Tackling Institutional and Behavioral Bottlenecks to Improve Sanitation and Hygiene in Shaanxi


This case study documents how the Government of Shaanxi Province provided sustainable and safe water supply, and improved sanitation and hygiene in poor rural communities. The Shaanxi Provincial Government introduced the Rural Water Supply, Sanitation and Hygiene Promotion Project in 2008 with the goal of addressing the lack of safe drinking water and sanitation facilities in poor rural areas. To overcome this, the project would have to change deep-seated behaviors, as villagers often did not follow sanitary practices, and overcome issues of organizational coordination, as government departments often did not cooperate on complementary issues of water supply and sanitation. The case study focuses on how the project was implemented utilizing a participatory “three-in-one” strategy—in which sanitation and hygiene promotion activities were integrated with water supply interventions—and how the delivery challenges were directly addressed during implementation. Multi-village or single-village water supply schemes were built along with public latrines and household sanitary toilets, while hygiene promotion activities were conducted for the public.

Lessons Learned

  • It is critical to win government support at all levels. Without government attention and support, it would have been difficult to promote the project.
  • Joint efforts of various departments, with clearly defined levels of responsibilities, facilitated effective implementation. For instance, the Development and Reform Commission is responsible for daily management while water and health departments offer technical guidance.
  • Specialized agencies can lend valuable experience to project implementation. The Shaanxi Foreign Loan Project Management Office, a permanent office, has rich experience and efficient work capacity in implementing foreign loan projects.
  • When conflicting interest occurs among local departments, there must be leadership support and an integrated management agency to coordinate, which is key to smooth delivery of complex projects. Streamlining levels of management may facilitate this.

Development Challenges

  • Lack of access to rural water supply: Shaanxi villages lacked access to safe drinking water, accounting for 47 percent of the total rural population.  Rural households mainly consumed untreated water harvested from rain, wells, and springs, while brackish water and water with a high content of naturally occurring fluoride were also frequently found.
  • Lack of access to rural sanitation facilities: Coverage rate of sanitary latrines in Shaanxi as a whole was 33 percent, while reaching only three percent in northern Shaanxi, central Shaanxi Plain, and Weibei areas. Randomly discarded garbage, discharge of sewage, and lack of sewage treatment facilities undoubtedly worsened the rural water supply.

Delivery Challenges

  • Behavior change in rural hygiene promotion -- the three-in-one approach: In the “three-in-one” approach, hygiene promotion is the “software” component aimed at changing people’s attitudes and behaviors compared with “hardware” components like water supply and sanitation. Rural residents in Shaanxi had low awareness of hygiene knowledge and low rates of hygienic behavior such as hand washing after using the toilet and before eating, and using soap to wash hands.
  • Coordination of conflicting interests among different agencies in the local government: There was a lack of unified policy guidance and no unified agency to coordinate between various departments. Local water resources department and sanitation departments worked separately to arrange most domestic projects in water supply, sanitation, and hygiene promotion, each of which often selected sites according to their own sectoral needs. Lack of coordination often resulted in ineffective projects.

Key contextual conditions: Shaanxi, in the northwest of China, is one of the country’s more economically underdeveloped provinces. For example, in 2003 the per capita GDP of Shaanxi was 3258 yuan, or about 64 percent of the national level of GDP per capita. Northern Shaanxi and central Shaanxi Plain, where the project took place, included 30 counties with net incomes below the poverty line, with a population of 4.6 million considered poor. With a small local economy, the local government was unable to adequately invest in rural water and sanitation infrastructure, leaving millions of residents without access to safe drinking water and proper sanitation.

Key stakeholders: Development and Reform Commission of Shaanxi Province, Department of Finance, Department of Water Resources, Department of Sanitation, Audit Office, Foreign Loans Project Office, municipal governments, participating schools, villagers, DFID, and UNICEF.