Poor water, sanitation, and hygiene (WASH) access and behaviors are significant contributors to diarrheal disease, which is linked to two million deaths annually.[1] While global progress toward achieving WASH needs is notable, the number of people lacking these essential services remains vast, and progress has been sluggish despite decades of development interventions. Since 2000, access to basic water services has only increased from 51% to 56% in the least developed countries, and basic sanitation access has only increased from 22% to 34%.[2] In response to this slow progress, sustainability has come more into focus in the last decade as WASH sector programming has evolved from a direct service delivery model to a systems approach oriented toward facilitating sustainable service provision through local actors.

USAID’s Ex-Post Evaluation Series

Social Impact (SI) has contributed to the sector’s evidence base on sustainability through six ex-post WASH evaluations that were conducted on USAID-funded activities that had been closed for three to 10 years in Madagascar, Indonesia, Ethiopia, India, Senegal and Mozambique. As part of USAID’s Water Communications and Knowledge Management (CKM) contract, under prime contractor ECODIT, SI’s team assessed which WASH outcomes were durable and what factors drove sustainability.

What was sustained?

Three to ten years after the projects’ close, SI found low or limited sustainability of WASH access and behaviors:

  • Water: 44-65% of rural water points wells (wells, water pumps, etc.) across four countries were still functioning.
  • Sanitation: Use of an improved, non-shared latrine was as low as 2% of households at Madagascar sites and as high as 47% at Senegal sites.
  • Hygiene: 0-31% of households had handwashing facilities with soap and water across four countries.

SI’s team examined four key dimensions: finance, governance, management, and behavior change to determine factors affecting sustainability.

Finance: Adequate and sustainable WASH financing is essential to improve service delivery and meet universal WASH standards and goals. SI found that while financial assistance to service providers in the form of business planning, improved financial management and cost recovery, and credit enhancements had promise, they were insufficient on their own to facilitate financial stability. Programs that incorporated technology such as improved water metering or e-governance tools experienced long-term improvements in financial management and cost recovery – the ability for managers to cover the costs for delivering water services.  

Governance: National government commitment to improving and expanding WASH delivery is a critical foundation for a strong governance framework. Governance-related challenges emerged in all settings; for example, the lack of policies to clarify roles and responsibilities for water point monitoring and maintenance in Ethiopia created challenges for managing rural water points. Government commitment, water tariff setting policies, and land tenure concerns were also significant challenges to sustainability.

Management: Effective management of water services in rural and urban settings plays a pivotal role in long-term sustainability but remains a significant challenge. Community-based management by voluntary committees did not sustain long-term water service delivery, and cost recovery and tariff setting were key barriers to durability.  

Sanitation and Hygiene and Behavioral Change: The low prevalence of basic handwashing facilities emphasized that achieving habitual handwashing with soap is one of the biggest challenges in the WASH sector. Programming did not eliminate open defecation in the long term, and communities relied upon poor quality latrines that constantly had to be rebuilt. Financial barriers were a major impediment to sustained latrine quality, maintenance, and use, though there was some evidence in Senegal that targeted subsidies might help bolster sustainability.


The findings emphasize the collective and intertwined impact that finance, governance, management, behavior change approaches have on the sustainability of WASH outcomes. For USAID’s response to the evaluation series and how they plan to take the findings forward, see their blog post here.

Read USAID’s reports, webinar recordings, and briefs from the series conducted by SI through the Water CKM Activity, including a summary “Synthesis Report” and webinar on USAID’s Global Waters website here.


[1] UN. 2018. Clean Water and Sanitation: Why It Matters. https://www.un.org/sustainabledevelopment/wp-content/uploads/2016/08/6.pdf

[2] According to the United Nations Joint Monitoring Programme, basic water service comes from an improved source (i.e. piped water, boreholes, tubewells, protected dug wells, protected springs, rainwater, or packaged/delivered water) that requires less than 30 minutes round-trip to collect. Basic sanitation is use of non-shared, improved facilities (i.e. flush/pour flush to piped sewer system, septic tanks or pit latrines, ventilated improved pit latrines, composting toilets or pit latrines with slabs). Statistics from UNICEF and WHO. 2019. “Progress on household drinking water, sanitation and hygiene 2000-2017. Special focus on inequalities.”

Photo Credit: Holly Dentz