Social Sciences & Humanities Open 2 (2020) 100028

Contents lists available at ScienceDirect

Social Sciences & Humanities Open

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

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 A B S T R A C T

Keywords: The phenomenon of poor environmental sanitation, which is a global challenge, but most so in developing
Environmental sanitation countries, requires that the solution to it be both conceptually and theoretically sound and clear enough for
Hardware and software solutions translation into practice. The purpose of this paper was to develop a theory-anchored conceptual framework to
Theory-anchored conceptual framework
guide Environmental Sanitation Management (ESM) in developing countries. Data were obtained from scholarly
Developing countries
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 ed-
ucation (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 to fill this gap. It is recommended that conceptualisation and imple-
mentation 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 coun-
tries 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 man-
agement, 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 in Abubakar (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

E-mail address: justice44mensah@gmail.com.

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
2590-2911/© 2020 The Author. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-
nd/4.0/).
J. Mensah
sanitation services that ensure privacy, dignity, accessibility, afford-
ability, 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 frame-
work for ESM is rooted in the finding (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 to Minh 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
Fig. 1. Material selection processes.
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Social Sciences & Humanities Open 2 (2020) 100028
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 environ-
mental sanitation and clean water in developing countries is low, that of
environmental sanitation is lower than clean water. The WHO/UNICEF
(2019) Report shows that while 785 million people lack clean water, over
2 billion lack basic sanitation service. Although both water and envi-
ronmental 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
J. Mensah Social Sciences & Humanities Open 2 (2020) 100028

the frameworks, develop an innovative framework for improving ESM in Table 1

developing countries. In doing this, aspects of methodological ap- Interpretation of material inclusion criteria.
proaches of ‘systematic review’ and ‘configurative review’ were bor- Criteria Interpretation Guiding Source
rowed. For the article selection, aspects of the “Preferred Reporting Items
Language The material must be in Author’s decision based on
for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were Ednglish ability to read and write in
used. For analysis, the configurative and recursive content abstraction the international languages
(RCA) [Levinsson & Prøitz, 2017] approach was used. This is because it Relevance The material must have Mensah (2019)
was important to summarise the information from the various sources in contributed or be contributing
substantially to the ESM
a concise and coherent manner to aid effective discussions and mean- discourse as gleaned from the
ingful conclusion. cogency of the augments being
Literature from various sources, including peer-reviewed articles, advanced by the material
theses and conference reports were used. Borrowing from PRISMA Credibility The document must have been Browning and Rigolon
published by an authority or (2019)
guidelines, PubMed, Scopus, Google Scholar databases and grey litera-
reputable source. For example,
ture were searched. These databases are known to contain large volumes the material must have been
of sanitation related literature. The search was guided by keywords and peer-reviewed and/or
phrases such as environmental sanitation, ESM frameworks, stakeholders professionally edited
of ESM, ESM approaches, and theories of ESM.. As many as 711 docu- Currency The material must still (to date) Browning and Rigolon
be influential in the debate on (2019)
ments were initially identified based on titles, abstracts, and body texts. sustainable ESM as evidenced,
These included materials obtained from reference lists of identified for example, by citations and
documents in order to avoid the risk of missing potentially relevant references
literature. Intelligibility The document must be orderly, Mensah (2019)
clear and articulate in terms of
Cognizant of the notion that the various databases do not have the
presentation of material
same or equal strength in terms of quantity and quality of materials, due Robustness This related to the strengths Author’s decision
diligence was done to ensure that materials selected for final inclusion in and weaknesses of the existing
the present review were credible with respect to sources and contents. In ESM frameworks
that regard, the ‘fitness for purpose’ of the materials from all the data- Consistency The theoretical and conceptual Author’s decision
arguments must follow clear
bases and grey literature were assessed by examining each material’s
paths and principles
robustness through various processes. For example, having identified the Date of No restriction on age of Author’s decision based on
materials from the various sources, series of screening were conducted publication of material was imposed since experience from similar
through reading the titles and abstracts, and in some cases and intro- material some old theories and studies
frameworks could still be
ductory background, which resulted in the removal of all duplicates and
relevant, credible, intelligible,
non-English materials. These screening processes led to 62 of the mate- thought-provoking and
rials being earmarked as potential candidates for inclusion. The potential insightful
62 full-text materials were then assessed for ‘fitness for purpose’ through
Adapted from Mensah & Graham, 2019.
a set of pre-determined eligibility criteria. The criteria included rele-
vance, credibility, currency, and intelligibility. They were also assessed
for the consistency of arguments as well as gaps. Additionally, they were Table 2
assessed in regard to their conceptual vigour for addressing the Statistics of key areas of inclusion in analytical syntheses and discussions after
complexity of environmental sanitation with special reference to devel- final material screening and selection.
oping countries. In short, irrespective of the database or source of the Thematic area Number of materials Percent
material, it was included only if the material was credible, relevant, included
current, intelligible, consistent, and represented a unique or conceptual
Theories 3 11.11
contribution to ESM, particularly in developing countries. No restriction Stakeholders of environmental sanitation 7 25.93
was placed on the age of the material. The foregoing material selection management
processes led to 27 documents being finally used for the review. The Sanitation management approaches or 8 29.63
options
material selection processes – identification, screening, eligibility deter-
Sanitation frameworks 9 33.33
mination and inclusion – are shown in Fig. 1. It must be noted that the Total 27 100.00
review was undertaken by a lead researcher and two hired research as-
sistants from January 2019 to October 2019. All processes of identifi-
cation and screening as well as final inclusion and exclusion criteria, several analytical methods can be applied in literature review, such as
were discussed by the lead researcher and the assistants for agreement. bibliometric approach, meta-analysis, and content analysis. The present
As noted, the material selection was guided by various processes and review used the content analysis approach. The information gathered
criteria. While the processes are explained in Fig. 1 the criteria and their were analysed using the qualitative content analysis and synthesised
interpretations are provided in Table 1. using the narrative, configurative synthesis method ((Ziraba, Haregu, &
The included materials were categorised into thematic areas as shown Mberu, 2016). A key analytic step in the narrative synthesis process is
in Table 2. It must be pointed out that although specific numbers of exploration of data to understand the relationships in the data, therefore,
document were selected for the various thematic areas, pieces of infor- preliminary analysis was done to understand the similarities and differ-
mation on the various areas were also obtained from a mix of the other ences within and across data. In this regard, summaries of theoretical and
selected documents. That is, some of the included documents contained conceptual reviews were analysed using configurative synthesis of the
information not only in their specific areas but across the other themes or gathered evidence based on which a theory-supported conceptual
areas under study. framework was developed.
The included documents were carefully read and summarised using The draft paper was then given to an expert in ESM for scrutiny.
the recursive abstraction (Leshan, 2012) technique. That is, for each Comments and suggestions made by the expert were incorporated in the
thematic area, the cogent arguments in the literature were repeatedly paper, especially in fine-tuning the resultant theory-based conceptual
summarised until a concise piece was obtained, making sure that no framework. Based on lessons learnt from literature and the novel con-
relevant information was left out. Carvalho et al. (2015) assert that ceptual framework developed from the review, conclusions and

3
J. Mensah
recommendations were made.
3. Key issues
As the thematic areas captured in Table 2 show, 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 manage-
ment) 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 to Kim 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 by Prochaska,
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 interven-
tion 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 ex-
tends this logic by advocating participation in environmental manage-
ment 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 asso-
ciated with environmental sanitation.
The systems theory has also been touted as one that can be leveraged
for effective ESM. According to Macy (1991), systems theory offers an
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Social Sciences & Humanities Open 2 (2020) 100028
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 comple-
mentarities of endeavours, approaches, and actions to achieve set ob-
jectives. 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 edu-
cation, regulation and infrastructure for purposes of improving envi-
ronmental sanitation. Therefore, the key concepts distilled from
literature are stakeholders, environmental education, regulation, infra-
structure 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 stake-
holder 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 co-
operation, collaboration and partnership to find solutions to the envi-
ronmental 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, gov-
ernment, 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
J. Mensah
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 of financial and human
resources often hamper effective service delivery at this level (Suther-
land & Payden, 2017).
The private sector is composed of non-government private in-
dividuals, groups and organisations. In the view of Cotton, 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 initia-
tives, NGO programmes commonly aim at building linkages between
technical interventions and social considerations. Besides providing
infrastructure and raising awareness on environmental sanitation pro-
motion, NGOs also deploy the necessary ESM knowledge to the com-
munities and directly leverage funding and expertise for the
implementation of sanitation projects which provide access to sanita-
tion 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 gov-
ernment institutions. Their strength lies in their proximity to commu-
nities 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 to Aziz et al. (1990), environmental sanitation manage-
ment 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 be-
tween 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 regu-
lation to influence sanitation practices as reviewed in the next three
consecutive sub-sections.
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Social Sciences & Humanities Open 2 (2020) 100028
8. Environmental sanitation education management
Hutton, Haller and Barttram (2007) maintain that sanitation educa-
tion, which refers to sensitising people, especially the masses on sanita-
tion 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 with Hutton, 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 by Saei (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 by Adubofour (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 with Adubofour (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 prin-
ciple of complementarity is the implicit acknowledgement that, although
sanitation education is necessary, it is not sufficient unless it is com-
plemented with other strategies, key among which is sanitation infra-
structure 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 includes flush or pour flush 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 in fields, bushes, bodies of water or other open
spaces. Sanitation (toilet) has direct bearing on environmental sanitation.
Global best practices recognise the importance of proper infrastruc-
ture for ESM, and a number of services some of which are underlined as
mandatory. Key among these services, which the ESM authorities are
J. Mensah
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 au-
thority should designate communal storage sites where solid waste can
be discharged into movable containers for collection for final 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 of Chudger (2010), include
the provision of policies, laws and by-laws to regulate people’s envi-
ronmental 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 compli-
ance 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
to Scott (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 to Scott (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),
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Social Sciences & Humanities Open 2 (2020) 100028
Fig. 2. Sustainable sanitation for all Framework.
Source: SNV/IRC (2016).
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 envi-
ronmental 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 hy-
giene (WASH) governance as illustrated in Fig. 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 to Dreibelbis et al.
(2013), the framework operates on the understanding that ESM is pri-
marily 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 involve-
ment of local stakeholders. The framework also puts premium on ap-
proaches 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
J. Mensah
target population need(s) for proper ESM. Minh and Nguyen-Viet (2011)
concur with Devine (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 sys-
tematic 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 what fits 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 in-
formation to the consumer. It aims to increase awareness about sanita-
tion 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 to USAID (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 com-
munity’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 pro-
vided as the basis or anchor of the framework.
UNICEF (2016) provides a sanitation framework, WASH 2016–2030,
which emphasis leveraging public and private financing 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
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Social Sciences & Humanities Open 2 (2020) 100028
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 sus-
tainability 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, there-
fore, 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 to Geere 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 ad-
vocates political, administrative and fiscal 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 to Whitley et al.
(2019), is that improving the effectiveness of sanitation investments is
not only about infrastructure and technologies. Lienert (2019) extends
J. Mensah
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 under-
standing 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 partici-
pation 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 infrastruc-
ture or facilities, the software solution primarily relates to the use of
regulation and education to address the sanitation challenge.
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Social Sciences & Humanities Open 2 (2020) 100028
From the reviewed literature, it can be argued that the existing
frameworks capture relevant issues such as sanitation behaviour, stake-
holder involvement, environmental education, policies and infrastruc-
ture 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 with Mensah 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 frame-
work for ESM (Reed et al., 2018; Tidwell et al., 2018) is supposed to show
relationships between concepts and theories, demonstrating that con-
cepts 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, imple-
mentation 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 pol-
icies, laws and institutions to influence ESM through provision of infra-
structure, 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
J. Mensah Social Sciences & Humanities Open 2 (2020) 100028

Fig. 3. Theory-anchored conceptual framework for environmental sanitation management

Source: Authors’ construct, 2019.

9
J. Mensah
well as affordability and durability of the facilities. Infrastructure pro-
vision 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 sanita-
tion 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 vari-
ables 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 man-
agement 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 in-
terventions. Interestingly, all these can be achieved through effective
participatory planning and implementation processes, which are under-
pinned 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 coun-
tries. It must also be noted that the key dimensions of ESM namely, ed-
ucation, 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, infra-
structure 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 stan-
dards. 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 ac-
tions 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
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Social Sciences & Humanities Open 2 (2020) 100028
conceptual variables include environmental sanitation education, regu-
lation, and infrastructure management. The existing frameworks also
recognise that involvement of stakeholders, in the ESM enterprise is
important. Although the existing frameworks capture relevant concep-
tual 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, behav-
ioural change and systems theories as important underpinning theories
for ESM in developing countries. While the participation theory advo-
cates 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 in finding appropriate so-
lutions, 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 di-
mensions to ESM (environmental education, regulation and infrastruc-
ture 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 imple-
mentation 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 sanita-
tion 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 practi-
tioners around the world publish in English. Some publish in other lan-
guages including their native ones. Besides, the search was limited to
some databases, implying there could be other materials in other data-
bases that could be useful. Additional synthesis of the possible uncovered
publications could have provided additional useful insights into
J. Mensah Social Sciences & Humanities Open 2 (2020) 100028

innovative ways to ESM. Despite the missed contributions, it is believed Hotta, Y., & Aoki-Suzuki, C. (2014). Waste reduction and recycling initiatives in Japanese
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that the paper is based on diverse enough contributions to offer mean-
857–866.
ingful insights and implications for sustainable ESM in developing Hutton, G., & Chase, C. (2016). The knowledge base for achieving the sustainable
countries. It is suggested that further reviews or researches delve into development goal targets on water supply, sanitation and hygiene. Int. J. Environ. Res.
innovative approaches to financing environmental sanitation in devel- Public Health, 13, 536.
Hutton, G., Haller, L., & Bartram, J. (2007). Global cost-benefit analysis of water supply
oping countries, as this is a huge challenge in the ESM enterprise but this and sanitation interventions. Journal of Water and Health, 5(4), 467–480.
paper did not consider that in detail, since it was not the major focus of Ilesanmi, I. J. (2006). Pre-feasibility assessment of onsite and decentralised sanitation systems
the review. for new satellite settlements in Abuja, Nigeria. Unpublished MSC Thesis. Humburg:
Department of Civil Engineering, Hamburg University of Technology.
Jimenez, A., Cortobius, M., & Kjellen, M. (2014). Water, sanitation and hygiene and
Declaration of competing interest indigenous peoples: A review of the literature. Water International, 39(3), 277–293.
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