Introduction

Sanitation is core to the health and wellbeing of individuals, cities, societies and environmental ecosystems, and constitutes a public good [1]. This means sanitation services must be organized into public service systems [1,2]. Effective regulation has been recognized as core to a public service approach to sanitation and as essential to realizing and accelerating universal access [3].

In most low-income countries, effective regulation means the regulation of onsite sanitation, as the most prevalent form of sanitation [3]. Regulation of these services is very different to networked water and sewerage. A greater level of regulatory sophistication is needed to address dispersed responsibilities to households and, implicitly or explicitly, a heterogenous private sector [4].

To date, the sanitation sector has typically taken a narrow view of regulation as a ‘specific set of commands’, focused on a traditional command and control approach [5,6]. This approach has prioritized the passive development of guidance and guidelines, failing to address the complexity of onsite sanitation, including the incentives and choices faced by service providers and households.

Recent experience from Eastern and Southern Africa has informed a new understanding of the role regulatory authorities can play in supporting onsite sanitation service improvements [7]. In countries such as Kenya, Mozambique, Rwanda, Tanzania and Zambia, autonomous regulators have supported the development of improved regulations, guidelines and standards for onsite sanitation. They have also adopted leading roles in coordinating stakeholders, driving processes of sector reform, and innovating and introducing incentives for equitable service provision; and are leading the sector response to new challenges such as climate change [7]. These efforts have been amplified through regional peer-to-peer learning and knowledge exchange, led by The Eastern and Southern Africa Water and Sanitation Regulators Association (ESAWAS).

Regulators have a critically important function in advising governments, and in enabling universal access to water and sanitation services. These functions mean regulators are naturally adopting an intermediary role, acting as the pivot between policy makers and service authorities [8]. As custodians of reform processes, regulators help to maintain the integrity of the separation of roles — policy, regulation, and service provision — strengthening accountability. Autonomous regulators in Eastern and Southern Africa are influencing upwards towards the ministries or the Executive they themselves are accountable to, while also providing direct capacity development support and training to service authorities to ensure that policy is implemented.

Towards active regulating

An important distinction is between the passive development of regulations and standards and active regulating. In many locations where regulations, and guidance, for onsite sanitation are in place, there remains a lack of implementation [9]. The translation of agreed regulations and standards into improved outcomes, delivering public health benefits to all, has proven difficult [10]. By contrast, in regions such as Eastern and Southern Africa and Latin America, autonomous regulators are recognizing the need to engage directly with both service authorities and households. This includes providing capacity development support, and evolving their approach to core functions such as compliance monitoring and enforcement, to ensure regulations are translated into improved service outcomes.

Synthesizing new experience into global guidance

This evolving role of the regulator in the context of onsite sanitation is reflected in A Roadmap for Advancing Sanitation Regulation. The Roadmap [9] supports regulators at different levels of maturity to identify a route to regulate for universal access to safely managed sanitation. Six steps are identified, each supported by underlying principles and recommended actions. The overall structure is shown in Fig 1.

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Fig 1. Roadmap for advancing sanitation regulation [9].

https://doi.org/10.1371/journal.pwat.0000414.g001

The Roadmap was based primarily on consultations with over 20 regulatory authorities across the Regions of Africa, the Americas, the Eastern Mediterranean, Europe, South-East Asia and the Western Pacific. Key informant interviews with these regulators were supplemented by consultations in sector forums, notably the 2023 annual meeting of the WHO International Network of Drinking-water and Sanitation Regulators (RegNet) — an international forum established to promote and share good practice in water and sanitation regulation for the protection of public health.

For many aspects of onsite sanitation, the basic foundations of clear responsibilities, regulations, and guidance on how regulations are to be implemented, are often not in place [3]. As outlined in the Roadmap, countries at an earlier stage in their journey of regulating sanitation must establish the current legal basis for service regulation, as a practical first step, potentially leading to review of the institutional and regulatory framework for sanitation (Step 2) to ensure clarity of roles. Regulatory tools must be in place (Step 3), which must include onsite sanitation and must address every step of the service chain, including containment. Robust data management systems must be established (Step 4) (Fig 1).

Step 5 of the Roadmap outlines the regulator’s role in strengthening service provider capacity and incentives. This directly reflects the shift to active regulating that has already been implemented by regulators such as NWASCO (Zambia) and WASREB (Kenya). As countries move towards completion of the Roadmap and higher-capacity regulation, they engage with the ongoing process of managing the delivery of regulations [9]. These steps then lead to more advanced building of capacity and approaches, as well as progressive iteration and improvement.

Enabling the shift towards active regulating of onsite sanitation

In synthesizing this experience, the Roadmap emphasizes that regulators can have a transformative role in the sanitation sector. Active regulating can build capacity and compliance of service providers, influence policy makers and mobilize sector finance [10,11]. These functions are particularly critical to the development of nascent onsite sanitation services [12].

However, the successful adoption of this role by regulatory authorities is hard-won. In countries at an earlier stage in their journey, it requires understanding of the long-term nature of sector reform processes; the progressive development of regulatory capacity; an appropriate level of decision-making autonomy for the regulatory authority; and the sustained and constructive engagement of the regulator with wider stakeholders, enabling the regulator to build trust and credibility.

Even when these foundations have been achieved, the tenacity to build incremental change will be required. Experience has shown that it can take 20 years or more for regulatory reforms to translate into improved service outcomes. As underscored by the new Global Call to Action for strengthening water and sanitation regulatory systems [13], adoption of the guidance in the Roadmap requires political commitment to regulating sanitation, as part of long-term systems strengthening work, guided by public interest principles.

The Roadmap represents an expansion of guidance and a change in the ways of working for the sanitation sector, to support the progressive advancement of regulatory systems. Active regulating describes a broader conception of regulation including a wide range of pragmatic and responsive approaches involving state and non-state actors [5,14]. This shift is necessary to respond to the challenges faced in regulating a low-demand and low-visibility sector which has a huge impact on public health.

Footnote: This opinion piece was inspired by sessions at the 2024 UNC Water and Health Conference, where a key theme concerned how to bridge the gap between policy and practice (UNC, 2024a).

Acknowledgments

The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the World Health Organization.