India’s urban water-sanitation crisis is staggering: Less than 50 percent of slums have drainage facilities of any kind, while an estimated 75 million people (approximately 81 percent of the slum population in India) lack access to any kind of toilet. The situation with respect to drinking water is not much better, with the majority of slum dwellers lacking access to consistent and adequate supplies.

In terms of health and safety, lack of basic services extracts a high price. Each year, India logs the highest number of diarrhea-related deaths worldwide; more than 30 percent of all deaths among Indian children under the age of five are diarrhea-related. For children who survive, repeated episodes of illness often result in chronic malnourishment that impacts both their physical and cognitive development.

And children aren’t the only ones at risk. Limited access to individual toilets and community toilets that don’t function—and that are often abandoned and unsanitary, to boot—leave women with no option other than defecating in the open. To avoid being seen, many opt to defecate only at night, when they’re vulnerable to attack.

Other stresses include disputes among neighbors about water-related issues and hours spent standing in queues at public facilities—time that could be devoted to school or earning a living.

A networked approach to change

The Michael & Susan Dell Foundation has supported pilot projects for provision of water and sanitation services to more than 50,000 urban families in India, and our experience has taught us that the hurdles to implementation of successful projects—those that provide sustainable solutions in a given neighborhood or city—span financial, technical, and behavioral complexities.

Moreover, in terms of health, the long-term success of any given project depends on achieving critical mass in terms of the number of households reached in a given neighborhood or slum. Consider: If I have a toilet in my home but my neighbor defecates in the open, then I will still be susceptible to diseases because my environment is not clean.

Likewise, efforts focused on ensuring sufficient penetration in a single neighborhood are typically more cost-effective than spotty efforts spread across an entire city, since the costs of building awareness and demand for technical assistance tend to be diluted over a larger number of households.

As with many issues, engaging a range of players in a networked coalition is critical to achieving lasting improvement. In the realm of water sanitation, here are the important players:

1. Local government: Many slum settlements, especially those that have not been officially recognized by the government, lack pipelines or other infrastructure to support supply of basic water and sanitation services to people’s homes. Local officials must be willing to establish and maintain infrastructure, to approve in-home water and sewage connections (or, where that’s not possible, community facilities,) and to subsidize household-level infrastructure costs.

2. Microfinance institutions (MFIs) must link affordable microloans to water sanitation projects.

3. Slum families must be willing to provide the up-front capital investment in water sanitation infrastructure. (One Ahmedabad study found that having individual households contribute to the costs of the initial infrastructure “inculcated a sense of ownership” of the facilities, which helps ensure maintenance of toilets over the long term.)

4. Community-based organizations must motivate community demand for adoption of new facilities (behavioral change is often the hardest thing to accomplish), mobilize government initiatives, and assist with technical aspects of construction such as materials sourcing and design.

So how can such diverse groups organize themselves into a functional network? In our work, we’ve applied a twist to a well-known tool: systems mapping. Instead of using systems maps to assess project impact after work is complete, we use it as a front-end tool for identifying and selecting urban geographies that have the capacity for both implementation at scale and sustainability.

Based on the evidence from research studies, stakeholder opinions, and our own experience in the water and sanitation space, we have identified four guiding principles in designing a sustainable intervention.

In our next post, we look at how organizations can apply systems mapping as a front-end tool to determine cities’ capacity for change.