The Last Mile Challenge of Sewage Services in Latin America and the Caribbean

Access to piped sewage in Latin America and the Caribbean (LAC) cities has been on the rise in recent decades. Yet achieving high rates of end-user connection between dwellings and sewage pipelines remains a challenge for water and sanitation utilities. Governments throughout the region are investing millions in increasing access to sewage services but are failing in the last mile. When households do not connect to the sewage system, the full health and social benefits of sanitation investments fail to accrue, and utilities can face lost revenue and higher operating costs. Barriers to connect are diverse, including low willingness to pay for connection costs and/or the associated tariffs, liquidity and credit constrains to cover the cost of upgrades or repairs, information gaps on the benefits of connecting, behavioral obstacles, and collective action failures. In contexts of weak regulation and strong social pressure, utilities typically lack the ability to enforce connection through fines and legal action. This paper explores the scope of the connectivity problem, identifies potential connection barriers, and discusses policy solutions. A research agenda is proposed in support of evidence-based interventions that have the potential to achieve higher effective sanitation coverage more rapidly and cost-effectively in LAC. This research agenda must focus on: i) quantifying the scope of the problem; ii) understanding the barriers that trigger it; and iii) identifying the most cost-effective policy and market-based solutions.