The last few decades have witnessed substantial gains in access to sanitation, as nearly 2.4 billion people gained access to improved toilets and open defecation (OD) rates fell 12 percentage-points globally (from 21% to 9%) between 2000 and 2020 (World Bank 2022; United Nations Children’s Fund [UNICEF]-World Health Organization [WHO] Joint Monitoring Programme [JMP] 2019). Despite this progress, many countries are off track to meet their sustainable development goal (SDG) 6.2 targets, with progressive improvement essential to achieve universal and sustainable access for all. To reach these targets by 2030, a concerted effort is needed to broaden, combine, and strengthen existing approaches throughout the sector.
One possible response to this is area-wide sanitation (AWS), a systems-based, outcome-driven framework to achieve equitable, universal access and use of safely managed sanitation and hygiene in a given administrative area, such as a district. The focus of AWS is on predominantly rural administrative areas, characterized by a mix of small towns/peri-urban communities with mixed rural and urban characteristics, rural on-road, and rural remote areas, as described in the 2019 Guidance on Programming for Rural Sanitation (WaterAid 2019). While recognizing that, given context and different starting points, area-wide coverage targets may initially be set at achieving ODF or universal basic sanitation, the end goal of AWS is achieving universal access to safely managed sanitation services (SMSS). The hypothesized benefits of an area-wide framework include greater leadership by local governments, alignment of stakeholders and resources, prioritisation of equity and inclusion, and improved sanitation outcomes for all, but AWS has not yet been subject to a thorough review in the literature.
The purpose of this desk review is to collate the definitions and frameworks developed for AWS and examine how AWS programming has been implemented in practice. The aim is to arrive at a common definition of AWS, identify its core components, and develop a high-level theory of change (ToC) for how these components are structured.
