8080 WP WP

PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES

Innovation and itd Technology for Development UPM Multilateral Investment Fund Centre Member of the IDB Group  ACKNOWLEDGEMENTS

The research team would like to express In : Ministry of Environment, Ministry of their thanks to all those who have made Energy and Mines; Supervisory Agency for contributions to this study, particularly the Investment in Energy and Mining; Peruvian following individuals and organizations: Agency for International Cooperation; Peru Jessica Olivares, Acciona Microenergía Peru; Waste Innovation; Catholic University of Peru; Julio Eisman Valdés, Acciona Microenergía recycler associations in ; and community Foundation; Albina Ruiz Ríos and Timon members in Cajamarca and Lima. Skoddow, Ciudad Saludable; Neil Macleod and Teddy Gounden, eThekwini Water and Sanitation Unit; Isabel Lobos, TulaSalud and In South Africa: Pollution Control Group; Betty Soto, Water For People. VUNA Project; Reinvent The Toilet Challenge and School of Development Studies (all in the University of Kwa-Zulu Natal); HERING South We are grateful to the Inter-American Africa Engineering PTY Ltd.; Johanna Road Development Bank offices in ,Community Health Club; and community Guatemala and Peru, as well as the following members and caretakers at Frasers informal organizations for information and support settlement and Johanna Road informal provided to the case study researchers: settlement.

In Bolivia: Deputy Minister for Water We would also like to thank to the following and Sanitation; National Service for the organizations for their suggestions of Sustainability of Basic Sanitation Services; possible case studies for this project: Asian Sanitation Unit at the Municipality of Development Bank; Global Partnerships; Cochabamba; Center for Water and Energy Division of IDB; Instituto de Energía Environmental Sanitation at San Simon Solar of Technical University of Madrid; Public University; Municipalities of Tiraque and Private Partnerships for Service Delivery of Cuchumuela; community members in UNDP; Red de Telecentros LAC and UN- Cochabamba’s District 9, Pucara Grande, Villa Habitat Basic Services Branch. Victoria and Yana Rumi.

In Guatemala: Ministry of Public Health and Social Assistance; Health Department of Alta Verapaz; Cobán National School of Nursing, Tula Foundation; community facilitators and members in Ixcán (Quiché), Campur and Betania. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

2 3 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 4 5 8 12 16 20 24 28 39 Challenges and possible solutions 1. Innovations 2. 3. Institutionalization ` ` ` ` ` ` TABLE OF CONTENTS OF TABLE Innovative partnershipsInnovative and sanitation: Equitable water to in access services in the municipality of eThekwini, South Africa Inclusive Sanitation Markets: Sustainable solutions in peri-urban areas of Bolivia Saludable The Ciudad : management solid waste Comprehensive model in Peru Introduction in rural communities in Peru energy sustainable to : Access Casa en Luz prevention and training care, medical to : Access Areas Rural eHealth in in Guatemala Methodology Final considerations Final Learning from the models the from Learning ` ` ` ` ` ` ` ` `

 ` ` ` ` ` ` ` ` `  METHODOLOGY

This document summarizes the key disciplinary research team was contracted findings from a case study research project to undertake the case study work. The team carried out for the Multilateral Investment members were provided with training on the Fund, a member of the Inter-American methodology to be used and equipped with Development Bank Group, by the Innovation appropriate guidelines and tools to support and Technology for Development Centre/ their inquiry2. Technical University of Madrid. The project was conducted in collaboration with Building Partnerships for Development in Water Following a desk-based literature review and Sanitation, ONGAWA and the Enlace which provided an initial appraisal of the Hispanoamericano de Salud. The research, model and its context, each initiative was which took place over a twelve month period visited for a period of 5-7 days to document between January-December, 2013, explored its work in practice. The fieldwork consisted five partnership initiatives that have adopted of semi-structured interviews with key innovative ways of delivering basic services stakeholders, focus group discussions with to the poor. user groups, site visits, and the collection of personal testimonies and audiovisual materials. The five case studies were chosen from a long list of suggestions provided by a range of development organizations1. The final Upon completion of the research visits, the selection was based upon criteria such as data was triangulated and carefully revised geographical and thematic diversity; length with each of the initiatives involved. A of time in operation; involvement of non- workshop was also held to look at emerging state actors; financial, technological and findings across the five studies and extract methodological innovations; and results to preliminary lessons learned. date. The original research data was captured in 3 The partnership arrangements were five long case studies . The information from explored in their particular contexts through these studies has been used to provide the an examination of: the rationale for the five case study summaries and infographics development of each model; the range of included in this publication. actors involved; the innovations undertaken; and their financial and operational 2 Stott, L. & Ramil, X. Case Study methodology, Five Case studies for sustainability. An experienced multi- basic service provision to low income populations in and the Caribbean, April 2013 3 The five long case studies are available on www.itd.upm.es and may

ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS 1 See acknowledgments for list of participating organizations also be requested from [email protected]

4 5 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES

8 9 11 12 13 10 . 6 , and significant improvements have have improvements , and significant 5 . The provision of quality basic servicesThe provision . 40 million lack modern electricity services 7 ` ` 100 million people without improved sanitation 100 million people without improved ` 125 million people lack access to health services125 million people lack access to ` ` ` 30 million people without access to safe drinking safe 30 million people without access to water ` 40% of the population “vulnerable”, earning US$4-10 a day “vulnerable”, 40% of the population ` ` ` Latin America and Caribbean the Latin America in numbers 80% of the population living in urban with 111 million in slums areas ` ` . Although regional economic growth in Latin America and the Caribbean has growth economic . Although regional 4

INTRODUCTION

UN General Assembly Resolution, Keeping the promise: united to achieve the Millennium Development Goals, A/RES/65/1, 19 October, 2010 October, 19 A/RES/65/1, Millenniumthe Goals, achieve Development to united Resolution, promise: the Keeping Assembly General UN all: accelerating of dignity for A life UN General Assembly, http://www.un.org/en/mdg/summit2010/pdf/outcome_documentN1051260.pdf. 2013 July, 26 2015, beyond agenda development Nations the Millennium GoalsUnited the advancing and Development towards progress SectorSee Meeting also: report Private Nations United http://www.un.org/millenniumgoals/pdf/A%20Life%20of%20Dignity%20for%20All.pdf. a provide Can the MDGs N. 2010. Kabeer, York, 22 September, New UN Global Compact Office, on the Millennium Goals, Development Forum 2010 UNDP, challenge of intersecting inequalities, The social justice? to pathway America and in Latin Trade Bulletin: International Merchandise 14% in 2010. Statistical of exports to rate 23% compared was In 2011 the growth http://www.cepal.org 2012 1st quarter, CEPAL, the Caribbean, 2013 World, Basic Services all in an Urbanizing GOLD III Report, Governments. for and Local Cities United prosperity in shared Bank, 2011. See also: Shifting accelerate World gears to MobilityEconomic and the Rise American Middle of the Latin Class, June 2013: 15 Bank LAC, World America and the Caribbean, Latin 2012, UN-Habitat Cities, America and Caribbean of Latin State Bank, 2011 World MobilityEconomic and the Rise American Middle of the Latin Class, 2012. http://new.paho.org/hq/index.php?option=com_content&view=article&id=2674 American Health Organization, II, Pan EquiLAC Proyecto %3Aequilac-ii-project--&catid=3452%3Ahss-equilac&Itemid=3720&lang=es Bank, 22, 2013. http://www. March World The remain, but inequalities in access management Day: America leads in water Latin Water World worldbank.org/en/news/feature/2013/03/22/world-water-day-latin-america-achievements-challenges Bank, 30,2012 http://www.worldbank.org/en/news/feature/2012/08/30/ August World The access, the gap in water America: Bridging Latin agua-saneamiento-america-latina Bank. Development http://www.iadb.org/en/topics/energy/energy-in-latin-america- Inter-America America and the Caribbean, in Latin Energy and-the-caribbean,1272.html been above the global average over the last decade over average the global been above A key of ensuring find ways to that basic services challenge is for whom access is reach those structuralby socio- location, distributionspatial such as inequalities limited geographical and while At the same time, or gender disparities. racial and educational, economic background, on US$4-10 a day lives 40% of the population still poverty decreased, regional have rates poverty falling back into vulnerable to are and many been made in the coverage and quality of basic services such as water, sanitation, urban sanitation, quality and servicesbasic of coverage the in made been water, as such transport services still substantial gaps in access to are management, there and solid waste population – the last mile of the the most poor and marginalized for 4 5 6 7 8 9 10 11 12 13

As 2015 draws near, there is wide acknowledgement is there that while the Millennium Development near, 2015 draws As services,basic to access within success their improving in progress solid made Goalshave has often particularly been uneven, countries and regions the poorest reach to in efforts of the poor  for people living in this situation is thus vital for keeping vital for them out of poverty people living in this situation is thus for and driving economic change. Although civil society organizations and service providers share responsibility with national, regional and local government authorities for improving access to basic services14, this role has mainly been assumed by the public sector. In many contexts, however, government bodies are constrained in this task by weak capacity, poor accountability and unstable financial provision. To address this situation, multi-stakeholder partnerships are emerging that offer innovative, locally relevant and sustainable solutions for bridging gaps in access to services. These collaborative arrangements pool the expertise, resources and knowledge of different actors in the public, private and civil sectors, and incentivize those living at the “base of the pyramid”15 to assume active roles in service provision.

The emergence of these new models does not mean the scrapping of traditional service delivery modes. Most partnership programs build upon existing systems by incorporating technological, financial and methodological innovations to extend and improve services to marginalized populations. By working closely with the public sector, these initiatives can also assist governments to provide alternative service modalities and reinforce public confidence in government institutions.

This document provides case study summaries of five partnership models that have successfully extended basic services to hard-to-reach groups through 4P innovations: in Product, Process, Position and Paradigm. The initiatives outlined cover a diverse range of services, including clean energy, ecological sanitation, health, water and solid waste management. In spite of these different focus areas, however, all the models use multi-stakeholder partnership arrangements to promote 4P innovations that provide quality services for those who are un- or under-served16.

4P Innovations

``Product: changes in products or services ``Process: changes in the ways services are created or delivered ``Position: changes in the way services are presented to the user and how these are communicated and reframed by government ``Paradigm: changes in the underlying mental models that shape what the service offers

14 International Guidelines on Decentralization and Access to Basic Services for All, UN-Habitat, 2009 15 Defining the Base of the Pyramid, Inclusive Business, International Finance Corporation. http://www.ifc.org/wps/wcm/connect/as_ext_content/ what+we+do/inclusive+business/news+and+highlights/defining+the+base+of+the+pyramid 16 Tidd, J. & Bessant, J. (2011) Managing Innovation: Integrating Technological, Market and Organizational Change, John Wiley & Sons, http://www. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS managing-innovation.com/teaching.php

6 7 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES . 17 . A social Peru in communities rural in energy sustainable to Access Casa: en Luz enterprise delivering off-grid electricity a pay-for-service through rural areas remote in close interaction upon with the local community. model centered . in Guatemala and prevention training medical care, to Access areas: eHealth in rural rural communities A partnership isolated health service for promotes that improvements (ICTs) personnel, train nursing to Technologies using Information and Communication people. and work with young telemedicine provide Boliviaof . areas peri-urban in solutions Sustainable Markets: Sanitation Inclusive market-driven for An ecosystem sanitation services social that boosts demand through marketing a quality low-cost and creates campaigns service via local entrepreneurs. offer . A Saludable model in Peru Ciudad The management: solid waste Comprehensive partnerships composed of multiple system management waste holistic solid the along and the socio-economic management value chain waste inclusion of recyclers. Equitable services sanitation: and in the water partnerships to Innovative access in and sanitation unit working. A municipal water South Africa to municipality of eThekwini, expand services community activities through outreach and partnerships with academia, and international foundations. the private sector, See for example: http://www.worldenergyoutlook.org/resources/energydevelopment/accesstoelectricity/ and http://recom.wider.unu.edu/ http://www.worldenergyoutlook.org/resources/energydevelopment/accesstoelectricity/ example: See for article/decentralization-south-africa-role-politics The final sectionfinal The summarizes the study of studies. case the five across key It from lessons been developed across have 4P innovations examination of how includes an overarching taken the main steps and their common challenges and possible solutions, all the models, long-term sustainability. ensure to institutionalization of their work in order towards A short overview with a description results of its main activities, of each model is provided partners, highlight of the different the role The case studies also analyze and impact date. to In financial and operational sustainability. and assess their developed, the 4P innovations far how to and scale-up, replication is given attention for understand their potential to order identification of and the each model has become institutionalized key success factors.      The models include: The five initiatives chosen for this study include four models from Latin America and, with Latin America from four models and, include for this study chosen initiatives The five South learning transnational a view from a model to and comparison another region, with water to approach municipal innovative its international for acclaim Africareceived has which Inand sanitation delivery. a context and levels of economic development similar that shares countriesinequality in Latin America with many and the Caribbean,South the African model servicesto basic access decentralization effortsto improve government through showcases region in the LAC serviceand serves effective programs as a useful benchmark provision for 17 DEPARTMENT OF CAJAMARCA, PERU 8080 WP WP LUZLUZ ENEN CASACASA 1,507,486 PEOPLE ACCESS TO SUSTAINABLE ENERGY IN RURAL COMMUNITIES 52.5% POVERTY RATE IN PERU Acciona Microenergía Peru is a social enterprise that has implemented 21.3% EXTREME POVERTY RATE an innovative pay-for-service model. This model will allow them to of rural households still reach economic sustainability, while offering quality energy to low 30% WITHOUT ELECTRICITY income families through Solar Home Systems (SHS) 36% in the number of rural households with access INVOLVED ACCIONA MICROENERGÍA PERÚ (AMP) | ACCIONA MICROENERGÍA FOUNDATION | LOCAL AND NATIONAL PUBLIC to energy (2001 - 2011) ACTORS ADMINISTRATION | MICRO-BUSINESSES | PHOTOVOLTAIC ELECTRIFICATION COMMITTEES (CEF) | RURAL COMMUNITIES

COMMUNITY ENGAGEMENT SUSTAINABILITY The community development process of AMP´s program begins by identifying rural communities currently excluded from the electrical grid in order to prepare for their participation in the program Participation from the community is promoted through CEFs, responsible for coordinating all the different actors, including the final users The Ministry of Energy and Mines has CEFs HAVE BEEN AGREEMENTS SIGNED certified the SHS as an alternative for 85 CREATED SO FAR 13 WITH MUNICIPALITIES energy service in rural areas

80 WP QUALITY SERVICE The SHS installed include 80 Wp solar panels that provide 3 low consumption The default rate in 2012 was 0.19%, 5.91 DAYS decrasing from 3.03% in 2011 AVERAGE WAIT FOR lights and energy outlets for at least 4 hours RESOLUTION OF a day PROBLEMS IN 2012

Users are trained on proper use of 30 TECHNICIANS the SHS, CEFs carry out basic system PROVIDING TECHNICAL supervision and payment management The price structure is based on a ASSISTANCE TO 75 COMMUNITIES and local technicians are trained in system cross-subsidy that allows families installation and maintenance with consumption levels below 100kWh/month a discount financed by those families who have a higher consumption

In 2014 AMP will reach operational BUSINESS MODEL sustainability by providing service to Families pay a monthly fee for the electricity offered, more than 3,000 families maintenance and equipment replacement for 20 years For each SHS installed, the government´s Electrical Social Compensation Fund provides a price subsidy to EXTENSION OF THE MODEL AMP, who then offer consumers a final price adjusted to their level of income The government has launched a program that will install half a million 3,000 12,600 domestic photovoltaic systems SHS IN USE DIRECT BENEFICIARIES throughout the country

AMP has played a key role in developing Peruvian legislation and regulation for isolated electrical systems

39% Acciona Microenergía Foundation has developed an energy program that will install 10,000 SHS in the region of REDUCTION IN AVERAGE +PRODUCTIVE HOURS INCREASE IN ACCESS TO Oaxaca, Mexico ELECTRICITY EXPENSES PER FAMILY +TIME FOR STUDYING MOBILE COMMUNICATION 9 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES that use solar panels to supply residential supply residential panels to that use solar 18 or CEF). In liaising addition to Fotovoltaica Comités de Electrificación

Luz en Casa: Access to sustainable energy in rural sustainable to in rural energy Access en Casa: Luz

Solar Home Systems (SHS) supply residential electricity using solar panels as the main source of power. electricity of power. (SHS) supply residential using solar panels as the main source Solar Home Systems The roll-out of the entrepreneurial program has been importantThe roll-out challenges program of the entrepreneurial in addressing service technical to parts. to of spare and the supply has also responded related AMP cover services boost LED lamps to higher strength improved introducing by consumer demand for lookingis and lighting, requests possibilitythe repair transmit into to phones cell using of Alongside the development of the CEF, AMP has worked AMP capacity-build to members of the of the CEF, Alongside the development communitya network use the SHS and trained to install and maintain to of local technicians instruction also offers technicians qualified for Program Entrepreneurship Technical them. A on opportunities setting up micro-businesses that service for as sell as well installations, adapters. and power mobile chargers bulbs, equipment such as lamps, with AMP on information relating to the Program, the CEF assist with service inspections, tariff service the CEF assist with tariff inspections, the Program, to relating on information with AMP collection of the SHS against theft. and protection Community the CEF has endorsement of similarity their ensure work structures to traditional organizational to AMP’s by been assisted support Explicit the CEF has also been equitable gender representation. for and promote partnership municipal authorities has signed obtained from with whom AMP agreements the installation of the SHS. easy access for and ensure program en Casa that endorse the Luz Close collaboration with community users is ensured through local Photovoltaic Photovoltaic local Close collaboration with community through users is ensured ( ElectrificationCommittees AMP has developed a model in which users pay a monthly fee for the service provided. This the service for provided. a monthly fee a model in which users pay has developed AMP constant that involves program within a comprehensive positioned SHS model has carefully qualityhigh a authorities, municipal and national with dialogue of service installation, capacity-building and the dedicated of local users. operation and maintenance, homes with low consumption lighting and energy outlets for up to four hours a day. The The day. hours a four up to outlets for and energy consumption lighting with low homes has been carriedprogram in two out phases with the initial installation of 1.300 SHS prior to 2012 and a further 1.700 put in place in 2013. 18 Acciona Microenergía Perú (AMP) is a social enterprise that was founded by the Acciona Acciona the by enterprisesocial a is (AMP) founded was that Perú Microenergía Acciona electricitysupply 2009 to in (FUNDAME) of rural inhabitants to Foundation Microenergía provides program (Light at Home) en Casa The Luz the Department in Peru. of Cajamarca electricity Solar (SHS) Home Systems through

communities in Peru communities  and make payments. In this way it is hoped that CEF fee collection systems, which often involve extensive travel and exposure to the risk of theft, will be enhanced.

The development of a positive relationship between AMP, the Energy and Mining Investment Supervisory Body and the Ministry of Energy and Mines has ensured clarity around regulatory requirements and the development of rules and regulations for new energy technologies in country-wide service expansion plans. As a result of this ongoing dialogue at national level, AMP was granted Peru’s first photovoltaic-based electricity concession in May 2012.

Close interaction with the Peruvian government has also meant that the pay-for-service model adopted by AMP is affordable at household level. The standard price arrangement subsidy administered by the Electrical Social Compensation Fund (FOSE), by which users who consume more pay a higher fee that compensates a lower tariff for those who consume less, has been extended to off-grid users receiving services from renewable energy sources. In this cross-subsidy arrangement FOSE compensates AMP with 80% of the tariff so that users only pay 20%. This arrangement allows AMP to assume the costs of service installation, operation and maintenance, and offer customers a fair user fee based on careful prior analysis of economic capacity and ability to pay.

The Luz en Casa program has been well-accepted by the community and the default rate is extremely low. As well as the social benefits of improved access to electricity and mobile communication, the average cost of electricity has been reduced as the service is cheaper than paying for kerosene and candles. Meanwhile, having reached its target of providing a SHS service to 3.000 families, AMP has achieved financial sustainability and a balance between service costs and income from monthly fees.

4P Innovations

``Product: Delivery of photovoltaic technology within a comprehensive service program that includes maintenance, community capacity-building alongside continuous testing of more portable and efficient systems. ``Process: Capacity-building of community users to ensure they understand SHS systems and development of local CEF. Promotion of network of local technicians to maintain the SHS with exploration of further job opportunities related to the service. ``Position: Growth in demand for SHS services as a result of ongoing community engagement and delivery on commitments. Acceptance by government of new energy technologies for isolated rural populations in country-wide service expansion plans. ``Paradigm: Service provision is centered upon recognition of rural communities as users, clients and entrepreneurs. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

10 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 11 Summary of key success factors factors Summary success of key Positioning of SHS within a comprehensive service program that includes communityincludes that service program comprehensive a within SHS of Positioning improvement. and continuous liaison with government capacity-building, SHS proper ensure to local level at and oversight reinforcement technical Constant use and maintenance. subsidy support sectorthe public enable cross dialogue with ongoing Close and to areas. in isolated access a fair tariff and improved for the start with the community from engagement tailoring of with dedicated Proactive roles of their recognition and their specific needs and circumstances, to the program entrepreneurs. and potential technicians as users, the model. and expand improve to Ongoing learning and information-sharing      program, the Peruvian the Peruvian partDue in large en Casa program, impact the positive of the Luz to country. the million SHS throughout a half install to launching a scheme is government While this institutional opportunity,huge a is push particularof understanding contextslocal importantfor users are considerations of different the requirements and adjustment to conscientious tailoring circumstances the specific of its work address to expansion. AMP’s This commitment has its success. and community to has been central needs in Cajamarca in Mexico as it adapts the model in this case, been duly taken using, FUNDAME by on board installation and services for pay in small villages. among families to scheme a microcredit AMP’s close proximity to the community, and its special attention to the features of the specific features the to attention and its special the community, to close proximity AMP’s AMP among users that a perception which it is working, in reinforced environment have opportunities local livelihoods. also promoting while it promises what improve delivers to This learning. of open and continuous a culture the model is also based upon The success of of knowledge, exchanges combines strategy experience and has enabled information and working of way This makeand challenges to well improvements. respond to model the and instrumental in positioning been who have its Director and FUNDAME much to owes and internationally. both nationally en Casa program, and the Luz AMP promoting      ALTA VERAPAZ, eeHEALTHHEALTH ININ RURALRURAL GUATEMALA 78% live in RURAL AREAS AREASAREAS BIRTHS attended by ACCESS TO MEDICAL CARE, TRAINING 1/3 healthcare personnel AND PREVENTION IN GUATEMALA 268 WOMEN DIE for every TulaSalud shows how access to health in isolated rural 100,000 LIVE BIRTHS communities in Guatemala can be improved by using Information CHILDREN do not reach the and Communication Technologies (ICTs) within a flexible and 1/50 age of 5 horizontal multi-actor partnership model 89.6% POVERTY rate ACTORS HEALTH DEPARTMENT OF ALTA VERAPAZ | MINISTRY OF PUBLIC HEALTH AND SOCIAL ASSISTANCE | 46.7% EXTREME POVERTY rate INVOLVED THE COBAN NATIONAL SCHOOL OF NURSING | COBAN HOSPITAL | THE TULA FOUNDATION | TULASALUD

TELE TELE EDUCATION MEDICINE SUSTAINABILITY

Ma Sa Laa Ch’ool? OPERATING COSTS By the end of 2013 the public health system will incorporate the FCs and begin covering their operational costs In 3 years the health system will cover the cost of 1,176 terminals Training of nursing technicians and assistants A community tele-facilitator (FC) attends to 1,176 in rural communities in coordination with the patients Communication Coban National School of Nursing 800 The FCs communicate with doctors by cell terminals 400 covered by the Students come from the local rural communities phone and gather epidemiological information Ministry of Health Staff who speak indigenous languages carry out medical consultations 24 hours a day through 2014 2015 2016 1,282 the telemedicine module in Coban Hospital NURSING TECHNICIANS, ENROLLMENT FEE 73 USD/MONTH ASSISTANTS AND GRADUATES The fee paid by the pupils allows for the CERTIFIED VIA DISTANCE TRAINING 195 sustainability of the training courses FCs HAVE A CELL PHONE EXTERNAL SUPPORT AND CATER FOR : Cooperation agencies such as the Tula 37 Foundation provide financial stability REMOTE TRAINING CENTERS until the project is institutionalized 710 35 RURAL COMMUNITIES TEACHERS INVOLVED IN DISTANCE TRAINING 860 qualified nursing assistants

BETWEEN 2008 AND 2012 THE FCs AT TULASALUD CARRIED OUT: 76% Working, the majority, in the public health system CHECK-UPS MEDICAL EMERGENCY FOR PREGNANT 116,275 CONSULTATIONS 6,783 2,014 TRANSFERS WOMEN MODEL EXTENSION

PREVENTION 98 Funding in 2013 FEMALE LEADERS 29.3% 70.7% TRAINED, WHO, IN TURN, Tula Public Foundation Through the X’beil li HAVE TRAINED : Kawilal initiative, female community leaders train young adolescents in The Government is setting up a health promotion and 750 ADOLESCENTS INVOLVED nutritional surveillance model using prevention IN PROJECTS ON HEALTH mobile phones in 8 Departments AND DEVELOPMENT ISSUES PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 13 . Endorsed by their communities and paid a small . Endorsed by 19

eHealth in Rural Areas: Access to medical care, training training care, to medical Areas: Access in Rural eHealth

stipend for their work the Ministry by communitystipend for Health and Social Assistance, of Public make them to equipped with a cell phone that enables inquiries are facilitators diagnostic doctors and in health centers to and nursing staff based and supply patient information ongoing training. as receive as well hospitals, health education and awareness-raising, TulaSalud and the Health Department of Alta TulaSalud health education and awareness-raising, The program initiative. jointly developed the X'beil have li Kawilal health”) to Verapaz (“path work girls on issues such supports leaders to with adolescent indigenous female young of self-esteem, life-planning improvement and pregnancies, of teenage as prevention decision-making. healthcare in remote areas. The Health Department of Alta Verapaz selects in the areas Verapaz DepartmentThe Health of Alta areas. in remote healthcare which the work will take place and health service then choose basic healthcare providers and communityteams facilitators technicians so that they can provide healthcare in their communities. A tele-education in their communities. healthcare so that theyprovide technicians can alongside a training systems that uses multi-videoconference module has been developed with the selection TulaSalud who supervisestutor as assisting well in person. As the process training in for premises School the Cobán National of Nursing provides of applicants, The Ministry establishes the training and Social Health Assistance locations. of Public remote costs. most of the teaching learning the distance covers courses and for requirements Under the Program for the Extension of Coverage (PEC) Health Service Providers are registered NGOs that are certified are by the NGOs that MinistryPublic registered (PEC) of are Health Service the Extension of Coverage for Providers Under the Program Health and Social Assistance, assigned specific jurisdictions and paid a fixed rate based on population coverage. based on population rate specific jurisdictions assigned and paid a fixed Health and Social Assistance, : In order to ensure long-term change through long-term: In change through ensure to order health protection and prevention Teenage : This component involves supporting component involves This provide local community to facilitators : Tele-medicine : This program focuses on the training of local nursing assistants and on the training of local nursing assistants focuses This program : Tele-education ` ` ` There are three core components to the work of the partnership: components to core three are There In 2008, the Guatemalan NGO TulaSalud established a partnership high address to initiative TulaSalud In NGO the Guatemalan 2008, maternal and infant mortality of rural areas communities in remote among indigenous rates (ICTs). Technologies using Information and Communication Verapaz the Department of Alta health service TulaSalud’s Foundation, Tula supportWith financial the Canadian-based from the Ministrymodel includes the Health Department Health and Social Assistance, of of Public Cobán National School Hospital. of Nursing and Cobán Verapaz, Alta 19 ` ` `

and prevention in Guatemala and prevention  To guarantee the sustainability of their work from the start, considerable efforts have been made by TulaSalud and the Tula Foundation to ensure that the public health system assumes control of the program in the long-term so that the partnership is institutionalized. An Advisory Board composed of all the partners has been established to manage the initiative and promote the active involvement of public health authorities. At the same time the Cobán National School of Nursing has taken over full responsibility for the training of nursing technicians. Although the nursing assistant course is still directed by TulaSalud, the School

issues the qualification, while the8080 WP WPteachers are paid directly by the Ministry. In the telemedicine work community facilitators have now been incorporated into the local rural health system and the salaries of staff involved in the telemedicine service are paid by Cobán Hospital. In addition, questions from community facilitators are referred to personnel in the public healthcare system rather than to TulaSalud.

The work of the partnership depends primarily on financial support from the Tula Foundation. This commitment is viewed as having contributed positively to the stability of the initiative by giving the program sufficient time to achieve tangible results. The Foundation’s long-term monetary contribution has enabled gradual assumption of program costs by the Health Department of Alta Verapaz and the Cobán National School of Nursing as positive results are demonstrated and public funds made available to support activities.

As well as the difficulty of finding donors willing to provide ongoing financial and technical support with the same flexibility as the Tula Foundation, other challenges are emerging as a result of the model’s success. Given the interest in scale-up from national government, one of these is determining the viability of being able to provide the necessary technical and human resource support for an expanded health service network in rural areas. At the same time, as healthcare interventions using ICTs are promoted more widely, coordination between the different agencies involved in these new initiatives will be important.

4P Innovations

``Product: ICTs such as the cell phone, portable ultrasounds and videoconferencing systems used as tools by locally-trained personnel to provide health services in remote rural areas. ``Process: Capacity-building of local community facilitators and young female leaders with careful consideration of cultural factors and community acceptance. ``Position: Adaptation of health services to specific needs of indigenous communities. Gradual adoption of activities by government agencies as a result of demonstrating positive program achievements. ``Paradigm: With appropriate training and support, indigenous actors can support local rural health systems efficiently and effectively. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

14 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 15 Summary of key success factors factors Summary success of key Promotion of local personnel able to provide healthcare services healthcare own their to provide to able personnel local of Promotion communities. of local needs takes account and service that training provision relevant Culturally and realities. costs human and financial support over to take Flexible institutions enabling public time. over and responsibilities new service that so Institutionalizationwith government of working relationships made sustainable. models are Balance between the use of appropriate technology and training so that personnel that so and training technology of appropriate use the between Balance effectively. problems resolve equipped with the capacities to are      The model developed by TulaSalud clearly demonstrates that healthcare in isolated rural rural in isolated clearly that healthcare demonstrates TulaSalud by developed The model backed-up are such initiatives that well- using ICTs, by by provided improved can be areas they localities in which of the a clear understanding personnel with trained and motivated of the community users of the role as healthcare work. and reinforcement Cultural sensitivity, relationships facilitation of cross-sector TulaSalud’s by been reinforced have and providers, the public allow to given Space has also been elements at their center. which place these This flexibility, activities and costs. program take responsibility for over sector progressively to departments government with relevant coordination alongside ongoing regional at local, ensuring to of the partnership the institutionalization has been integral and national levels, and its work.      DISTRICT 9 OF COCHABAMBA, INCLUSIVEINCLUSIVE SANITATIONSANITATION BOLIVIA MARKETSMARKETS 120,000 PEOPLE SUSTAINABLE SOLUTIONS IN PERI-URBAN 85 USD/Month AVERAGE INCOME AREAS OF BOLIVIA Water For People (WFP) promotes the sanitation value chain through 59 Years LIFE EXPECTANCY the installation of Ecological Dry Toilets (BES) alongside which WFP is generating inclusive businesses, creating demand and adapting products for low income families 20% access to SEWAGE NETWORKS

ACTORS WATER FOR PEOPLE | UNIVERSITY OF SAN SIMÓN | MICROBUSINESSES | 15% access to SEPTIC TANKS INVOLVED GRASSROOTS ORGANIZATIONS | FAMILIES | PUBLIC ADMINISTRATION | INTERNATIONAL COOPERATION ACTORS

SOCIAL MARKETING SUSTAINABILITY WFP has designed its strategy around the extension of the BES, a sanitation system that allows toilets to be linked to other products such as showers, sinks or laundry areas Social marketing campaigns are carried out through television, radio and newspapers, as well as through practical demonstrations of systems already in use. Families are informed about different models, financing schemes and, at a later stage, With the support of the firm Casa del proper use guidelines and maintenance Ceramista the design of the BES has been improved and its cost reduced by 45% SAVING 56% OF FAMILIES 34% COMPARED TO CONNECTING PREFER THE BES TO TO THE SEWAGE NETWORK FLUSH TOILETS

SYSTEM INSTALLATION The micro-business Servicio Integral de Saneamiento Ecológico The commitment by Government to (SISE), founded in 2010, is responsible for constructing the BES and provide universal sanitation coverage supplying materials at affordable prices by 2015 could lead to 6,000 new BES potentially being built per year in At the moment families contribute between 72-85% of the total Bolivia value and the rest is paid by WFP

22 25 40% MORE AFFORDABLE MEN WOMEN BES CONSTRUCTION COMPARED TRAINED IN BES CONSTRUCTION TO THAT OF FLUSH TOILETS

SISE has become operationally viable after reaching a minimum demand of EXTENSION OF THE VALUE CHAIN 8 BES per month As the construction cost is The micro-business Unidos por el Cierre del Ciclo Ecológico (UCCE), approximately 50% more than the created for the disposal, transformation and enhancement of waste, average annual salary, 12.3% of the BES sells transformed products (compost and liquid fertilizer) from its have been acquired through a micro- processing plant and in specialized fairs finance program The design of the BES toilet facilitates waste disposal by storing solid and liquid waste in different deposits EXTENSION OF THE MODEL 80 FAMILIES THE ENVIRONMENTAL IMPACT HIRE DISPOSAL SERVICES OF WASTE IS PRACTICALLY ZERO Initial replication in peri-urban areas of Bolivia is taking place in Santa Cruz and Riberalta

The extension of the BES has received institutional support from the Vice- 162 4,000 ministry of Drinking Water and Basic 95% BES INSTALLED LTS. OF WATER PER YEAR Sanitation as well as the National Service for the Sustainability of Basic Sanitation Services BES UTILIZATION RATE PROVIDING A SERVICE TO SAVED BY FAMILIES USING BES AFTER ONE YEAR APROXIMATELY 800 PEOPLE INSTEAD OF FLUSH TOILETS PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 17 Â Â

Inclusive Sanitation Markets: Sustainable Sanitation in solutions Inclusive Markets:

While still incipient, microenterprises emerging from this process include the Servicio this process from While still incipient, microenterprises emerging Integral and Unidos and builds low-cost (SISE) which provides Saneamientode bathrooms, Ecológico Business fertilizer. organic into waste which transforms (UCCE) por el Cierre del Ciclo Ecológico for WFP has, opportunities BES product and service also emerging. are for improvements new BES models at reduced design to workedexample, company Ceramista del with the Casa exploringis and technology, BES improve cost,Universitythe with links made to Simón San of is no electricity. there where the use of solar heating panels in areas The growing take-upThe growing opportunities new employment business and of the BES has led to with and development of toilet the development of microenterprises in the design specialize that construction, services, bathroom maintenance waste of use and management the and bowls, activitiesWFP has engaged in support of these small local businesses, the growth To products. start-upaccessing on advice with entrepreneurs capacity-build to female and male both and marketfunds the deliveryand information, certificated of skills-trainingfor workshops construction.bathroom In order to stimulate demand for the BES and position them as an acceptable and viable the In for demand stimulate to order of WFP has engaged in an process extensive toilet, the traditional flush to alternative partas BES the presenting as well a of As users. potential among awareness-raising package laundry hygiene and domestic that includes a toilet, shower comprehensive area, marketingsocial used has WFP arrangementssanitation domestic the suit that promote to families. particular of different requirements The American NGO Water For People (WFP) People For find new to ways piloting a global initiative is Water The American NGO services sanitation small enterprises income from generate to the whole for throughout the construction and from of appropriate treatment, to disposal chain: from sanitation value In waste. the peri-urban and sale of organic the management to systems of Cochabamba areas (Baños Toilet Dry on the use of the Ecological this program WFP has centered in Bolivia, where in situations option affordable sustainable and a is BES The SecosBES). Ecológicos or however, use, and adoption BES or unavailable. limited are systems sewerage conventional as education as well acceptance, familiarization culturally appropriate ensure to require maintenance. and their care around

peri-urban areas Bolivia of  To encourage an enabling environment for the development of sanitation inclusive businesses, WFP has obtained support for its work from the Vice Ministry of Drinking Water and Basic Sanitation, as well as the National Service for the Sustainability of Basic Sanitation Services. Such connections are also important for obtaining clarity and promoting dialogue around regulatory issues, including forthcoming legislation on the commercialization of organic waste.

8080 WP WP The initiative aims to make a range of products and services available to poor families so that they can access sanitation services without having to depend upon subsidies. The prices range from between US$730 for the construction of a bathroom with a toilet to US$1.171 for a bathroom with a toilet, shower and laundry area. To pay for the BES and ensure their continued use, families are required to make a financial contribution of between 72-85% towards total construction costs. WFP provides the remaining amount, describing this as a “smart incentive,” that enables them to oversee correct installation, use and maintenance of the BES.

Flexible payment options are available for families who are unable to meet the full installation costs, including the possibility of building their own bathrooms with supervisory support from the program. In other cases, costs are off-set by user supply of construction materials. WFP has also sought to make microcredit services available to pay for BES installation. Although this option has been well-received, the fact that lending institutions often require title deeds to secure loans has been a challenge as many properties in the areas where the program operates are still not legally registered. To address this situation, some constructors have provided users with loans directly and WFP is also considering the idea of a guarantee fund to assist those without title deeds to obtain credit.

4P Innovations

``Product: Improvements in the design of Ecological Dry Toilets (BES) linked to business opportunities for related products and services. ``Process: Social marketing and intensive educational work to ensure potential users are fully informed about BES operation and maintenance, as well as support for related business opportunities. ``Position: Promotion of consumer demand through social marketing approach to meet user needs and aspirations. Support from government for promotion of BES and market opportunities related to services. ``Paradigm: Presentation of sanitation in marginalized areas as a business opportunity with market logic that includes peri-urban dwellers as both service users and entrepreneurs. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

18 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 19 Summary of key success factors factors Summary success of key Focus on the whole sanitation value chain and involvement of all related actors. of all related chain and involvement value on the whole sanitation Focus package domestic hygiene Social of a comprehensive marketing and promotion the particular to tailored and means of individual families. needs the use of a new promote to work Close and ongoing community development microenterprises. product and support of related the development actors different an intermediary bring together able to by organization Coordination with government. relationships positive and foster Use of business incentives and market opportunities of business incentives position non-traditional Use to servicesanitation the poor. for options           In view of government plans to ensure universal sanitation coverage by 2025, the WFP WFP 2025, the by Incoverage sanitation universal ensure view plans to of government national expansion. By as a sanitation for positioning access to potential has real initiative a new service communitymarket endorsement for created WFP has delivery opportunity, and capacity- in awareness-raising role pivotal upon the organization’s This has relied model. position a newbuilding to product, support business opportunities inclusive it, and around its work. bring reinforce actors all the relevant in the sanitation value chain to together In take to order opportunitiesof these advantage an upon WFP insists its work,and improve Itopen learning culture. is an active participant such exchanges information in multi-level which generates Knowledge Sustainable Sanitation as the Decentralized a platform Node, knowledge as wider in Bolivia, as well and capacitysanitation systems sustainable around international linkages. WFP’s model is now being replicated in other peri-urban from with assistance of Bolivia being replicated is now model areas WFP’s Internationalthe Swedish Opportunities expanding Development Cooperation Agency. for markets compost organic to being also related initiatives are through areas the model in rural Development Bank.supported Investment the Multilateral Fund/Inter-American by 80 WP 80 WP PROVINCE OF LIMA, COMPREHENSIVECOMPREHENSIVE SOLIDSOLID PERU 8.5 MILLION PEOPLE WASTEWASTE MANAGEMENTMANAGEMENT of solid waste goes to 34.2% landfills or is recycled THE CIUDAD SALUDABLE MODEL IN PERU Ciudad Saludable has become a catalyst for change within 108,594 RECYCLERS the national solid waste management system, combining the of recyclers live with creation of inclusive business, the social insertion of recyclers 86% under 1.25 USD per day and environmental impact for the cities 30% of recyclers are WOMEN ACTORS CIUDAD SALUDABLE | PERU WASTE INNOVATION | HEALTHY CITIES INTERNATIONAL | CENTRAL AND MUNICIPAL GOVERNMENTS 36% of recyclers are INVOLVED | RECYCLERS | DONORS | COMMUNITIES | BUSINESSES | EDUCATIONAL INSTITUTIONS | MEDIA | SOCIAL ORGANIZATIONS concentrated in LIMA

POLITICAL ADVOCACY SUSTAINABILITY The Zero Trash Program supports municipal legislation by promoting recycling, training local civil servants and providing technical assistance to improve waste management

INCENTIVE FOR PUBLIC ADMINISTRATIONS: To develop an integral solid waste management model with the participation of recyclers Peru is one of the first countries to IN 2010 A SOLID WASTE MANAGEMENT LAW WAS PASSED have passed a law regulating the work THAT PROMOTED THE LEGAL INTEGRATION OF RECYCLERS of recyclers

SOCIO-ECONOMIC INTEGRATION The Pro-Recycler Program encourages partnerships among recyclers, promoting the creation of micro- businesses and favoring their socio-economic integration Recycling Work Groups have been created that bring together recyclers, INCENTIVE FOR RECYCLERS: businesses and the public sector in Socio-economic inclusion and substantial improvements order to improve waste management in living conditions and promote inclusive businesses Ciudad Saludable is developing a system to guarantee the quality of the 637 33% +24 service provided by recyclers in waste RECYCLERS WOMEN ASSOCIATIONS management programs FORMALIZED CREATED

ENVIRONMENTAL AWARENESS The Environmental Citizens Program combines training with the promotion of better environmental practices among To promote implementation of the households, schools, businesses, communities and universities model, funds transfered from the central to the municipal governments INCENTIVE FOR USERS: are linked to meeting recycling goals Creating a clean and healthy environment within their neighborhoods

IN THE DEFAULT RATE FOR WASTE MANAGEMENT SERVICE PAYMENTS EXTENSION OF THE MODEL

IN THE MUNICIPALITIES OF SAN JUAN DE MIRAFLORES, VILLA MARÍA DEL TRIUNFO, VILLA EL SALVADOR AND LIMA CERCADO: Ciudad Saludable’s model is being adapted in Brasil, , Haiti, India and the Dominican Republic

320 35 57% 74% The Ciudad Saludable Group has JOBS MICRO-BUSINESSES been created with the participation of the firm Peru Waste Innovation INCLUDING GREENHOUSES, ORGANIC OF RECYCLERS INCREASED IN THE NUMBER OF RECYCLERS and the Healthy Cities International COMPOST PLANTS, RECYCLED PAPER THEIR INCOME TO MORE WITH ACUTE DIARRHEAL DISEASES Foundation located in New York COMPANIES AND SANITATION LANDFILLS THAN 2 USD/DAY PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 21

Comprehensive solid waste management: Ciudad The solid waste Comprehensive

engages in activities with the wider public to Program Citizens Environmental The Environmental management. Local In about waste awareness the community, promote collection, and manage solid waste separate to been formed Management have Committees market recyclable participate materials, the monitoring in of microenterprises established by that cannot be recycled that solid waste is disposed of in controlled and ensure recyclers, to assist Partnerships with local and national businesses also been created have landfills. Collaboration with educational separation systems. and implement waste design them to and training activities Research about recycling. school children teaching institutions involves also carried management are waste such as the Pontifical to out with universities related Catholic University of Peru. assists recycler collectives to create formal associations and to associations and to formal assists recycler create collectives to Program Pro-Recycler The Ciudad and recycle manage collect, businesses that solid waste. develop inclusive process, able recyclers (small vehicles with equipment such as motofurgones Saludable provides and training microcredit transport narrow finance through negotiate access to to routes), advice such as occupational health, business on topics both men and women for programs In separation. and courses waste solid in development classroom to addition professional and makes the program use of virtualworkshops, and community learning activities platforms that support of recyclers. the social inclusion aims to change policies and practices by promoting an integrated an integrated change policies and practices promoting aims to by Program Trash Zero The and disposal reuse the generation, handling, management that covers of solid waste system It general public businesses and the of waste. governments, works local and regional with recycled of is disposed materials and that unusable waste are that all reusable ensure to on solid waste the implementation of local legislation To guarantee landfills. in controlled workshops municipal staff with training and management, Ciudad Saludable provides management systems. local waste improve assistance to technical The NGO Ciudad Saludable has established an integrated model for waste management in management waste for model integrated an established has Saludable Ciudad NGO The solid the entire address to The model seeks Peru. across in 20 cities operates Lima that now linking by chain value waste key three together advocacyelements: to municipal-level at inclusion social and economic management system; solid waste a comprehensive reinforce set a diverse these themes, address To awareness-raising. of recyclers; and environmental of partnership arrangements between stakeholders central, as private such companies, recyclers and local government, and communities has been educational institutions, regional cross-cutting three programs: channeled into

Saludable model in Peru  The model is financed from a number of different sources. In 2012, nearly 90% of Ciudad Saludable’s funding came from donor and government grants, and the rest from public funds and waste management consultancy activities offered to businesses and government institutions. Of the money obtained from grants and service revenue, 32% is assigned to cover core costs. The remaining amount is used for the development of activities.

To further ensure financial and operational sustainability, the Ciudad Saludable Group was established in 2009 with the aim of sharing information about the model worldwide and raising funds for the implementation of its activities. The Group was founded by Ciudad Saludable in partnership with Peru Waste Innovation, a service company that undertakes organizational and technological consulting projects to support Ciudad Saludable financially, and Healthy Cities International, a New York-based foundation responsible for dissemination of the Ciudad Saludable model and international fundraising.

Ciudad Saludable’s advocacy work has contributed to the comprehensive focus of Peru’s General Law for Solid Waste, one of the first national laws to integrate regulations for recyclers. The transfer of funds for waste management from central to municipal government has also been successfully linked to recycling goals. Meanwhile, community awareness about waste management as a result of Ciudad Saludable’s work has contributed to a decrease in the default payment rate of municipal solid waste management taxes.

Recycling Work Groups have also been created to bring together key actors to facilitate appropriate waste management and promote inclusive businesses related to recycling at district and national levels. Through these Groups, recyclers and exporters of products made from recycled waste have been able to join together to push for exemption from taxes on purchases related to the sale of small-scale solid waste.

4P Innovations

``Product: Training via virtual learning platforms and the provision of motofurgones to collect and transport waste so that recyclers are provided with opportunities to establish formal associations and create microenterprises. ``Process: Awareness-raising and capacity-building activities for all actors in the solid waste value chain. ``Position: Reappraisal of waste as a business opportunity and inclusion of regulations for recyclers in regulatory framework for solid waste management. ``Paradigm: Comprehensive solid waste management model that operates throughout the value chain and integrates recyclers as users, clients and entrepreneurs. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

22 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 23 Summary of key success factors factors Summary success of key Reappraisal of waste in order to support to in order recycling. business opportunities of waste Reappraisal to related whole waste the service addresses that system of a comprehensive Development chain. value management capacity- with education, inclusion of recyclers on the social and economic Focus building and business support. waste and improve recycling with multiple actors promote Partnerships to systems. management with municipal and and relationships Groups Work Institutionalization via Recycling policy changes in promote and practice. to in order government national      Ciudad Saludable has successfully facilitated the development of a model with recyclers the development facilitated Ciudad Saludable has successfully at chain. Its management value arrangements the solid waste of collaborative across the core and educational activities awareness-raising by has been reinforced approach comprehensive to institutions government with engagement continued and actors, of range wide a with Peru. management across waste for regulatory a positive environment promote Endorsed by ongoing knowledge has raised Endorsed by the Ciudad Saludable initiative exchange, in in a range of countries the world and is currently being replicated throughout interest the DominicanRepublic with support InvestmentMultilateral the Fund/Inter-American from adaptation and scale-up for While the potential Development of the model is high, it is Bank. the complex understanding of important that its success is based upon a profound note to continuous has made Ciudad Saludable recyclersby faced and challenges in Peru. issues workingto resistance of these collectives and perceptions negative overcome with effortsto in championing founder and active Saludable’s of Ciudad leadership The committed them. the rights in the model. international of recyclers interest has also ensured In order to improve its work and ensure sustainability, Ciudad Saludable has recently has recently Ciudad Saludable sustainability, work its ensure and In improve to order a results- and scorecard use of a balanced including the a seriesimplemented of changes, participatory includes the This of design program. each for system based management of follow-up ongoing close and responsibilities activities specific actor’s of each analysis with as training recyclers well in leadership skills As activities. quality and developing a guaranteed the initiative service recyclersumbrella, Saludable the Ciudad under operate that for system model can furtheris also looking Group Work support the Recycling at how comprehensive at district management as outside Peru. waste as well levels, and national      MUNICIPALITY OF eTHEKWINI, INNOVATIVEINNOVATIVE PARTNERSHIPSPARTNERSHIPS SOUTH AFRICA ININ ACCESSACCESS TOTO WATERWATER ANDAND SANITATIONSANITATION +3.7 MILLION PEOPLE EQUITABLE SERVICES IN THE MUNICIPALITY OF eTHEKWINI, 34% INFORMAL households SOUTH AFRICA eThekwini´s Water and Sanitation Unit brings together academic 31% POVERTY RATE research, private business services, technological innovation and community participation, through multi-stakeholder partnerships, 92% access to WATER offering each of them the right incentives

ACTORS ETHEKWINI WATER & SANITATION SERVICES (EWS) | UNIVERSITY OF KWAZULU-NATAL | WATER RESEARCH 76% access to SANITATION INVOLVED COMMISSION | WATER AND SANITATION FIRMS | COMMUNITY REPRESENTATIVES | INTERNATIONAL DONORS

PARTNERSHIPS WITH THE PIT LATRINE EMPTYING: PRIVATE SECTOR 5 SUSTAINABILITY The municipality signs contracts with the CONTRACTS WITH FIRMS private sector to, among other services, manage sewerage and wastewater 125 treatment or empty pit latrines COMMUNITY MEMBERS EMPLOYED INCENTIVE FOR FIRMS: Clear and transparent online bidding processes Community participation to ensure 35,000 adequate service and correct use of LATRINES EMPTIED systems

PARTNERSHIPS WITH ACADEMIA Scientific, technological and social research UNIVERSITY RESEARCH analyzes the viability of the systems, user ALLOWS EWS TO DESIGN ITS PROGRAMS BASED Innovative designs in water and perception and social acceptance ON THE REAL NEEDS sanitation systems in order to reduce OF COMMUNITIES environmental impacts INCENTIVE FOR UNIVERSITIES: Research carried out in a practical context

PARTNERSHIPS WITH CROSS-SUBSIDIES COMMUNITIES 17 EWS is successfully implementing User platforms and focal groups participate USER PLATFORMS the central Government’s initiative in the supervision of services and problem to establishing a cross subsidization system that guarantees access to solving water services for the poorest families The ‘Water Detectives’ program in schools 80,000 The first 9,000 liters of monthly educates students on the protection and BENEFICIARIES OF URINE- consumption are free for those preservation of water DIVERSION TOILETS households whose property is valued at less than 24,900 USD

INCENTIVE FOR USERS: Fees for water consumption vary Job creation through the private sector or 95% STILL IN USE depending on the pressure system of the municipality each household, and they increase in cases of industrial or commercial use

PARTNERSHIPS IN PRACTICE EXTENSION OF THE MODEL

Municipalities in South Africa, as well as other countries, are replicating and adapting eThekwini´s approach 3,500 UNIVERSITY 480 JOBS RESEARCH JOBS The Municipal Institute of Learning, EWS has brought together different actors in a pioneer platform for knowledge order to build 400 community ablution blocks CREATED ON THE USE FOR COMMUNITY FROM CAB OF CABs MEMBERS IN CAB management, is used to share the (CAB). Each block is equipped to provide service CONSTRUCTION MAINTENANCE experience of EWS for 50 to 75 families living in informal settlements CONTRACTS PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 25

Innovative partnerships in access to water and sanitation: partnerships to water access in Innovative

The community the service piece is central to delivery EWS. by adopted strategy In order and socio-economic geographic meet diverse to simultaneously to made efforts are needs, job opportunities, In infrastructure, appropriate education and training. provide informal the assisted have residents housing, formal awaiting are residents where settlements The EWS model is centered upon understanding and meeting the right incentives for different different The EWS upon understanding and meeting the right for incentives model is centered partners and sanitation services.Water contribute water partners to to Academic include the Group Research Commission and the UniversityResearch of KwaZulu-Natal whose Pollution works with EWS undertake to trans-disciplinary and sanitation delivery. on water research also afforded out their work and are test in practice able to and at scale, are Researchers opportunities projects with international partners work edge research to on cutting such as undertake sector partners, meanwhile, Private service MelindaBill and the Gates Foundation. emptying the and of deliverywastewater, and sewerage of activities treatment as the such for beneficial are such relationships as clarity well procedures, tender As pit latrines. around with the community job creation. relationships through building positive The approach developed by EWSregulatory by developed The approach a positive within the confines of has evolved services and sanitation water that has clear frameworks at national level for and water regime minimum with a customers poorer provides Policy Water Basic management. A Free resource quantity and sewageservices disposal of water at no cost. In these guarantees, addition to EWS has further and extended and sanitation services water improved upon the drawing by skills, academia, donors capacity civil society, different and of the private sector, knowledge These partnerships enabled EWS have work to on a range of mutually and the public sector. issues while developing health and environmental social, that address initiatives reinforcing those without services. facilities for appropriate In South Africa, uneven access to water and sanitation across different socio-economicIn different South and sanitation across and Africa, water access to uneven further has been post-apartheidracial groups by boundary complicated geographical changes populations in municipal increase a massive led to which have and urban migration, in the eThekwini situation is clearlyThis manifested basic services.for and demand people some 2.6 million Metropolitan by Municipality population has increased the where To rural areas. settlements and since 2001, with most new inhabitants living in informal of extendingthe challenges service and sanitation that address water and ensure coverage, and Water eThekwini met, adequately are groups community needs of different the diverse (EWS)Unit Sanitation serviceof system a developed has innovative upon based provision multi-stakeholder partnerships.

Equitable services in the municipality of eThekwini, South Africa servicesEquitable the municipality in of eThekwini,  construction of Communal Ablution Blocks20 which, in turn, has provided job opportunities for caretakers who supervise their proper use. In areas where pit latrines are in place, private companies have subcontracted members of the community for pit emptying, while in rural areas with few facilities the introduction of urine diversion toilets has been accompanied by an extensive hygiene education and behaviour change program.

Community engagement has been further promoted through User Platforms that participate actively in water services monitoring and conservation activities. Platform members are provided with a short cross-disciplinary training course on basic legislation, water and sanitation policy, environmental conservation and hygiene issues. Community representatives also participate in Focus Groups that address the specific needs of groups such as people with disabilities. In schools, meanwhile, young pupils are involved in educational activities related to water protection.

In line with the national Free Basic Water Policy, EWS provides indigent families and consumers whose properties are valued at less than 250.000 South African Rand ($US2.500) with 9 kiloliters of free water. A progressive block tariff structure is applied for other domestic consumers based upon the type of connection and the amount of water used over a 30 day period. This means that those who consume most water pay a higher price for it. The low bill payment default rate indicates that tariffs are affordable and that customers are willing to pay the established fees. In addition, information on tariffs is made accessible to consumers via the Municipality’s website and offices, and customer call centers report high levels of satisfaction with the service generally.

As a local government entity, funding for EWS and its activities comes from municipal budgets. However, the development of new initiatives is also made possible with additional finance from external research and donor agencies. Some examples include the Valorization of Urine Nutrients in Africa and Reinvent The Toilet Challenge projects which are funded by the Bill and Melinda Gates Foundation with support from the Swiss Federal Institute of Aquatic Science and Technology. 4P Innovations

``Product: Development of tailored socio-environmental sustainable technologies and products through links with different community groups and other partners. ``Process: Building of multi-actor partnerships based upon experimentation and learning, with community involvement in user platforms, focus groups and research links with academia. ``Position: Delivery of variegated services to meet different community needs. Wide acceptance of partnerships as viable business models for delivery of services. `` Paradigm: New product, service and business model in which multiple actors work collaboratively to deliver quality services that support local livelihoods. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

20 Shared water and sanitation facilities in female and male blocks that contain toilets, urinals, showers and basins for washing hands and laundry facilities. 26 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 27 factors Summary success of key Establishment of multidisciplinaryEstablishment and multi-actor partnerships health link social, that issues with service provision. and environmental partners the particular their of potential on addressing ensure to incentives Focus and participation.commitment and practice-based that sensitive, culturally approach of an affordable, Development community and specific needs. different addresses and capacity-building to Linking with job creation development of infrastructure sustainability. ensure are improvements learning so that evidence-based of continuous and Use research start able to are scale. at made and initiatives           The highly effective model developed by model developed EWSby the vision and been made possible has The highly effective a As ideas and approaches. innovative space for has created dedication of a leadership that set of multidisciplinary a diverse result, and multi-actor partnerships practice- has generated decision-making strategic based learning service appropriate that informs and ensures eThekwini community the needs across Municipality. a vast range of different for provision the replicate to In attempted municipalities in South Africa, have consequence, and beyond, EWS in their specific contexts. some of its approaches model and adapt As transfer of knowledgeof transfer expertiseand As EWS model, the of success the to aware central is is and managerialtechnical to encourage mid-level skills required efforts are that greater for staff transitions. demand increased Other challenges include fully for more and prepare population, and possible changes in services and better more a continuously growing from elections. personnel and budgets following areas, municipal focus To ensure the continuity of funding for service improvements, ongoing efforts are made made serviceefforts ongoing are continuity the ensure for funding of improvements, To the projects undertaken. from outcomes positive sharing demonstrate to of Proactive international and learning regional national, through assured is and results information knowledge including the Municipal a collaborative Instituteexchanges, of Learning, EWS by developed government capacity. enhance local management platform which aims to  LEARNING FROM THE MODELS

This section summarizes key lessons from the five models in order to provide further insight into their potential for replication and scale-up. Its overarching premise is that the transfer of learning about how the models work in their specific and dynamic contexts is central to an assessment of how far they, or elements of them, might be extended. While it is clear that “one size does not fit all”, by sharing the learning from these different experiences, the models, or specific aspects of them, may be adapted, expanded or used to inspire the development of new initiatives that assist access and delivery of basic services to the poor elsewhere.

The ability of the initiatives to test innovative solutions in their particular environments, and ensure that the changes they promote are sustainable, is at the heart of their success. In order to explore how the models have achieved this it is necessary to examine:

``1. The different 4P innovations that have been introduced; ``2. The challenges faced and solutions for addressing these; and, ``3. The steps taken to institutionalize the models and ensure sustainability. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

28 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 29 As well as building holistic programs, the as building holistic programs, well As also workedmodels have constantly to the products and servicesimprove that they response in largely These changes are offer. coupled clients and are demands from to not that costs are with effortsto ensure example, for In AMP, of increased. case the LED lamps that boost electric are power WFP has promoted while being introduced, BES models that the development of different in needs family specific fit to adapted be can InCochabamba. respect,this emphasis the that has been placed upon a flexible choice qualityof servicethe to respond that options particular and expectations of requirements end users in poor communities is different also a product innovation. 21 Product innovations Product  eHealth in rural areas: access to medical care, training and training medical care, to access areas: eHealth in rural prevention in Guatemala prevention  21 The models in this study have innovated innovated The models in this study have adapting or building upon existing by products or services, the use often around their work the same time, At of technology. on ensuring that products is also focused part and their use are of overarching rather than standalone or systems programs devicesor interventions. Some of the most shown are product innovations exciting ICTs case where in the Guatemala such as portablethe cell phone, and ultrasounds been have systems videoconferencing locally-trained personnel to by used as tools health servicesprovide rural areas. in remote “…The use of ICTs has been a means to achieve an use of ICTs “…The end and not an end in itself.” An analysis of the innovations promoted by the models in each of the four overlapping areas areas overlapping the models in each of the four by promoted An analysis of the innovations below. is provided While the models differ in their emphasis on particular of them has been each differ While the models innovations, innovations These Paradigm. and Position Process, Product, activeareas; 4P the of all in doing by - radically and better, something doing by - incrementally achieved been have from linear process a followed have the initiatives none of Interestingly, different. something Instead, found been has space innovation. paradigm and position to productprocess and and together experimentto come actorsworking of with new ways different at different for has clearly of innovation conceptualization enhanced the This broad levels simultaneously. to access wider guaranteeing in ability maketo models the all of difference sustainable a basic services. 1. INNOVATIONS 1. ÂÂProcess innovations roles in encouraging new approaches and facilitating relationships between different “Good coordination and the presence of institutions actors. This has involved special emphasis on and facilitators that promote collaboration among working with government so that efforts are different actors are necessary for ensuring the efficient use of resources.”22 streamlined with public sector systems and plans.

The central process innovation of all All the promoter organizations have clear and the models is their adoption of flexible realistic expectations of their stakeholders. In collaborative processes in which actors from the Luz en Casa case, for example, community the public, private and civil society sectors users have been capacity-built to ensure work together to provide and improve that they understand the SHS systems that services. This approach is best illustrated provide them with electricity, a network of by the EWS model in South Africa where local technicians has been promoted to partnerships are constantly evolving through maintain them, and job opportunities related experimentation and learning links between to the service are being explored. In Bolivia,– local government, academia, the private meanwhile, WFP has used social marketing sector, donor agencies and community alongside an intensive education program groups. so that potential users are fully informed about BES operation and maintenance, and The partnerships in this study have emerged options for business development around its as the result of exhaustive examinations of use. each operational context, with careful study of geographic, cultural, political, economic, Other process innovations include social, organizational and institutional responsive ongoing review systems that factors, and examination of prior experiences are built in from the start and encourage to inform their work. Such research has led feedback from all actors in order to to an ongoing and proactive connection make improvements. Comprehensive that informs, raises awareness and capacity- appraisal processes are demonstrated builds actual and potential clients, as well as through access to documentation, partners. encouragement of progressive reiterations, and the institutionalization of learning. The leadership and mediation role played AMP, for example, is renowned for its open by promoter organizations has been information-sharing, WFP is an active central to the development of process participant in national and international innovations. TulaSalud, WFP, AMP, Ciudad networks, and EWS has promoted a range of Saludable and EWS have all acted as change learning connections to share its knowledge agents by assuming vital intermediary and experience.

22 Inclusive Sanitation Markets: Sustainable solutions in peri-urban

ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS areas of Bolivia.

30 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 31 24 Paradigm innovations innovations Paradigm  Light at Home: Access to sustainable energy in rural communities in communities in rural sustainable energy to Home: Access at Light Peru.  24 "...The focus is on the commitment and the focus is on the commitment "...The obligations of the users..." beyond moves of innovation This form ways simply positioning new and different to basic servicesof providing the poor, to overarching the and redefining changing in which these servicessystems delivered. are been has users end of Inrole the models, the all re-conceptualized involvement their with in the development and as active players operation of new services, than as rather or beneficiaries. recipients In the cases of AMP, example, for WFP and Ciudad Saludable, basic service upon the is centered provision such as remote groups idea of marginalized rural or peri-urbanrecyclers and dwellers as hitherto marginalized collectiveshitherto in service marginalized important requires models to ensure efforts the to is given attention that government Inparticular this way needs of these groups. with clarity an enabling environment, around regulatoryand the development issues encourage that incentives of policies and In service them, is created. expansion for Ciudad Saludable has example, for Peru, worked closely with national government on changes in legal regulations promote to management that supportwaste recyclers. In South Africa, EWS has positioned the meet the needs to initiatives idea of diverse the across groups community of different inhabitants of informal including Municipality, rural housing, formal settlements awaiting people with disabilities. and dwellers area 23 Position innovations Position  Comprehensive solid waste management: The Ciudad Saludable Ciudad The management: solid waste Comprehensive model in Peru. model in Peru. The promotion by the models of cultures of cultures the models by The promotion learningof continuous enabled the has their improving newdevelopment of ideas for work. cross-organizational vibrant a result, As in which eco-systemscreated been have experimentation and innovation are start and activitiesable to are encouraged, at out through being tested scale rather than pilot projects. small or ad hoc  23 As well as workingas well As partnershipclose in with of “re-positioning” the the public sector, All the models have redefined the way way the redefined have All the models services by and delivered accessed are in pro-pooradopting an inclusive approach which service tailored carefully solutions are or co-designed, who are with those for, or most disadvantaged. reach to hardest has TulaSalud example, In for Guatemala, on workingfocused with indigenous so that they rural areas populations in remote health services improved their to can provide particularlycommunities, during pregnancy This has necessitated and childbirth. in a manner that positions cultural engaging of its work.and gender issues at the center and rural communities work in isolated AMP’s activities with recyclers, Ciudad Saludable’s due consideration to both of which also give gender and the participation are of women, further examples of this focus. “Ciudad Saludable“Ciudad has applied a systemic vision of the value management system based on the waste actors”. of all relevant chain and involvement users, clients and entrepreneurs, with a clear acceptance that “a pro-poor opportunity is also a business opportunity”.25

The case studies illustrate how members of poor and vulnerable populations have successfully assumed roles in new service systems as users and consumers, teachers and trainers, entrepreneurs and producers, technicians, advisors and reviewers, among others. This acceptance of the multifaceted nature of “base of the pyramid” populations has enabled the identification and mobilization of previously unacknowledged local resources and skills, including community knowledge, expertise and entrepreneurial abilities. In this sense, the models endorse broad concepts of inclusive business and social entrepreneurship which recognize the poor as change agents in the development of sustainable solutions that address multiple rather than single problems.26

25 What is Inclusive Business?, Spotlight on Inclusive Business, April 2012 http://businessinnovationfacility.org/page/publications-spotlights 26 See Anja Cheriakova, “Framing the concept of social entrepreneurship”, The Emerging Social Enterprise, October 28, 2013 http://www.thebrokeronline.eu/en/Articles/The-emerging-social-

ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS enterprise

32 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 33 InSouth generally Africa, have costs although donor budgets, municipal by been covered funding has been important in enabling In the expand. the model to case, the AMP by was covered first SHS installation phase Microenergía the ACCIONA from a grant during the second phase, while, Foundation of full cost recoverythe achievement was of a the repayment made possible through SHS systems. purchase to loan acquired upon work has centered in Bolivia WFP’s make families to encouraging a contribution the cost of BES 85% towards of up to mechanisms have construction. Different these cover assist families to to been tested However, credit. including access to costs, been able families have only a few date to take to the stringent up this option due to agencies for credit from requirements such as land tenure. collateral Financial sustainability Financial   Upfront costs to install services costs to Upfront and get generally been going have programs international from grants by provided governments foundations, aid agencies, for Saludable, Ciudad privateor actors. upon donor and heavily has relied example, put its model in place. to government grants The achievement of financial sustainabilityThe achievement of financial all the models. for has been a challenge to Concertedrequired been efforts have the initial installation obtain funding for of service and community components and put fair and affordable activities, outreach services consumers that also in place for This has necessitated running costs. cover mixture of funding the adoption of a diverse community including grants, options, in-kindcontributions, cross- resources, donor- and novel subsidy arrangements, government connections. The challenges outlined here clearly require long-term investments of time and commitment of time and commitment long-term investments clearlyThe challenges outlined here require it is worth Infor difficulties noting that shortcuts this regard, resolve. to and easy fixes scrupulous Instead, in all cases, the model promoters. by been avoided have encountered for the specific and dynamic tailor-made solutions that are finding has been paid to attention contexts working. in which they are Adaptation and scale-upAdaptation by the models faced appraisals of the difficulties upon honest rely them. In problems potential overcome way this to solutions proposed of the and investigation or parts models, the emulate those wishing to of by and addressed anticipated can be better are shared a number are context difficulties specific, that, while many The study shows them. all the models. by 2. CHALLENGES AND POSSIBLE SOLUTIONS SOLUTIONS POSSIBLE AND CHALLENGES 2. The costs of community awareness-raising tariff subsidy by which families pay 20% of and capacity-building activities, activities that the fee required for full cost recovery. These are essential to guaranteeing smooth service user fees also offer savings of up to 39% operation, add substantially to financial compared with previous energy costs for overheads. In the cases of AMP and WFP, for candles, kerosene and the charging of cell example, community outreach work implies phones. In the WFP initiative, meanwhile, an additional 33% to the cost of the systems the relatively low costs of BES operation and installed. In both cases, these expenses are maintenance, of between US$2.9 to US$3.6 assumed by the promoter organizations per year, are covered by families whose rather than passed on to the customer as average household income is US$83 per part of user fees. Ciudad Saludable is able month. to recoup some of these costs by charging businesses and government institutions for waste management consultancy activities. The fact that default rates across the models In this model, 32% of the income derived have been extremely low suggests that the from service revenue and grants is assigned tariffs and charges in place are both affordable to core costs while the rest is used for the and acceptable to users. AMP notes that the development of activities. default rate in Cajamarca dropped from 3.03% in 2011 to 0.19% in 2012. In Cochabamba, WFP estimates a 95% success rate in the usage of Once the service has been installed, most BES a year after installation, while customer of the models charge user fees that cover call centers in eThekwini report high levels running costs. The Guatemala initiative is an of satisfaction with the service generally. In exception to this as, due to the nature of the all these cases, the provision of accessible service (pre-natal care), no fees are charged. information about service costs also appears In this case, the Tula Foundation has worked to have generated a sense among users that to gradually integrate program activities prices are transparent and fair. within government budgets over time.

The importance of an early and long-term The remaining models have made important vision of funding that considers the volume efforts to tailor tariffs and installation of the service to be provided, and the payments to the diverse needs and capacities consolidation of a client base for it, has been of different local users. In some cases they fully understood by all the model promoters. have relied upon subsidies so that poorer As the AMP model demonstrates, this clarity of families can access services. In eThekwini, focus is important in enabling the breakeven for example, poor and indigent families are point for full cost recovery to be achieved provided with a free basic service while a more smoothly. Such an approach also relies progressive tariff system ensures that users upon sharing results and demonstrating who consume more water subsidize those impact on a continuous basis so that all who consume less. AMP, meanwhile, has stakeholders, including partners, clients and been able to base fees upon a government donors, fully understand the potential of the ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS model and are willing to invest in it. 34 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 35 Working with government Working Changing attitudes and behavior attitudes Changing     While all the models have ensured close ensured While all the models have liaison with the public sectoroften this can influence or lack of access, be impeded by at policy changes due to information level, public sector and weak electoral processes of Municipal attitudes and rotation capacity. acknowledgedstaff are by Ciudad Saludable recyclingof application the limiting as Inlegislation. South Africa, as as well the application and reinforcement restraining municipal changes as of enabling legislation, as potentially viewed are of elections, a result of good the development discouraging and with wards ongoing relationships possible Incouncilors. Bolivia, meanwhile, the use to relating in regulations changes The time, resources and energy required required and energy resources The time, for delivering models different situate to services In cannot be underestimated. changes in behavior position to order things, of doing new encourage and ways activities awareness-raising education and for WFP, and ongoing. be consistent to have a of up to that oversight estimates example, constructionBES necessaryis following year correct their ensure maintenance. and use to the reinforces TulaSalud In Guatemala, importance of continuously monitoring while in South Africastaff training, the behavior and hygiene environmental, EWS by initiated have change programs of its services. the rollout been essential to Human resource limitations resource Human   All the models demonstrate the importanceAll the models demonstrate the building time to of dedicating adequate In addition, as capacity. of human resource the Municipal Institute platform of Learning the EWSby developed it confirms, initiative is also important make to for space available skillsimproving sharing by knowledge and expertise partners, levels among different and disciplines. As well as acquiring well managerial mid-level As within promoter competencies skills leadership organizations, gaps among partners, community are users end and capacity- focused through being overcome Ciudad These include building activities. program training leadership Saludable’s training of young TulaSalud’s recyclers, for community leaders and indigenous female Program. Entrepreneurship Technical AMP’s The case studies show that good leadership show The case studies of the models, the development is vital to earlyespecially in the stages of their work. Sometimeskey as those such individuals, EWS and Ciudad Saludable leading the AMP, particularly play initiatives, important roles long-term However, guides. as catalysts and sustainability and institutionalization rest champions beyond individual upon moving senior management functions broadening by developing and responsibilities, and leadership skills at other levels. of organic waste may limit opportunities for all the models have adopted a paced and commercialization of BES waste. participatory delivery process that is deeply rooted in the particular environments in which they are working. To address this, The multi-pronged approach adopted by robust connections with government that the models in making and maintaining enable ongoing dialogue to ensure that linkages at national, regional and local levels these factors are acknowledged and built of government is a useful way of addressing into expansion plans are important. these challenges. As well as raising public sector awareness and support for new models of service at policy level, public sector While also a challenge, client demands for capacity-building initiatives, such as those improved services offer opportunities to promoted by Ciudad Saludable and EWS, enhance the models by providing better are also important activities for generating quality services to end users. Work by AMP government understanding of the models to provide stronger electrical power in and buy-in for them. Cajamarca, and WFP’s efforts to put forward improved BES models in Cochabamba, are examples of positive responses to customer Once again, it is worth noting that changing demands. Such improvements require public sector attitudes and practices requires careful consideration to ensure that they do time and patience. This is clearly shown by not increase costs for the end user. To address the ongoing negotiation processes between this, the models have drawn creatively upon AMP and the government of Peru, and the their partnership connections. Research links long-term support provided by TulaSalud with universities in the EWS, WFP and Ciudad and the Tula Foundation while waiting for Saludable initiatives, for example, have government agencies to take over their work. been central to the promotion of improved products and services that maintain or even reduce costs. ÂÂAddressing growth in demand for improved services

The success of the models has augmented demand from both national government and end users for their expansion and improvement. In some cases, such as that of EWS, a growing population as a result of increased migration has added to these demands. Institutional pressure for extensive and rapid rollout has raised concerns about contextual appropriateness, technical viability and sustainability, particularly as ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

36 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 37 Step 2: Internalizing the learning 2: Internalizing Step   As the models have developed, partner developed, have models the As have and communityorganizations groups the learning internalize begun to from Inactivities. collaborative the medium- term, of doing things have new ways become part and cultures of organizational promoter the the changes positioned by started a deeper have have organizations to This is clearlyimpact they on how work. where case Guatemala the in illustrated take begun to government agencies have the activitiesover and costs initially assumed Foundation. Tula and the TulaSalud by confidence of community The growing Electrification Committees Photovoltaic and participation of municipalities in the this also demonstrate Casa program en Luz Inchange. the case of EWS, the model is serviceseen as an example for provision it because of the transformation elsewhere as communitywithin generated has groups, donor businesses, as among politicians, well academia and other stakeholders. agencies,

Step 1: Demonstrating tangible 1: Demonstrating Step   change All the initiatives have begun by positioning positioning begun by have All the initiatives gaps address to new products or processes in service access or delivery in a practical with an emphasis on demonstrating manner, and positive results tangible change through the over area collaboration in a specific With the introduction of the BES short-term. in peri-urban of Cochabamba; the tele- areas serviceseducation and telemedicine in Alta the recycling servicesVerapaz; in promoted of Ciudad Saludable; the provision Lima by electricity photovoltaic and in Cajamarca; services and sanitation water the improved in eThekwini, each model has quickly put the central elements of a new service in place working by and, closely with multiple actors, and support interest stimulated in expanding this. The models in this study appear to follow three key institutionalization: three towards steps follow to The models in this study appear The ability to overcome challenges, achieve financial and operational sustainability, and build and sustainability, operational and financial achieve challenges, abilityThe overcome to upon the extent rest to 4P innovations, promote to able relationships collaborative robust This process in the contexts mainstreamed they in which operate. are which the models are the models by time as the changes initiated necessarilyof institutionalization requires so that they become part systems governance within overarching consolidated and parcel policyof standard and practice. 3. INSTITUTIONALIZATION 3. ÂÂStep 3: Changing the way things are done

In the long-term, the models become sustainable by formalizing and reinforcing partner relationships and government connections, influencing policy so that legal and regulatory changes are promoted, and ensuring that results are reinforced at end user level through expansion and improvement. In this manner, changes in how services are accessed and delivered become accepted practice. As a result of the work of Ciudad Saludable and AMP in Peru, changes have been made to legal and regulatory frameworks for waste management and new energy technologies that reinforce improved basic serve provision. The establishment of the multi-partner Advisory Board for the running of the rural health service initiative in Guatemala is a clear example of the formalization of a cross-sector decision- making mechanism for basic service delivery, and a step away from the now fully accepted and institutionalized multi-stakeholder model for water and sanitation services that exists in eThekwini. ACCESS TO BASIC SERVICES BASIC TO ACCESS IN INNOVATION FOR PARTNERSHIPS

38 PARTNERSHIPS FOR INNOVATION IN ACCESS TO BASIC SERVICES 39

FINAL CONSIDERATIONS FINAL

Reposition an active the end user as agent in service provision, and close and ongoing cooperation with the public sector, Ensure service covering newGenerate activities. business models for and related costs ` ` ` The models outlined in this document have initiated a progressive process of process a progressive initiated The models outlined in this document have in turn,This has, sectors and levels. organizations, institutionalization between and across new and improved for environment enabling the development of an overarching assisted innovation The space for services communities. of providing ways marginalized previously to of knowledge frank and ongoing exchanges by and experience, and practice-is reinforced to-policy By loops. sharing learning they feedback about how work, the models demonstrate lasting improvements partnership secure that innovative to potential arrangements real have of the poor and makein the lives a valuable contribution development. sustainable to While replication and scale-upWhile replication important it is of such models is desirable, highlight to contextual to the adoption of variables, attention careful that their success is based upon the development of and whole value chain systems, that address models comprehensive decision-making dialogue, and review for mechanisms among the different appropriate and dedication of the The commitment end users themselves. including actors involved, positioning new the models to multi-sector service promoted agencies that have options, of the them, and ensuringto finance reinforcement ongoing finding non-traditional ways these efforts. central to are built and maintained, as they are initiatives

Innovative “out of the box” solutions that involve different social actorsworking social different in together solutions that involve of the box” “out Innovative case studies The basic servicespartnership access to globally. on the increase improve to are the long-term change for ensure to that the capacity initiatives show these collaborative of upon their ability rests of the poor to: poorest  ` ` ` This report is part of the Partnerships for Innovation in Access to Basic Services consultancy project carried out by the Innovation and Technology for Development Centre at the Technical University of Madrid (itdUPM) for the Multilateral Investment Fund (MIF), a member of the Inter-American Development Bank Group (IDB).

The project was conducted in collaboration with:

With support from:

© Innovation and Technology for Development Centre/Technical University of Madrid (itdUPM) and the Multilateral Investment Fund/Inter-American Development Bank (MIF/IDB). The publications that make up the Partnerships for Innovation in Access to Basic Services study may be reproduced totally or in part, with permission from, and attribution to, the Innovation and Technology for Development Centre/Technical University of Madrid (itdUPM) and the Multilateral Investment Fund/Inter-American Development Bank (MIF/IDB).

The information and opinions presented in this publication are those of the research team and do not necessarily present the official position of the Inter-American Development Bank.

July, 2014

INNOVATION AND TECHNOLOGY FOR MULTILATERAL INVESTMENT FUND DEVELOPMENT CENTRE INTER-AMERICAN DEVELOPMENT BANK TECHNICAL UNIVERSITY OF MADRID (itdUPM) (MIF/IDB) www.itd.upm.es www.fomin.org

Author: Leda Stott Basic Services for the Poor Agenda Team

Contributors: Directed by Carrie McKellogg Miguel Ángel Egido Aguilera Tracey Keatman (BPD) Concept: David Bloomgarden, Celia Bedoya del Julio Lumbreras Martin Olmo, Ignacio Fernández Admetlla Andrés Martínez Fernández (EHAS) Carlos Mataix Aldeanueva Project Team: Carlos Sanchez, Christina Jaime Moreno Serna Lengfelder, Claudia Sáenz, Svante Persson Xosé Ramil Ferreiro Eduardo Sánchez Jacob (ONGAWA) www.facebook.com/fominbid www.twitter.com/fominbid @ [email protected] @itdUPM

Layout: Sara Romero Muñoz Innovation and itd Technology for Development UPM Multilateral Investment Fund Centre Member of the IDB Group