Outcomes are changes which result from an intervention rather than the activity itself and impacts are the positive and negative long-term effects. The goal of sanitation and hygiene programmes is not only that everyone has access to a safely managed sanitation and improved handwashing facility but that these facilities are used continuously over time, and that this contributes to desired outcomes and wider societal impacts (i.e. health, education, livelihoods and gender equality).
Changes to outcomes and impacts are arguably the most meaningful and MEL systems are increasingly required to include these. However, they take longer and are more complex to evaluate than previous output-based indicators.
This complexity can result in inconclusive or seemingly illogical conclusions. For example, despite a growing recognition of the multiple links between sanitation and hygiene practices and health, there are limited robust evaluations of the health impacts of improved S&H and those that have been done generated disappointing results.
Focusing on how programmes can achieve intermediate outcomes such as inclusive and sustained use of services and improved hygiene behaviours could be a first step towards achieving broader, less tangible health impacts. As development partners shift from direct implementation to supporting national and sub-national programmes and system strengthening, work will be needed to assess the effectiveness of this work.
The S&H sector has much to learn on this and good practices of MEL systems strengthening to capture progress towards outcomes and impacts need to be trialled and lessons shared.