The article was first published here: http://wawash.fiu.edu/drupal-cms/news/2017/02/15/dr-kamal-kar-clts-founder-meets-usaid-wa-wash-staff 

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Photo credit: Lefaso.Net

Burkina Faso has made the least progress in sanitation during the MDG period in spite of the fact that most of its neighbouring countries made remarkable progress during the later part of MDG. In Burkina Faso, 75% of the rural population still defecate in the open. The incidence of diarrhoea and child mortality rate of Burkina Faso is alarming. However, Burkina Faso still remains the only country in the Western and Central Africa region that has been providing household sanitation subsidy and also has not institutionalized CLTS in its national sanitation policy.

Almost 24 countries of Western and Central Africa, have institutionalized CLTS with no hardware household toilet subsidy as a non-negotiable principle into their national sanitation policy. The achievements in terms of sanitation outcome have been remarkable in these countries.

Photo credit: Lefaso.Net

Realizing the lack of an enabling environment in scaling up of CLTS in Burkina, major actors of sanitation including UNICEF in Burkina have been trying to influence the government policy to move beyond the subsidy approach and to adopt community empowerment approach of CLTS.

However, Burkina Faso is one of the last countries in the region to adopt the no subsidy strategy in the government policy and to become open defecation free (ODF). Recently, CLTS Foundation Global was invited by the Government of Burkina Faso and UNICEF Burkina to organize and facilitate a two days institutional triggering workshop on CLTS with the senior ministers, policy and decision makers and heads of national and international organizations in Ouagadougou. Dr. Kamal Kar led the triggering workshop with colleagues from CLTS Foundation Global, UNICEF WCARO, and Burkina Faso.

Photo credit: Lefaso.Net

Recently, Dr. Kamal Kar visited Beniou village on the invitation of the United Nations Children’s Fund (UNICEF) in the province of Sissili. On Saturday, February 4, 2017, he facilitated and witnessed the triggering session for ending open defecation in Burkina Faso. During the triggering session, Dr. Kamal Kar has mentioned that the communities should no longer wait for years for state subsidy by continuing to eat their poo. He is absolutely assured and convinced that the people of Burkina Faso can take control of the alarming situation and stop open defecation.

The CLTS triggering session got featured in an esteem news portal of Burkina Faso, lefaso.net. Though it is in French but is indeed a good and informative read.

The article was originally published here in French: http://lefaso.net/spip.php?article75656

The post Community Led Total Sanitation: Triggering Session in Beniou village in Burkina Faso appeared first on CLTS Foundation Global.

Group Photograph of CLTS Practitioners and Policy Makers in Thies, Senegal

It was a major advocacy and training workshop organised in Bamako in Mali later, in which leaders from 23 countries in the region participated, that provided the necessary impetus for mainstreaming CLTS in the region. Following this, CLTS pilot projects were introduced in most of the countries in the region and was subsequently adopted as the core strategy for enhancing sanitation progress during the Millennium Development Goals (MDG) period. This is the second follow up intervention of CLTS Foundation Global for this region after Bamako 2009 CLTS workshop. In between intensive efforts were given in many Francophone and Anglophone countries by Community Led Total Sanitation Foundation. A recent regional workshop organised in Dakar with participation from 18 countries can be seen as a similar milestone to boost sanitation efforts during the Sustainable Development Goals (SDG) period.

Experience of CLTS in Western and Central Africa Region (WCAR):

Simulation exercise by Dr. Kamal Kar in progress at Thies, Senegal.

In the last decade, majority of countries in WCAR decided to adopt CLTS as the recommended methodology for rural sanitation programming. The early adopters of the approach were Sierra Leone, Mali, Ghana and Nigeria. Subsequently, other countries such as Benin, Cote d’ ivoire, Cameroon, Chad, Congo Brazzaville, Gambia, Guinea, Guinea Bissau, Liberia, Mauritania, Niger, Nigeria, Senegal and Togo followed suit. At the end of 2010, it was estimated that more than one million people were living in open defecation free environments as a result of the CLTS interventions. As the momentum to achieve results picked up towards the end of the MDG period, it is certain that the ODF achievement in these countries would have increased at the end of the year 2015.

However, huge challenges persist for the región during the SDGs. While individual countries might have made progress, the rate of open defecation (OD) has increased on the whole.  At the end of the MDG period, the rural OD rate in WCAR stands at 38%. Countries like Burkina Faso and Democratic Republic of Congo are yet to do away with a subsidy policy entirely and lag far behind its counterparts in the region. More than half of the population in Benin, Burkina Faso, Chad, Niger, Sao Tome and Principe and Togo defecate in the open. The rate of OD in Cote d’Ivoire, Mauritania and Nigeria is equally high between 25% and 50%. Nigeria is ranked 4th in the world for number of people practicing open defecation, which is as much as 45 million people.

While the rolling out of CLTS in the countries in the region produced impressive results during the last decade, scaling up of these interventions nation-wide has remained a challenge. This has been primarily due to the lack of an enabling environment and persistence of institutional bottlenecks that have prevented capacity building and change in mindsets at different levels, mobilisation of the necessary government and external funds, and mechanisms for actor coordination; all of which are critical in achieving CLTS outcomes. Going forward, what is required in the SDG period are context specific strategies to scale up CLTS in each of the target countries in the WCAR. While some countries require immediate capacity strengthening and process support at different levels, some others need advocacy support to influence their national policy to create an enabling environment for CLTS implementation and scale up. In most cases, for effective CLTS implementation, it is critical to establish functional linkages among key actors, develop an engagement strategy among different levels of government functioning and capture outcome and impact through locally evolved monitoring and verification mechanisms.

A community member presenting in the workshop

Towards achieving this objective, CLTS Foundation Global will support the Western and Central Africa Region to accelerate and improve sanitation and hygiene behaviour practice through elimination of open defecation, in partnership with UNICEF WCAR Office. Following the landmark regional workshop in Mali in the year 2007, this will the second stage of CLTS Foundation Global’s institutional support to the region, which will involve policy advocacy to build an enabling environment for CLTS, enhancing capacity to implement and scale up CLTS; assessing the status of CLTS programming in countries already implementing CLTS through an innovative methodology; and improve regional learning and exchange via capacity building, documentation and learning events.

Regional Workshop with CLTS Practitioners and Policy Makers in progress at Thies, Senegal

To kickstart this initiative, a regional workshop bringing together participants from 18 countries in the region, was organised recently in Dakar in Senegal. The objective of the workshop was to enhance capacities for scaling up through appropriate policy and coordination mechanisms that bring all formal and informal actors ( like Natural leaders and local actors) into the fold. As part of the regional planning to meet the sanitation milestones set out in the SDGs, the aim of the workshop was to establish a pool of trained individuals and organisations within WCAR who would not only contribute to capacity building nationally at various levels but would also support the organisation of trainings in other countries in the region.

This 7 days’ regional training workshop took place in Dakar and Thies in Senegal from August 22nd to 28th, 2016 and involved participants from the following countries: Senegal, Benin, Cameroun, Liberia, Sierra Leone, Cote d’ivoire, Mali, Mauritania, Burkina Faso, Congo, Chad, Djibouti, Guinea-Bissau, Guinea Conakry, Madagascar, Ghana and Burundi.  The participants were directors and senior officers from different ministries (mainly Ministry of Health, Ministry of Water and Sanitation, Ministry of Environment), deputy heads of NGOs and UNICEF WASH teams from different countries in the region. The workshop included discussions and deliberations in Dakar on key topics related to CLTS scaling up, followed by a hands-on field training experience. Eight communities were triggered in the villages of Thies, as part of this workshop. The last two days of the workshop focused exclusively on essential elements of post triggering follow up and post ODF activities addressing the elements of sustainability, effective monitoring mechanisms and scaling up with quality to produce ODF districts/ regions etc. Each country team met in small groups to brainstorm on and develop action plans focusing on streamlining the national sanitation policy to ensure an enabling environment for CLTS, developing an appropriate scaling up strategy involving all conventional and non-conventional actors such as Natural leaders and Community Consultants, and building national capacity and mechanisms for sharing and disseminating experiences and best practices.

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Lesotho is one of the smallest countries in Sub-Saharan Africa with a population of a little over 2 million people, most of which are rural. The country is landlocked within South Africa, one of the most developed countries in the continent in terms of access to basic education, primary health care, access to water and sanitation, infrastructure, per capita income, livelihood opportunities and other basic indicators of development. In contrast, Lesotho’s access to most of these indicators is very dismal and skewed in comparison to even some of the other smaller countries in the region. Lesotho has fallen short of achieving most of its Millennium Development Goals (MDG) and ranks 161 out of 188 countries, in the Human Development Index (HDR 2014). According to the Lesotho Demographic Health Survey (LDHS) 2014, 38% of the rural population continue to practice open defecation (OD). The under-5 mortality rate is high with 85 deaths per 1000 live births and the infant mortality is equally alarming at 59 deaths per 1,000 live births. The maternal mortality ratio has been increasing steadily since 2001 and stood at 1,143 deaths per 100,000 live births in 2011 despite various initiatives. Additionally, the 2014 LDHS survey showed that 33% of children in Lesotho are stunted and 11% are severely stunted. An estimated 3% of children were found to be wasted during the survey while 10% was found to be underweight.

CLTS Foundation Global team (Dr. Kamal Kar and Preetha Prabhakaran) with Mr Tlali Hlasa, Director of DRWS, Ministry of Water (far right) and the World Vision team in Lesotho.

Lesotho’s sanitation story is particularly depressing. Not just because of its current sanitation coverage which stands at only 53% – there are other countries in sub-Saharan Africa that have recorded lower access rates than this. Having said this, the current coverage does not necessarily reflect the toilet usage; there is no official data currently available to know that all the people who have toilets are using them. A look at the above health statistics raises grave doubts in this regard, as the direct links between poor sanitation and low health outcomes are all too well known. Lesotho’s sanitation story is disheartening because, this current scenario when placed in the context of its sanitation history, reveals how an entire generation of people have been deprived of basic sanitation and hygiene, bringing with it the burden of diseases, ill health and under nutrition, most of it preventable, merely because of incorrect planning, management and coordination of resources, guided by ill-informed policies.

At a field mission in Lesotho.

Lesotho’s sanitation tragedy lies in the fact its story wasn’t meant to have unfolded this way. Lesotho started way ahead of its counterparts at the beginning of the MDG period, with 50% of the population already having achieved access to sanitation. It was identified as one of the countries that would steadily make progress and achieve universal access by the end of the MDG period. A sound national rural sanitation programme (NRSP), under the Ministry of Health, had been established way back in 1987 and was fully operational, with principles of community empowerment, collective action, entrepreneurship and self-reliance at the heart of its strategy. Lesotho’s home-grown sanitation model was exceptional and Lesotho was considered a trailblazer, with the potential to set a winning example for other countries in the region. It seemed only a matter of time before Lesotho would fast-track its efforts towards becoming one of the first open defecation free (ODF) nations in the region and inspire other countries in the region to do the same. However, almost a decade and half down the line, as Lesotho embraces the new Sustainable Development Goals (SDGs), it stands at the same point where it began in the early 2000s. How did this happen?

The decision to situate the NRSP when it evolved in 1987, in the Environmental Health Section of the Ministry of Health was a conscious step, keeping in view that health and hygiene should be seen as the main entry point as well as outcomes of sanitation and toilet usage. The government played largely an organisational and facilitative role, focusing on health and hygiene promotion to create user demand through campaigns and education. Communities constructed their own latrines by engaging private- sector latrine builders based in their or neighbouring communities. The entire costs for construction, including materials and builder’s wages were taken up by the households. People reduced their cost by collecting and using local materials for construction. The Ministry of Health invested in training rural community members on technical skills for construction and maintenance and many of these developed into small scale entrepreneurs, who had a direct economic incentive to promote improved sanitation and toilet usage in their communities. In this way, sustainability of the initiative was ensured.

Dr. Kamal Kar and Preetha Prabhakaran of CLTS Foundation Global with government officials from different ministries at Mokhotlong district, Lesotho.

As a result, rural sanitation coverage increased significantly in just over 20 years, from a mere 15 percent at the end of 1980s to over 50 percent by the beginning of the MDG period. Research in Lesotho also suggested a significant reduction in the incidence of sanitation related diseases in areas where water and sanitation projects had been implemented. For reasons unknown or undocumented, however, the whole approach changed track at the beginning of the millennium when the primary mandate for rural sanitation shifted from the Ministry of Health to the Ministry of Water, under the Department of Rural Water Supply (DRWS).

Under the DRWS, sanitation was perceived as an extension to provision of water supply facilities. It became a matter of infrastructure over everything else. External private contractors were brought in and the government took on the responsibility to construct toilets for the community with external support. The government thus moved from playing a facilitative and supportive role towards a direct implementation role. Other than building latrines the present approach of DRWS has no provision for initiating collective behaviour change focused towards ensuring usage of the facilities. External donor agencies support the government in providing hardware sanitation subsidy of varying amounts to rural households. This hardware subsidy comes with a universal toilet prescription design built with high external input dependent materials like cement, iron sheet, pans pipes etc. Most of these materials are not always available locally particularly in the remote rural areas and often it not easy to transport the materials to villages located in high mountains or in the valley with difficult access, thus increasing the cost considerably. At the end of it all, even official government data shows that this approach has not met with success in terms of outcomes.

At the end of the MDGs and the dawn of the SDG period, globally nations are consolidating their achievements and lessons of the past, to forge a new path towards success. Additionally, every country is under pressure to respond to regional and international commitments to meet the new global goals. These factors have collectively brought about a new awakening in the Lesotho government and administration for the need of a more sustainable approach to ensure universal sanitation coverage and move towards better sanitation and health outcomes.

The first steps towards initiating this change was notably taken by DRWS, and in November 2014, with the support of UNICEF, the government organized the first national CLTS workshop in Thaba-Tseka district. Among the 11 communities triggered during the training, one village Ha Khupiso has been certified as open defecation free (ODF) and 2 more villages have claimed ODF status. Other districts such as Mafeteng, Botha-Bothe, Quthing and Qacha’s Nek have started triggering their villages. The success of Ha-Khupiso has triggered across the nation a renewed hope of the past, of the community’s power to bring about sustainable change. Key sanitation actors and sector partners are realising that it is impossible to achieve universal coverage with sustained change in sanitation and hygiene behaviour practices unless the community sees sanitation as an internal need and leads its own process of change.

During the recent consultations led by CLTS Foundation Global at the district and national level, stakeholders voiced the need to put in place a national sanitation strategy with CLTS as its core principle, to set a national target date for achieving ODF along with a clear roadmap and milestones to fast track access to basic sanitation in the country. It was felt that being a country with a small population of just over 2 million, Lesotho has the potential to achieve ODF in a very short time. Additionally, this would make Lesotho one of the first ODF countries in the African continent, thus becoming a role model for other countries, especially the BNLS countries in the region. Looking back at the MDG era, while many countries did not achieve their MDG sanitation targets, a great number among them have put in place national policies and strategies focusing on community empowerment to fast track their country’s progress. These efforts need to be streamlined and accelerated to push ahead sanitation progress in the continent during the SDGs. For this, a few quick successes, in the form of ODF nations, is critical for the SDG target to become a reality. In the larger perspective, Lesotho could regain lost ground and play an instrumental role in leading change in the continent by becoming its first ODF nation.

The post How this African country is rewriting its sanitation story in the SDG era appeared first on CLTS Foundation Global.

CLTS Rapid Appraisal Protocol (CRAP)

Methodology & Sharing Country Experiences from the Region

UNICEF Eastern and Southern Regional Office (ESARO) and CLTS Foundation Global are jointly organising a CRAP tool regional workshop at ‘SAN LEARN 2016 – Sanitation Learning Workshop’ at Johannesburg, South Africa from 10-12 May, 2016.

SAN LEARN 2016 – Sanitation Learning Workshop, South Africa. Photo Credit: Amit Sengupta / CLTS Foundation Global

In this 3-day SANLEARN workshop, CLTS Foundation Global is playing a vital role by facilitating a one full day session on CLTS Rapid Appraisal Protocol (CRAP) on 11^th May. This is a unique tool developed by CLTS Foundation Global and UNICEF ESARO to assess the status and quality of community-led total sanitation in any community, country or region in a quick and comprehensive manner.

The three-day regional level conference by UNICEF ESARO at Johannesburg aims to bring in at least 70-80 senior practitioners working on sanitation from UNICEF and government officials from at least 20 different countries from eastern and southern regions of Africa to exchange experiences of implementing and scaling up sanitation initiatives in their respective countries.

FAQs on CRAP:

What is the CRAP Tool?

The CLTS Rapid Appraisal Protocol (CRAP) is a diagnostic tool to assess the status and quality of CLTS (Community Led Total Sanitation) in any particular country. The tool reviews the present practice of CLTS at the national and sub-national/regional level through a rapid appraisal, which means that it is administered in a quick and comprehensive manner using participatory approaches. Through a series of exercises, all the major sanitation actors in a country are involved in a reflective process, to identify the strengths and gaps existing in the current programme, and think of ways to take sanitation initiatives to scale with quality.

READ the FULL CRAP Brochure HERE

Why CRAP?

Since its inception in 1999-2000, CLTS has spread rapidly in more than 65 countries globally. Of these, more than 35 countries in the continent of Africa have rolled out CLTS as a strategy to achieve their national sanitation goals, with at least 20 of them adopting the approach in their national sanitation policy. However, there is a wide variation in the quality and scale of implementation of CLTS in these countries based on varying resource capacities, quality of CLTS facilitation, degree of political will, and institutional mind-sets and attitudes, among other factors. Additionally, experiences during the Millennium Development Goals (MDGs) era have shown that while countries have been able to achieve small islands of success, the real challenge has been in scaling it up to achieve open defecation free (ODF) districts or regions or countries. The conceptualization of the CRAP tool emerged from the need to address these challenges, as countries embrace new and ambitious goals at the onset of the Sustainable Development Goals (SDGs) era. CRAP is therefore a simple tool with a methodology that is easy to administer in order to achieve a common basic standard of CLTS implementation across different countries.

6 Pillars of CRAP

6 Pillars of CRAP. Copyright: CLTS Foundation Global and UNICEF ESARO

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