To address the lack of fecal sludge management,

which poses environmental and public health risks, public sanitation blocks were built and rehabilitated in strategically identified areas to address service gaps, as part of a new integrated urban sanitation model (collection, transportation, treatment, public sanitation infrastructure, and its financing). Municipal management involves professional service delivery, transparent fee collection systems, subsidy mechanisms to support the most vulnerable citizens, and economic and social sustainability. Innovation also includes converting treated fecal sludge into Biozezika, an organic soil conditioner that complies with Malagasy standards and is useful for agriculture. Furthermore, the institutionalized cross-subsidy mechanism, whereby revenues from public sanitation services directly fund school sanitation services, creates a socially integrated financing model.