2.1. Ethics

This study was reviewed and approved by Cranfield University Research Ethics System (CURES/23444/2024). Informed consent was obtained from key informants.

2.2. Overview

A literature review synthesised the established roles and characteristics for regulators. Secondary data from the Eastern and Southern Africa Water and Sanitation Regulators Association (ESAWAS) and the International Network of Drinking-water and Sanitation Regulators (World Health Organisation) were then analysed to identify emergent roles and characteristics which appear to differ or go beyond established good practice. These findings were combined into a coding framework and used to design and analyse interviews with 19 key informants within national and local regulators. The findings are then discussed against wider trends in sanitation and regulatory policy.

2.3. Definitions

This paper takes a broad view of regulation as a process of effecting change, led by regulators who work through, and with, a wide range of actors [34].

‘National regulator’ is used for whichever national authority has the primary responsibility for regulating sanitation service provision.

‘Local regulator’ is used for utilities and municipalities, or the responsible department within the municipality, which are seeking to monitor and control the activities of a local private sector. This regulation could be explicit or implicit, for both formal and informal service providers. In many cases utilities or municipalities may also be directly contracting or providing services themselves. This paper looks only at the de-facto local regulatory role for utilities and municipalities.

‘Service provider’ refers to the individuals or businesses directly involved in faecal sludge emptying and transport.

‘Trust’, both interpersonal and interorganizational, is used in this paper to mean “the intention to accept vulnerability to the actions of another party, based upon the expectation that the other will perform a particular action” [[35], p.61].

‘Pro poor regulation’ aims to extend service to low-income groups, for example designing social tariffs and explicit targets for low-income areas [5].

The ‘informal’ sector or service providers refers to all individuals and organisations “that are – in law or in practice – not covered or insufficiently covered by formal arrangements” [36].

‘Formalisation’ means bringing ‘informal’ service providers under “the regulation of the state with the advantages and obligations that this entails” [36]. The formal and informal sectors are seen as distinct and separate, as commonly presented in literature road-based sanitation [31].

2.4. Literature review, secondary data analysis and development of the coding framework

A review was completed of academic and practitioner literature which laid out roles and characteristics of good practice regulation. Academic and practitioner literature looking specifically at the regulation of road-transported sanitation in urban settings was identified building from a published scoping review by the same lead authors completed in 2023 [23]. This review on road-transported sanitation was updated for 2024 and 2025, with peer-reviewed publications and practitioner literature from international bodies which are active in regulatory policy of the related sectors of water, sanitation and environmental regulation; World Health Organisation (WHO), East and Southern African Water and Sanitation Regulators’ Association (ESAWAS), and the International Water Association (IWA). This review of regulation of road-transported regulation was supplemented by cross-sector definitions of roles and characteristics using four seminal texts as the basis: (i) Baldwin et al. (2011), still the most comprehensive interdisciplinary introduction [1]; (ii) Nolan Committee (1995), as a foundational text for how the authors consider public sector responsibilities [37], (iii) Sparrow (2000) which, in the opinion of the authors is the most comprehensive outline of the challenges inherent in regulation [33], and (iv) Brown et al. (2006) which is used in the evaluation of regulatory systems by the World Bank and has informed commonly used indicators such as Global Indicators of Regulatory Governance [38]. The literature review then builds from these references and checks for consistency and updates, supplemented by practitioner literature from the organisational websites of the World Bank, Organisation for Economic Cooperation and Development (OECD), and the International Network for Environmental Compliance and Enforcement. A total of 26 documents were shortlisted for coding, including 11 peer reviewed articles, or chapters, and 15 practitioner documents from international organisations. The overall process and PRISMA diagram are given in the literature review protocol provided as Supplementary Materials (S2 Text).

Roles and characteristics were extracted from this shortlisted literature, grouped and synthesised. The process consolidated findings until data saturation was reached [39]. The final eight bullet points defining the role and characteristics of a good practice regulator is given in Table 1a. If an issue was only referenced by a small number (<5) of recent (since 2020) publications, then it was classed as emergent, rather than established good practice. Trust and engagement of the informal sector was the one emerging issue identified. The full list of literature is given as a footnote to Table 1.

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Table 1. Initial coding framework for the roles and characteristics of a good practice regulator and regulators as a change agent.

https://doi.org/10.1371/journal.pwat.0000385.t001

The literature review defined good practice, in Table 1a. The next step was to review recent secondary data from national and local regulators active in scaling faecal sludge emptying and transport services and extract and compare their perspectives. Transcripts from interviews completed to inform WHO and ESAWAS publications on accountability and regulating onsite sanitation were sourced from partners [31,40]. There was no formal ethical process as part of developing these previous publications and the use of this data is therefore limited to informing primary data collection. However, it did enable the authors to develop more targeted questions, therefore reducing the time requested from key informants. Open text responses from a Delphi study completed by the authors [31] on building compliance in faecal sludge emptying and transport were also collated [23] and reviewed. Secondary data reviewed is summarised in Table 2.

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Table 2. Secondary data analysis and Primary key informant interviews.

https://doi.org/10.1371/journal.pwat.0000385.t002

Commentary related to the roles and characteristics of regulators was extracted from this secondary data and compared to the definition of good practice in Table 1a. Roles and characteristics were coded as good practice or emergent.

There were two elements which were consistently raised which clearly go beyond the definition of good practice developed: (i) Courageous: Going beyond the mandate, challenging the status quo, acceptance of risk, recognises and overcomes prejudice, and (ii) Accessible: Understanding service providers and developing relationships of trust, reaching across the divide to engage unconventional partners including those working informally and illegally. These elements, given in Table 1b were used to inform the questions for semi-structured interviews used for primary data collection, including about working with the informal sector and adding probing questions around going beyond mandates, risks taken, and unpopular or difficult decisions.

2.5. Key informant interviews

A series of 19 semi-structured interviews with senior leadership from national and local regulators were completed to analyse and extend the emergent roles and characteristics in Table 1b.

This paper targets ‘information rich’ country cases [54] where water and sanitation regulators are widely considered to be driving change in the sector. Country cases (i) are within east and southern Africa in order to build directly from secondary data; (ii) have at least 40% of the urban population reliant on road-transported sanitation; (iii) have seen change in either sector reform or engagement of service providers in faecal sludge emptying and transport, over the last five years; and (iv) have a multilayered regulatory system, with both national and local regulators scaling faecal sludge emptying and transport services [55].

The selected locations, Kenya, Mozambique, Tanzania, Uganda and Zambia, are described in detail in the ESAWAS publication on sanitation regulatory journeys [55]. Within each country the national regulator and the small number of local regulators in each country who are actively moving forward with regulating services were identified as sources of key informants. The local regulators were identified from ESAWAS, WHO and UN-Habitat case studies [46] and confirmed with ESAWAS. These national and local regulators are not intended to be presented as homogenous, or representative of the wider sector; they are at different stages and working at different levels, however they are all considered to be actively progressing.

Purposive sampling was then used to identify key informants from these identified national and local regulators. Interviews are summarised in Table 2. All interviews were conducted with current, or recently exited, senior managers with responsibility for sanitation. Key informants were individuals who have been instrumental to the changes observed. They were asked to speak from their own experience within the organisation, rather than formally as an organizational spokesperson. Initial interviewees were identified through the secondary data analysis referenced in Table 2. Interviewees were requested to recommend other key informants.

As described above, the key informants were leading individuals, within leading organisations, within leading countries regulating road-transported sanitation in the east and southern Africa region. The perspectives given within this paper are therefore taken to represent positive outliers in terms of sector reform [54].

The interviews were conducted remotely in English by the UK based first and second authors, online through standard video conferencing platforms. Each interview was held for 45–60 minutes. Conducting interviews remotely facilitates a wider geographic scope, however, it also limits participant observation and contextual understanding [56]. Additional time has been invested in researching participant backgrounds, and structured questions are limited to allow time for discussion, as advised in [57].

National and local regulators were asked to reflect on their own role and how it changed as they started to regulate faecal sludge emptying and transport services. They were asked to reflect on what characteristics they thought regulators required to be effective in scaling these services and to reflect on their relationship with either national or local regulators. In addition, practical questions around the resources, organisation and steps required for this transition were asked. The interview guide is provided as Supplementary Materials.

Initial invitations were sent to key informants from 16 July 2024–8 November 2024. The interviews were run between 16 August 2024 and 16 December 2024. The informed consent template and information sheet was provided to participants in advance of the interview. Interviews were recorded using the video conferencing software. A simple verbatim transcription was produced for each interview, removing repetition, verbal tics and false starts. Consent for data collected, including audio and video recordings and interview notes, was obtained either verbally or in writing from all key informants before the commencement of the interviews. The information sheet and consent form template are provided as Supplementary Materials (S1 Text). The signed consent form with the participant numbers was shared with each participant along with the anonymized transcript for validation. Ethical clearance for the interviews was obtained from Cranfield University (CURES/23444/2024).

2.6. Analysis

A thematic analysis was completed in NVivo (v14, 2023), applying the coding framework laid out in Table 1 [58]. The analysis looked for common themes, outliers and contradictory information. Four themes emerged from this process; (i) confirming the basic definition of good practice, (ii) challenges preventing established good practice being implemented, (iii) evidence of regulators going beyond good practice in two areas: courage in making bold choices and engaging the informal sector, and (iv) how local regulators understood and described their role.

Only those aspects which were consistently raised across multiple locations, and where there appeared to be consensus within national or local regulators, were considered in the results section. This approach limits the range of issues considered in the results and discussion. However, it increases the confidence that they are likely to be generalisable to other locations.

The results were then reviewed and discussed against the urban sanitation literature and the wider regulation literature. The discussion aims to clarify; is there anything novel in how these national and local regulators are working? Is there anything which could or should be learnt by others?

The draft research manuscript was shared with key informants for feedback and validation. More than 70% of key informants responded confirming that the findings resonated with their experience, providing some level of testimonial validity.

3.1. Definition of a good practice regulator

The definition of the roles and characteristics of a good practice regulator taken in this paper, and the range of literature reviewed, are given in Table 1. The requirements on the regulator to meet established good practice, as summarised in Table 1, are substantial. As outlined in the regulator’s dilemma [[33]p.17] regulators need to “be less intrusive – but more effective, focus your efforts – but be consistent, process things quicker – and be more careful next time, deal with important issues – but do not stray outside your statutory authority, be more responsive to the regulated community – but do not get captured by industry, be kinder and gentler – but don’t let the b*******s get away with anything”.

3.2. Case locations

Table 3 summarises the legal frameworks and current status in each of the case countries.

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Table 3. Legal and regulatory frameworks and progress [19,29,55].

https://doi.org/10.1371/journal.pwat.0000385.t003

3.3. Revisiting the concept of local regulators

Interviews started by asking about the conception of multi-layered national and local regulators. With some notable exceptions, utilities and municipalities were often seen, and saw themselves, as contract managers or enablers and monitors, rather than local regulators. Utilities and municipalities typically identified the local government departments of health, environment, labour and construction as being the local regulators of sanitation services. These local departments often had conflicting aims and incentives, to prevent unsafe practices, rather than scale safe practice. The manual handling of faecal sludge has historically been a particular issue in these conflicts, often perceived locally as unacceptable, even when allowed for in national regulations.

The importance of public health, and reaching complete coverage, as a personal and professional driver was raised by many key informants. This topic then led to reflections on the arms-length influence required for engaging informal manual pit emptiers. It was often only during these discussions that the language of local regulation began to be used by utilities or municipalities in reference to their own work. Ultimately all interviewees talked about utilities and municipalities as local regulators, however this appears to be novel language in some locations. In some cases, the perceived role of the utility as being responsible for only directly delegated services persisted alongside mandates for universal sanitation access. Several local regulators identified their regulatory role as being unclear in the regulatory framework, an implied rather than explicit role.

“So, we kind of regulate, sort of. I don’t know the right term to use.... it is implied that if you get into partnership with any service providers,.... you play a regulatory role. But I think in the regulatory framework that doesn’t really come out.” - Local regulator.

3.4. Good practice

The majority of the roles and characteristics described by national and local regulators fell within the current definition of good practice as outlined in Table 1. The scope of this established good practice was not contradicted. However, it may already be an ambitious requirement for regulators in many resource-constrained settings. Respondents across locations identified gaps in (i) adequate resources and capacity, (ii) clear role and requisite powers, and (iii) complete and clear rules.

A lack of adequate resources and capacity to work effectively was the most prominent gap. National and local regulators across all locations identified insufficient financial and human resources, and a lack of skills, as important barriers to building their own or others’ capacity and scaling services.

Clear role and requisite powers were often not in place. Overlapping mandates and unclear responsibilities hampered implementation.

For all local regulators at least some of the powers to enforce safe practices were held by others. The department of health or environment would issue fines to households for unsafe emptying, or to emptiers for unsafe disposal. The department of labour, or equivalent, would enforce licensing of enterprises.

The largest gap in requisite powers identified by national and local regulators was around household containment and the lack of formal influence over the regulations or enforcement of containment quality. Two substantial impacts were noted due to poor quality design and construction resulting in pit latrines and septic tanks which are difficult or impossible to empty safely. Firstly, that it is not possible to comply with national or local guidelines and standards for emptying, and secondly that the market for pit emptying services is reduced, thereby increasing the transport and logistical costs per household and making it more difficult to realise economies of scale.

Complete and clear rules. The key informant interview locations were selected partly because the local or national regulators had led in developing frameworks and guidance. However, there were still challenges in cascading new guidelines for local implementation, particularly around safe and dignified manual handling.

In most locations manual emptying of pit latrines and septic tanks is disallowed – with at least semi mechanised or specialist equipment being required. Zambia appears to be the only location where adapted garden tools are explicitly accepted for manual emptying. Even where manual handling is accepted by the national regulator, there may be local bylaws which effectively criminalise the practice.

In most locations the feasibility of safe disposal was limited by a lack of treatment infrastructure. There was little clarity on allowable interim options while faecal sludge treatment plants, or transfer stations were built.

3.5. Beyond currently defined good practice and potential learning for others

Through the key informant interviews there was evidence of regulators going beyond good practice in; (i) courage in making bold choices, and (ii) engaging the informal sector.

4.1. Moral courage and navigating uncertainty

The bold choices as described in Section 3.5.1 are more clearly understood as moral courage; an individual, or organisation’s “ability to act ethically, even when it may not be popular or could result in personal loss” [64].

There is scant literature explicitly referencing regulatory courage, or regulators acting with moral courage. Perez [65] highlights the need for courage in regulatory judgement. Kasdorp [66] expanded this idea further into the conception of the regulator being able to take on the role of a ‘public architect’ in going beyond the law and generating public value. Moral courage is considered an important regulatory principle in areas which, arguably, pose an existential crisis to human existence; the regulation of nuclear power [67] and in the development of regulatory frameworks for climate law [68]. We believe that this concept of moral courage is pertinent also to the public health risks linked to poor sanitation, given the scale of the challenge.

Moral authority, being recognised as doing the ‘right thing’, is considered in the regulatory literature an antecedent to building trust and thereby voluntary compliance [[35] p.17] [[69] p.35] [70].

Looking more widely at management literature there is a recognition that moral courage, in individuals and organisational culture, may be more important for business ethics than setting the ‘right’ rules and regulations [71]. Moral courage in this context is considered to encourage moral conduct, particularly where a morally correct choice could have negative repercussions [72]. Moral courage is highly pertinent when the moral decision to scale safe sanitation services in low-income or informal areas requires actors to work outside of the law. The ‘obligation to disobey’ an unjust law has been accepted by ethicists for some time [73]. It has also been demonstrated by public responses to insufficient sanitation programmes in South Africa [74]. However, it has not been documented as an institutional response in sanitation.

It should be noted that, in large part, the moral courage demonstrated through this paper was a response to challenges faced. Moral courage was needed to navigate an unclear role, incomplete rules and a lack of resources. This brings us to the second question of this paper, what should be learnt for others?

The willingness of regulators, particularly local regulators, to work in a legal grey space and take, potentially substantial, financial and legal risks to scale safe sanitation services should, we believe, be applauded. However, we would argue that courage should not be a requirement for organisations trying to scale the most basic of public services. National and local regulators should be supported and protected. As regulators take this activist role, investment is needed for infrastructure and the enabling environment to make universal access to safe sanitation feasible.

4.2. Scaling public services through informal, or less formal, providers

There were two main findings around the informal sector; firstly, that regulators are trying to engage them as part of the wide range of service providers, secondly that regulators see the informal sector as an opportunity to scale safe service into low-income areas.

The first finding confirms existing research in urban sanitation and wider regulation literature. In multiple locations manual handling of faecal sludge was criminalised in an attempt to improve practices but found to create greater negative impacts for both sanitation workers and households [75,76]. The importance of engaging the informal sector is reflected in the sector literature and advocacy around the rights of sanitation workers, positioning them as front-line public workers playing a critical role in service provision [72]. A number of analogous sectors have identified the need to engage with, rather than displace, informal service providers. There are multiple examples, across street food, artisanal mining, solid waste management and informal transport, where state actors attempted to displace the informal sector, and witnessed the negative social impacts of this punitive approach, before finally shifting to a more conciliatory stance and supporting improved practices [77–79]. A transnational review identifies progressive formalisation, rather than displacement, as the main approach now adopted by supra-national agencies and national governments [80].

The novel finding from this paper is regulators’ perspectives of the informal sector as a part of the solution for universal access to sanitation. Specifically, the focus on scaling safe services through changing practices in the informal sector. Both national and local regulators described informal sector service providers as well positioned to serve the lowest income areas due to their history, knowledge and specialist skill set. Some described working with informal providers to provide training and support to all those willing to participate. This perspective was maintained while understanding the well documented challenges of engaging the informal sanitation sector [81].

There is scant literature in urban sanitation reporting regulators’ positive perspective of the informal sector, particularly the need for wide scale engagement to change practice. The predominance of informal sector providers and the need for policies to target and protect this group is recognised by many [31,82,83]. However, recommended responses across these publications are gradual formalisation, often starting with formal recognition and enforcement despite recognition of the barriers of cost and bureaucracy [31,82,83]. Only in Burundi are there noted examples of nascent policies which support both formal and informal sanitation providers [55]. WHO (2025) recommend the gradual formalisation of informal sectors as part of their roadmap for sanitation regulation, including the development and enforcement of Standard Operating Procedures and additional protection and training for sanitation workers [31]. The findings from this paper support those recommendations, as a long-term goal. However, the findings also demonstrate that in the short-term, the informal sector should be accepted and supported as an important part of sanitation service provision. What this could mean in practice is described below.

Research in regulation of analogous sectors, such as off-grid water, street food and small-scale mining, support these findings. Several papers across these sectors identify that the use of a binary formal/informal distinction is not helpful in improving service quality or environmental outcomes, and that there is a need to focus on changing practice and managing informality [84–86].

The active engagement of the informal sector in scaling safe faecal sludge emptying and transport services, whether actual or anticipated, appears to be a novel finding for road-transported sanitation.

In terms of the second question of this paper; what should be learnt for others? We believe that much could be learnt from leading regulators in how to effectively engage and scale through the informal sector. We also see this as an important area for faecal sludge emptying and transport provision going forward. A focus on practice rather than paperwork is a pragmatic response in east and southern Africa given the high levels of informality in the wider economy. Excluding South Africa, informal employment makes up 50–90% of total employment across the region (ILO, 2024).

The proactive engagement of the informal sector to rapidly scale incremental improvements to services requires regulators to accept some level of informality and a reduced level of control. As identified in this paper, it will require local regulators to recognise and support service providers who are not legally registered and have amnesties in place until capacity to comply is built. The steps identified in this paper reflect much of the documented good practice for engaging the informal sector; understanding the landscape and strengthening the evidence base, providing safe spaces for collaboration, public recognition and social protection, building up low-capacity and informal service providers, a focus on practices rather than bureaucracy, and bringing them into an appropriate regulatory system [36,87].

The approach described of amnesties and phased implementation reflects the enabling and facilitating role of regulation [1]. It may be appropriate in this scenario to protect de-facto local regulators by setting final end states and timelines, rather than rigid standards.

A final reflection is that the current understanding of informality in the sanitation sector literature may need to be reconsidered in the light these findings, to shift towards an understanding of the formal and informal sectors as intertwined and interdependent [88].

4.3. Terminology of local regulators

Utilities and municipalities are acting as de-facto local regulators in addition to the well-established roles of contract manager for delegated services and direct service provider. We found that the terminology of ‘local regulator’ was novel for utilities and municipalities, and that this role was often implicit, rather than explicit. This confirms findings from previous research with utilities in the target locations [89]. In putting this term forward, we recognise that the position of utilities and municipal departments as service authorities is quite different to that of national regulators. We are drawing attention to the wider role being played, not implying self-regulation by utilities or municipalities.

We believe that recognising the significant regulatory role being taken on by utilities and municipal departments and considering them as de-facto local regulators provides a useful distinction for three reasons. Firstly, utilities and municipal departments are responding to explicit aims to extend services and reach universal access to safe services. Within the current context of limited resources and assumptions of private sector delivery, this mandate necessarily entails a regulatory role to engage service providers who fall outside of direct or delegated arrangements. Secondly, as they support incremental improvements, this aim may be in conflict with departments of environment, health and labour, who are trying to control and prevent unsafe emptying and disposal of faecal sludge. Considering utilities and municipal departments as local regulators might enable closer alignment with others in terms of sanctions and support. Thirdly and finally, as outlined in Table 1, the skill set of a good practice regulator is very different to that of a contract manager or service provider. Recognizing this regulatory role may support gap analysis and capacity building, it also signposts utilities and municipal departments towards a wide range of approaches and tools for engaging private sector providers.

4.4. Limitations and generalizability

The use of positive outliers within positive outliers as key informants means that the conclusions drawn point towards possible future trends rather than documenting current sectoral practice [90]. In addition, self-reported practice is likely to be impacted by social desirability bias [91]. Scaling road-transported sanitation has been financed by international organisations in many cases and some key informants had gained recognition due to their involvement in this work [32].

In addition, the framework for analysis and discussion is limited by the positionality of the authors who, while geographically diverse, have all been trained and employed in western headquartered organizations [92]. The concept of moral courage as expressed in this article has strong European roots [71]. The assumptions of regulated market-based sanitation as the approach to reach universal access is a paradigm largely led by IFIs and western institutions [25].

However, working within the current framework of resource constrained regulators mandated with universal access, the findings do appear to be highly relevant and generalisable beyond the case study locations. Across east and southern Africa, and other locations where road-transported sanitation is the main form of urban sanitation, municipalities and utilities will need to take on regulatory responsibilities for private sector providers and engage the informal sector.