Reshaping the Landscape of Public Health and Economic Growth Through Transformative Sanitation Projects

KEY HIGHLIGHTS

• Tunisia's Sanitation Public-Private Partnership (PPP) Support Project, launched in 2024, is expected to improve sanitation services for 2 million direct beneficiaries.
• In Viet Nam, between 2016 and 2024, nearly 7 million people benefited from the Results-based Scaling up Rural Water Supply and Sanitation program.
• In Zambia, between 2015 and 2024, the Lusaka Sanitation Project benefited over 345,000 people through improved sanitation facilities and waste treatment, constructing new treatment plants, and building or rehabilitating 117 kilometers of sewers.

Tunisia

"This project will support improved water supply and sanitation services for an estimated two million direct beneficiaries—more than 500,000 households—in six governorates during the ten years of implementation, with around half being women and girls. Given its long-term involvement in the sector and the continuous support provided to the Office National de l’Assainissement (ONAS), since its creation in 1974, through eight World Bank-financed projects, the World Bank is well placed to support this initiative.”

— Alexandre Arrobbio, World Bank Country Manager for Tunisia

Viet Nam

"The Results-based Scaling Up Rural Sanitation and Water Supply Program has exhibited commendable success, reflecting a synergy between strategic planning at the central level and diligent execution at the local level. A cornerstone of the program's approach was its focus on sustainability. The initiative not only aimed for immediate improvements in access to water and sanitation but also sought to establish enduring solutions. In essence, the Program stands as a testament to what can be achieved when strategic planning is underpinned by a commitment to sustainability and backed by the World Bank’s expert technical support."

— Ministry of Agriculture and Rural Development (MARD).

Challenge

Water serves as the lifeblood of the planet, supporting lives, livelihoods, biodiversity and the environment, food and energy security, and economic growth and development. Yet, 1.81 billion people face significant flood risk, 2.3 billion lack access to safely managed water, and 3.5 billion lack access to safely managed sanitation as of the 2024 fiscal year (FY24). These challenges are exacerbated by the intensifying effects of climate change, rapid population growth, and rising food insecurity as reflected in the FY24 GWSP Annual report. The World Bank is working to confront these challenges, which manifest differently across diverse client contexts, but represent a vital development constraint to solve.

In Tunisia, ONAS, the national wastewater utility, serves 63 percent of the population. The utility covers only 62 percent of its costs through user fees, however, leading to aged infrastructure, staff reductions, and inadequate wastewater treatment. In 2020, 24 percent of ONAS-managed wastewater treatment plants were operating above hydraulic capacity, and 20 percent above biological load capacity. In project areas, (Choutrana, Gabes, Tataouine, Tunis, Ariana, Sfax, and Medenine) 71 percent of facilities failed to meet effluent quality standards, posing health risks. About 360,000 people lacked sanitation services, and untreated wastewater from 1.7 million urban residents degraded freshwater resources.

While urban areas in Viet Nam have near-universal water access, 56 percent of the rural population relies on unsafe water, and significant regional disparities further sharpen this contrast. Poor sanitation costs Zambia 1.3 percent of its GDP annually due to groundwater contamination and diseases like cholera and typhoid. Moreover, the Lusaka Water and Sewerage Company’s (LWSC) faces challenges like inefficient staffing, as well as high non-revenue water: 45 percent of processed and distributed water is not billed to customers, in particular due to loss and leakage before the water reaches them.

Approach

The World Bank’s approaches to addressing the current global water crisis include enhancing sanitation services, strengthening institutional capacity, leveraging private sector expertise, and improving financial and operational efficiency. The highlighted projects show how these approaches are being implemented on the ground, as these projects aim to boost economic growth, public health, and environmental benefits through targeted investments, policy dialogue, and governance strengthening.

The Tunisia Sanitation PPP Support Project, approved in December 2022, aims to enhance wastewater management services and strengthen ONAS’s capacity to manage Public-Private Partnership (PPP) contracts. By improving ONAS’s financial efficiency and operational performance, the project will boost well-being, economic growth, and fiscal deficit management. The project employs 10-year performance contracts with private operators, leveraging private sector expertise and financing.

The Results-based Scaling up Rural Water Supply and Sanitation project in Viet Nam, approved in November 2015 and concluded in July 2023, aimed to enhance hygiene practices and expand sustainable access to rural sanitation and water supply. It focused on improved management and quality of implementation, promoting cost-efficiency by reinvesting savings, targeting the poorest provinces. The program supported policy and institutional capacity development at the provincial, district and commune levels for school water, sanitation, and hygiene (WASH), as well as promoting policy research and private sector engagement.

The Lusaka Sanitation Project, approved on May 22, 2015, and closed on April 30, 2024, worked to strengthen capacity in the LWSC. The project focused on pro-poor growth and improving public health, including by addressing long-standing issues of insufficient access to sustainable sanitation facilities. These efforts were supported by analytical work, including the Zambia Water Supply and Sanitation Sector Diagnostic and a cholera risk analysis using geospatial data. The analytics produced recommendations to improve the effectiveness of water and sanitation and reduce cholera risk. Additionally, through GWSP financing, the World Bank supported technical assistance to the LWSC information technology (IT) department to upgrade its mobile payment system, enhancing billing and incentivizing sewer service connections.

Results

Worldwide, active World Bank Group projects have reached over 66 million people with water, sanitation, and hygiene, and these projects are expected to reach a total of 155 million people.

In Viet Nam, the Results-based Scaling up Rural Water Supply and Sanitation project in Viet Nam benefited nearly 7 million people. By February 2024, it provided 285,259 new water supply connections (1.2 million people) and connected 144,163 households to Sustainable Water Systems (600,000 people). Additionally, 5.8 million people in over 700 communes gained access to sanitation, with hygienic latrines built in 260,000 households and 1,721 schools and 826 health stations.

In Zambia, the Lusaka Sanitation Project launched in 2015. By 2024 it had completed key works, including sewerage in Kanyama (the project built or rehabilitated 117 kilometers of sewers) and the Manchinchi Fecal Sludge Treatment Plant. The project benefited over 345,000 people (50 percent of them female), primarily in Lusaka’s poorest areas, through improved sanitation facilities and enhanced waste treatment.

In Tunisia, the project aims to enhance wastewater management services for over 2 million beneficiaries in Greater Tunis and the southeast region by 2030. The first PPP contract began in June 2024 in the Sud-Tunisien area, with the Tunis-Nord contract expected in Spring 2025. The project aims to improve sanitation services and create approximately 1,000 jobs, including 380 full-time positions and 700 for construction and other services. It also aims to increase women's representation in ONAS’s PPP unit to 30 percent and the project is also expected to help ensure that at least 95 percent of treated wastewater effluent meet applicable quality standards for discharge and for specific reuse applications. Emphasizing financial sustainability, the project includes annual tariff increases, and a 30 percent tariff increase for nonvulnerable consumers in 2023 to cover operating costs and concession fees.

Data Highlights

PROGRAM ACHIEVEMENTS IN VIETNAM 

Collaboration across the World Bank Group

The Tunisia PPP project provides an example of collaboration across the World Bank Group. International Bank for Reconstruction and Development (IBRD) funds are supporting the mobilization of private sector capital and expertise as well as operational efficiencies and institutional strengthening. In parallel, the International Finance Corporation (IFC) has supported the preparation of PPP transactions and is supervising the work of the technical and legal advisors (consultants) recruited by ONAS (and funded by the Islamic Development Bank) for structuring PPP transactions.

World Bank Group Contribution

In Tunisia, the project is funded by a $113 million IBRD loan, $410 million from the government and user fees, and $17 million from private contractors, totaling approximately $540 million.

The project in Viet Nam is funded by a $200 million grant from the International Development Association (IDA) and $100 million from the government, while the Global Water Security and Sanitation Partnership (GWSP) provided 1.3 million funding for technical assistance and capacity building.

The project in Zambia is funded by $65 million from IDA and $3.5 million counterpart funding from the government of Zambia, while the GWSP has provided $390,000 for technical assistance that informed the design of the project and capacity building.

Partnerships

The Tunisia Sanitation PPP Support Project is an example of broad collaboration, with contributions from various development partners, thus optimizing resources and ensures complementarity. The Islamic Development Bank’s Arab Financing Facility for Infrastructure funded the initial feasibility study, by financing the consultants, and has supported the project since its inception. The project is also aligned with the French development agency’s support for a next generation of PPPs and institutional support for the water and sanitation sector in Tunisia, through technical assistance and financial support. Bilateral assistance has also been provided by Germany and Japan to support infrastructure, capacity and policy development in Tunisia’s sanitation sector.

In Viet Nam, the project collaborated with UNICEF in designing the program. UNICEF funded the baseline assessment for designing the sanitation part of the program. This was complemented by Technical Assistance working in collaboration with the National Center for Rural Water Supply and Sanitation. In Zambia, the Lusaka Sanitation Program received financial support from three other international financial institutions: the European Investment Bank (EIB), Kreditanstalt fur Wiederaufbau (KfW), and the African Development Bank (AfDB).

Looking Ahead

As the World Bank Group continues to work to address the global water crisis, each of the highlighted projects requires continuous engagement, coordinated investments, and capacity building to meet water demands, improve services, and align with national development goals and visions.

In Tunisia, the Global Water Security and Sanitation Partnership (GWSP) is extending grant support to Tunisia's national water security project until 2028. This technical assistance will help optimize strategies for meeting water demands and mitigating climate risks in areas such as wastewater treatment, groundwater management, and irrigation efficiency, in line with Tunisia's Water Vision 2050.

The World Bank is continuing to support Viet Nam through continuous engagement at the institutional and policy level, supporting coordinated investments in water and wastewater, including river management, sustainable and resilient rural water supply, dam safety and irrigation modernization, and strengthening inter-provincial water security.

In Zambia, engagement with the government, LWSC, and international financial institution partners is crucial for the long-term functionality and sustainability of the sanitation investments. With World Bank and AfDB projects closed in 2024, a transition plan was financed by the World Bank, with KfW assessing performance, and EIB funding long-term capacity building for LWSC.