News & Learning

18 Mar 2012
Stories | Multi-Country

Thrive Networks Output-Based Aid Approach to Sanitation – A Smart Development Story

The Challenge

Two million people around the world die every year from diarrheal disease. Safe latrines and hygiene behavior change are recognized as key to preventing diarrhea, yet one third of the world’s population still lives without a toilet.

Access to sanitation also remains highly inequitable. Vietnam is a country experiencing rapid economic growth, and while latrine coverage is relatively high overall, less than 1 in 5 of the poorest 40% of the rural population has access to a safe toilet.[1]

Thrive Networks recognizes that increasing sanitation coverage is a complex challenge, with no single “silver bullet” approach that can be applied in all contexts. Bearing this in mind, we designed our sanitation strategy to target and reach those poorest 40% of rural households.

The Approach

Thrive Networks has developed a financial rebate scheme that incentivizes WASH service providers to target poor customers and poor areas. This financial scheme is unique, as funding is only provided after verification of predefined outputs – properly constructed household toilets!

In practice, this means that sanitation change agents[2] receive a fee for each latrine they successfully convince a household to build. A rebate is also paid to poor households, which covers a small percentage of the total latrine cost.[3]  The household rebate is only awarded to families from the poorest 40% of the population.

The change agents conduct village meetings, supply chain development and hygiene behavior change education, and also assist households to access micro-loans to finance their toilets. Thrive Networks provides technical assistance to the change agents with each of these activities, and then verifies approximately 30% of completed latrines before awarding the rebates.

This approach is working in Vietnam and Cambodia, and is now being introduced in Lao PDR.  The chart below demonstrates the success of Output-Based Aid sanitation reaching the poor in eight Vietnamese provinces.

The programs are implemented hand in hand with selected change agents from all levels of the partner organizations. This allows the change agents to test the approach, build up their capacity and, most importantly, see first-hand the effectiveness of Output-Based Aid to achieve cost-effective results.

A senior government official from Vietnam’s central health agency noted that: “The key objectives of Output-Based Aid and targeting the poor are consistent with our own government objectives. We will prepare a new national sanitation action plan at the end of the National Target Program 3 in 2015. We will consider how to integrate these approaches into the national plan”.

The Thrive Networks Advantage

The highest-level goal of this sanitation program is scale. Thrive Networks encourages the use of Output-Based Aid approaches among other organizations, government agencies and donors. Key to achieving this is a monitoring and evaluation system and evidence base to demonstrate the effectiveness that Output-Based Aid can achieve.

The integration of new organizations such as Blue Planet Network has created exciting new dissemination opportunities with WASH organizations around the world.  Further, working with Blue Planet Network has led to partnership opportunities that build our technical and knowledge management capacity.  For example, the sanitation program is partnering with Cause Labs to develop an App for Android tablets. The App completely eliminates the cumbersome system of hard copy forms from the latrine verification process and shares “live” program results through an online dashboard with the team and donors.


[1] CHOBA research on 8 provinces throughout Vietnam.

[2] Change agents are local mass organizations or government agencies that are, and will continue to be, the key responsible agents for improving sanitation and hygiene in their communities.

[3] In Vietnam the rebate covers about 10% of the latrine cost, and in Cambodia up to 40%.

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At the heart of our programs are strong partnerships with government, private sector, civil society groups, and local communities. We also implement learning and feedback strategies to strengthen our approaches to promoting gender and socially inclusive WASH practices in our partner communities.