The true costs of participatory sanitation

Plan International USA and The Water Institute at UNC have conducted the first study to present comprehensive, accurate, disaggregated costs of a WaSH behaviour-change programme.  The study calculated programme costs, and local investments for four community-led total sanitation (CLTS) interventions in Ghana and Ethiopia.

Jonny Crocker, Darren Saywell, Katherine F. Shields, Pete Kolsky, Jamie Bartram, The true costs of participatory sanitation : evidence from community-led total sanitation studies in Ghana and Ethiopia. Science of The Total Environment, vol. 601–602, 1 Dec 2017, pp: 1075-1083. DOI: 10.1016/j.scitotenv.2017.05.279 [Open access]

Abstract

Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behaviour-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34–$81.56 per household targeted in Ghana, and $14.15–$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93–$22.36 per household targeted in Ghana, and $2.35–$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behaviour-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behaviour-change programs.

Science, Silver Bullets, and Sanitation: How Operational Research Improved Plan’s Global Programming

Science, Silver Bullets, and Sanitation: How Operational Research Improved Plan’s Global Programming. 

• Full text

Plan International is a pioneer of the Community-Led Total Sanitation (CLTS) approach — a method that triggers community-wide behavior change on sanitation practices, ending open defecation, and stimulating household investment in toilets.

We tested, implemented, and evaluated the relative effect of different CLTS facilitation methods to examine how scalability and sustainability improved under alternate models. This comparison was coupled with “deep dive” evaluations in Ghana, Ethiopia, and Kenya, complemented by seven rapid evaluations worldwide to compare and contrast the findings.

Global Waters Radio: Darren Saywell on Community-Led Total Sanitation

Global Waters Radio: Darren Saywell on Community-Led Total Sanitation

• Link to the podcast

Darren Saywell is Senior Director for the Water, Sanitation and Health Practice with Plan International USA, an international NGO with a presence in more than 70 countries around the world. 

For the past four years, Plan International has teamed up with the Water Institute at the University of North Carolina on “Testing Community-led Total Sanitation (CLTS) Approaches for Scalability,” an operational research initiative funded by the Bill & Melinda Gates Foundation.

The project has conducted extensive analysis on the role and effectiveness of local actors in community-led total sanitation (CLTS) in 10 countries across Africa, Asia, and Latin America. It has collected hard evidence that attests to the methodology’s effectiveness in enabling large-scale sanitation behavior change.

In this conversation with Global Waters Radio Saywell talks about the key findings of the project to date and discusses why it is critical for the sanitation sector to replace anecdotal evidence on CLTS’ effectiveness with rigorous evidence.

Sanitation for all: Scaling up is hard to do – Jan Willem Rosenboom

Sanitation for all: Scaling up is hard to do | Source: Jan Willem Rosenboom, Devex, March 22 2016 |

If you invest even a little bit of your time in keeping on top of developments in the water, sanitation and hygiene sector, you will have seen at least some of the blogs, reports and articles reminding us all that the world failed to attain the Millennium Development Goals’ sanitation targets — by a wide margin.

A school teacher leads a community-led total sanitation activity in Ethiopia. Photo by: Plan International / Bill & Melinda Gates Foundation

The Sustainable Development Goals give us a second chance to get it right, but they seriously up the ante. Instead of “merely” providing half of the unserved population with access to improved sanitation, as the MDGs required, the SDGs tell us we can only declare success once every person, every school and every health facility has — and uses — safely managed sanitation facilities.

We have 15 years to get it right. Given the below-average results we obtained in the past 15 years, it is clear that we should ask some hard questions and examine the evidence emerging from the field, in the hope we can do much better in the next 15 years.

Pilots never fail, and never scale

Anywhere in the world, if we look hard enough, we can find successful, innovative projects changing people’s lives for the better — and not only in sanitation; this is true for every sector.

The assumption that successful pilots will — by some unexamined magic — lead to sustained scale up efforts is mostly false and, as a result, we seem stuck with repeated small-scale successes, rather than impact at scale. In the past I have labeled this observation “Rosenboom’s law on pilots:” Pilots never fail, and never scale.

Read the complete article.

Plan International and the Water Institute at UNC Findings on CLTS

Plan International USA and the Water Institute at the University of North Carolina at Chapel Hill (UNC) have released new findings and results about rural sanitation behavior change processes using the Community-led Total Sanitation (CLTS) approach. Entitled CLTS Learning Series: Lessons from CLTS Implementation in Seven Countries, the research report identifies implications for practice and delivers policy recommendations based on a rigorous review of seven country case studies and their approach to CLTS implementation.

Covering experiences from Haiti, Uganda, Niger, Cambodia, Lao PDR, Nepal, and Indonesia, long-form, individual country reports are complemented by a meta-analysis of all case studies, as well as a shorter, executive summary style briefing paper for rapid review. 

The reports present common features to CLTS implementation, identifies consistent bottlenecks and enabling conditions, and shares lessons relevant to scaling-up CLTS.

Copies of all reports from this work are available at the project website: https://waterinstitute.unc.edu/clts/

Testing CLTS Approaches for Scalability: Nepal Learning Brief

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: https://waterinstitute.unc.edu/files/2015/11/learning-series-nepal-learning-brief-2015-11.pdf

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.

Plan International – Testing CLTS Approaches for Scalability: Indonesia Learning Brief

Testing CLTS Approaches for Scalability: Indonesia Learning Brief, 2015. Plan International.

Sanitation Marketing Project in Grobogan District, Indonesia. photo credit to Jonny Crocker

• Link to Learning Brief

Plan International supports Community-led Total Sanitation (CLTS) implementation in a number of sub-districts in Indonesia.

In this learning brief, we review the roles of local actors in Plan International Indonesia’s program activities and highlight considerations for scalability, planning, implmentation, and evaluation.

Plan International and other sanitation practitioners can support the national government and local actors by placing more responsibility on sub-district staff to lead triggering, enlisting the added support of village facilitators to lead post-triggering, and scaling up village-based financing mechanisms to sustain CLTS outcomes.

Link to project website: http://waterinstitute.unc.edu/clts/

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

Creative measures improve sanitation programmes in eight African countries

Sapling handwashing, Malawi. Photo: Plan Malawi

Eight African countries are creatively achieving the goals of community led total sanitation programmes (CLTS) including one idea in Malawi where handwashing is monitored according to the health of tree seedlings planted beneath water outlets.

In Zambia several schools have established vegetable gardens to reduce malnutrition and improve school attendance. Some of the harvests have been sold raising funds for school activities.

In Sierra Leone men have traditionally been the community leaders but women are now being encouraged to play a major part in village committees and networks of natural leaders.  To support CLTS women conduct house-to-house monitoring, giving health talks and reporting diseases –- many of them overcoming challenges such as illiteracy to maintain the programme.

Plan International’s five year Pan African CLTS (PAC) programme which ends in December, 2014, is operating in the eight countries of Sierra Leone, Ethiopia, Uganda, Kenya, Zambia and Malawi, Ghana and Niger. With the backing of the Dutch government the project was designed to promote and scale up sanitation in communities and schools.