Focus on people, not their toilets

Q&A with WSSCC’s Carolien van der Voorden about whether building toilets is sufficient for stopping open defecation

About herself: “I work for the Global Sanitation Fund of the Water Supply and Sanitation Collaborative Council (WSSCC). The Fund is all about collective sanitation and hygiene behaviour change to tackle the sanitation crisis, currently working in 13 countries in Africa and Asia to demonstrate viable models that result in open defecation free (ODF) communities, districts and states, and can pave the way towards ODF nations.”

Q: Do you think the SDG of ending open defecation by 2030 is realistic?

A: We have to believe the goal is feasible, if governments and all their partners agree on common strategies and roadmaps that are based on collective behaviour change and demand creation rather than on subsidy driven approaches which, apart from their effectiveness, in most countries would require many times more the financial resources than are available.


Photo: WSSCC

Q: How can someone be convinced to want and use a toilet, when they don’t currently?

A: Some of GSF’s country programmes are having great success applying the community led total sanitation (CLTS) approach. This can really work, just look at Madagascar’s programme has so far resulted in more than 11,000 communities declared ODF, but it does come with challenges in terms of going to scale with quality. We are finding that especially the quality of facilitation, and the need to make sure community engagement is a process of pre-triggering, triggering and strong follow-up, are two key elements.

It is not a silver bullet but we have seen the approach work in many different circumstances and countries. The key as far as we can see it, is to ensure these “demand creation interventions” are really community driven, which is sometimes tricky when CLTS becomes government policy or strategy and so local governments might feel pressured to push communities into ODF, rather than these being real community learning journeys.

Our Madagascar colleagues put a lot of emphasis on the principle that community problems require community solutions – to make sure these do not become outsider-driven programmes. This is not to say that the communities do not need support and advice, but even there we have found that many of the most innovative solutions to deal with specific infrastructure issues come from within the community.

Q: 11,000?! That’s impressive. By “declared” you mean self-declared? Or independently verified?

A: Verification in Madagascar is a five step process where the fourth and fifth steps are third party verification.

The numbers we publish are at the very least based on three steps of verification, where communities first self declare are then checked by sub-grantees and then by our Executing Agency, and some of them also by the additional third party verifiers.

Q: What behaviour change initiatives around hygiene do we know work? Can/how they be replicated or adapted to reduce open defecation rates?

A: We see hygiene and sanitation messages as linked, especially the need for systematic hand washing with soap or ash. The three key behaviours to defeat ODF, keeping toilets fly proof and washing hands after using the toilet and before preparing food are the key ways to ensure that communities are key to our CLTS approaches. As well as being the key indicators for declaring a community ODF.

Q: How can governments be encouraged to take the lead on this issue?

A: I think there is real value in showing what is possible if government dedicates the necessary resources and really gets involved, at all levels.

In some of our programmes we’ve had success in doing institutional triggering, where decision makers, from the president down to the local councillor, are taken on the same journey as communities are and they get triggered to take action in whatever way is most relevant and appropriate linked to their position.

In terms of the president of Madagascar, this helped to establish the national Roadmap towards ODF. And more importantly, doing this at the local level really creates the sense of a movement for change, where everybody is clear on the role they have to play and puts that into concrete action plans that they can then hold each other accountable for.

Another thing we have learned from our programmes in Uganda and Nigeria, where local governments are the implementing agents, that capacity building and training of trainers can only go so far. The real capacity comes from learning on the job, and that requires an implementation budget.

There is no point just training local governments and then leave it at that. There must be a focus on implementation and continuous presence in order to refine strategies and approaches. As said before, there is no silver bullet so even CLTS needs to be continuously adapted and local governments must be given a chance to learn and understand this on the job over time.

Q: Any final comment?

A: Lift every stone, increase the movement, find champions and most importantly, focus on people, less on their toilets!

The original Q&A was hosted by Katherine Purvis of the Guardian and can be found here.

Will better sanitaton and nutrition reduce stunting?

Zimbabwe SHINE trial - Cornell University

Photo: Cornell University

A trial is underway in Zimbabwe to measure the independent and combined effects of improved sanitation and hygiene (WASH) and improved infant diet on stunting and anemia among children 0-18 months old [Cornell University CENTIR Group blog].

The Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) Trial is led by the Zvitambo Institute for Maternal and Child Health Research in Harare, Zimbabwe in collaboration with the Ministry of Health and Child Care/Government of Zimbabwe. Other contracted experts include Sandy Cairncross, Val Curtis and Peter Morgan.

The SHINE Trial is being undertaken in Chirumanzu and Shurugw, two districts with high HIV prevalence. Besides investigating the effects of sanitation and nutrition, SHINE will also test whether Environmental Enteric Dysfunction (EED)is a major cause of a major cause of child undernutrition. EED, also called environmental enteropathy, is a condition believed to be due to frequent intestinal infections.

SHINE is being being funded by the Bill & Melinda Gates Foundation and the UK Department for International Development (DFID). There are additional contributions from Wellcome Trust, National Institutes of Health, and the Swiss Development Cooperation.

A special open access supplement of Clinical Infectious Diseases is devoted to SHINE containing the following articles:

  • The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial Team, doi:10.1093/cid/civ844
  • Design of an Intervention to Minimize Ingestion of Fecal Microbes by Young Children in Rural Zimbabwe, doi:10.1093/cid/civ845
  • The SHINE Trial Infant Feeding Intervention: Pilot Study of Effects on Maternal Learning and Infant Diet Quality in Rural Zimbabwe, doi:10.1093/cid/civ846
  • Using Geographic Information Systems and Spatial Analysis Methods to Assess Household Water Access and Sanitation Coverage in the SHINE Trial, doi:10.1093/cid/civ847
  • Assessment of Environmental Enteric Dysfunction in the SHINE Trial: Methods and Challenges, doi:10.1093/cid/civ848
  • The Potential Role of Mycotoxins as a Contributor to Stunting in the SHINE Trial, doi:10.1093/cid/civ849
  • Assessing the Intestinal Microbiota in the SHINE Trial, doi:10.1093/cid/civ850
  • Assessing Maternal Capabilities in the SHINE Trial: Highlighting a Hidden Link in the Causal Pathway to Child Health, doi:10.1093/cid/civ851
  • Theory-Driven Process Evaluation of the SHINE Trial Using a Program Impact Pathway Approach, doi:10.1093/cid/civ716

Australia helps carry the can on World Toilet Day

Article by Steven Ciobo, Australias Minister for International Development and the Pacific

In Australia, we love toilet humour. The 2006 comedy Kenny, which followed a portable toilet man about his daily business, was a local box office hit, and our televisions are awash with advertisements of puppies unravelling toilet tissue rolls around the house.


United Nations staff installed a 15-door-high inflatable toilet to mark the World Toilet Day in front of the UN headquarters in New York on November 19, 2014. Photograph: Jewel Samad/AFP/Getty Images

We can see the funny side of toilets, because we’re able to use a toilet and wash our hands as often as we need. The Australian Department of Social Services publishes an online National Public Toilet Map so we can find, in a matter of seconds, the nearest of some 16,000 public toilets.

Unfortunately, for too many in the world, this is far from the case. According to United Nations estimates around 2.4 billion people, or a third of the world’s population, don’t have access to a basic toilet, leaving them exposed to the many diseases transferred through human waste, such as cholera, typhoid and dysentery. Approximately 946 million people defecate in the open, in fields, streams, forests and open city spaces, which puts entire communities at risk of diarrhoeal diseases.

On 19 November, the world will mark World Toilet Day. This year, the focus is on the link between toilets and nutrition. Regular bouts of diarrhoea caused by open defecation, poor hygiene and unclean water, contribute to poor nutrition, growth stunting and developmental impairment, preventing children from reaching their full potential. In 2014, the World Health Organisation reported 159 million children under five years of age suffer from growth stunting. Nearly 1,000 children die every day from diarrhoeal diseases and poor nutrition, making diarrhoea the world’s second leading disease killer of children . These children are missing valuable time at school and their families are forced to spend their limited incomes on medical care, which exacerbates the cycle of poverty.

Read the full article on the WSSCC Guardian partner zone.

Making the link: Community initiatives for sanitation and health – webinar on 26 Nov. at 10:00 – Postponed

Note: Thank you for your interest in the SuSanA webinar on making the link between sanitation and health. Unfortunately one of our presenters has received news of a family emergency and we will be postponing the webinar to allow for their participation at a later date. If you already registered on EventBrite, you can remain registered for the event and you will receive an update to confirm a new date, which will likely be mid-January.

Poor sanitation has serious implications for health including a large burden of diarrheal diseases, which remains the second leading killer of children under 5 globally, and a large burden of intestinal worms. Improving access to sanitation and hygiene and changing behaviours can bring not only health benefits but also many other positive changes in a community, including social, economic and environmental gains.

Deepening our understanding of the linkages between sanitation interventions and health outcomes provides key insight and evidence for decision-makers making investments in sanitation services.

We invite you to join an interactive webinar where experts will discuss how these critical connections at a community level can be improved.
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Testing CLTS Approaches for Scalability: Nepal Learning Brief

Nepal UNC

Pour Flush Toilet in Nepal. Photo Credit: Vidya Venkataramanan

Plan International supports Community-led Total Sanitation (CLTS) implementation in a number of districts in Nepal. In this learning brief, we review Plan International Nepal’s CLTS activities. We found government targets and definitions to be ambitious while decentralized planning allowed a focus on community-led processes. Plan International and other sanitation practitioners can support CLTS outcomes by providing post-triggering training and technical support to community volunteers, focusing on achieving gradual, yet sustained outcomes in program areas, and continuing to work with local governments to ensure that financing mechanisms for the poor are locally developed and equitable.

Link to learning brief:

Citation: Community-led Total Sanitation in Nepal: Findings from an Implementation Case Study. Venkataramanan, Vidya, Alexandra Shannon, and Jennifer Bogle. 2015. Chapel Hill, USA: The Water Institute at UNC.

New Video Offers Five Lessons for Sanitation Policy and Practice

A new video from Plan International and the Water Institute at UNC offers a preview of five exciting lessons on sanitation policy and practice, based on findings from operational research on community-led total sanitation (CLTS). These lessons relate to CLTS planning at the national and local levels, its place in national sanitation systems, and the importance of involving local actors. In particular, government officials, teachers, and natural leaders can play important roles in improving access to basic sanitation, and their involvement can ensure sustainable outcomes over time.

WSSCC increases support to Swachh Bharat Mission

The Water Supply & Sanitation Collaborative Council (WSSCC) has announced that it will amplify its support to the Swachh Bharat Mission (SBM), the Government of India’s (GOI) programme to achieve a Clean India by 2019, by establishing an in country India Support Unit and bolstering its work linked to the Global Sanitation Fund (GSF).

The government has welcomed these moves, which enhance WSSCC’s normative and implementation work to improve access and use, equality, knowledge and collaboration in sanitation and hygiene. WSSCC has appointed Mr. Vinod Mishra, previously the organization’s volunteer National Coordinator, to the position of National Officer in a new India Support Unit (ISU). Mr. Mishra will lead a WSSCC team of three professionals, including Ms. Kamini Prakash, an Equality and Non Discrimination Officer, and Ms. Sanchita Ghosh, a Knowledge and Learning Officer, based in Delhi. The unit will coordinate WSSCC support to SBM on policy and monitoring guidelines, capacity building and rapid action learning.

Credit: Anil Teegala

Credit: Anil Teegala

In addition, WSSCC’s work through the Global Sanitation Fund-supported programme managed by NRMC India Private Ltd. will include four additional elements: extension of field operations in the States of Jharkhand, Bihar and Assam; support to the Namami Ganga Mission (NGM) within SBM; support to Bihar State on a “District Approach” to collective behaviour change; and facilitation of peer exchanges with neighbouring States in Northern India. Collectively, these additions respond to the Government’s aims to expand and share through successful sanitation programming.

These additional elements build on an already successful GSF programme which, since 2010, has been instrumental working in those three States with high open defecation rates, to establish the modalities for implementing collective behaviour change at scale, an essential pathway to the practical realization of SBM. To date, WSSCC has facilitated open defecation free status for Gram Panchayats in Jharkhand and Bihar. As of July 2015, the GSF programme has empowered 551,000 people to live in open defecation free villages, and 1.4 million people to gain access to improved sanitation in India. “The Swachh Bharat Mission is a call to action for finally ending the practice of open defecation and ensuring equal access to sanitation and hygiene,” says Dr. Chris W. Williams, Executive Director of WSSCC. “We aim to answer that call and work together to solve the serious and deep rooted sanitation challenges for the well-being, prosperity and very survival of India’s 1.2 billion citizens.”

Since 1990, WSSCC has worked closely through its individual members, National Coordinators and partners to support improved access to sanitation and hygiene. In the past five years alone, the Council held the first Global Forum on Sanitation and Hygiene in Mumbai, facilitated innovative sanitation programming through the GSF, and worked with the Government of India and States to transform sanitation policy and practice to include safe menstrual hygiene management with dignity, responding to the demands of hundreds of millions of women whose monthly periods were hitherto linked to pollution and impurity and therefore shame and indignity.

More recently, along with other partners, WSSCC contributed to the design of the SBM to include equity, innovation, rapid action and learning, and sustainability aspects before it was launched in October 2014. In 2015, GOI called upon WSSCC to organize the first ever national workshop to define the verification of open defecation free (ODF) status in India, followed by the first national sharing of innovations, best practices and failures in sanitation and hygiene. On equity, the Indian example and experience has been leveraged systematically to forge partnerships, innovations and guidelines wider in South Asia and in Africa. Inclusive WASH has also been clearly articulated in regional declarations and hygiene and sanitation proposals for the Sustainable Development Goals. “In a country where pervasive caste and gender inequalities threaten life itself, over 300 million women and girls in India try to squat in a sari, while holding a cup of water to cleanse themselves and keeping an eye out for molesters. Imagine how much more complex and impossible this becomes every month during a woman’s menstrual period!” says Ms. Archana Patkar, Programme Manager, WSSCC. “It is time for the entire development community to unite behind this cause.”

Mr. Mishra added: “The deleterious impacts of poor sanitation and hygiene on health, productivity and well-being extend well beyond India, which is responsible for 60% of the world’s total open defecation, and is nothing short of a global emergency. WSSCC’s amplified engagement will therefore lead to successes and solutions which will not only tackle the emergency here, but help elsewhere.”

Find out more about WSSCCs work in India and in other countries: