Multi-level sanitation governance: Understanding and overcoming the challenges in the sanitation sector in Sub-Saharan Africa

The paper examines the slow progress of sanitation coverage in Sub-Saharan Africa, specifically in Rwanda, Uganda, Tanzania, and Burundi. It identifies a critical disconnect between macro-level policies and micro-level household implementation, driven by institutional inertia and path dependency. The authors argue that sustainable progress requires moving beyond supply-driven subsidies toward demand-driven strategies, private sector involvement, and a better understanding of informal norms and multi-level actor interactions.

• Sub-Saharan Africa is unlikely to meet the Millennium Development Goal for sanitation, with approximately 70% of the population still relying on open defecation or unimproved/shared facilities.
• Inadequate sanitation has severe economic consequences in Africa, costing 18 countries an estimated USD 5.5 billion annually, primarily due to premature deaths from diarrheal diseases.
• There is a systemic disconnect between formal macro-level policies and micro-level implementation, as policies are interpreted through multiple layers of actors and often contradicted by informal norms and customs at the household level.
• The sanitation sector in Sub-Saharan Africa is characterized by path dependency, where the dominance of traditional pit toilets and flush toilets creates a socio-technical regime that resists the scaling of alternative 'sanitize-and-use' systems due to psychosocial and cultural barriers.
• Sanitation governance varies significantly across East African countries: Rwanda leverages strong political will and a Sector Wide Approach; Uganda suffers from a lack of a leading ministry and poor coordination; Tanzania relies heavily on a demand-driven commercial approach; and Burundi lacks a national hygiene and sanitation policy.
• Sustainable sanitation coverage is more effectively achieved through the promotion and marketing of sanitation and private sector involvement rather than through supply-driven subsidies for infrastructure.

APA

Ekane, N., Nykvist, B., Kjellén, M., Noel, S., & Weitz, N. (2014). Multi-level sanitation governance: Understanding and overcoming the challenges in the sanitation sector in Sub-Saharan Africa. Stockholm Environment Institute. https://www.sei.org/mediamanager/documents/Publications/Water-sanitation/sei-workingpaper-ekane-multi-level-sanitation.pdf

Chicago

Ekane, Nelson, Björn Nykvist, Marianne Kjellén, Stacey Noel, and Nina Weitz. Multi-level sanitation governance: Understanding and overcoming the challenges in the sanitation sector in Sub-Saharan Africa. Stockholm Environment Institute, 2014. https://www.sei.org/mediamanager/documents/Publications/Water-sanitation/sei-workingpaper-ekane-multi-level-sanitation.pdf.

Wikipedia

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BibTeX

@techreport{ekane2014multilevel, author = {Ekane, Nelson and Nykvist, Björn and Kjellén, Marianne and Noel, Stacey and Weitz, Nina}, title = {{Multi-level sanitation governance: Understanding and overcoming the challenges in the sanitation sector in Sub-Saharan Africa}}, institution = {Stockholm Environment Institute}, year = {2014}, month = jul, url = {https://www.sei.org/mediamanager/documents/Publications/Water-sanitation/sei-workingpaper-ekane-multi-level-sanitation.pdf}, urldate = {2026-10-23}, note = {Indexed by Climate Insights Directory} }