The typical PR we see for water, sanitation, and hygiene (WASH) programs include something like the following: The new water pump is working and everyone is celebrating. Images of smiling, healthy villagers to show that this community now has access to an improved water source…

Girls at a new water pump in Uganda. Photograph: Whave

What we don’t see is that, often within less than a year, the water pump stops working. The community has no money to pay for repairs, mechanics are unwilling to work before any payments are made, and they aren’t able to find decent spare parts. In this common situation, community members resort to using the contaminated water sources they used before. The shiny new pump – touted in those original photos – becomes another broken, unused tool to walk by.

Collecting water after the pump breaks. Uganda. Photograph: Whave

In another scenario, extension workers launch a hygiene campaign in a community. Everyone is excited and we see excellent hand-washing and improved water handling practices for a while…

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Hand-wash stations like this are generally promoted, and many photos like this imply they are used happily and regularly. The reality is that most are not used, and are broken. Photograph: Whave

..for a few weeks or months. Then soap runs out, hand-washing stations break and repairs are neglected, the posters fade, and households return to their old customs and practices.

We call this a hygiene relapse.

After years of observing this frustrating cycle of promising development followed by broken infrastructure and behavior relapse, along with persistent ill-health and poverty, our organization began looking for true, sustainable solutions to provide safe water that would last after the ribbon was cut.

Whave is a Ugandan social enterprise that takes fundamental practical steps toward elimination of water-borne disease and therefore alleviation of rural poverty. The two routes we saw as vital were daily reliable provision of clean water and improved hygiene and sanitation conditions.

When we started, our first priority was to change the way local technicians thought about their jobs. We discussed with them a new arrangement: rather than to wait for breakdowns to occur and then to engage with villagers in repair contracts, we asked them if they would prefer to do regular checks and prevent breakdowns, without having to negotiate village payments themselves. They enthusiastically took up this new role, and so became “reliable water service providers” rather than emergency repairmen. Later, as they took on more sanitation and hygiene roles they became “WASH service providers.” Since this system was put in place 3 years ago, more than 200 pumps have only lost 1% of operational days, a huge step from the usual average of nearly 50%.

For WASH interventions to have permanent impact several more steps need to be taken. We call these the “Sustainability Steps.” Here’s what we’ve found to work:

Step 1: A business deal with community leaders. We found that most community leaders were tired of the headaches, costs, and diseases caused by pump breakdowns. So we asked if they would pay an annual fee for service checks and immediate repairs. In our experience, the leaders and community members almost always sign on. Our organization operates a “business for development” approach: we are a model service company (non-profit) offering a service level which matches the payment made by the community. So no payment means no service, a smaller payment means less service, and a full payment means full service.

Flavia Balabye, Water and Sanitation Committee Chair Person, Maumo community, Luuka district signing a Service Agreement with a Whave field officer
Flavia Balabye, Water and Sanitation Committee Chair Person, Maumo community, Luuka district signing a Service Agreement with a Whave field officer. Photograph: Whave

Step 2: Government partnerships with “Service Companies.” We found that local government officials at all levels, whether senior or extension workers, understood this prevention approach and welcomed it as readily as the community leaders. Of course that made sense – the constant breakdowns and long downtimes, disputes with mechanics, and overly expensive repairs meant complaints to the government and demands for free repairs, which the government budget is never large enough to satisfy. A preventive maintenance system means less pressure on officials. We’re working with several local governments in Uganda to mainstream the service contract and the WASH service provider approach.

Step 3: Generating confidence through rural banking systems. Almost all villages in Uganda have local laws that oblige everyone to pay a monthly service fee to pay for pump upkeep. Villages have no banks of any kind, so the cash is usually kept in a box in a local leader’s home. It isn’t uncommon for the cash holder to borrow the money for his own needs and not have repaid it when it’s needed for a repair. It isn’t hard to see why almost no villagers actually pay this fee. We felt that it was essential to have a banking system in place that people trust, along with receipts and accountability reports. We talked to mobile phone networks and commercial banks and persuaded them to set up mobile money banking for village WASH committees, an approach that is working well. We also established a banking association for village committees, which works well when mobile phone banking is not available due to network coverage. We are working to normalize rural banking, as a way of increasing willingness-to-pay and confidence that dues are being used properly.

Step 4: Hygiene monitoring as a driver of change. There are a number of different barriers to maintaining good hygiene practices in most villages in Uganda. An obvious hindrance is that because people must walk to far-off collections and carry water back home (piped water is unlikely to serve even 70% of Ugandan families for many years to come), it’s hard to have enough water available for hand-washing.. We also noticed some more subtle relapses: in the name of modernity, plastic mugs rather than locally made ladles are used to draw drinking water from pots, so contamination from scooping is rife. Also the traditional practice of cleaning oneself with leaves in latrines has been abandoned, with nothing to replace it. Kids commonly eat in neighbors’ homes, so hygiene has to be uniform throughout the village to avoid cross-contamination.

It was clear that sustainable change wouldn’t happen without willingness. We asked community members if they would like to participate in monthly hygiene surveys, which also serve as reminder visits, to see what’s working and where improvements were needed. We were pleased to find the communities warmly welcomed this idea. Data from the surveys work to promote pride between villages, reward WASH service providers for their success, and inform local government health workers. After more than two years, it has been interesting to see that the monitoring work does really prevent relapse. In fact we have shown that with regular monitoring (doubling as reminder visits), hygiene levels have continued to rise more than two years after a hygiene campaign has taken place.

We are not alone in the quest towards true sustainability of WASH programs. There are several examples in Kenya: the Safe Water and AIDS Project (SWAP) is implementing a performance-related incentive system with community health promoters; Maji Milele promote preventive maintenance of water sources by local mechanics, and village loan systems for sanitation improvements are being established by UMANDE Trust. We think it’s important to share what we’re learning, so we continue to publish our work and talk about challenges, successes and failures. We’d like to hear what’s working for your community to sustain good WASH practices and we want to share and engage with this information.

Correction: 11 May, 2016. The title of the article has been changed to better reflect the work of the organization written about. Some photo captions have also been edited for clarity but the information remains unchanged.