The $33 million USAID-funded Rural Access to New Opportunities in Water, Sanitation and Hygiene (RANO WASH) program seeks to increase equitable and sustainable access to WASH services to maximize impact on human health and nutrition and preserve the environment in 250 rural communes of Alaotra Mangoro, Amoron'i Mania, Atsinanana, Haute Matsiatra, Vakinankaratra, and Vatovavy Fitovinany regions of Madagascar. RANO WASH has three strategic objectives:
1) To support governance and monitoring at national, regional, and communal levels for sustainable WASH services;
2) To increase access to water and sanitation supply through supporting private sector capacity and public-private partnerships for sustainable water and sanitation supply across several regions in Madagascar; and
3) To increase good hygiene and sanitation behaviors by identifying and addressing multiple behavioral determinants.

The project was designed using the Sanitation and Water for All (SWA) Collaborative Behaviors and is guided by a system strengthening approach that establishes the building blocks for sustainable delivery of WASH services. This report presents findings from the midterm review, which evaluated the project's performance from 2018 to 2020 across five criteria, benchmarked progress and contribution towards WASH building blocks, and assessed the effectiveness of the consortium team.