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.

Community Led Total Sanitation (CLTS) was piloted in Thaba Tseka district of Lesotho in November 2014 and 11 villages were triggered during the training process. Of these, Ha Khupiso is the first village to have attained ODF status within a short period of 6 months, making it the first and only ODF village in Lesotho at present.

During a recent visit to Lesotho, the CLTS Foundation Global team members met with four ‘Natural Leaders’ from Ha Khupiso who emerged from within the community during the CLTS triggering process. During the interaction, the champions highlighted some actions initiated by the community, leading to their village becoming ODF or in their own words, becoming “A Proud Village”. These are key elements that are generated as outcomes of any successful CLTS process and should be seen as useful lessons to be emulated in/by other villages across Lesotho.

Formation of “our own” committee:

Various committees had been formed by the health, water and other ministries as part of earlier initiatives. In these cases, the members were pre-selected by outside authorities and the committee was given specific duties to perform. Many of these committees remain inactive and dormant. However, it was for the first time, during the CLTS process, that the community took initiative to form their own committee and act collectively on actions initiated during the triggering process. This also brought new energy into the community and reunited old groups to act together. Community members exhibited more ownership and collective responsibility to set milestones and achieve results.

Community Solidarity:

As seen in many successful CLTS triggering examples, when community members understand that their health and those of their loved ones are at risk if even one household in the community defecates in the open, they all come together to help each other so that their entire village is free from open defecation. We were informed that in Ha Khupiso, out of a total of 44 households, there were 9 households with elderly people, 3 households with blind persons, 3 very poor households and 1 household with a mentally challenged person. These were households that found it challenging to build their own latrines.

This is when the traditional practice of “litzema’ or community solidarity came into play. The other households in the village helped these households by offering their labour in digging their pits, collecting materials from the fields, making toilet seats for them using stones, tins or wood etc. This helped in making the village completely free from open defecation in no time.

The Natural Leaders from Ha Khupiso : Motumi Ntlou, Mosiuoa Khasoane, Matseliso Mokabo and Mamasheane Khasoane with Ms Makhotso Mohoanyane from Department of Rural Water Supply, Ministry of Water ( 2^nd from right) and the CLTS Foundation Global team members at Thaba Tseka district in Lesotho

Influencing schools to build toilets:

The community members reported that once all the households had achieved ODF, every child in the community imbibed the practice of using the toilet. As a result, when they went to their school which did not have any toilets, they would hold back their urge to urinate or defecate until they were able to rush back to their homes and use their toilets either during break time or after school time. As a result, this triggered the schools to invest and build toilets for the children. Today, the schools in Ha Khupiso have toilets, as a result of the CLTS exercise.

Formulation of by-laws:

Everyone in the village is now bound by community by-laws that prohibit open defecation in the village. Even schools in the neighbourhood are expected to follow these by-laws which means that children coming to these schools from neighbouring villages cannot practice open defecation and have to use school toilets. Those breaking any of the by-laws are subject to penalisation by the village chief.

Use of Indigenous knowledge:

In order to get rid of the smell of shit, in addition to ash, the community members use a traditional shrub called “lengana” and aloe vera. The shrub is immersed in water and after the moisture is absorbed, the leaves are spread over the shit which has been reported to kill the smell.

The Natural Leaders are very proud of their achievement and also understand that the battle against open defecation will remain alive unless every village in Lesotho becomes ODF. They recognise that they are still not completely free from contamination unless their nearby villages also become ODF.

A national level stakeholder meeting underway in Lesotho.

When asked, they said that they were willing to help other villages in this process. In return, they asked for support to hire horses to travel to these villages on horseback, some triggering materials and some snacks and refreshments. They said they did not want any money! They also said that they were confident that it would not take more than 2 months each to make the other 7 villages in their electoral division ODF. Currently Ha Khupiso residents are the recipients of the trophy given by the Lesotho government for the first ODF village in their country. When asked which village would they hand this trophy to next, the Natural leaders said “We do not plan to give this trophy back. We will make our village the cleanest one in the country, more than any other village.”

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