1. 11 A Conversation with Our Grantees Water, Sanitation & Hygiene Initiative Bill & Melinda Gates Foundation 5 th World Water Forum Istanbul, Turkey March 2009

2. 22 Our goals and approach  Goal: Catalyze the adoption of WS&H solutions that meet 3 criteria – »Impact on the health, economic and social well being of the poor »Sustainable in terms of long-term operations and funding »Scalable to reach tens to hundreds of millions of people (Just counting new taps and toilets isn’t enough)  Principles: »Listen, listen, listen (we haven’t invented any of this) »Add value – find a role that takes advantage of our capabilities and complements, leverages the strengths of other players in the sector »Build partnerships  Approach: »Learning, not just doing »‘Economic’ perspective – motivations and incentives »Take risks to drive innovation »Insist on rigorous evaluation of impacts, not inputs or outputs »Work with all sectors – public, private, NGO »Focus on cross-cutting approaches that work across different countries and contexts, albeit with adaptation to local situation

3. 33 Lessons learned on what it takes to succeed Core Elements Success Factors Service Delivery There needs to be a stronger focus on triggering demand and sustaining use Market structure It doesn’t matter if a service provider is public or private, but rather whether they are held accountable to service standards, whether through appropriate regulation and/or market forces Financing Better evidence of the financial viability of pro-poor investments is needed to increase access to market-based finance Better evidence of the health, economic and social impacts on the poor is needed, in order to justify more and better-targeted public funding Leadership Leaders must support solutions that achieve long-term sustainability and impact as well as scale Learning WS&H solutions should include learning components that build on past practice and encourage innovation to improve future practice Short version: It’s not just about supplying hardware!

4. 44 Our role depends on where we can catalyze change  Our main role is to find and test effective, sustainable models that can be replicated to achieve scale  Two types of models to achieve impact, sustainability, scalability:  Solutions deliver high impact, sustainable W S or H services to the poor »For example, stopping open defecation or purifying water in the household  Levers affect key decisions in the WS&H system, which in turn improve service delivery to the poor »For example, more accurate costing data or facilitation of key parties to serve the poor  But in practice good ‘solutions’ and good ‘levers’ must both consider three components for success: (i) user motivations;(ii) appropriate hardware; and, (iii) policy context  We will intervene only at the stage(s) where we’re needed: Pilot Try them out Test at Scale See if they really work R&D Find better solutions Catalyze For widespread use Advocate Most models will need to be tested at scale in order to be ready for sustainable, widespread use # people affected: 1,000,000s We will only play a catalytic role to support the widespread use of solutions or levers (i.e., we will primarily leverage other people’s money) # people affected: 10,000,000s-100,000,000s We aim to pilot in neglected areas and support rigorous evaluation of others’ piloting activities # people affected: 10,000s-100,000s R&D will be limited to neglected areas such as sanitation and development of products targeted for the poor

5. 55 Focal areas for our grants How can we have the biggest impact on the lives of the poor?  Bringing sustainable solutions to scale Take user-focused W, S or H solutions that have succeeded at the pilot level and bring them to scale  Leveraging large-scale players Work with governments and big donors to make traditional large-scale projects much more effective and sustainable  Testing market-based solutions Test new business models and financing tools to deliver affordable, user-oriented services through the private sector  R&D for pro-poor goods and services Support R&D in critical but neglected areas and develop products targeted for the poor  Policy and advocacy Shape sector policies to improve decision-making and advocate to champion proven approaches Opportunities to catalyze impact for tens to hundreds of millions of the poor in the medium term Innovations that could change the way the game is played over the longer run Convincing others to implement and fund solutions that really work

6. 66 Examples of grants  Bringing sustainable solutions to scale »WSP Total sanitation and sanitation marketing »WSP Scaling up hand-washing behavior change  Leveraging large-scale players »CARE Schools-based WS&H interventions »WSUP Catalyzing water and sanitation services for the urban poor »IRC WASHCost Developing accurate costing data and embedding it in local decision-making »IRC Rural water sustainability »CEPT University Benchmarking performance of urban water and sanitation services  Testing market-based solutions »Acumen Fee-based water and sanitation services »PATH Commercializing household water treatment »Acumen/IDEO Water storage and transportation for the very poor »Enterprise Works/VITA Commercializing domestic rainwater harvesting  R&D for pro-poor goods and services »Univ. of Bristol Low-cost water quality test »UC Berkeley Study on comparative rural water interventions  Policy and advocacy »International Year of Sanitation communication materials