapt them to your situation. Not everything effective will be appropriate. You have to consider the sensitivity of the issue and cultural and religious values in your country and make your decisions based on this understanding.

4. Continuous Action

Just as soft drink companies NEVER stop advertising, advocacy for sanitation should also never stop. Populations continue to grow and existing systems need to be maintained. The job is never done, but if advocacy stops, the funds to support sanitation may start to disappear along with public interest.

5. Build partnerships with influential supporters

Advocacy requires that the subject must seem important to important people. Movie stars and presidents of large corporations, for example, should be persuaded to become partners in an advocacy campaign. Some can become spokesmen and women for the cause. How to mobilize partners is explained in Mobilizing partners for sanitation.

6. Work with the media

The media is probably the most influential advocacy vehicle available. By putting the problem of sanitation before the people through television, newspapers, magazines and radio, politicians and decision-makers will take notice. Politicians are very sensitive to public opinion, they have to respond, explain the actions they intend to take, or risk losing popular support. The media, therefore, plays a key role in mobilizing public support and setting the political agenda. How to mobilize the media is explained in Mobilizing the media for sanitation.

BOX 2. Tips for effective advocacy

· Identify the persons and groups you need to influence in order to bring about change.

· Concentrate your efforts and start with those you know are sympathetic.

· Develop an information base of facts presenting the sanitation problem and the solutions.

· Choose only a few key messages.

· Make sure the messages are simple to understand.

· Increase the relevance of sanitation messages by expressing them in terms of their social, economic, and political impact.

· Time the release of your messages to coincide with other events that will attract additional attention.

· Make news by saying something “new”.

· Get support for change by using powerful messages which touch peoples' everyday lives.

· Provide evidence to prove your point.

· Suggest practical actions that leaders could take.

· Inspire people; don't present the case as beyond hope.

· Make people and institutions feel that their contributions can make a difference.

· Attract the attention of the media.

· Multiply your efforts by finding partners, building coalitions and recruiting influential supporters.

· Never stop trying, persistence pays off.

· Be opportunistic, and take advantage of situations which come up to promote sanitation.

· Be innovative and think of new ideas, but don't miss the opportunity to borrow the good ideas of others and adapt them to your own situation.

Box 3. 10 Tips for effective presentations

· Check out the physical set-up of the room before speaking. Note the room size, acoustics, microphone and audio-visual set-up.

· Focus your presentation on one or two main messages. Repeat these main messages in different ways again and again.

· Don't turn your presentation into a recitation of facts and data. Your main message could be lost if you bombard your audience with too much information.

· Practice, practice, practice! The more comfortable you are with the presentation, the more dynamic you will be. Practice giving your presentation before a colleague who can offer comments on how to improve your delivery.

· Make a good first impression. Memorize the first part of your presentation. Be confident.

· Make eye contact with your audience. Change your pace, tone, and hand gestures at key points to make an impact.

· Use powerful visual aids to emphasize main points. One well-planned photograph or chart can be worth a thousand words.

· Make sure overheads or slides can be quickly understood. Avoid complex graphs, small type and lots of words. As a rule of thumb, print no more than 50 words on any visual. Be sure everything can be clearly read from the back of the room.

· Your enthusiasm and concern about the issue will often be remembered more than the words you say.

· Keep to your time limit and allow time for questions. This is a critical opportunity to keep your audience engaged and excited about the topic.

Source: (3).

Monitoring and evaluating change as a result of advocacy

It is crucial to measure whether advocacy and other techniques are achieving change. Indicators of change should be developed for each target group. As an example, a list of indicators of increased political commitment from politicians may include:

- creating a national sanitation policy;
- creating a sanitation department with a responsible chief;
- well-maintained toilets in government buildings; and
- more government funds allocated to sanitation and hygiene education.

Source: (4).

Box 4. Other advocacy techniques

Job performance awards. In Indonesia in 1993 the political commitment of provincial governors was obtained by making the infant mortality rate a factor in assessing job performance. Governors were advised that there were several factors responsible for high infant mortality, a major one being diarrhoeal disease, best prevented by high latrine coverage and good hygiene behaviours. Many governors became more active in promoting sanitation. Awards were given to governors whose provinces have low infant morality rates (5).

Putting sanitation on the agenda of other sectors. In 1994, the Indonesian Department of Health launched the Clean Friday Movement to mobilize the support of religious leaders for sanitation and improved hygiene behaviours. While the movement was targeted at all government departments concerned with sanitation, NGOs, and political leaders, it was designed especially to call upon religious values in creating a clean environment. Religious leaders were asked to lead the movement from their Friday sermons. It was formally launched by the President of Indonesia.

Bringing politicians to successful sites. In 1994, the Department of Environmental Health of Zimbabwe brought political leaders to successful project sites to see progress and hear from communities how success was achieved. Zimbabwe had been conducting field trials of participatory methods and found them very successful. As a result Zimbabwe has decided to expand the approach nationally (6).

National high-level conferences. The Prime Minister of Bangladesh inaugurated a national conference in 1992 on Social Mobilization for Sanitation and Hygiene. Nationally televised, it greatly strengthened sanitation and hygiene promotion in the country. In 1994, the Prime Minister launched a National Sanitation Week to promote sanitation and hygiene nationwide. During the inaugural function, she called for a new Mid-decade Goal of 50 percent coverage by 1995, since the Mid-decade Goal of 35 percent sanitation coverage had been achieved in early 1994. The Minister of Finance immediately responded to the promotion of sanitation by allocating substantial funds to sanitation activities.

Inter-country workshops. In 1994, UNICEF held a four-day Sanitation Workshop for Eastern and Southern Africa in Zimbabwe, in which UNICEF staff and their government counterparts decided on what they could do personally and collectively to promote sanitation (7).

Inter-ministerial conferences. Sanitation advocates in Zimbabwe used the opportunity of a Regional Ministerial Conference in 1994 to produce a statement of intent from the ministers to go for full latrine coverage of the southern African region, with appropriate low-cost designs.

A condition for grants and loans. In 1993, a WHO consultant negotiated into an agreement for health centre equipment that the government build a latrine at each health centre prior to receiving the equipment. The agreement received the highest endorsement from the government, construction began immediately, and latrine coverage of health centres increased rapidly.


(1) WHO. Community water supply and sanitation: needs, challenges and health objectives. Report by the Director-General. Forty-eighth World Health Assembly, Provisional agenda item 32.1. Geneva, World Health Organization, 1995 (unpublished document A48/INF.DOC/2).

(2) WHO/UNICEF. Water supply and sanitation sector monitoring report: sector status as at 31 December 1994. Geneva, World Health Organization, 1996 (WHO/EOS/96.15).

(3) Owens B, Klandt K. TB advocacy: a practical guide 1998. Geneva, World Health Organization, 1998, (unpublished document WHO/TB/98.239).

(4) WHO. Promotion of sanitation. Report of the Sanitation Working Group to the Water Supply and Sanitation Collaborative Council. Geneva, World Health Organization, November 1995 (unpublished document WHO/EOS/95.24).

(5) Mathur S, UNICEF, Indonesia, personal interview.

(6) Mr Temba, Ministry of Environmental Health, Zimbabwe, personal interview.

(7) Sanitation: The missing link to sustainable development. Report from the Eastern and Southern African Region Workshop on Sanitation, Harare, Zimbabwe, UNICEF 1994.