The Water, Sanitation and Hygiene Sector in Nepal: A Systemic Approach

According to data from the Multiple Indicator Cluster Survey conducted in Nepal in 2019, 95.4% of the Nepali population had access to a basic water supply , and 94.5% had improved sanitation . However, the coverage for safely managed drinking water and safely managed sanitation stood at just 19.1% and 61%, respectively.

According to data from the Multiple Indicator Cluster Survey conducted in Nepal in 2019, 95.4% of the Nepali population had access to a basic water supply , and 94.5% had improved sanitation . However, the coverage for safely managed drinking water and safely managed sanitation stood at just 19.1% and 61%, respectively. To achieve its Sustainable Development Goal (SDG) target of universal access to water, sanitation, and hygiene (WASH) services, Nepal should adopt a new approach—strengthening systems—to ensure that it can provide sustainable services in terms of both quality and quantity. Monitoring data reveals that only 30% of Nepal’s WASH infrastructure is fully functional. Data on sanitation and hygiene interventions are concerning, too. A few multi-country studies found, for example, that the rates of slippage on toilet ownership sometimes reach 13%.

Strengthening WASH Systems

Across the WASH sector, the challenge of poor post-project sustainability persists and is widespread. Conventional approaches to improving access to WASH services, which focus on constructing infrastructure, training water and sanitation committees, and promoting appropriate sanitation and hygiene behavior, have often failed to achieve the expected results and ensure sustainability. As an approach, strengthening systems considers governance and an enabling environment to be fundamental. This approach can improve both the quality and quantity of service delivery. By focusing on political economy, life cycle costs, and the role of local institutions , strengthening systems can help Nepal meet its SDG 6 targets of universal and equitable access to WASH for all.

No WASH system exists in isolation. Each consists of many factors, including a web of actors and their behaviors. In addition, the political economy, demographic pressure, and decision-making processes in other sectors affect the underlying factors as well as the behavior of actors . WaterAid defines a systems-strengthening approach as “understanding that WASH exists in complex systems with many component parts and within different social, economic, political and environmental contexts. It involves identifying and working to address the barriers in behaviours, policies, processes, resources, interactions and institutions that block the achievement of inclusive, lasting, universal access to WASH” (WaterAid, 2019).

By strengthening systems, organisations can broaden the scale of their impact beyond target communi¬ties and build foundations for sustaining outcomes. For example, when properly designed and implemented, a set of systems-strengthening interventions at the province/municipality level (e.g., strengthening the regulation of service pro¬viders or government monitoring systems) can have a positive impact on every community in the province/municipality, not just on the target communities as those regulations will apply across the board. If lessons learnt locally are shared at the regional and national levels, a systems-strengthening intervention can even have a positive influence on the WASH sector of the entire country.

Use of Building Blocks

Systems-level diagnosis analyses the status of each building blocks of a WASH system. Such a diagnosis includes analyses of the political economy, service level, and root causes. These analyses must be done with local actors at the outset of a WASH system-strengthening effort but should not be a one-off exercise. Because systems are dynamic, analyses need to be periodic to allow for adaptation and to maintain focus on system-strengthening. A participatory approach conducted in collaboration with relevant authorities, community associations, and non-governmental organisation in a workshop setting is generally used to assess the scores of tools. These tools are then – scored periodically to track changes in the WASH system over time. In order to simplify systems analysis, various organisations have come up with different building blocks categorising various factors affecting the system. With reference to the classifications of the IRC and the
International Water and Sanitation Centre, this paper has defined the following nine building blocks:The Water, Sanitation and Hygiene Sector in Nepal: A Systemic ApproachFigure 1: Conceptual framework for WASH system-strengthening

Building block frameworks have played, and continue to play, an important role in supporting WASH system-strengthening efforts. In particular, they help inform policy and investment decisions through one-off analyses. To a much lesser extent, they have also informed ongoing monitoring of progress at the levels of international policy (e.g., UN Water Global Analysis and Assessment of Sanitation and Drinking Water) and national and international commitments (e.g., Sanitation and Water for All), as well as at the level of individual aid programmes and projects.

Each of the nine building blocks is briefly explained below.

  1. Policy and legislation: Policy and legislation helps local governments manage and implement projects the water and sanitation sector and deliver services.
  2. Planning: For sustained progress use a clear framework for preparing plans at all levels of government and all levels of service providers as well clarity on their capacity development.
  3. Institutional arrangement and coordination: The institutions responsible for drafting sector policy and for planning for service provision need to have clearly defined roles and mandates and have the capacity and means for acting in coordination within the WASH and related sectors.
  4. Finance: Sufficient funding is available and is allocated for service delivery. Life-cycle costs must be considered and a source for each component clearly identified.
  5. Service delivery infrastructure: Adopting an infrastructure asset management approach to the planned management of infrastructural assets (e.g., water supply facilities, sludge treatment plants, etc.) maximises the useful lifespans of those assets.
  6. Regulation and accountability: Regulation focusing on economics (e.g. enforcing tariffs and service quality), customer protection (e.g. complaints mechanisms) and competition is an important mechanism to ensure that both users and the environment are protected, marginalised groups have fair access to services, and providers do not abuse their position as monopolies. Accountability refers to holding service providers, elected officials, and others in charge of providing services to ac¬count through informal and formal channels.
  7. Monitoring: Having reliable and up-to-date information strengthens the ability of both national and local governments to assess pro¬gress, identify areas of weakness, and prioritise resource allocation and support. Comprehensive monitoring is critical for strong systems.
  8. Water resource management: Water resource and environmental management refers to the coordinated development and management of water and related resources to maximise economic and social welfare without compromising the sustainability of the environment.
  9. Learning and adaptation: Having a framework and the capacity to capture lesson learnt and adapt and update service delivery approaches and wider building blocks in the face of change is imperative.

The Situation of WASH Systems in Eight of Nepal’s Municipalities

Agenda for Change (A4C) commissioned a study to assess the current status of the eight building blocks above in eight municipalities (palikas) through both an interactive meeting and focus group discussion (FGD). The objective of the study was to design systems-strengthening interventions. Most building blocks were rated either weak or medium, and no palika score the desired level in any building block due to poor state of the systems at local government as shown in the matrix below.

Figure 2: Scores for eight building blocks in eight local governmentsFigure 1: Conceptual framework for WASH system-strengthening Figure 2: Scores for eight building blocks in eight local governments

Limitations of the Approach

Most approaches that have been proposed for monitoring the WASH sector system rely on building blocks to provide a structure for discussing the different actors, resources, and institutions at work and identifying bottlenecks. However, the practical application of this approach for use in ongoing, routine monitoring is limited. Instead, the approach is usually used to support one-off diagnostic or review exercises. Experience from the WASH and health sectors suggests that when building block frameworks are used to monitor sector systems, the following four key risks arise :

  1. The indicators used encourage focusing on what a sector system should look like but do not say much about, or incentivize, improved function within the system.
  2. Dividing up a WASH system into manageable component blocks, as this approach does, may result in overlooking interactions among different sub-systems and across governance levels despite the fact that such interactions improve sector performance and bolster learning, coordination and political commitment.
  3. The block approach may encourage a static view that does not adequately recognise, capture, or measure the sorts of unpredictable changes that are a feature of complex systems.
  4. Aspirating to be comprehensive, as this approach does, does not necessarily help tackle complex problems. In addition, the lack of focus on the binding constraints on system performance may result in undue attention on marginal issues and encourage ineffective responses.


Interactions held with selected local governments about the approach revealed a good deal of skepticism about its efficacy. Officials continue to focus on infrastructure development, and there is no culture of working on system improvement. Implementing the following recommendations can help overcome these limitations.

  • Tackle key constraints that impede performance of the WASH sector.
  • Empower local stakeholders to define detailed indicators for monitoring progress in each of the above blocks as well as any additional, locally specific building blocks they deem necessary.
  • Select indicators that track how institutions function, rather than just what they look like. These could range from quantitative proxies for performance such as non-revenue water to measures that asses users’ satisfaction.


  • WHO/UNICEF Joint Monitoring Program for Water Supply Sanitation and Hygiene: Having improved water sources located on the premises of household or up to a 30-minute round trip away meet the SDG criteria for basic drinking water service.
  • An improved sanitation facility is defined as one that hygienically prevents human contact with human excreta.  Such facilities include flush and pour-flush toilets attached to piped sewer systems, septic tanks and pit latrines, ventilated improved pit latrines, pit latrines with slabs, and composting toilets.
  • A factor is “a non-human element, aspect, or component of a system that directly or indirectly influences system functioning or outcomes”.
  • Actors are the key stakeholders that directly or indirectly influence the system, including public, private, politicians, technocrats, non-state, civil society and users. There are also different ‘levels’ of actors, from national-level authorities (responsible for aspects such as legislation, policy and regulation); ‘service authorities’ (those legally responsible for WASH services in a defined area – which is often, but not always, local government); and ‘service providers’ (those responsible for the day-to-day operation and management of WASH services).
  • Through the Sustainable Services Initiative, CARE NepalHelvetas NepalSplash/Smart PaaniWater Aid Nepal, and Welthungerhilfe support systems-strengthening work in Nepal by supporting local authorities.
  • Policy and Legislation building block is not relevant to local body at this moment because they mostly follow national and federal policies and legislation.
  • Beyond building blocks? Identifying and monitoring dynamic drivers of sector performance Synthesis report March 2019; WaterAid.
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