80104 WPP WATER PARTNERSHIP PROGRAM Briefing Note: Towards Progress on Sanitation: The Case of Cameroon Meike van Ginneken (Sector Manager, World Bank), Jan Drozdz (Senior Water and Sanitation Specialist, World Bank) and Miguel Vargas-Ramirez (Senior Water and Sanitation Specialist, World Bank) WPP BRIEFING NOTE 3 / FEBRUARY 2013 Access to sanitation in Cameroon fell from 61 percent in 2000 to 58 percent in 2010. While rates of access to drinking water and improved sanitation in Cameroon are higher than average for sub-Saharan Africa, progress has been uneven. Similarly, it has reached a larger portion of the urban population than the rural. This is taking place at a time when urbanization is increasing and an estimated 75 percent of urban residents live in informal settlements. To achieve its human and economic development goals, Cameroon requires a significant change in its approach to basic service delivery, including sanitation. The country has already taken its first step, which was to design a suitable national strategy to increase sanitation coverage based on an assessment of sector issues. Following a request by the government of Cameroon, the Water Partnership Program (WPP) (through its Sanitation, Hygiene, and Wastewater Support Service, SWAT)1 supported the development of a sanitation strategy for two major cities, Douala and Yaoundé. This effort spurred a much-needed national dialogue on sanitation and provided convincing evidence that change was needed. Based on the outcomes of this dialogue, the WPP supported the development of a 10-year national sanitation strategy that aims to increase sanitation coverage from 34 percent to 57 percent by 2020. The national strategy was signed by the Prime Minister of Cameroon and adopted by the Ministry of Energy and Water (MINEE) in 2011. It is now being implemented through a $30 million, World Bank credit (see box on the right). This credit is expected to result in more cost-effective public investments, thus providing more people with access to improved sanitation without increasing household and government costs. The WPP-funded activities not only leveraged World Bank financing but also helped to WORLD BANK rekindle donor interest in investing in Cameroon. Indeed, other donors have shown interest SANITATION PROJECT in supporting the new framework as well. FOR CAMEROON The objective of the proposed program Background on several indicators of social well-being. is to increase the quality of sanitation The country is ranked 131 out of 169 services as well as the rate of access to Although rich in natural resources, countries on the 2010 Human Development these services for people in Cameroon. Cameroon lags behind the rest of the world Index. More than half the population suffers The first phase involves a $30 million Bank 1. SWAT is one of the three Expert Support Teams (ESTs) funded by WPP. As of January 2011, the three ESTs have loan that will be executed between 2011 merged into the new Water Expert Team (WET). and 2015. The objective of this phase is to improve planning and management of the sanitation sector as well as to provide The Water Partnership Program (WPP) is a World Bank program funded by the governments of the Netherlands, Denmark and the United Kingdom. The access to improved sanitation services in WPP aims to enhance the World Bank’s performance on reducing poverty selected rural and urban areas. This will through the mainstreaming of pragmatic approaches for Water Resources be achieved by piloting new approaches, Management and development, the improvement of quality and effectiveness hands-on capacity building for improved of Water Service Delivery, and the mainstreaming of water services and local planning, and institutional, technical management in climate-resilience, inclusive green growth. and financial studies. 2 / HTTP://WATER.WORLDBANK.ORG/WPP from poverty, including poor education and health as well as a low standard of living. Like many developing countries, Cameroon has fared better in meeting its water supply goals than its sanitation goals, and reached a larger portion of urban than rural inhabitants. Ninety-five percent of the people living in urban areas have access to an improved water source, compare to only 52 percent of the population in rural areas. For the entire country, access to sanitation fell from 61 percent in 2000 to 58 percent in 2010. Moreover, 12 percent of the population in rural areas still practices open defecation. In Cameroon’s largest Unsafe sanitation conditions in flood prone areas in Cameroon increase health risks for the population. Right and left: Open sewers in low-lying areas in Douala. (Photos: Miguel Vargas-Ramirez, World Bank) cities, Yaoundé and Douala, each home to approximately two million people, the access rate has decreased over the past the country’s two largest cities: Douala facilities, and on-site and communal systems. 20 years. Challenges will increase as the and Yaoundé. Due to the specific technical Each scenario included a cost analysis country further urbanizes and more informal expertise needed, the WPP assigned and provided options for spending about settlements spring up. the work to its Sanitation, Hygiene, and $40 million to reach varying portions of the Wastewater Support Service (SWAT). population. The study showed that the biggest Low levels of access to sanitation, coupled SWAT undertook a study that evaluated health gains could be obtained through with high vulnerability to flooding, pose huge options for increasing access to sanitation investments in hygiene promotion and by health risks to the population of Cameroon, in both cities in cooperation with local and providing access to basic sanitation services. as evidenced by the 2010 cholera outbreak national authorities and other stakeholders. that infected an estimated 10,000 people.2 SWAT emphasized the need to reinforce The SWAT study found that most capacity at all levels, and for the government The institutions mandated to regulate and households in the two cities use on-site to offer a variety of technological options provide sanitation services are many and sanitation, and that sludge from latrines that suit the urban layout, as well as the their responsibilities overlap. Ministries and and septic tanks is not disposed of properly. limited availability of human, financial and local governments lack the resources and A few hygiene education programs have material resources. The study concluded capacity to carry out their mandates. been implemented, but only in response that the government should allow the local to public health emergencies. Virtually no market for sanitation services to develop. Historically, the government focused only public investment in sanitation in Douala By providing space for innovation, the on collective sewers and wastewater or Yaoundé has been made in the last government could help lower the cost of treatment plants. However, these proved to twenty years. Sewerage networks and infrastructure in the long term and thus be too expensive to maintain and too large wastewater treatment works covered few partially address issues of affordability. to expand to new urbanizing populations, people and their operation was hindered as is the case for much of the region. by an inadequate management system, The WPP Grant: Towards inappropriate technology, lack of qualified A Sanitation Strategy for WPP Expert Support for staff, and lack of capacity to adequately Cameroon Cameroon’s Two Largest Cities operate and maintain facilities. The SWAT recommendations emphasized In 2009, the government of Cameroon SWAT devised three scenarios for sector that the development of an adequate national requested support from the WPP to development, including options for upgrading sanitation strategy is crucial for the country develop an initial sanitation strategy for sewerage networks, wastewater treatment to achieve its Millennium Development Goals 2. International Federation of Red Cross and Red Crescent Societies, Cameroon: Cholera outbreak, Emergency appeal n° MDRCM011, GLIDE n° EP-2011-000034-CMR, April 4, 2011 TOWARDS PROGRESS ON SANITATION: THE CASE OF CAMEROON / 3 (MDGs). The lack of direction has constrained investment in sanitation and has been a factor in the country’s delay in meeting the MDG on sanitation. Data from the 2010 Joint Monitoring Programme report indicate that approximately 6.5 million additional people must have access to improved sanitation by 2015 to meet the goal.3 Following the work carried out by SWAT, the WPP funded the development of a national sanitation strategy. The strategy aims to increase national sanitation coverage from 34 percent to 57 percent by 2020 through four major components: Left: Traditional latrine in the Far North Region. Right: Ventilated Improved Pit (VIP) latrines built for project to improve sanitation in the Far North Region. (Photos: Miguel Vargas-Ramirez, World Bank) 1) Stimulating demand for new facilities through hygiene promotion and partial The cost of the ten-year investment program Implementing the National hardware subsidies for household facilities; is estimated at $600 million. Despite its focus Sanitation Strategy 2) Setting up a septage treatment program on low-cost technology and limited use of and offering subsidies to pay for sludge subsidies for hardware, implementing the Following a request from the government collector tipping fees; national sanitation strategy requires major of Cameroon, the World Bank approved 3) Supporting sector decentralization public investments. The strategy’s financing a credit in June 2011 to support the by strengthening the procedures and plan includes introducing a surcharge on implementation of the sanitation strategy. capacity of local authorities to meet water consumption for users with sewer their new role as a service provider connections, continuing to charge an existing The project will rely on a learning-by-doing and regulator; and fee to polluters, and additional funds from the methodology to demonstrate how increased 4) Constructing 1.1 million improved public sector and donors. A financing plan investment can lead to sustained results sanitation facilities across the country. estimated that 24 percent could be contributed in urban and rural sanitation. Because by households and the remainder provided by improving sanitation requires changes in The strategy was developed through a governments and donors. To start the process, attitudes and behavior as well as access stakeholder engagement process that the government of Cameroon received a $30 to improved infrastructure, the project will included government, private sector, and million credit from the World Bank. emphasize hygiene education and sanitation NGO participants, and was completed in marketing. April 2011. During the process, the WPP In addition to investment in infrastructure, facilitated the exchange of knowledge institutional reforms that clarify roles and The project aims to provide 2 million people by bringing in experiences from Ghana, responsibilities will also be necessary to with direct and indirect benefits, nearly Senegal, Burkina Faso, and Brazil and significantly improve sanitation services in one quarter of whom will receive improved conducting stakeholder workshops. Cameroon. The national strategy proposes household sanitation facilities. The project will Representatives from these countries empowering local authorities to take a improve sanitation not only at the household provided feedback to their Cameroonian leadership role in sanitation, and includes level, but in health centers, public markets, counterparts regarding financial, a mechanism to channel resources to and schools. The local private sector will be engineering, and institutional aspects of the them. It also proposes the establishment encouraged to provide sludge management, draft strategy. A letter outlining the sector of a Department of Sanitation within the and NGOs will support the project’s policy was signed by the Prime Minister in Ministry of Energy and Water to support education and marketing campaigns. May of 2011, and the full strategy was then local authorities and coordinate the adopted by the government. national sanitation program. 3. The population in Cameroon is expected to reach 21.3 million people in 2015 (source: US Census Bureau International Database), of which 73 percent should have access to im- proved sanitation to reach the sanitation MDG (JMP, 2010). TOWARDS PROGRESS ON SANITATION: THE CASE OF CAMEROON / 4 The project consists of three components: The combination of SWAT and WPP work (1) urban sanitation, (2) rural sanitation, and (3) institutional strengthening and project culminated in a World Bank credit for the management. implementation of a new national sanitation 1) The urban sanitation component will strategy for Cameroon. support at-scale pilot projects in Douala that integrate support for The combination of SWAT and WPP work Stratégie Nationale d’Assainissement promoting hygiene and marketing culminated in a World Bank credit for the Liquide au Cameroun. Rapport Diagnostic: household latrines, implementation of a new national sanitation Aspects Institutionnels, Financiers et 2) The rural sanitation component will support strategy for Cameroon. More donors have Techniques. World Bank –WPP. April 2011. hygiene promotion and marketing of also taken an interest in providing technical household and public latrines particularly assistance and lending to the country’s Ministry of Energy and Water (MINEE) - in the Far North Region, sanitation sector, including UNICEF, the Republic of Cameroon. 2011. Stratégie 3) The institutional strengthening and project French Development Agency (AFD), the Nationale d’Assainissement Liquide. Final management component will support the African Development Bank (AfDB), and the report World Bank – WPP. August 2011. provision of technical assistance to clarify European Investment Bank (EIB). institutional roles and responsibilities. WHO/UNICEF Joint Monitoring References Programme. 2010. Estimates for the Use By increasing access to sanitation and of Improved Sanitation Facilities, Updated improving the disposal of sludge, the Guene, O. and A. Savina. 2009. Revue de March 2010, Cameroon. project is expected to have a positive la Situation de l’Assainissement a Yaounde impact on public health and the quality of et Douala et Propositions pour un Projet World Bank. 2011. Project Documents for life, and reduce environmental pollution. It Assaissement des Eaux Usées, Rapport Cameroon Sanitation Project Phase 1 (Apl-1). will contribute toward achievement of the final. SWAT Final Report. September. health, water supply and sanitation, and urban development MDGs, and stimulate Ministry of Energy and Water Resources further investment in the sector. (MINEE) – Republic of Cameroon. 2011. The Water Partnership Program (WPP) supports technical assistance and analytical work, and bolsters project preparation and imple- mentation across all water sub-sectors and water-related sectors in all World Bank Borrowing Member Countries. WPP activities are coordinated through nine Windows: six Regional Windows managed by the Bank’s Regional water units, and three Windows managed by the Water Anchor - the Expert Support Team, the Programmatic, and the Water Anchor Windows. The WPP is coordinated by a Program Management Team based in the Water Anchor of the Transport, Water, and Information & Com- munication Technology (TWI) Department of the World Bank. © 2013 The World Bank. This work is a product of The World Bank with external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors or the governments they represent. 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