A literature review

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Theory-anchored conceptual framework for managing environmental sanitation in developing countries: Literature review

Justice Mensah

Academic Planning and Quality Assurance, University of Cape Coast, Cape Coast, Ghana

A R T I C L E I N F O Keywords:

Environmental sanitation Hardware and software solutions Theory-anchored conceptual framework Developing countries

A B S T R A C T

The phenomenon of poor environmental sanitation, which is a global challenge, but most so in developing countries, requires that the solution to it be both conceptually and theoretically sound and clear enough for translation into practice. The purpose of this paper was to develop a theory-anchored conceptual framework to guide Environmental Sanitation Management (ESM) in developing countries. Data were obtained from scholarly databases such as Scopus, PubMed, and Google Scholar as well as grey literature through predetermined material selection and screening processes, and analysed qualitatively using the narrative, configurative synthesis approach. The review revealed that, among the key conceptual issues in ESM are environmental sanitation education (software), regulation (software) and infrastructure (hardware), which are managed by the government and private sector stakeholders, using various frameworks. However, while the existing frameworks recognise important concepts and variables, the frameworks are unclear regarding the theories underpinning the concepts and the relationships among the variables, thus, making it difficult for one to establish the synergies among the issues to be translated into practice. Arguing that inadequate application of systems thinking, participatory processes and behavioural change mechanisms is the key missing link in the previous ESM frameworks, a theory- anchored ESM framework is developed tofill this gap. It is recommended that conceptualisation and implementation of ESM programmes in developing countries be driven by a framework of hardware and software solutions that are underpinned by the systems, behavioural change and participation theories in order to comprehensively address the complexities of ESM in developing countries for sustainable development.

1. Introduction

Environmental sanitation in developing countries has taken a centre stage in contemporary development debates due to the poor state of af- fairs with respect to its management in those countries. Developing countries, in this context, are those in the low income and lower middle income brackets. The United Nations [UN] (2019), has classiﬁed countries based on their level of development as measured by per capita Gross National Income (GNI). In that regard, countries with less than $995 GNI per capita as determined by the World Bank are classiﬁed by the UN as low-income countries, those with between $996 and $3895 as lower-middle-income countries, those with between $3896 and $12,055 as upper-middle-income countries, and countries with incomes of more than $12, 056 as high-income countries (UN, 2019). Besides the low income feature, the developing countries exhibit several characteristics, including the phenomenon of poor environmental sanitation. While sanitation basically refers to toilet or latrine management (Mosler, Mosch,&Harter, 2018;WHO/UNICEF, 2019), environmental sanitation

refers broadly to human excreta control, solid and liquid waste management, as well as pest and vector control. However, as used in this paper, environmental sanitation refers to management of defecation and waste disposal practices in a given settlement or location. This paper focuses on environmental sanitation, which per the paper’s operational deﬁnition, embodies sanitation (toilet or latrine management), apart from waste disposal practices.

Going by the UNICEF/WHO (2019) deﬁnition of sanitation, which emphasises access to a facility that hygienically separates excreta from human contact, 2 billion people of the global population, have no access to sanitation. Out of this proportion, 673 million people, most of whom are in the developing countries, engage in open defecation (WHO/UNI- CEF, 2019), In Sub-Sahara Africa (SSA), the picture is even gloomier. The World Bank (2016), cited inAbubakar (2017), reported that while the SSA’s population nearly doubled from 1990 to 2015, access to improved sanitation increased by only six per cent in that period, making it the region with the lowest sanitation coverage (37%) in the world. This is an affront to the human right to sanitation, which entitles everyone to

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Social Sciences & Humanities Open

journal homepage:www.elsevier.com/locate/ssaho

https://doi.org/10.1016/j.ssaho.2020.100028

Received 7 October 2019; Received in revised form 18 March 2020; Accepted 8 April 2020 Available online 1 August 2020

nd/4.0/).

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sanitation services that ensure privacy, dignity, accessibility, affordability, safety, and are also socially and culturally acceptable (Albu- querque, 2014;Geere&Hunter, 2019;UN, 2010, UN, 2019).

The importance of environmental sanitation is reﬂected not only in the United Nation’s endorsement of sanitation as a human right but also its inclusion in the Sustainable Development Goals (SDGs) in 2015. Goal 6.2 of the SDGs enjoins global leaders to ensure universal access to adequate clean water, equitable sanitation and hygiene by 2030 (Hutton

&Chase, 2016;UN, 2018). However, it has been realised (Mensah, 2019;

Prüss-Ustün et al., 2019) that the environmental sanitation Goal of the SDGs cannot be achieved, especially in the developing countries, without recourse to a sound and practicable ESM framework which can be translated it into practice. This calls for an ESM framework which is theoretically and conceptually sound enough to support a holistic appreciation of the ESM enterprise, leading to a workable solution to the problem (Abubakar, 2017). The justiﬁcation for a theory-driven framework for ESM is rooted in theﬁnding (Reed et al., 2018;Tidwell, Chi- pungu, Chilengi,&Aunger, 2018) that there is a relationship between concept and theory, since the fundamental constituents of a theory are concepts and principles.

According toMinh and Nguyen-Viet (2011), one of the major reasons for the slow progress of improved water and sanitation coverage in the developing countries is that, some policy-makers, practitioners in the ESM enterprise, and the general public have not fully grasped the concept of ESM and the theories behind effective solutions to the menace.Hed- berg, Pardo, Frontini and Daryous (2015) advocate that developing countries be encouraged to take ownership of water and sanitation

management. This paper concentrates on ESM in developing countries because it has been found (Geere&Hunter, 2019;Jimenez, Jimenez, Cortobius,& Kjellen, 2014) that although coverage of both environmental sanitation and clean water in developing countries is low, that of environmental sanitation is lower than clean water. TheWHO/UNICEF (2019)Report shows that while 785 million people lack clean water, over 2 billion lack basic sanitation service. Although both water and environmental sanitation have not been sufﬁciently studied, literature on ESM in developing countries is dramatically skewed towards water at the expense of sanitation and hygiene.

The foregoing background suggests that there is a compelling need for a theory-anchored conceptual framework to guide effective ESM in the developing countries where the phenomenon of poor environmental sanitation is most prevalent. The germane question is; what theories and concepts are important for ESM and how do they relate to proffer an effective solution to the challenge? Based on the need and its related research question, the purpose of this paper is to provide a holistic theory-supported conceptual framework to guide ESM endeavours in developing countries. The rationale is to provide the governments and private sector agencies working in the environmental sanitation sector in developing countries with an innovative model for improving ESM for sustainable development.

2. Methodology

This was a narrative review whose aim was to explore theories, concepts and frameworks related to ESM, and based on gaps identiﬁed in

Fig. 1.Material selection processes.

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the frameworks, develop an innovative framework for improving ESM in developing countries. In doing this, aspects of methodological approaches of ‘systematic review’ and ‘conﬁgurative review’were bor- rowed. For the article selection, aspects of the“Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. For analysis, the conﬁgurative and recursive content abstraction (RCA) [Levinsson&Prøitz, 2017] approach was used. This is because it was important to summarise the information from the various sources in a concise and coherent manner to aid effective discussions and meaningful conclusion.

Literature from various sources, including peer-reviewed articles, theses and conference reports were used. Borrowing from PRISMA guidelines, PubMed, Scopus, Google Scholar databases and grey literature were searched. These databases are known to contain large volumes of sanitation related literature. The search was guided by keywords and phrases such as environmental sanitation, ESM frameworks, stakeholders of ESM, ESM approaches, and theories of ESM.. As many as 711 documents were initially identiﬁed based on titles, abstracts, and body texts.

These included materials obtained from reference lists of identiﬁed documents in order to avoid the risk of missing potentially relevant literature.

Cognizant of the notion that the various databases do not have the same or equal strength in terms of quantity and quality of materials, due diligence was done to ensure that materials selected forfinal inclusion in the present review were credible with respect to sources and contents. In that regard, the‘fitness for purpose’of the materials from all the databases and grey literature were assessed by examining each material’s robustness through various processes. For example, having identified the materials from the various sources, series of screening were conducted through reading the titles and abstracts, and in some cases and intro- ductory background, which resulted in the removal of all duplicates and non-English materials. These screening processes led to 62 of the materials being earmarked as potential candidates for inclusion. The potential 62 full-text materials were then assessed for‘fitness for purpose’through a set of pre-determined eligibility criteria. The criteria included relevance, credibility, currency, and intelligibility. They were also assessed for the consistency of arguments as well as gaps. Additionally, they were assessed in regard to their conceptual vigour for addressing the complexity of environmental sanitation with special reference to developing countries. In short, irrespective of the database or source of the material, it was included only if the material was credible, relevant, current, intelligible, consistent, and represented a unique or conceptual contribution to ESM, particularly in developing countries. No restriction was placed on the age of the material. The foregoing material selection processes led to 27 documents being finally used for the review. The material selection processes–identification, screening, eligibility deter- mination and inclusion–are shown inFig. 1. It must be noted that the review was undertaken by a lead researcher and two hired research assistants from January 2019 to October 2019. All processes of identification and screening as well asfinal inclusion and exclusion criteria, were discussed by the lead researcher and the assistants for agreement.

As noted, the material selection was guided by various processes and criteria. While the processes are explained inFig. 1the criteria and their interpretations are provided inTable 1.

The included materials were categorised into thematic areas as shown in Table 2. It must be pointed out that although speciﬁc numbers of document were selected for the various thematic areas, pieces of information on the various areas were also obtained from a mix of the other selected documents. That is, some of the included documents contained information not only in their speciﬁc areas but across the other themes or areas under study.

The included documents were carefully read and summarised using the recursive abstraction (Leshan, 2012) technique. That is, for each thematic area, the cogent arguments in the literature were repeatedly summarised until a concise piece was obtained, making sure that no relevant information was left out. Carvalho et al. (2015) assert that

several analytical methods can be applied in literature review, such as bibliometric approach, meta-analysis, and content analysis. The present review used the content analysis approach. The information gathered were analysed using the qualitative content analysis and synthesised using the narrative, conﬁgurative synthesis method ((Ziraba, Haregu,&

Mberu, 2016). A key analytic step in the narrative synthesis process is exploration of data to understand the relationships in the data, therefore, preliminary analysis was done to understand the similarities and differ- ences within and across data. In this regard, summaries of theoretical and conceptual reviews were analysed using conﬁgurative synthesis of the gathered evidence based on which a theory-supported conceptual framework was developed.

The draft paper was then given to an expert in ESM for scrutiny.

Comments and suggestions made by the expert were incorporated in the paper, especially inﬁne-tuning the resultant theory-based conceptual framework. Based on lessons learnt from literature and the novel conceptual framework developed from the review, conclusions and Table 1

Interpretation of material inclusion criteria.

Criteria Interpretation Guiding Source

Language The material must be in Ednglish

Author’s decision based on ability to read and write in the international languages Relevance The material must have

contributed or be contributing substantially to the ESM discourse as gleaned from the cogency of the augments being advanced by the material

Mensah (2019)

Credibility The document must have been published by an authority or reputable source. For example, the material must have been peer-reviewed and/or professionally edited

Browning and Rigolon (2019)

Currency The material must still (to date) be inﬂuential in the debate on sustainable ESM as evidenced, for example, by citations and references

Browning and Rigolon (2019)

Intelligibility The document must be orderly, clear and articulate in terms of presentation of material

Mensah (2019)

Robustness This related to the strengths and weaknesses of the existing ESM frameworks

Author’s decision

Consistency The theoretical and conceptual arguments must follow clear paths and principles

Author’s decision

Date of publication of material

No restriction on age of material was imposed since some old theories and frameworks could still be relevant, credible, intelligible, thought-provoking and insightful

Author’s decision based on experience from similar studies

Adapted fromMensah&Graham, 2019.

Table 2

Statistics of key areas of inclusion in analytical syntheses and discussions after ﬁnal material screening and selection.

Thematic area Number of materials

included

Percent

Theories 3 11.11

Stakeholders of environmental sanitation management

7 25.93

Sanitation management approaches or options

8 29.63

Sanitation frameworks 9 33.33

Total 27 100.00

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recommendations were made.

3. Key issues

As the thematic areas captured inTable 2show, the key issues are the relevant theories, concepts, and frameworks. The issues are presented below under theoretical perspectives, conceptual issues (stakeholders of sanitation management, strategies or dimensions of sanitation management) and environmental sanitation frameworks. These are followed by a discussion which includes a critique of the existing frameworks followed by a theory-anchored conceptual framework before the conclusion.

Finally limitations of the review and suggestions for further research are presented.

4. Theoretical perspectives

A theory presents a systematic way of understanding behaviours, events and/or situations. Theories use plausible principles, concepts, and propositions to predict or explain events, situations or phenomena.

Though many argue that theories are abstract, it cannot be denied that they (theories) have general or broad applications (Hart, 1998:Ohmer, 2010).

Literature suggests three key theories that underpin ESM namely, the behavioural change, participation. and systems theories. The behavioural change theory holds that individuals usually consider the consequences of their behaviour before engaging in it (Herek, 1986;Zanna&Rempel, 1988), and that attitudes influence behaviour.Shove (2010)as well as Nour (2011)continues that an attitude is a disposition connected in a meaningful way to a specific situation and, therefore, serves as a basis for a reaction in that situation, which becomes a behaviour. Bringing this logic to bear on ESM, it can be argued that since attitude is connected with behaviour, how an individual feels about environmental sanitation, namely one’s attitude to it, influences one’s sanitation behaviour, which invariably becomes demonstrated in one’s sanitation practices (Mensah, 2019).

According toKim and Hunter (1993), thinking and beliefs shape attitudes, behaviours and actions towards ESM. In an exposition on knowledge-attitude-behaviour change theory, Matthews and Riley (1995)argued that an increase in knowledge could lead to attitudinal change and subsequently inﬂuence behaviour. It can be deduced from Matthews and Riley’s (1995)argument that an increase in people’s environmental sanitation knowledge could increase their awareness and deepen their appreciation of sanitation issues, which could posi- tively inﬂuence their attitude and behaviour towards maintaining acceptable sanitation practices. This is further supported byProchaska, Johnson and Lee’s (1998)advocacy for behavioural change theories, which establish a relationship between environmental knowledge, awareness, attitude, and how these can translate into action to improve ESM.

The participation theory, on the other hand (Sukhor, Mohammed, Sani,&Awang, 2011), emphasises the idea of empowering stakeholders of a development endeavour to be actors rather than passive subjects in taking decisions and undertaking activities that improve the lives of the people. The central tenet of this theory is that although change agents serve as catalysts, the ultimate beneﬁciaries of a development intervention must participate in the intervention so they will own it to make it sustainable (Singhirunnusorn, Donlakorn, & Kaewhanin, 2012; Reed et al., 2018). The ecological perspective of the participation theory extends this logic by advocating participation in environmental management endeavours by stakeholders for improved health and environment (Hotta & Aoki-Suzuki, 2014; Ramayah, Lee, & Lim, 2012). This perspective argues that individual and collective efforts and capacities should be harnessed to address unpleasant community challenges associated with environmental sanitation.

The systems theory has also been touted as one that can be leveraged for effective ESM. According toMacy (1991), systems theory offers an

investigative framework for exploring a given phenomenon in a comprehensive manner. The central thesis of the theory borders on taking a holistic view of a system to ensure that all of its components work to make the entire system function as efﬁciently as expected (von Bertalanffy, 1968). In this regard,Mizikaci (2006)recognises complementarities of endeavours, approaches, and actions to achieve set objectives. Besides, it recognises the principle of feedback. The systems theory has relevance for the environment and implications for ESM as the theory, by extension, supports the participation theory’s advocacy for involvement of stakeholders in ESM (Ackoff, 2010: Checkland, 1981). In sum, it can be argued that the three theories could combine to provide a solid theoretical foundation for effective ESM by the relevant stakeholders.

5. Conceptual issues

A large body of literature (Adubofour, 2010;Mensah, 2019;Mosler et al., 2018;Musoke et al., 2016;Santaboni, 2018;Whitley et al., 2019) suggests that the main conceptual issues in ESM relate to stakeholders using various strategies and frameworks relating to environmental education, regulation and infrastructure for purposes of improving environmental sanitation. Therefore, the key concepts distilled from literature are stakeholders, environmental education, regulation, infrastructure management, and EMS frameworks, which are reviewed in the subsequent sub-sections in support of the principles and tenets of the reviewed theoretical perspectives.

6. Stakeholders of environmental sanitation management

As the systems and participation theories suggest, dealing with complex issues that transcend several domains such as ESM, requires the participation of different actors who have stakes in the issues. Stake- holder, as a concept, deﬁes precise deﬁnition, culminating in the concept attracting a plethora of conceptualizations. While all the various views may help to illuminate the concept, the conceptualisation of a stakeholder as being“any group or individual who affects and/or is affected by the issues at stake”is seen as a broader way of understanding the concept (Bourne, 2005). However, relative to ESM, Ramayah et al. (2012) conceptualise stakeholders as a wide range of actors who perform various functions to help maintain a clean physical environment in human set- tlements in order to protect the health of the environment and the population.

Key issues regarding stakeholder involvement in ESM are their cooperation, collaboration and partnership toﬁnd solutions to the environmental sanitation challenges. The idea of collaboration connotes an implied acknowledgement that, the ESM challenges facing society cannot be unilaterally dealt with by a single body (Ramayah et al., 2012), hence, there is need for collaboration among different actors to address them.

This logic is embodied in the systems (Macy, 1991) and participation (Sukhor, Mohammed, Sani,&Awang, 2011) theories. In addition to the above conceptualisations of stakeholders in ESM, Movik and Mehta (2010)categorise stakeholders of ESM as individuals, households, government, community-based organisations (CBOs) and non-governmental organisations (NGOs).

With respect to government as a stakeholder in ESM,Nour (2011) identifies two levels namely, the central and local government. Whereas the central government is at the national level, the local government refers to specific institutions that are created by the national constitu- tion to deliver various specified services to a geographically delineated area.Scott, Cotton, and Sohail (2015)posit that the central government has the leadership responsibility in relation to policy and legislation, definition of roles and responsibilities, coordination, regulation and monitoring. The government is a major player in ESM as it is the largest funder of sanitation activities and also sets the overall policy framework for sanitation management (Mason et al., 2018;Singhirunnusorn et al., 2012). The responsibility for implementation of sanitation

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programmes, especially in the developing countries, is often left in the hands of the local governments, which are often at the forefront of implementing national policies at the district and community level (Santaboni, 2018). However, in the developing countries, lack of clarity in implementation guidance and inadequacy ofﬁnancial and human resources often hamper effective service delivery at this level (Suther-

land&Payden, 2017).

The private sector is composed of non-government private individuals, groups and organisations. In the view ofCotton, Adams and Shaw (2013), the participation of the private sector in ESM is expected to bring about efﬁciency, accountability and transparency in ESM.Water Institute at UNC (2018) argues that with the needed incentives, the private sector can make an important contribution to ESM as it can offer a strong platform for developing ESM programmes. The main advantages of private sector participation in ESM include efﬁcient and innovative ways of service provision (USAID, 2018).

Literature shows that non-government organisations (NGOs) play a key role in delivering environmental sanitation services to disadvan- taged communities (Scott et al., 2015). Museke et al. (2016) have argued that, in contrast with large scale infrastructure-focused initiatives, NGO programmes commonly aim at building linkages between technical interventions and social considerations. Besides providing infrastructure and raising awareness on environmental sanitation promotion, NGOs also deploy the necessary ESM knowledge to the communities and directly leverage funding and expertise for the implementation of sanitation projects which provide access to sanitation facilities at affordable cost to the beneﬁciaries (Ekane, 2013;

Mwangi&Aggrey, 2014).

Community-based organisations (CBOs) are key local associations that can encourage change in their communities by exercising inﬂuence on their members. It is argued that involving CBOs in ESM has many advantages as they are more capable of delivering services to grassroots groups and slum residents that might not be easily reachable by government institutions. Their strength lies in their proximity to communities and households who need environmental sanitation services.Setty (2019)adds that CBOs have a better understanding of local conditions, thus, they can more easily manage to achieve consensus with the targeted beneﬁciaries and ensure their support during the implementation of sanitation projects, compared to other“external actors. This augurs well for inclusiveness and sustainability. Community-based actors, including households are ultimately those who have to make choices about the adoption and use of improved sanitation, therefore, they cannot be left out in the ESM enterprise (Setty, 2019).

7. Strategies for addressing environmental sanitation management challenges

According toAziz et al. (1990), environmental sanitation management strategies refer to plans and approaches for maintaining proper sanitation practices.Sabur (2013), on the other hand, sees the concept as connoting a way of inﬂuencing sanitation behaviour in conformity to acceptable standards. However, there is a convergence of views between Aziz et al. and Sabur that, although there are several strategies or tools for ensuring the maintenance of proper sanitation practices, they can be broadly captured under hardware and software management strategies.Sanitation hardware refers to technical options for optimi- sation of sanitation delivery (Bisnath, 2011). According to Bisnath, hardware solutions involve the use of physical things that can be seen and touched such as toilets, refuse dumps, dust bins, refuse containers, vehicles and other logistics. On the other hand,Bisnath (2011)refers to sanitation software as intangible instruments or means to change the behaviour, attitudes and practices of different actors to optimise the environmental sanitation system. In the main, software strategies involve management of environmental sanitation education and regulation to inﬂuence sanitation practices as reviewed in the next three consecutive sub-sections.

8. Environmental sanitation education management

Hutton, Haller and Barttram (2007)maintain that sanitation education, which refers to sensitising people, especially the masses on sanitation issues, raises the consciousness of the people on ESM. They argue that raising awareness and increasing knowledge of people through public education on ESM are central to addressing the ESM challenges.

Further to this,Mazeau (2013)has extolled environmental education as important for promoting proper ESM practices, stressing that it helps to change people’s sanitation attitude and behaviour. Mazeau, therefore, urges that public education on environmental sanitation should be given priority and taken seriously by the stakeholders.

Sharing similar views withHutton, Haller and Barttram (2007)and Mazeau (2013)on environmental sanitation education,Spencer (2012) states that such education relates to sanitation awareness campaigns aimed at enabling the masses to know not only the importance of ESM but also what should be done to improve sanitation for environmental justice and sustainable development. Spencer is of the conviction that sanitation education is an indispensable tool or strategy for changing people’s attitudes towards poor ESM practices and, therefore, should not be downplayed in ESM endeavours.

As further argued bySaei (2012), environmental sanitation education instills in individuals, ethics, values, attitudes and behaviour consistent with proper sanitation management. This is in line with the behaviour change theory as argued byAdubofour (2010), that in order to achieve the desired results in ESM, certain indicators are important and need to be considered. The indicators include the content of the education, with particular emphasis on relevance of the message, coverage of issues, target audience in terms of their level of education, beliefs and percep- tions.Mansuri and Rao (2013)concur withAdubofour (2010), regarding the consideration of these indicators in environmental education but add that the media and language through which the education is given are equally important.

All these conceptualisations, propositions and viewpoints accord not only with the tenets of the participation theory, but also those of the systems theory (Flood, 1995). The tenets implicitly endorse different but complementary approaches to addressing issues. Underneath the principle of complementarity is the implicit acknowledgement that, although sanitation education is necessary, it is not sufﬁcient unless it is complemented with other strategies, key among which is sanitation infrastructure management. The next sub-section, therefore, captures a review of sanitation infrastructure as an ESM strategy or approach.

9. Sanitation infrastructure management

The systems theory (Flood, 1990) identifies hard and soft systems, which are applicable to ESM. In ESM, the hard systems can be likened to sanitation hardware. According to Ileasanmi (2006), ESM hardware management borders on the provision and maintenance of infrastructure such as toilet facilities, refuse dump site, drainage system, vehicles for transporting waste to the dump site, dust bins and other tools and equipment for ESM. The availability, adequacy, affordability, location and quality of these facilities, according to (Mugaga, 2006) are important for ESM practices, especially with regard to defecation and waste disposal practices.UNICEF (2016), for example, indicates that improved sanitation, that is, toilet facilities, ensures hygienic separation of human excreta from human contact and includesflush or pourflush toilet, ventilated improved pit (VIP) latrine, pit latrine with slab, and com- posting toilet. Unimproved sanitation facilities, according to (McCon- ville, 2010), do not ensure hygienic separation of human excreta from human contact and include pit latrine without a slab or platform, bucket latrine, open defecation infields, bushes, bodies of water or other open spaces. Sanitation (toilet) has direct bearing on environmental sanitation.

Global best practices recognise the importance of proper infrastructure for ESM, and a number of services some of which are underlined as mandatory. Key among these services, which the ESM authorities are

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charged to enforce without compromise include the promotion of do- mestic or household toilet and waste bins (McConville, 2010). Further- more, places of convenience and waste collection infrastructure are expected to be provided at vantage points in the communities, especially in heavily used areas such as markets and lorry stations, for people in transit. Additionally, global best practices dictate that in communities where door-to-door collection of waste is not appropriate, the local authority should designate communal storage sites where solid waste can be discharged into movable containers for collection forﬁnal disposal. In such cases, the evacuation of such containers must be effected at fre- quencies sufﬁcient to prevent undue accumulation and decomposition of waste (Sukhor, Mohammed, Sani, &Awang, 2011). However,Achiro (2012), writing on constraints and prospects of law enforcement for improved sanitation in Uganda, contended that environmental sanitation education and infrastructure provision alone may not be enough to ensure the desired environmental sanitation standards so there is the need to complement them with regulation management, hence, the devotion of the next sub-section to the review of regulation as an ESM strategy. Such complementarity is endorsed by the systems theory.

10. Regulation as a sanitation management strategy

Regulation as an ESM tool or strategy refers to control of sanitation behaviour and practices, usually by means of rules. This entails imposi- tion of restrictions by an authority on the execution of an action in relation to ESM. These activities, in the words ofChudger (2010), include the provision of policies, laws and by-laws to regulate people’s environmental sanitation behaviour, a monitoring system for checking to ensure compliance, and sanctioning mechanisms for non-compliance.

Ekane (2013) continues that the major issue regarding regulation of sanitation behaviour or practices is the application of the law. In this connection Hedberg, Pardo, Frontini and Daryous (2015), writing on implementing the human right to water and sanitation in developing countries identiﬁed important determinants of compliance with the law.

According to these authors, strong political leadership can play an important role in ensuring compliance with sanitation laws but compliance is inﬂuenced by rewards and punishment or sanctions.

As Yardley (2010) argues, awareness about sanitation laws is important because some people may go contrary to the laws not because they are disobedient but due to ignorance, although ignorance may not be accepted as an excuse for breaking it. In addition,Onda, LoBuglio, and Bartram (2012)as well as Sharmila and Murthy (2013)observe that co-operative behaviour of the households, communities, institutions and the general public is considered necessary in ESM and so they advise these units to co-operate and collaborate with the law enforcement agencies. Thus, it can be asserted from these that three key issues in ESM are environmental education, infrastructure, and regulation.

11. Environmental sanitation frameworks

One framework of ESM is the F-diagram, which was developed by Wagner and Lanoix (1958). The framework shows that poor hygiene practices, lack of adequate sanitation and unsafe water can contribute to the spread of preventable diseases such as cholera or typhoid. According toScott (1996), the F-diagram demonstrates the movement of pathogens from the faeces of a sick person to where they are ingested by someone else through many pathways, some direct and others indirect. Under- standing this framework allows engineers and public health workers to intervene in ESM using appropriate ways to break the transmission cycle, thereby saving lives (Cairncross, 1992). However, the F diagram is critiqued for being too linear. This is because it shows a summary of linear pathways, but other associated routes may be important, especially in a developing country environment. According toScott (2019), other frameworks emerged in the late 1990’s that moved away from this linear conceptualisation in an attempt to capture the different elements of ESM.

These frameworks include Strategic Sanitation Approach (1997),

Household Centred Environmental Sanitation [WSSCC, 1997], and Sanitation 21. The frameworks provide systematic ways to navigate the urban sanitation service chain; the capture, storage, transport, treatment and reuse or disposal of faecal waste (UNICEF, 2016). The critique is that, they concentrate more on provision of sanitation infrastructure but less on sanitation education and regulation. Meanwhile, sensitisation and regulation are very important in developing countries. Theoretical literature indicates that three dimensions (education, regulation and infrastructure) combine to ensure effective ESM. The frameworks are also not clear with respect to what theories underpin them although they provide useful practical guidance for managing environmental sanitation and hygiene. Besides, the frameworks pay more attention to defecation than waste disposal practices, but both issues present health and environmental challenges in developing countries that need to be addressed.

The Netherlands Development Origination (SNV) and International Research Council (IRC) developed the Sustainable Sanitation and Hy- giene for All (SSH4A). The framework is an integrated one that combines demand creation, strengthening of sanitation supply chain, hygiene behaviour change communication as well as water, sanitation and hygiene (WASH) governance as illustrated inFig. 2.

Basically, SSH4 is a capacity building framework that supports local authorities to spearhead district-wide sanitation coverage, focussing on institutional sustainability and learning. According toDreibelbis et al.

(2013), the framework operates on the understanding that ESM is primarily about behavioural change. The framework gives prominence to demand creation and affordable hardware solutions (Bongartz, Vernon and Fox, 2016), and emphasises inclusivity by advocating the involvement of local stakeholders. The framework also puts premium on approaches that are scalable, and stresses innovative ESM through sustainable behaviour change (Mensah, 2019). Lastly, SSH4A focuses on the need to monitor and evaluate progress along the sanitation ladder to track access, use and maintenance of sanitation facilities, with particular reference to toilet. One missing link with respect to this framework is the regulation (law enforcement) aspect of ESM, which is a huge issue in developing countries. Furthermore, the framework tends to place more premium on toilet than waste disposal, which is also a challenge in developing countries. Also unclear in the framework are the principles of complementarity and feedback which the systems theory touts as needful for the management of a complex issue such as ESM in the developing countries.

Another ESM model is sanitation marketing (SM), which according to Divine (2010), is the application of social and commercial marketing practices to change environmental sanitation behaviour, and to scale up the demand and supply of ESM facilities in order to achieve improved sanitation, particularly among the poor.Devine (2010)argues that SM is a process for creating, communicating, and delivering beneﬁts that a Fig. 2.Sustainable sanitation for all Framework.

Source:SNV/IRC (2016).

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target population need(s) for proper ESM.Minh and Nguyen-Viet (2011) concur withDevine (2010), and add that the essence of SM is to know what people value as good defecation site and offer these features in the form of attractive household sanitation options that they can readily access through the market without any need for hardware subsidies.

Formative research is imperative in any SM programme. However, understanding what products the target population desires and what price they are willing to pay for them, as well as components such as the marketing mix, communications campaign, and implementation are also critical to the design and implementation of effective SM programmes (Jimenez, Cortobius,&Kjellen, 2014;WHO-EURO, 2016). SM is a systematic process to make strategic decisions about four components known as “the four Ps of the marketing mix. The components are;

product, place, promotion, and price (Mutua, Agwata,&Anyango, 2017).

The product is the object, service, or behaviour change to be promoted. In the case of sanitation, it is the latrines and associated services and needs (e.g., pit digging and emptying) and a range of latrine technologies that respond to what people want, not simply whatﬁts the environment or what public health engineers think the people should have (Santaboni, 2018: Sutherland, 2018). The price is how much the product is to be sold.

Since high price can prevent the acquisition of a sanitation facility, there is the need to innovate and develop cheaper options to make them affordable to the poor (Water Instituteat UNC, 2018). Place is essentially about ensuring that all supply chain elements are available and accessible to the people. Promotion is about communicating product and sales information to the consumer. It aims to increase awareness about sanitation products, providers, and sales outlets; and to increase the desire for sanitation facility through motivational messages (Divine, 2010), The critique levelled against SM is that, the extremely poor minority may be unable to buy a latrine by themselves. This is particularly relevant in the case of developing countries where incomes are low and poverty is endemic. Additionally, while the framework reﬂects the behavioural theory somehow, there is little reﬂection, if any, of the participation and systems theories.

Another sanitation model is the Community Led Total Sanitation (CLTS) which was pioneered by Kamal Kar in Bangladesh in 2000 as an innovative methodology for mobilising communities to eliminate open defecation (OD). With this framework, communities are facilitated to conduct their own appraisal and analysis of OD and take action to become ODF-free. CLTS recognises that merely providing toilets does not guarantee their use, nor results in improved environmental sanitation (Weber, Patrick, Hayter, Martinsen,&Gelting, 2019;World Bank, 2016).

Earlier approaches to ESM offered subsidies as an incentive for uptake.

But according toUSAID (2018), the subsidy model often led to challenges with adoption and sustainability. It also created a culture of dependence on subsidies. In contrast, CLTS focused on the behavioural change needed to ensure sustainable improvements –investing in community mobi- lisation (software) instead of hardware solutions, and shifting the focus from toilet construction for individual households to the creation of OD-free communities. Mosler et al. (2018) argue that, by raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of catching a disease, CLTS triggers the community’s desire for collective change. This propels people into action and encourages innovation for local solutions, thus leading to greater ownership and sustainability. The critique is that the sustainability of this framework is not easy due to the cost involved in follow-ups to ensure that it succeeds in a developing country setting. Another criticism is that the resultant latrine’s quality and durability cannot be guaranteed. The framework highlights defecation and fails to give prominence to waste disposal aspect of ESM. Additionally, no underpinning theories are provided as the basis or anchor of the framework.

UNICEF (2016)provides a sanitation framework, WASH 2016–2030, which emphasis leveraging public and privateﬁnancing for scaled-up ESM programmes based on transparency, monitoring and people’s participation as anchors of good governance. According to the WASH 2016–2030, the provider is responsible for delivering the service to the

population in line with policies that govern service provision (WHO/EURO, 2016). The provider can be the government, private sector or the communities themselves.Bongartz et al. (2016)argue that, the inter-relationship among the actors is critical to the success and sustainability of ESM projects as it provides the core incentives for actions that either promote or hinder sustainability.Mutua et al. (2017)add that the framework assumes that regulation protects consumers’rights and promotes good governance for improvement in service delivery, therefore, users as citizens, can claim their rights to services from the policy-maker and the policy-maker can inﬂuence the behaviour of the service provider using policy and regulatory instruments. The critique is that, this assumption might not hold in the case of developing countries where the government, as the overarching policy maker, is often not able to enforce the policy but the citizen are always claiming their rights to services from the government. Furthermore, while the framework implicitly makes a reference to the behavioural and participation theories for ESM, it completely ignores system thinking as a possible robust theoretical underpinning for ESM, thus, downplaying the potential roles of complementarity and feedback in ESM.

Mason et al. (2018)examine Kenya’s Environmental Sanitation and Hygiene Policy 2016–2020 and propose institutional changes in the framework within the sanitation sector. Their proposed framework aims at leveraging decentralisation reforms to beneﬁt the sanitation sector.

The underlying assumption of the framework, according toGeere and Hunter (2019), is that as decentralisation unfolds, a strong institutional framework can help secure better urban sanitation outcomes by coordi- nating actions, ensuring cooperation and generating commitment among the many responsible organisations and individuals at different levels.

Mason et al.’s (2018)framework advocates government’s engagement with the stakeholders for sanitation service delivery at decentralised levels. It also advocates cooperation among the stakeholders to put in place appropriate infrastructure while ensuring proper oversight of on-site sanitation service provision (Reed et al., 2018). Although it advocates political, administrative andﬁscal support for ESM, the notable limitation of the framework is that there is overlap and competition for sector leadership at national and devolved levels. Interestingly, however, this could be solved through proper application of the tenets of systems thinking which the framework fails to take full advantage of.

Santaboni (2018) develops a framework for ESM in urban poor communities in India with case studies of effective initiatives. Using the place-based sanitation approach, Santaboni argues that any target-driven sanitation framework should consider three context-speciﬁc elements:

physical infrastructure, sanitation behaviour, and community capacity.

The framework (Tidwell, Chipungu, Chilengi, Curtis,&Aunger, 2019) recognises the multi-stakeholder approach to ESM and highlights the fact that change agents seldom act in isolation from one another. It argues that the more representative the partnership is, the better it will capture the organisational complexities of ESM challenges (USAID, 2018) The framework believes that change towards inclusive and sustainable ESM systems is possible when stakeholders and agents get together to optimise resources and complement their areas of expertise, making cooperation and collaboration a crucial element in the process of sanitation service delivery. However, clearly missing in the framework is the role of regulation (law enforcement) in ESM, which is very pertinent in the case of developing countries. Furthermore, like most of the frameworks, it does not capture the element of feedback to aid corrective and remedial actions.

Lienert (2019)examines the sanitation framework proposed by the International Water Association task force for the analysis and selection of appropriate sanitation systems called Sanitation 21. Sanitation 21 is an approach used for sustainable sanitation planning in the developing world. Sanitation 21 has three parts for effective ESM. These are.deﬁning the context, identifying technical options and determining the feasibility of the options A basic tenet of the framework, according toWhitley et al.

(2019), is that improving the effectiveness of sanitation investments is not only about infrastructure and technologies.Lienert (2019)extends

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this argument by opining that it is also about developing an explicit understanding of what the objectives of a system are and then designing a system which meets the objectives. Sanitation 21 suggests that technical planners need to design sanitation systems which respond to the needs of urbanisation. This requires a change in the way technical decisions are taken, so that they can respond better to the human and political context in which they are made (Manga, Bartram,&Evans, 2019). An advantage of the framework is that it promotes an analysis of the external drivers and contexts which impact on ESM behaviour (Lienert, 2019). The disadvantage is that it does not provide in-depth guidance for planners and operators. It is also silent on the role of law enforcement in ESM which is a huge problem in developing countries; neither is it clear regarding the underpinning theories on which the framework is grounded.

Scott (2019) examines the Sanitation Cityscape Framework (SCF), which locates sanitation service delivery within the wider urban systems.

SFC considers complex urban sanitation service delivery systems by locating existing tools and enabling environmental analysis to look beyond the linear framing of sanitation services to gain a better understanding of the surrounding context and externalities (Scot 2019). The framework highlights the key interfaces between sanitation stakeholders and issues that are overlooked in the sanitation value chain. The SFC demonstrates that by breaking the urban sanitation system down into component parts, there is scope for granular analysis which helps to unpack the complexity of sanitation (Martinez, 2016; Setty, 2019).

Although the SFC helps to locate the components of the ESM puzzle for appropriate targeting of appropriate interventions, the framework does not make provision for feedback to facilitate corrective measures, if need be. Furthermore, the framework does not show the underlying theories that facilitate the unpacking of the complex ESM milieu; and this will make it difﬁcult to work in developing countries where the sanitation terrain is characterised by complexities and complications.

12. Discussion

This section discusses and synthesises the central arguments of the reviewed literature and, based on the strengths and weaknesses of the reviewed frameworks, develops a novel theory-anchored conceptual framework for ESM in developing countries. According to Miles and Huberman (1994), a conceptual framework explains, either graphically or in a narrative form, the main things to be studied, the key factors, concepts and/or variables and the presumed relationships among them.

Similarly, Nour (2011)argues that a conceptual framework is used to outline possible courses of action or to present a preferred approach to an idea or thought.

Four key issues are involved in this review namely; the theories, the stakeholders in ESM, the strategies or dimensional approaches to ESM, and the frameworks for ESM. The behavioural change theory suggests that managing attitudes and behaviour is key to ESM in developing countries. The participation theory argues for multi-stakeholder participation in ESM, while the systems theory espouses complementarity of efforts and strategies, as well as the importance of feedback in ESM.

Therefore, it can be posited that the three theories could combine to provide a solid theoretical foundation for ESM.

A careful look at the stakeholder concept in ESM reveals that although the stakeholders are many (government, private sector, NGO, CBOs, households etc), they can be technically condensed and categorised into two broad ones; namely the government and non-government or private sector. This technical categorisation is signiﬁcant as it strengthens the argument for effective public-private partnership and/or participation in ESM. Literature also suggests that, technically, there are two main ways of dealing with the challenge of environmental sanitation, namely the hardware and software solutions. While the hardware approach refers basically to the provision, maintenance and use of sanitation infrastructure or facilities, the software solution primarily relates to the use of regulation and education to address the sanitation challenge.

From the reviewed literature, it can be argued that the existing frameworks capture relevant issues such as sanitation behaviour, stakeholder involvement, environmental education, policies and infrastructure management, however, the common critique it that their conceptualisations are not sufﬁciently grounded in theories and so they lack comprehensive theoretical foundation that show synergies among the key issues in ESM. This is consistent withMensah and Graham’s (2019) argument that most ESM frameworks are not sufﬁciently theory-driven as they concentrate more on practice. Though the practice is important, the theoretical underpinnings are equally important, and the two are mutually supportive. Literature (Akintunde, 2017;Tidwell et al., 2018;Weber et al., 2019) indicates that practices that are informed by good theories tend to achieve better results. A theory-driven framework for ESM (Reed et al., 2018;Tidwell et al., 2018) is supposed to show relationships between concepts and theories, demonstrating that concepts are symbolic depiction of the actual, and the building block of the theory (Akintunde, 2017). Apart from the frameworks not showing the underpinning theories and relationships between the theories and the concepts, the frameworks are also not explicit regarding feedback, although some of them allude casually to monitoring mechanisms. The frameworks also do not emphasise ESM as a culture. Additionally, the existing frameworks emphasise the defecation (toilet) aspect of ESM to the virtual neglect of the waste disposal practices. This paper argues for a more comprehensive ESM framework that captures both the defecation and wastes disposal aspects as provision of toilets alone cannot guarantee proper ESM for sustainable development.

The present paper also argues, based on the reviewed literature, that the actions and/or inactions of the stakeholders in proffering hardware and/or software solution to ESM constitute the core issue of the ESM enterprise. The processes to get the right policies, laws, institutions and infrastructure, are critical for maintaining a sustainable ESM system. The key conceptual issues for ESM are environmental sanitation education, regulation and infrastructure, while the key theoretical issues are systems thinking, participation and behavioural change mechanism. However, it takes the stakeholders (actors) to link the theories and the concepts, as well as translate them into practice through proper planning, implementation and monitoring to ensure effective ESM. This presupposes that there should be an innovative framework that provides linkages and relationships among these issues or variables.

One relationship or linkage that should be understood is that proper infrastructural management would result in increased availability of, and access to basic sanitation facilities. Furthermore, as learnt from the behavioural theory, environmental education as a tool for behavioural change management is expected to result in increased knowledge or awareness of sanitation issues. Additionally, enactment and enforcement of sanitation laws through proper regulation management is expected to exact compliance with sanitation laws. The expectation, therefore, is that the participation of the relevant actors (stakeholders), using the systems thinking principles would inﬂuence sanitation attitude, behaviour and practice and, thereby, bring about improved ESM as captured in the theory-anchored conceptual framework (Fig. 3).

The framework shows that ESM entails the participation of two main structures, government and private (non-government) actors, using policies, laws and institutions to inﬂuence ESM through provision of infrastructure, education and regulation. That is, while it is acknowledged that several change agents (central government, local governments or municipalities, private sector, NGOs, community based organisations, households) are involved in ESM, they could be broadly categorised under the umbrellas of government and non-government (private) stakeholders. Apart from the stakeholder dimension, the framework shows that ESM can be approached using three main strategies namely;

management of infrastructure (hardware) as well as education and regulation (software).

Regarding infrastructure management, the variables to be considered in planning and implementing ESM projects and programmes should include availability of and access to facilities, preferences for facilities as

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Fig. 3. Theory-anchored conceptual framework for environmental sanitation management Source: Authors’construct, 2019.

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well as affordability and durability of the facilities. Infrastructure provision programmes must also be scalable so as to reach the wider society.

The underlying assumptions is that, proper management of sanitation infrastructure (including technology) would make the preferred sanitation facilities available, accessible and affordable to the intended users.

The practical implication of considering user preferences, for instance, is that it helps to increase uptake. This consideration allows for the design of sanitation facilities that cater for the needs of the users, including the vulnerable such as the poor, women and the disabled, thus making the system inclusive.

As far as environmental sanitation education is concerned, the variables that need to be considered in designing effective ESM programmes are targeting, messaging and channel of communication as well as awareness and knowledge level of the people about environmental sanitation. The key principle in this regard is that the message should be well packaged, appropriate and made clear to the people using the appropriate media. For example, everyone should be made aware that proper ESM is everyone’s responsibility, since diseases resulting from insanitary conditions are no respecter of persons. That is, anyone could be at risk of catching a disease if anybody defecates in the open or litres indiscriminately, therefore, proper environmental sanitation should be practised as a culture.

With regard to regulation, the pertinent issues to be considered are that the law must be enacted, enforced and monitored to ensure compliance. Rewards and sanctions are necessary as compliance management mechanisms. In most developing countries, the laws are in place but enforcement is a huge problem and so this needs to be researched into for improvement. However, some key principles are important in designing and implementing all the hardware and software solutions.

These are the principles of sustainability, equity, inclusivity, scalability, adaptability, gender sensitivity and cost-effectiveness of the interventions. Interestingly, all these can be achieved through effective participatory planning and implementation processes, which are underpinned by the systems, participation and behaviour change theories.

From the discussion, it is clear that sanitation stakeholders do not have to act in isolation from one another because the complexity of ESM makes the multi-stakeholder approach a prerequisite for effective action.

Therefore, solutions that are generated through collaborative and coor- dinated stakeholder efforts are more likely to lead to appropriate actions for improved environmental sanitation outcomes in developing countries. It must also be noted that the key dimensions of ESM namely, education, regulation and infrastructure management are complementary so the synergies among them should be recognised and taken advantage of. That is, provision of the infrastructure should be complemented by appropriate public education or sensitisation, dwelling on appropriate messages on sanitation to inﬂuence the knowledge, awareness and perception of sanitation issues. In order to make sanitation management holistic as dictated by the systems and participation theories, infrastructure and education management need to be complemented with regulations in terms of adequate law enforcement, monitoring, sanctions and/or rewards to ensure compliance with approved sanitation standards. This is the unwritten import of the theory-supported conceptual framework. Thus the newly developed framework lends itself to systems thinking, participatory planning and execution processes, and behaviour change approach to ESM, while acknowledging the multi-stakeholder involvement in the ESM enterprise. Furthermore, as the framework de- picts, there is a feedback mechanism from the outcomes to the structures and processes to allow for monitoring and evaluation for corrective actions or remedial measures where necessary and needful.

13. Conclusion and implications

This paper aimed at providing a theory-anchored framework for effective ESM in developing countries. The review has shown that the existing ESM frameworks are good as far as the capture of important conceptual variables for ESM in developing countries is concerned. These

conceptual variables include environmental sanitation education, regulation, and infrastructure management. The existing frameworks also recognise that involvement of stakeholders, in the ESM enterprise is important. Although the existing frameworks capture relevant conceptual issues for ESM, they are largely deﬁcient with respect to theoretical underpinnings that explain the synergies among the key concepts.

Neither do they sufﬁciently capture the issue of feedback in an explicit manner to provide direction for remedial measures.

The review identifies three theories namely, participation, behavioural change and systems theories as important underpinning theories for ESM in developing countries. While the participation theory advocates active involvement of the stakeholders in ESM, the systems theory reinforces it by arguing that effective approaches to ESM endeavours should draw on the strengths in complementarities of the stakeholders as well as software and hardware solutions to ESM. Additionally, the behavioural change theory suggests that ESM is influenced by people’s attitudes to environmental sanitation which translate into behaviour and ultimately become demonstrated in practice, and that these could be improved through increase in sanitation knowledge and awareness coupled with law enforcement and infrastructure management. These reinforce the argument that, driving system change in developing countries thrives on multi-stakeholder collaborations that bring together government and private sector organisations infinding appropriate solutions, thus, justifying the argument and advocacy for public-private partnership for ESM.

The novelty associated with the present framework is that, it brings the key ESM strategies or dimensions together and establishes synergetic relationships among them, arguing that, although each of the key dimensions to ESM (environmental education, regulation and infrastructure management) is distinct, they complement one another for effective ESM. The novel framework also acknowledges the complexity of ESM enterprise arguing that, optimising the sanitation system for effective ESM requires that solutions be informed by tried and tested theories and principles, which can be translated into practice in a holistic manner. It is also explicit on the variables for each of the key concepts–education, regulation and infrastructure–that need to be targeted and worked on for meaningful ESM. Furthermore, the present model incorporates feedback mechanisms to ensure that corrective measures are taken to address anomalies and deviations in order to trigger long-lasting behaviour change among individuals and communities in developing countries, using participatory and systematic processes espoused by the suggested theories.

The implication of all this is that the conceptualisation and implementation of effective ESM systems in developing countries need to be driven by theoretical constructs that can translate into best practices to address the complexities of sanitation, drawing on the principles and tenets of systems thinking, participatory processes and behaviour change for meaningful sanitation outcomes. It is recommended that guided by the systems, participatory and behavioural change theories, key sanitation actors leverage the synergies among the ESM dimensions (education, regulation and infrastructure) and collaborate to inﬂuence people’s sanitation awareness, knowledge, attitude, behaviour and practices for improved ESM in developing countries.

14. Limitations of the review

Although attempts were made to cover all relevant materials on the issue at stake, this was not possible. The data collection process certainly excluded some potentially relevant sources of information about the topic because the review was carried out with literature published only in English. However, not all researchers, academics, scholars and practitioners around the world publish in English. Some publish in other languages including their native ones. Besides, the search was limited to some databases, implying there could be other materials in other databases that could be useful. Additional synthesis of the possible uncovered publications could have provided additional useful insights into