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‘Last Mile’ groups are those who are not currently reached by sanitation and hygiene programmes (or not able to sustain improved sanitation and hygiene behaviours) due to challenging contexts they live in or because they are in some way vulnerable. In this workshop, participants identified the ‘Last Mile’ in West and Central Africa as:

  • People living in conflict-affected or insecure areas (e.g. areas affected by armed insurgencies).
  • People living in remote or physically challenging contexts (e.g. riverine, mountainous, lake-side, water-scarce areas, deserts, flooded areas, areas with sandy or rocky soils).
  • People living in non-responsive or hard to reach communities (e.g. mobile fishing groups, pastoralists, miners, plantation farming communities, scattered settlements, small towns, ethnic groups who practice “cat method”, communities with taboos about menstruation, adolescent girls, traditional rituals).
  • Non-responsive or hard to reach groups within communities (e.g. people with socio-cultural beliefs and norms that prevent toilet use, chronically ill, widows, chronically poor, orphans, street children, elderly without support, those with a mental or physical disability, landless, tenants, migrants, koranic schools).

Recommendations for reaching the last mile include:

  • Urgently advocate to increase domestic resource allocation. This should include the costing of activities and advocating for government (both national and sub-national) to allocate resources with dedicated budget lines for rural sanitation. Highlight the financial benefits of all people having access to safely managed sanitation and the loss to GDP of inaction.
  • Create specific country-level strategies for reaching the ‘Last Mile’. In countries with high numbers of OD use public health data to target and prioritise communities in high-risk areas such as those suffering from regular outbreaks of cholera or areas with high under-nutrition rates. No clear best practices on how to implement programmes in areas of conflict and insecurity are apparent however these areas must be considered in strategies, plans and programmes
  • Use of evidence on ‘Last Mile’ demographics and practices to encourage inclusion in policies, strategies, capacity building, programmes and monitoring systems – and allocation of appropriate capacity and resources for reaching last mile groups.
  • Avoid rigid policies and practices and be less dogmatic about what approaches are used. Encourage flexibility and adaptation of approaches to recognize the needs and priorities of the target groups. However this needs to balanced with consensus and harmonisation of different approaches to ensure they are not undermining one another.
  • Use area-wide approaches (i.e. ODF districts, local government areas) to ensure all are covered. This should encourage inclusive, equitable and large-scale approaches that reach all groups. Identify “insider” champions from hard-to-reach/challenging communities invite them to join programme intervention teams.


A number of countries in the region are collecting and analysing data on the sustainability of ODF status through sustainability checks. Those studies demonstrate a wide range of slippage rates with an average of around 30 per cent endangering both past achievements and the drive for ODF nations by 2030.

The participants shared their experience regarding the three key dimensions of sustainability:

  • Enabling conditions referring to institutions and processes, including: political prioritisation and campaigns, programme quality, inclusiveness and intensity, planning and timing of activities, and post-ODF follow up.
  • Physical and technical sustainability including: physical conditions and ease by which one can take immediate action, toilet quality, technical support and market supply, filling of pits, affordability and accessibility of sanitation goods and services to move up the sanitation ladder.
  • Social and behavioural sustainability including: social norms, natural leaders and other reference networks as drivers of sustainability.

Recommendations for sustainability and POST-ODF interventions include:

  • Systematise post-ODF interventions to ensure sustainability.
  • Identify, strengthen and promote local technological solutions – explore making incremental changes to climb the sanitation ladder and move towards improved and safely managed toilets where this has not already been achieved.
  • Conduct formative research focusing on:

 - the last mile to better quantify and understand these groups and identify barriers to them gaining improved sanitation options 
 - sustainable, locally available solutions,
 - on ways to change long-term behaviour and social norms

  • Strengthen knowledge management initiatives to better support the region, especially for francophone practitioners. This should include better ways to document and evaluate promising practices from the field and ensuring French speakers are better engaged in global discussions. A good first step could be to identify organisations and institutions that can help support this change and translating and disseminating relevant documents currently only available in English.
  • Collect, make publically available and respond to data. This includes a focus on disaggregated data to ensure equity and inclusion – through baseline, mid-line and end line surveys and during sustainability checks - during monitoring and evaluation.