Review of 'Synergies and Trade-offs between Sanitation and the Sustainable Development Goals'

Importance:

The paper adds a new perspective to the already wide consensus that sanitation contributes to many aspects of development and needs to be managed in a cross-sectoral manner.  By linking sanitation to all the SDGs, it might provide extra justification for the use of international development assistance – which tends to be aligned with the SDGs – to fund sanitation.

Response: Thank you very much for your helpful feedback.

Level of validity:

While the study clearly demonstrates the interlinkage of sanitation with the whole range of SDGs, the recommendations and conclusions seem to draw largely on views established within the sanitation sector, without particular reference to the SDGs.  The implicit hypothesis, that demonstrating synergies between sanitation and the SDGs in general can guide policy and decision-making towards increased prioritisation of sanitation, is not supported, since this would demand comparison with all the other sectors competing for limited resources.

Response: The scope of the study is to identify links between sanitation and the SDGs, and whilst comparing all sectors competing for limited resources would be ideal, we focussed on sanitation as a sector which has been under resourced for a long time. We have re-adjusted the scope in order to better delineate its boundaries, as well as refined the recommendations for future research accordingly.

• In the abstract: “The results demonstrate the far-reaching benefits that can be unlocked from investment in sanitation, which extend beyond health and spread across sectors. The evidence base for the 17 goals establishes links that can inform cross-sectoral action, collaborations and investment across governance levels for integrated sanitation solutions.”
• In the introduction: “The aims of this study are twofold: a) to provide a replicable methodology that establishes linkages with the comprehensive 2030 Agenda and can be applied in specific contexts to demonstrate the wide-ranging benefits of sanitation that extend across sectors and beyond health; b) to establish an evidence base of published material to be further expanded as part of efforts to strategically meet the SDGs. Overall, this paper argues that sanitation plays a crucial role in the achievement of the 2030 Agenda and will be key to developing policies and programmes that support sustainable development.”

• In the discussion: “To practitioners (including funding institutions, private enterprises, INGOs/NGOs and community-based organisations): there is a need to expand evidence on cross-sectoral and multi-level governance collaboration. Practitioners can play an important role in supporting evidence-driven approaches by documenting and disseminating the impact of integrated sanitation interventions. This can be done with support from researchers and used to leverage further funding, in particular for regions and communities currently bypassed by investment. Financing institutions play a fundamental role in supporting the development and scaling-up of innovative solutions for the delivery of adequate, equitable and dignified sanitation interventions through harmonising funding streams to achieve the wide-ranging benefits of sanitation investments evidenced in this study. The private sector, NGOs and community-based organisations will be instrumental in adapting our framework as a participatory monitoring and evaluation tool which can be used to holistically consider impacts of sanitation interventions, socio-cultural factors, and acceptance of solutions.

To researchers: significant research is needed to analyse collaborative investment and intervention models to meet the SDGs. This is key to support practitioners whose resources are often limited to conduct such studies to develop documentation and expand the evidence base. It is crucial to apply the methodology set out in this study in a variety of contexts to build a compendium of case studies with research that reflects realities on the ground and that considers evidence in different languages and goes beyond what has already been published (e.g. verbal testimonies and unpublished data). Similar to Evans and Howard (2019), we argue this would support an enriched evidence base and help to substantiate the wide-ranging synergies between sanitation and the SDGs for a variety of socio-political settings. This requires research that embraces the principles of transdisciplinarity and knowledge co-production with active participation from  multiple actors including policy actors and end-users to incorporate and embed knowledge in concrete political, geographical and socio-economic settings (Lang et al., 2012).”

On resources: we agree that investment is problematic, but that resources exist and need to be better targeted. One key argument we make is that strategic investment means that shared resources can achieve multiple benefits. This is now done more explicitly including in the discussion where we added: “Synergies exist between sanitation and all Targets that consider inclusivity, social diversity and human wellbeing. Hence, cross-sectoral thinking will result in using resources more effectively, thereby encouraging collaboration and reducing conflict over resources.” This statement remains relatively high-level because guidance will be largely context-specific.

Level of completeness:

The authors would appear to have carried out a very systematic and wide-ranging piece of work.  However, in at least one case, a reference (Bartram et al., 2012, quoted in the spreadsheet, and also in box 2) does not appear in the list of references appended to the text.  I am not sure whether this is a mistake, or if the list is only supposed to contain references quoted in the text.  If the former, then I would suggest the authors run a quick check.

Response: Thank you for identifying this mistake (in-Box citations cannot be made in Word), the Bartram et al. (2012) reference has now been added to the list. A new check of all references in the manuscript and in the Excel matrix has been carried out.

Level of comprehensibility:

Apart from a few minor lapses, the text is clear and correct.  A quick proofing could resolve these.

Response: Thank you, we have done this now.

Report:

Sanitation practitioners have recognised for some while that sanitation cuts across sectors, and that successful action on sanitation requires the coordination of many partners. The SDGs represent the consolidated views of many development specialists, so it is not surprising that the SDGs corroborate this finding. The high level of synergies identified (77%) provides further reinforcement. However, to be useful for policy and decision-making, the analysis would need to address the relative priorities of different sectors, and this it does not do. Nor does it examine the potential magnitude of the benefits that could be derived from sanitation. It seems to be written from a sanitarian’s perspective, while aiming to exert influence at the level of overall policy and planning.  It is perhaps relevant to ask who the intended audience is, and what action they are being asked to take on the basis of the paper.

Response: Addressing the relative priorities of different sectors would be beyond the scope of this research, and wording around the scope was therefore revised as detailed below:

• In the abstract: “The results demonstrate the far-reaching benefits that can be unlocked from investment in sanitation, which extend beyond health and spread across sectors. The evidence base for the 17 goals establishes links that can inform cross-sectoral action, collaborations and investment across governance levels for integrated sanitation solutions.”
• In the introduction: “The aims of this study are twofold: a) to provide a replicable methodology that establishes linkages with the comprehensive 2030 Agenda and can be applied in specific contexts to demonstrate the wide-ranging benefits of sanitation that extend across sectors and beyond health; b) to establish an evidence base of published material to be further expanded as part of efforts to strategically meet the SDGs. Overall, this paper argues that sanitation plays a crucial role in the achievement of the 2030 Agenda and will be key to developing policies and programmes that support sustainable development.”

• In the discussion: “To practitioners (including funding institutions, private enterprises, INGOs/NGOs and community-based organisations): there is a need to expand evidence on cross-sectoral and multi-level governance collaboration. Practitioners can play an important role in supporting evidence-driven approaches by documenting and disseminating the impact of integrated sanitation interventions. This can be done with support from researchers and used to leverage further funding, in particular for regions and communities currently bypassed by investment. Financing institutions play a fundamental role in supporting the development and scaling-up of innovative solutions for the delivery of adequate, equitable and dignified sanitation interventions through harmonising funding streams to achieve the wide-ranging benefits of sanitation investments evidenced in this study. The private sector, NGOs and community-based organisations will be instrumental in adapting our framework as a participatory monitoring and evaluation tool which can be used to holistically consider impacts of sanitation interventions, socio-cultural factors, and acceptance of solutions.

To researchers: significant research is needed to analyse collaborative investment and intervention models to meet the SDGs. This is key to support practitioners whose resources are often limited to conduct such studies to develop documentation and expand the evidence base. It is crucial to apply the methodology set out in this study in a variety of contexts to build a compendium of case studies with research that reflects realities on the ground and that considers evidence in different languages and goes beyond what has already been published (e.g. verbal testimonies and unpublished data). Similar to Evans and Howard (2019), we argue this would support an enriched evidence base and help to substantiate the wide-ranging synergies between sanitation and the SDGs for a variety of socio-political settings. This requires research that embraces the principles of transdisciplinarity and knowledge co-production with active participation from  multiple actors including policy actors and end-users to incorporate and embed knowledge in concrete political, geographical and socio-economic settings (Lang et al., 2012).”

On the potential magnitude of the benefits that could be derived from sanitation: this research does not provide quantitative analysis, which would require very complex methods at global level and this is also beyond this research’s scope. However, the matrix highlights a range of studies in which such analyses have been carried out in specific contexts, and this is reflected in the results part.

On the intended audience: we have shaped and now revised the discussion part so specific actions could target different audiences in relation to this study and the way to take it further. The abstract was also revised accordingly: “We propose a range of recommendations to policy-makers, practitioners, and researchers who seek to take this study further to help achieve the SDGs”.

From within the sanitation silo, the paper does support the growing view that sanitation should be delivered as part of a package of basic services, which is a useful silo-breaking concept.  This has been recently examined by Scott, R. et al., 2019, Sustainability, 11, 6706, which found widespread agreement among expert opinion, but a dearth of evidence, possibly due to (a) rather few examples of such interventions in practice and (b) a paucity of published data where they have occurred.  This paper adds to that expert opinion, but also runs up against the same obstacles.  Indeed, in the recommendations to researchers it calls for just such documentation.

Response: Our study provides a strong foundation through review of circa 500 publications in the field as the first step to generating an evidence base. We call for contextual case studies which is the next logical step to generate contextual evidence base. The following sentence was added in the discussion part: “While this study demonstrates the need for governance systems to be strengthened regarding integrated and cross-sectoral action, this requires further efforts around contextual guidance and documentation which is also a gap identified by Scott et al. (2019)”.

The authors applied this approach to Brazil – see the paper published and listed below which evidences grey literature, local policy documents and relevant publications to take the global mapping work a step further.

“Diep, L., Martins, F.P., Campos, L.C., Hofmann, P., Tomei, J., Lakhanpaul, M. and Parikh, P., Linkages between sanitation and the sustainable development goals: A case study of Brazil. Sustainable Development.”

The paper takes many positions which would be widely accepted by sanitation practitioners, such as: “the need for increased understanding of behavioural aspects, such as needs, aspirations, values and acceptance of sanitation services”; “wide-ranging benefits of investing in sanitation”; “addressing the financing gap in sanitation requires either convergence of efforts across ministries or the creation of dedicated cross-sectoral agencies”; or “the need to adopt holistic sanitation systems which consider the entire value chain”.  However, it is not clear how this study of synergies and trade-offs with other SDGs leads to these positions, although it is consistent with them.

Response:  We have now removed the sentence “the need for increased understanding of behavioural aspects, such as needs, aspirations, values and acceptance of sanitation services” and further reviewed other such high level statements. We argue that we demonstrate the “wide-ranging benefits of investing in sanitation” through the multiple linkages established in the study, although recognising the limits of this statement in the discussion part. The argument around “the need to adopt holistic sanitation systems which consider the entire value chain” forms one of the key rationales on which the study is based, and is therefore framed as an accepted assumption in our text. On “addressing the financing gap in sanitation requires either convergence of efforts across ministries or the creation of dedicated cross-sectoral agencies”: this argument is a suggestion emerging from the demonstrated need for cross-sectoral collaboration which comes from results described in part 4) Governance and partnerships for the goals: “At national-level, policy coherence remains an important challenge that requires stronger cross-sectoral collaboration between multiple institutions (Target 17.14) (Georgeson and Maslin, 2018).”

Overall, I found the study as a whole somewhat frustrating in that it fails to provide a compelling argument which decision-makers could use for prioritising sanitation – the “evidence base to inform strategic investment in sanitation and particularly by integrating sanitation interventions into collaborative cross-sectoral development efforts”.  This is a useful and laudable objective, but simply demonstrating the interlinkages between the SDGs does not achieve this. In any case, the challenges to achieving integrated and cross-sectoral action do not arise so much from lack of information, but rather from the practical constraints imposed by limited resources and weak governance systems.

Response: The intent behind establishing the interlinkages and documenting them is to make a compelling case of the wide-ranging benefits of sanitation. We agree that this is not sufficient to make the case for cross-sectoral collaboration which requires other forms of research, so we more simply argue that such collaboration is needed as opposed to claim informing how it should be done through this study. Wording around the scope has now been revised throughout the text as described more in detail in the responses above. The point made – and which we share - on the challenge to achieving integrated and cross-sectoral action that arises from weak governance systems has now been made more explicit in the discussion: “While this study demonstrates the need for governance systems to be strengthened regarding integrated and cross-sectoral action, this requires further efforts around contextual guidance and documentation”. 

Although the foregoing comments may seem critical, this is directed towards the line of argument, and not the conclusions, which I fully share, but primarily on the basis of experience, rather than the linkages with the SDGs identified by the authors. The evidence base that will make a compelling case to policy-makers for an integrated and cross-sectoral approach to sanitation will in the end arise from implementing and documenting it, as recommended by the study.

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