Developing and Monitoring Protocol for the Elimination of Open Defecation

Developing and Monitoring Protocol for the Elimination of Open Defecation in Sub-Saharan Africa, 2013.  UNICEF.

• Link to full text, pdf

Eliminating open defecation is increasingly seen as a key health outcome, with links to reduced stunting, improved educational and positive health outcomes for children. In Sub Saharan Africa, over 35 countries are implementing some form of CLTS, ranging from TATS in Tanzania to CLTSH in Ethiopia. Since the introduction of CLTS in 2005 in the region, rapid scale-up has been achieved with suggested numbers of ODF communities in the range of 30,000 affecting over 15 million people in SubSaharan Africa. Several countries have set aggressive targets for elimination of Open Defecation in rural areas for the next five years which often include not only safe disposal of faeces but handwashing facilities, cleanliness and solid waste management.

Sustaining the progress made through the application of the CLTS process is emerging as a challenge with experience suggesting that sustainability is determined by the process followed to achieve ODF. Rapid scale up in SSA is arguably linked to the fact that CLTS is based on the concept of triggering community-wide behaviour change, requires no subsidies and integrates easily into existing health programming structures. Current focus is on ‘triggering’ communities into action; while considerably less resources and emphasis on following up and mentoring of communities ‘post-triggering’.

This paper reviews process and protocol for defining, reporting, declaring, certifying ODF and sustaining ODF, highlighting where the process varies between countries and potential determinants of sustainability within the process itself. Critical questions include what elements (should) constitute an ODF protocol, what are the determinants of sustainability and what impact does target-setting have on achievement of ODF goals in country?

Kiribati’s North Tarawa declared first open defecation free island in the Pacific

Everyone on North Tarawa now has access to improved sanitation. Photo: ABC Radio Australia / UNICEF Pacific.

North Tarawa in Kiribati is the first island in the Pacific to be declared open defecation free, thanks to the “Kiriwatsan I Project”. The Ministry of Public Works is implementing this project with technical support from UNICEF and funding from the European Union.

North Tarawa is made up of a string of islets with a combined population of 6,102 (2010) and a land area of 15.26 sq.km.  Previously about 64 per cent of people used the beaches and mangroves for defecation and dumping their rubbish.

UNICEF spokeswoman Nuzhat Shahzadi says that diarrhoeal diseases cause 15 per cent of the deaths of children under five in Kiribati.

In March 2013, North Tarawa adopted the Community-Led Total Sanitation (CLTS) approach following a training of trainers course conducted by Dr Kamal Kar. The CLTS pioneer wrote that he had convinced Kiribati President Anote Tong to set December 2015 as the target date for the whole nation to become open defecation free.

The villagers of North Tarawa dig shallow pits and use local materials like brick and coconut leaves to build the toilet superstructure. They keep water and soap in one corner. After using the toilet, the villagers sprinkle ash to stop the smell and flies getting in, and then keep it covered.

Ms Shahzadi said that the women and girls were very happy that no longer have to go out on the beach in the middle of the night if they need to use the toilet.

Source: UNICEF, 11 May 2013 ; Radio New Zealand International, 13 May 2013 ; ABC Radio Australia, 14 May 2013

UNICEF/Malawi: CLTS Triggering Tools: How to Trigger for Hand Washing with Soap

UNICEF/Malawi: CLTS Triggering Tools: How to Trigger for Hand Washing with Soap, March 2013.

• Link to full-text, pdf

An Excerpt: The tools outlined by this document were developed based on actual field research in testing, done as a collaborative effort between UNICEF and Salima District Council. Salima was selected for the research and testing of new hand washing triggering tools because they already had experience attempting to incorporate hand washing into their triggering process, and also have data showing high numbers of new hand washing facilities being built after CLTS. Also, Salima was selected because they implement CLTS continuously as part of their routine extension staff work.

Nine different tools were tested for how well they instilled a realization of the importance of hand washing with soap (HWWS). When these tools were used, hand washing practice increased by 69% and soap availability at hand washing facilities increased by 15%, compared to when CLTS didn’t include specific
tools to trigger HWWS. However please take these guidelines with a grain of salt, as they are based on a small sample size, overall only a few villages.

THE 10 FIELD-TESTED HAND WASHING TRIGGERING TOOLS OUTLINED IN THIS DOCUMENT:

• Anal Cleansing Materials
• Shit and Shake
• Cassava/Egg Demonstration
• Charcoal
• Smelly Hands
• Charcoal Smearing
• Scratch & Smell
• Wall Contamination
• Food Sharing
• Dirt Under Fingernails

USAID/Afghanistan – Afghan Sustainable Water Supply & Sanitation (SWSS) Project

Afghan Sustainable Water Supply & Sanitation (SWSS) Project, 2012. Sustainable Health Outcomes Unit, Project Final Report.

• (Full text, pdf)

USAID/Afghanistan

Introduction
The USAID Sustainable Water Supply and Sanitation (SWSS) project, led by Tetra Tech ARD, was designed to improve the sustainability of rural infrastructure and the health of rural populations through a balanced commitment to providing water supply and sanitation facilities and improving community hygiene behaviors. It built upon the significant work done in the water supply, sanitation, and hygiene (WASH) sector in Afghanistan over the previous five years. A national policy framework was in place, engineering standards were set, and over 100 projects had provided facilities in rural communities.

Despite this high level of investment, extremely low percentages of rural Afghans used improved water supplies or sanitation facilities. Widespread utilization of water systems, sanitation facilities, and a core set of hygiene behaviors is the foundation for achieving health impacts. Without health impacts, especially among women and children under the age of five, rural water and sanitation (WatSan) projects were not reaching their goal of reducing the time and money spent by farming families on treating diarrheal diseases, allowing them more time for activities that improve their economic well-being.

Darren Saywell/Plan Int’l – Urban Frontiers for Sanitation Programs

Below is a link to Darren Saywell’s presentation to the USAID Sanitation Working Group on December 12, 2012.

• Urban Frontiers for Sanitation Programs (pdf, 4.8MB)

Content

• Urban Frontiers for Sanitation Programs - Time to Get Real or Time to Get Really Worried?
• How urban sanitation is different
• The gap in urban sanitation
• What’s new and different?
• Community-Led Total Sanitation
• And more

Join the Sanitation Marketing Community of Practice

Welcome to the Sanitation Marketing Community of Practice!

Are you a WASH practitioner currently working on Sanitation Marketing activities? Do you find yourself struggling to find others you can talk to about the practical issues you face – like how to work with a marketing agency, support a small business or design a new low-cost product? Are you thinking about starting a sanitation marketing program, but don’t know where to start?

Why a Sanitation Marketing Community of Practice?

As you know 2.5 billion people still lack access to basic sanitation and this has devastating impacts on the lives and health of people and communities.  At this rate the sanitation target of the Millennium Development Goals (MDGs) may not be met until 2026, making it one of the most off-track targets in many countries of the world. To address this sanitation crisis, it is now clear that programs focused on latrine construction will not be enough. New approaches like Community-Led Total Sanitation (CLTS) have proven that communities can be motivated to change their sanitation situation – but that the first step is triggering behaviour change.

WSP – What Does It Take to Scale Up Rural Sanitation?

What Does It Take to Scale Up Rural Sanitation? 2012. Water and Sanitation Program.

• Full-text (pdf)

A new WSP working paper, What Does It Take to Scale Up Rural Sanitation? shares lessons and best practices that were identified to:

• generate demand for sanitation at the household and community level;
• increase the supply of affordable, aspirational sanitation products and services; and
• strengthen local and national governments to lead large-scale sanitation programs.

Over the last 30 years, most rural sanitation projects have had pockets of success, but were small in scale and could not be scaled up. Learning how to expand on the successes of small-scale projects to increase access at large scale has been an enduring challenge. Project outcomes often fail the sustainability test once external funding ceases, and the benefits, even if sustained, remain limited to project areas.

Despite growing political will to do more about rural sanitation, the lack of evidence and examples of effective and sustainable large-scale rural sanitation programs has constrained governments and development partners. In an attempt to help address these issues, starting in 2007, the World Bank’s Water and Sanitation Program (WSP) provided technical assistance to help governments design, plan, implement, and monitor national rural sanitation programs that start at scale and are sustainable. This initiative was carried out in three countries, India, Indonesia, and Tanzania. In each country, at scale service delivery was led by governments, communities, and the local private sector.

Key components are introduced and illustrated with examples from the field, including an overview to programmatic approaches that have been combined and tested to create demand, change behaviors, and improve supply chains: Community-Led Total Sanitation, Behavior Change Communication, and Sanitation Marketing. The Working Paper introduces the basic methodology for these approaches, and the roles of national and local government and the local private sector, and discusses strategies to strengthen the enabling environment and build capacity to achieve and sustain improvements in rural sanitation.

Links to WASHplus Weeklies on Sanitation

Below are links to WASHplus Weeklies on sanitation-related topics:

• 06/01/2012 - A WASHplus Weekly: Focus on WASH-Related Diseases
• 05/11/2012 - A WASHplus Weekly: Update on Sludge Management
• 04/20/2012 - A WASHplus Weekly: Focus on Small-Scale WASH Service Providers
• 04/13/2012 - A WASHplus Weekly: Hygiene Behavior Update
• 04/06/2012 - A WASHplus Weekly: Focus on the Informal Sector and Solid Waste Management
• 03/30/2012 - A WASHplus Weekly: Focus on Nanotechnology
• 02/17/2012 - A WASHplus Weekly: Focus on Ecological Sanitation
• 01/20/2012 - A WASHplus Weekly: Year in Review, Community-Led Total Sanitation (CLTS)
• 01/13/2012 - A WASHplus Weekly: Year in Review – 10 Key Handwashing Studies From 2011

A Challenge Paper on Water and Sanitation

A Challenge Paper on Water and Sanitation – 2012

• Full-text (pdf)

by Frank Rijsberman and Alix Zwane and released by the Copenhagen Consensus Center.

The world has met the Millennium Development Goal on the provision of clean drinking water five years early, but is set to miss its goal on basic sanitation by almost 1 billion people. An astonishing one-third of the world population, 2.5 billion people, lack access to basic sanitation and over one billion people defecate out in the open. 

Inadequate sanitation caused a cholera outbreak in Haiti in late 2010 that has now made half a million people sick and cost some 7000 lives; smaller cholera outbreaks are still commonplace during the rainy season in Bangladesh or the low-lying parts of many Africa cities. Diarrheal diseases are still a leading cause of death for children under five, second only to respiratory infections. The World Bank concludes that the economic impact of poor sanitation can be as high as 7% of GDP for some Asian countries and on the order of 1-2% of GDP for African countries.

Copenhagen Consensus 2012 asked Frank Rijsberman and Alix Peterson Zwane from the Gates Foundation to establish the best ways to reduce the size of this challenge.

Good practices in Community-Led Total Sanitation

GOOD PRACTICES IN COMMUNITY-LED TOTAL SANITATION: Plan’s experience in Uganda 2007 – 2010. May 2011. 

• Full-text 

Where it has been introduced, CLTS has been integrated with other development initiatives. Besides ending open defecation, the focus is on a more comprehensive package which includes wastewater management, solid waste disposal, overall hygiene and more. The approach has also been modified in some countries to ‘School-led Total Sanitation (SLTS)’, whereby schools are the prime drivers in achieving ODF status. This has widened the spread of CLTS and its impact, both among adults and children. Plan, Water Aid and UNICEF have become important disseminators and champions of CLTS. Today, it is present in many countries in Asia, Africa, Latin America, the Middle East and Africa. In sub-Saharan Africa, it has taken root in 28 countries and gained the support of decision makers and professionals, who have recognised it as a successful, cost-effective approach and have issued a declaration to urge governments to take more decisive steps to ensure ODF environments among local communities.