Study examines sustainability of CLTS programmes in Africa

Despite the widespread implementation of Community Led Total Sanitation (CLTS) programs and many claims of success, there has been very little systematic investigation into their sustainability.  A new study, which aims to change that, is creating a stir in the WASH sector.

A study commissioned by Plan International on the sustainability of CLTS programs in Africa revealed that 87% of the households still had a functioning latrine. This would indicate a remarkably low rate of reversion (13%) to open defecation (OD) or “slippage”.

However, if the criteria used to originally award open defecation free (ODF) status to villages are used, then the overall slippage rate increased dramatically to  92%. These criteria are:

• A functioning latrine with a superstructure
• A means of keeping flies from the pit (either water seal or lid)
• Absence of excreta in the vicinity of the house
• Hand washing facilities with water and soap or soap-substitute such as ash
• Evidence that the latrine and hand washing facilities were being used

WSP promoted CLTS approach in Indonesia criticised

A highly critical article in Development and Change argues that the Community-Led Total Sanitation (CLTS) approach, which the Water and Sanitation Program (WSP) has promoted in Indonesia, is not only “inadequate” but also “echoes coercive, race-based colonial public health practices”.

Dr Susan Engel, University of Wollongong, Australis

Authors Dr Susan Engel and Anggun Susilo reveal striking similarities between developments in Indonesian sanitation in the 1920s and the 1990s. In both eras the focus changed from “the provision of hardware to […] participation and social mobilization” to encourage “individuals and communities to construct and maintain their own sanitation facilities”.

In the 1920s, the Rockefeller Foundation led the change, 70 years later it was WSP. In both cases the approaches are said to have met resistance because they were coercive and humiliating for the poorest, who also had to pay for latrines they couldn’t really afford.

Engel and Susilo found no evidence that the CLTS approach in Indonesia was sustainable. They conclude that government involvement, not just self-help CLTS approaches, is essential for successful sanitation.

Engel, S, and Susilo, A., 2014. Shaming and sanitation in Indonesia : a return to colonial public health practices?. Development and change, 45, 1, pp. 157-178. DOI: 10.1111/dech.12075

See also:

• India, Madhya Pradesh: sanitation campaign humiliates women, say critics, Sanitation Updates, 24 Dec 2014
• WASHplus Weekly: Community-Led Total Sanitation, Sanitation Updates, 13 Dec 2013
• Topic: CLTS and human rights: Should the right to community-wide health be won at the cost of individual rights?, SuSanA Forum

 

India, Madhya Pradesh: sanitation campaign humiliates women, say critics

Controversial illustration from Madya Pradesh sanitation campaign booklet

A government campaign to stop open defecation in the Indian state of Madhya Pradesh has been criticised for using humiliation to change behaviour. Journalist M. Poornima writes that the ambitious scheme called ‘Maryada Abhiyan’ (Hindi for dignity), “gives little of it to women”.

From catcalls to publishing names to photographing the people caught — the government booklet [1] suggests a number of measures meant to humiliate people. That it would hit women the hardest is not a thought that appears to have occurred to the authorities.

The criticism is backed up by WaterAid programme officer Binu Arickal, who called whistling at or photographing women practising open defecation “foolish”. This reflects a discussion started at the beginning of this year on community-led total sanitation (CLTS) and human rights in the SuSanA Forum, which was sparked by a journal article [2] by Jamie Bartram and others.

UNICEF contributed to the Maryada campaign booklet. The campaign’s brand ambassador is Anita Narre, the bride from a Madhya Pradesh who  sparked a “sanitation revolution” in her village by forcing her husband to build a toilet in their home.

[1] Madhya Pradesh. State Water and Sanitation Mission (2012?). Maryada Abhiyan: guideline. Available at: <http://washurl.net/42kkyn>

[2] Bartram, J. … [et al.] (2012). Commentary on community-led total sanitation and human rights: Should the right to community-wide health be won at the cost of individual rights?. Journal of water and health, 10(4), pp. 499–503. doi: 10.2166/wh.2012.205. Available at: <http://washurl.net/56qm77>

Related web sites:

• Madhya Pradesh. State Water and Sanitation Mission
• India. Ministry of Water and Sanitation – Nirmal Bharat Abhiyan
• IDS – Community-Led Total Sanitation

Source: M. Poornima, No ‘maryada’ for women in MP govt’s sanitation drive, Hindustan Times, 24 Dec 2013

WASHplus Weekly: Community-Led Total Sanitation

Issue 126 December 13, 2013 | Focus on Community-Led Total Sanitation

This issue updates the May 2013 Weekly on CLTS with more recent reports and other resources. Included are presentations from a sanitation workshop in Benin, reviews of CLTS successes and shortcomings, a UNICEF overview of CLTS in Asia and the Pacific, a video on school-led total sanitation in Nepal, among others. 

REVIEWS

Testing CLTS Approaches for Scalability: Systematic Literature Review (Grey Literature), 2012. V Venkataramanan. (Full text)
This study presents findings from a systematic literature review on the effectiveness and impact of CLTS programs. This document was prepared by The Water Institute at UNC for Plan International USA as part of the project Testing CLTS Approaches for Scalability, funded by the Bill & Melinda Gates Foundation.

Community-Led Total Sanitation in Africa: Helpdesk Report, 2013. Health & Education Advice & Resource Team (HEART). (Full text)
Decreases in diarrhea, cholera, and skin infections were the main health outcomes reported in this study. However, methodological weaknesses, including the lack of clarity around the proportions of the population exposed before and after implementation of CLTS to these conditions, made it challenging to determine the quality of the evidence presented.

The Cost of a Knowledge Silo: A Systematic Re-Review of Water, Sanitation and Hygiene Interventions, 2013. M Loevinsohn. (Full text)
The health impacts of CLTS have yet to be comprehensively assessed, although it is evident that people realize a range of benefits such as dignity, privacy, security—especially for women—and a clean environment, which they may value more than protection from infection.

AND THE WINNER IS….Community-led Total Sanitation in Himachal Pradesh

Water and Sanitation Program – The Indian state of Himachal Pradesh has made good progress in achieving rural sanitation outcomes and is well recognized as a high performer at an all-India level. Like other states, Himachal Pradesh also implemented the Total Sanitation Campaign/Nirmal Bharat Abhiyan and Nirmal Gram Puraskar/Clean Village program since their launch and the 2011 Census finds that open-defecation in rural Himachal Pradesh has come down from 72% to 33% in 2001, a downward reduction of 39% and highest among all states of India. By contrast, at national level, open-defecation has come down by 11% from 78% to 69%. This film showcases the state-level strategy which resulted in successful outcomes.

Extended call for abstracts: West Africa Workshop “Towards sustainable total sanitation”:

West Africa Learning and Exchange Workshop “Towards sustainable total sanitation”

Cotonou, Benin, 12-14 November 2013

Organised by: IRC, UNICEF, WaterAid and SNV

This workshop targets sanitation practitioners that have hands-on experience with the implementation of Community Led Total Sanitation (CLTS) programmes and projects and aims to bring together professionals working on rural sanitation in West Africa, particularly practitioners, researchers, policy makers, and people from government agencies, donors and media.

It will emphasise the role of CLTS, with a geographical focus on West Africa; the roles of hygiene/sanitation behaviour change and the enabling environment around CLTS and other sanitation improvement approaches.

The workshop will build on the sanitation life cycle framework as developed by IRC and also reflect on methodological experience from IRC’s past learning and sharing exchanges and workshops in the field of Sanitation & Hygiene.

The participation fee is free although participants must take care of their own travel and accommodation costs.

Abstract deadline extended to: 27 September 2013

Abstract form can be downloaded here

More information at: www.irc.nl/page/79226

Read the First Announcement and Call for Abstracts

WASHplus Weekly: Sanitation Marketing

Issue 112 August 16, 2013 | Focus on Sanitation Marketing

This issue focuses on sanitation marketing. Several sources define sanitation marketing as an emerging field that applies social and commercial marketing approaches to scale up the supply and demand for improved sanitation facilities. Most of the studies and resources in this issue are from 2012 and 2013, but it also includes a 2010 USAID sanitation marketing guide for managers. Of note is an article by Gordon McGranahan who reviews and discusses shortcomings of the sanitation marketing approach. 

Please contact WASHplus if you have recent studies, manuals, etc., on sanitation marketing that can be added to this compilation.

BLOG POSTS/VIDEOS

Sanitation Marketing in Antananarivo: Progress and Impact, 2013. Water and Sanitation Program for the Urban Poor (WSUP). (Video)
This video describes the WSUP sanitation marketing approach in Antananarivo, Madagascar, and the impact of improved latrines on the local community.

Selling Toilets in Cambodia, 2013. J Graham. (Video)
A video by Dr. Jay Graham of George Washington University about his tour of a WaterSHED project in Cambodia.

Toilet Teachings: 2 Toilet Ventures Illustrate Strategies for Success in Inclusive Business. Business Fights Poverty, Apr 2013. C Ashley. (Blog post)
This article discusses two sanitation marketing ventures: 3S Shramik, which is supported by the Business Innovation Facility and works in Pune and other cities in India, and Sanergy, which works in Nairobi slums and is supported by Innovations Against Poverty. Both ventures are developing business models for private provision of sanitation in slums, covering everything from careful toilet design to evacuation of waste.