Output-Based Aid for Accelerating Water and Sanitation Service Delivery

Our Impact


Hygienic toilets delivered to the rural poor of Cambodia and Vietnam


Individuals enjoying improved, well-designed sanitation services


Average leverage ratio on the donor dollar

The Need

Globally, the statistics are dire. Nearly two million people die from water-, sanitation- and hygiene-related causes each year. Approximately 750 million people lack access to an improved water source. One third of the earth’s population lack adequate sanitation. Nearly 30% of people in Vietnam and 80% in Cambodia lack access to improved sanitation. Open defecation and other common unsanitary practices create a breeding ground for illnesses like diarrhea, parasites, and hepatitis A, which decrease the productivity of adults and can be especially life-threatening in children and the elderly.

People in rural communities in Cambodia, Laos, and Vietnam face many obstacles in accessing improved sanitation and practicing improved hygiene behaviors. Those who understand the advantages of building a hygienic latrine may be unable to afford one, unable to access financing for one, or unable to find a builder who will construct a reliable and long-lasting toilet.

The negative impact of poor sanitation and lack of clean water in human terms is considerable, resulting not only in decreased productivity but also in increased family health expenditures and lost days of school attendance. Measured in economic terms, Vietnam loses an estimated $778 million per year due to poor sanitation. Cambodia, with less than a quarter of Vietnam’s population, fares even worse, losing an estimated $448 million annually.

Our Approach

Thrive Water’s Community Water, Sanitation, and Hygiene program promotes improved community health by increasing sanitation adoption, hygiene behavior change and access to clean water among people in poor rural areas of Vietnam, Cambodia, and Laos. In those countries, the program is known as CHOBA (Community Hygiene Output-Based Aid). Focusing on the poorest 40% of the population, this innovative approach starts by combining stakeholder incentives, community education, and assistance in securing financing, to help disadvantaged families build a sanitary household latrine. Reducing the practice of open defecation helps decrease the incidence of waterborne illnesses in poor communities, so adults and children can be healthier and more productive at work and in school.

Thrive Water has been a pioneer in applying the output-based aid (OBA) approach in the fields of clean water, sanitation, and education for many years. With the help of local partners, the Community Water, Sanitation, and Hygiene program consolidates different approaches including: education, media, marketing, helping people access financial resources, and OBA financial incentives to encourage hygienic latrine ownership and hygiene behavior change. The program offers a series of incentives to grassroots workers, households and villages to stimulate demand for hygienic latrines in rural communities and increase adoption of proper hygienic and sanitation practices to prevent the spread of disease.

The OBA approach works by providing a cash reward for results that have been confirmed by an Independent Verification Agency. Poor households that purchase hygienic latrines and demonstrate usage receive a rebate. Rural communes that reach milestones in sanitation coverage receive a financial award. Grassroots workers also receive a cash award when they successfully promote and arrange financing for poor beneficiaries. The program’s strong partnerships with local groups and officials are key to ensuring that community leaders are invested in promoting improved sanitation. The program also promotes hygiene behavior change — hand washing with soap at critical times, safe handling of water for cooking and drinking, and proper garbage disposal.


Selected Partners & Funders