Improving access to sanitation is a global public health priority. Sufficient consumer demand is required for sanitation coverage to expand through private provision. To measure consumer demand for hygienic latrine platform products in rural Tanzania, we conducted a randomized, voucher-based real-money sales trial with 1638 households with unimproved latrines. We also evaluated multiple supply chain options to determine the costs of supplying latrine platform products to rural households. For concrete latrine SanPlats, 60% of households were willing to pay US$0.48 and 10% of households were willing to pay US$4.05, yet the average cost of supplying the SanPlat to households was US$7.51. Similarly, for plastic sanitary platforms, willingness-to-pay (WTP) dropped from almost 60% at a price of US$1.43 to 5% at a price of US$12.29, compared to an average supply cost of US$23.28. WTP was not significantly different between villages that had participated in the National Sanitation Campaign and those that had not. Randomized informational interventions, including hygiene data-sharing and peer-based exposure to latrine platform products, had minimal effects on WTP. In conclusion, current household demand for latrine platform products is too low to achieve national goals for improved sanitation coverage through fully commercial distribution.

Global sustainable development goals call for universal access to safely managed sanitation by 2030. Here, we demonstrate methods to estimate the financial requirements for meeting this commitment in urban settings of low-income countries. Our methods considered two financial requirements: (i) the subsidies needed to bridge the gap between the willingness-to-pay of low-income households and actual market prices of toilets and emptying services and (ii) the amounts needed to expand the municipal waste management infrastructure for unserved populations. We applied our methods in five cities– Kisumu, Malindi, Nakuru in Kenya; Kumasi in Ghana; and Rangpur in Bangladesh and compared three to five sanitation approaches in each city. We collected detailed cost data on the sanitation infrastructure, products, and services from 76 key informants across the five cities, and we surveyed a total of 2381 low-income households to estimate willingness-to-pay. We found that the total financial requirements for achieving universal sanitation in the next 10 years and their breakdown between household subsidies and municipal infrastructure varied greatly between sanitation approaches. Across our study cities, sewerage was the costliest approach (total financial requirements of 16–24 USD/person/year), followed by container-based sanitation (10–17 USD/person/year), onsite sanitation (2–14 USD/person/year), and mini-sewers connecting several toilets to communal septic tanks (3–5 USD/person/year). Further applications of our methods can guide sanitation planning in other cities.

Most residents of Kisumu, Kenya, use latrines constructed over basic pits or attached to more durable concrete vaults and septic tanks. Only one-third of fecal sludge generated in the city, however, is safely collected and treated. Programs for improving fecal sludge management among poor households include the development of formal manual emptying organizations that are recognized by local authorities, employ safety procedures, and transport fecal sludge to a treatment site. In this study, we compared the financial structures of these organizations with those of vacuum trucks that primarily serve wealthier households. We also employed an incentives-based strategy to promote the expansion of safe pit-emptying services in a low-income area and compared the performance of three managing groups to coordinate these services: (1) The Association of Wastewater Managers (The Association); (2) a formal manual emptying organization; and (3) a community-based water supplier interested in coordinating emptying services. Vacuum trucks were more cost-effective than the formal manual emptying organization, and The Association was most efficient in servicing poor households. The Association also demonstrated the ability to service low-income areas comprehensively by delegating a fraction of jobs (11%) to formal manual emptiers in locations not serviceable by VTOs, and overall showed the highest potential to achieve pro-poor service delivery at scale.