The event was inaugurated and hosted by Mr. Sisir Pradhan, who is currently a Ph.D candidate at the School of Environment, Enterprise and Development, University of Waterloo. Pradhan has worked with Kar for several years and highlighted various instances of their work together and the emergence and importance of CLTS moving forward.

Following that, Dalbir Singh, Sarpanch of Bilaspur Village from Panipat, one of the natural leaders from Haryana
elucidated his experience with CLTS, how the state of sanitation had undergone a change in his community, and how the community benefitted from CLTS. He also stated proudly that his community was now open defecation free (ODF). The author of the book, Dr. Kamal Kar then took the stage and elaborated upon the history and development of the CLTS movement and how the approach came to be adopted by various governments, non-governmental organizations (NGOs), and international agencies, citing the successful transformation in Bangladesh to an ODF country using the CLTS approach.

Kar added some anecdotes from his experiences in Asia, Africa and Latin America on the strength of collective action to end open defecation. He also briefly outlined the important CLTS case studies which have been enumerated from around the world, as well as the need, obstacles and potential to scale-up the approach, taking the journey ‘From Village to Nation’.

Following the official launch, a panel discussion was held. The panel was moderated by Dr. Kar and the speakers included Mr. V.K. Madhavan of WaterAid India, Ms. Meena Narula of Water for People, and Mr. Jamie Myers of the Institute of Development Studies, University of Sussex. As the theme of the event was ‘Behaviour Change and Human Dignity’, panellists elaborated upon a wealth of topics including gender impacts, subsidies for sanitation hardware, access to latrines, the Swachh Bharat Abhiyan (SBA), and the ways forward for the CLTS movement.

While Madhavan applauded the national importance given to the SBA as a movement against open defecation, he stated that the program and the CLTS approach must be retrofitted to address the emerging challenges of inclusion, sanitation demands and post ODF sustainability in this journey towards total hygiene. He said “the CLTS approach is not only an effort to help people build toilets and use them. It is meant to help people transform towards hygiene behaviour”, thereby drawing attention to the next phase of WASH concerns.

Similarly, Kar praised the SBA but also stated that sanitation has turned from a people’s movement to the
government’s movement requiring more participation for sustainability. While Myers shared his experiences
from India and Africa to highlight the idea and impact of gender specific sanitation interventions, Narula
expanded on the need for an intermingling of local culture and practices towards bringing forth sustained
behaviour change for human dignity.

Members of the audience then posed a number of questions to the panellists, which focused on issues related to modifying CLTS in the future, CLTS solutions for women’s dignity and gender parity, institutional triggering, political factors, efficacy of subsidies, and others. The panellists shared their thoughts on making this a holistic movement with special focus on these emerging concerns.

After the panel discussion, Pradhan expanded upon the book, citing its various sections, case studies and
findings. He also described its various uses for the future of the CLTS program development and
implementation, as well as notable anecdotes from its writing and publishing. Mahesh Kumar, Sarpanch of
Basara from Haryana then took the podium to illustrate his experience with scaling up CLTS. He stated that
the momentum of the CLTS approach in Haryana was established because his village was involved in
helping neighbouring villages become ODF after becoming ODF itself. He emphasized that this strategy is
an effective way to build support and traction for CLTS.

The event was concluded with the closing address by Ms. Urvashi Asthana from Practical Action, India. She
thanked the various organizations, media and community members for attending the event and making their
presence felt. She also stated that this book marked the beginning of a new phase for CLTS.

About the Book

The book has been written by Dr. Kamal Kar, and is an extensive account of how the CLTS movement came about, got adopted/institutionalized by governments and other agencies, and spread across the world. It includes methodologies for influencing the sanitation policies at the national level as well as ‘triggering’ villages/regions/districts to initiate and sustain collective local action against open defecation. A major publication after more than a decade since the Handbook on CLTS was published in 2008, the book also encapsulates case studies from across the world with special emphasis on scaling up and institutionalization of the CLTS approach.

The book is available for purchase online at:-

1. https://developmentbookshop.com/scaling-up-community-led-total-sanitation?fbclid=IwAR3brsAlCqgxGAqrzVvOYuGqs6fgO5ueqsc75ahl0vCnQHLhUXZMd8rUvzc
2. https://www.amazon.in/Scaling-up-Community-Led-Total-Sanitation-village-ebook/dp/B07NNRYBQ3/ref=sr_1_1?keywords=scaling+up+CLTS&qid=1557120725&s=gateway&sr=8-1-spell

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CLTS Foundation Global with UNICEF Myanmar and other WASH partners

On 9^th January 2019, CLTS Foundation Global and UNICEF Myanmar initiated a discussion at the UNICEF Country Office in Bahan Yangon. The focus of the discussion was to review the progress in sanitation made by the nation so far and to look forward towards planning for scaling up of Open Defecation Free (ODF) initiatives in a meaningful partnership. The proposed agenda of the discussion was:-

1. Regional and global updates on CLTS initiatives focusing SDG 6.2 by Dr Kamal Kar
2. Brief updates on current ODF initiatives in Myanmar by WASH partners
3. Question/Answer/Discussion

The Sustainable Development Goal 6 is to ensure availability and sustainable management of water & sanitation for all. Target 6.2 within the goal specifies that by 2030, the world must achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations. This will be monitored by Indicator 6.2.1 which is the proportion of the population using safely managed sanitation services, including a hand-washing facility with soap and water.

Globally, there are 2.3 million people who still lack access to basic and safe sanitation services. According to the JMP Report, 2015, South East Asia accounts for 8.27% of people having access to basic sanitation; East and South-Eastern Asia accounts for 2.66% and Central and Southern Asia account for 33.25%. It is surprising to note that while most of the countries of South East Asia (For e.g. Cambodia, Indonesia, Philippines, Vietnam) showed an improvement in the access to basic sanitation services from the year 2000 to the year 2015, Myanmar showed a decrease from 70% to 65% despite its efforts. The percentage is stunting among infants stands at 35%. The under-five mortality rate is 50 per 1000 live births and diarrhoea incidence is 61%.

What are the reasons for the decline and lack of sustainability in Myanmar?

Myanmar has the existence of CLTS guidelines in the local language but without adaptability. While the off criterion is being established, the current standards seem quite high considering the sanitation market’s underdevelopment with either limited access to markets by the rural population, very few affordable sanitation options, or both.

There is a lack of an enabling environment including the existence of a formal well circulated proper policy/strategy. Triggering and integration with other approaches have shown good results, however low triggering quality and post off support without the access and availability of materials for scaling up does not yield good results in the long term.

Sanitation is under the Ministry of Health and since it has been integrated with other approaches, one would assume that the sanitation and health outcomes would be better. However, CLTS process continues to be led by NGOs or other implementers and is not implemented under the government’s leadership leading financial crunch in terms of funding from the government. Coordination with other ministries for CLTS is ad hoc or nonexistent without any formal mechanism.

Myanmar has only shown improvement with regards to implementation which to a large extent the victory of the communities but the support after has not been enough to ensure sustainability. The lack of government commitment and associated budget and human resources is seen as holding back the scaling up of CLTS and taking it beyond the hands of development partners and NGOs into a national approach.  The need for well-trained facilitators, including from governments, with regular refresher training, was noted in Myanmar. Construction of low-quality latrines with pits that flood in high water table areas or collapse in sandy soils resulted in a reversion to open defecation. Village leaders can generate community support for individuals in the form of labour, materials or cash, but this depends on the strength of the local leader.

What does Myanmar need to do to ascend along the sanitation ladder?

• Establish a national level WASH policy/protocol and strategy including all stages of CLTS and across all levels.
• Develop market linkages to provide access to better sanitation materials- Example Lixil (Japanese company providing to African countries in 5-10$ )
• Develop local context related proper training and triggering materials and modules along with quality control mechanisms
• Remove subsidies and mainstream CLTS into the MoH guidelines and strategy
• Establish inter-institutional working groups from all ministries
• Create flexible funding from all the ministries for implementation of innovative ideas
• Include Natural Leaders and Community Consultants along with civil society organisations for scaling up and integration
• Establish proper ODF protocol at the national level including guidelines for continuous monitoring

The post Can Myanmar be the first ODF nation in South East Asia? appeared first on CLTS Foundation Global.

Day 1 (30th November 2018): The CLTS Foundation Global team met with officials from UNICEF Eritrea including the Country Representative, the Deputy Country Representative and the WASH team members to discuss and develop a strategy for a successful mission at the Unicef office, UN Compound. The primary aim was to establish was to identify the cause for the low access to sanitation across the country and devise a plan to free up these bottlenecks in order to fast-track sanitation work in the near future. As of October 2018, only 907 amounting to 32% of the rural population have stopped practising open defecation. Therefore, there exists a mammoth size task in front of the stakeholders to accelerate the access to sanitation for all to achieve the SDG target.

However, the focus of this mission would be to draw from the good practices and successful outcomes the CLTS approach has demonstrated across the country to convince the stakeholders at the zoba(zonal) and national level to prioritise sanitation.

The meeting was to fine-tune the strategy for the first Eritrean Sanitation Conference to be held on the 11th and 12th of December this year. This will witness participation of a number of ministers, ambassadors from different countries, partners and departmental/ ministerial officials from the different levels to seek commitments from them to support and coordinate for faster, smoother and better quality implementation of CLTS across the country making Eritrea ODF soon.

Left to Right: David Tsetse (WASH Chief, UNICEF Eritrea), Dr. Kamal Kar (Chairman, CLTS Foundation Global), Dr. Pierre Ngom (Country Representative, UNICEF Eritrea),  Megha Sen (Programme Officer, CLTS Foundation Global), Shaya Asindua (Deputy Country Representative, UNICEF Eritrea), Geoffrey Acaye (CSD Chief, UNICEF Eritrea), Yirgalem Solomon (WASH Specialist, UNICEF Eritrea)

Day 3 (3rd of December): The CLTS Foundation Global team along with members from the UNICEF WASH team had a meeting with Her Excellency Amina Nurhussein, Minister of Health and Dr. Andat Tefatsion, Director General of  Public Health of The State of Eritrea. The discussion revolved around the current access to sanitation which stands at 32% and how the country could achieve better results in the coming years. The Minister was convinced of the power of collective local action and stated that the political willingness and enthusiasm from the community could make the country ODF by 2022. On a highly encouraging note, she also agreed with Dr. Kamal Kar, the Chairman of CLTS Foundation Global that the date of achievement for an ODF Nation could be advanced to 2020, given the right kind of enabling environment and motivation. She believes that the focus of all the ministries and stakeholders should move beyond the sub-national level to free up the blockages and the aim to become the first African country to achieve ODF National status.

Left to right: Megha Sen (Programme Officer, CLTS Foundation Global), Yirgalem Solomon (WASH Specialist, UNICEF Eritrea), H.E. Amina Nurhussein (Minister of Health), Dr. Kamal Kar (Chairman, CLTS Foundation Global), Mr. David Tsetse (WASH Chief, UNICEF Eritrea), Dr Andat Tefatsion (Director General of Public Health)

Day 4 (4th of December): Dr. Kamal Kar and Ms. Megha Sen of the CLTS Foundation Global Team along with Yirgalem Solomon, Wash Specialist  (UNICEF) met with Berhane Habtemariam, the Minister of Finance to seek his presence at the First National Sanitation Conference in Eritrea (Eri-San I) which is to be held on 11th and 12th of December. After an intense discussion on the urgent need for a common platform with the involvement of all institutional actors across all departments and levels to fast track access to sanitation in the country, the Minister agreed that it is crucial to hav e a healthy population to build capacity. He graciously accepted the invitation to the conference and agreed to show his support towards the national movement against open defecation.

Badaraoh village in Maekel Zoba

Day 5 (5th of December): Dr. Kamal Kar and Ms. Megha Sen met with Dr. Zemui and Mr. Abraham Milash Head of Sanitation and Health Unit under the Ministry of Health in order to prepare for the upcoming Field visit to the different Zobas as well as the Sanitation Conference. The CLTS Foundation Global team also visited Badaraoh village in the Maekel Zoba (89 out of 94 villages are ODF) to see the villages which have embraced and consistently maintained the ODF status for a long time. It was also interesting to note that these community members had not just refrained from open defecation but had also invested their resources to move along the sanitation ladder to better sanitation facilities including hand-washing systems. The women of this community spoke out about the need for better sanitation and how their health, dignity, privacy, security and environment had significantly improved since they stopped the practice of open defecation. a

Day 6 (6th of December): Dr. Kamal Kar and Ms. Megha Sen along with Mr. Abraham Milash Head of Sanitation and Health Unit under the Ministry of Health and other members visited Anseba Zoba to understand the status and quality of CLTS implementation in these areas. Anseba Zoba has comparatively performed better and 199 out of the total 295 villages have been declared ODF. The team visited Fanna village in Haggaz sub-zoba, Anseba Zoba. This village had successfully maintained its ODF status for almost a decade and showcased massive strength through collective action and social solidarity mechanisms. The women community members of the village said, ‘We do not have to go very far in this heat anymore and we can use the toilet next to our house which gives us more privacy and security and we have witnessed its health benefits, as well.’ The community members also showed the visiting team a toilet they had constructed for an 84-year-old man who was unable to do it himself due to physical, financial and familial constraints. When asked about the inspiration to keep their village ODF, the community members said that they have seen the health gains and want to continue them through clean and healthy practices and surroundings. The community members were requested to join the upcoming National Sanitation Conference and present their sanitation story to the high officials and ministers.

Picture above: Interactive session with community members from Fanna Village, Haggaz sub-zoba, Anseba Zoba

Day 7 (7th of December): The visiting team continued their travel to Gash Barka Zoba to understand the reasons for the inefficient implementation and monitoring in this particular area. The Environmental Health Officers and the Medical Officers of the Zoba explained that one of the reasons for heavy slippage to OD rate was the presence of nomadic communities and the unavailability of material. Following this, the team met with General Tekhle, an Army official who has become a crusader against the practice of OD in the area and mobilized his army officers to make the Zoba ODF. He proudly said that the Zoba communities are capable of changing and sustaining their sanitation practices even before the official date of declaration. He also said that Gash Barka will set an example for other Zoba Army Generals to mobilize their troops in the fight against OD. The team proceeded to meet the Zoba Governor who said that though it is an ambitious task to make the Zoba ODF in a short span, keeping in mind the huge number of villages (937 Total and 211 ODF), all the efforts will be undertaken to make this a reality.

Picture above: National Sanitation Conference Day 1, Eritrea

Community Members presenting their sanitation story

Speech by Mr. Ian Richards, the British Ambassador to Eritrea

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Bill Gates 

August 23, 2012

 This was the brief given to applicants of Reinvent the Toilet Challenge initiated by the Water, Sanitation & Hygiene programme of Bill & Melinda Gates Foundation in 2011. The mission of this challenge: To bring sustainable sanitation solutions to more than 2.5 billion people worldwide.

From drinking a glass of water made from treated human waste to bringing a jar of human poop to the recent Reinvented Toilet Expo in China, Bill Gates has done it all to raise awareness about the problem. Such acts may seem outrageous to some, but the world needs such commitment as we are running out of time. Today, 4.5 billion people live without a safe toilet and 892 million people still practise open defecation. A single gram of human feces can contain 10 million viruses and one million bacteria, but in most countries of the global south, human faeces, on a massive scale, is not being treated safely. In such a situation, untreated human feces gets into our food chain and degrades ecosystems. To make this crisis worse, extreme weather events which include unprecedented droughts and floods pose a major risk to our fragile sanitation systems.

The good news is, Bill Gates belongs to a rare club of philanthropists with a profound commitment to bring sustainable sanitation to those who don’t have access to it. Financially, this commitment has translated into more than $200 million investments from the Gates Foundation over the last seven years and he plans to invest more to bring these solutions to the mainstream.

 The ‘Reinvented Toilets’

At the recent Reinvented Toilet Expo in Beijing, a range of companies from around the world came together to display a new generation of non-seweredsanitation solutions that could eliminate harmful pathogens and convert human feces into viable by-products – clean water, fuel and fertilizer.In this expo, Indian companies such as, Eram Scientific, Ankur Scientific and Tide Technocrats displayed their reinvented toilets and small-scale waste treatment plants, which are now ready for sale to municipal and private entities.Some of the winning innovations around the globe which have been funded by the Reinvented Toilet Challenge are:

• California Institute of Technology, USA: CalTechh as developed a self-contained, solar-powered toilet and wastewater treatment system. A solar panel produces enough power for an electrochemical reactor that is designed to break down water and human waste. Excess power can be stored to provide energy for night-time operation or for use under low-sunlight conditions.
• Cranfield University, UK: Cranfield developed a prototype toilet that removes water from human waste and vapourizes it using a hand-operated vacuum pump and a unique membrane system. The remaining solids are turned into fuel that can also be used as fertiliser. The water vapour is then condensed and can be used for washing, or irrigation.
• Loughborough University, UK: The team from Loughborough University has been developing a toilet that transforms feces into biological charcoal (biochar) through hydrothermal carbonization (decomposition at high temperatures in water without oxygen) of fecal sludge. The system will be powered from heat generated by combusting the biochar and will recover water and salts from the feces and urine it produces.

To most of us, these innovations sound like expensive gadgets from science fiction movies.  Even Bill Gates admits “it will be at least a decade” before the reinvented toilets reach tens of millions of people in the poorest areas, and they will have to prove both practical and economical.

Which brings us to an important fact. Hardware innovations are not enough to ensure universal sanitation.

CLTS: A proven approach from the global south

While admitting that there has been limited hardware innovations in the sanitation sector, we have to keep in mind that ‘software’ i.e. behaviour change approaches are important for adoption and ownership of toilets. One of the most successful approaches is Community-Led Total Sanitation (CLTS), whichhas been rolled out in more than 70 countries worldwide. Itis one of the most successful approaches in the development sector with roots in the global south.  Pioneered by Dr Kamal Kar in Bangladesh, CLTS is an innovative approachfor empowering communitiesto completely eliminateopen defecation. It focuses on igniting a change in collective sanitation behaviour, which is achieved through a process of collective local action stimulated by facilitators from within or outside the community. As an approach, CLTS has proved that with the right ‘triggers’ and enabling environment communities will take charge and build their own toilets.

The core philosophy of CLTS is : ‘no human being, rich or poor, wants to live in shit’. Affordable reinvented toilets which can be deployed at scale will be successful if they get this basic philosophy right. The Indian story till now has demonstrated that investing millions through a top-down hardware approach to end open defecation is bound to result in failure.There are hopes that Swachh Bharat Mission might have succeeded in building a sanitation movement among the masses, but building toilets for every household is not enough, communities should continue using these toilets without slipping back to old habits.

Thus, reinvented toilets could play a major role when communities which have lived without access to basic sanitation climb up the sanitation ladder and are ready to adopt these new technologies. However, private companies, NGOs,  national and local governments which are/will be involved in rolling out these reinvented toilets must keep in mind that only a toilet that is ‘desired’ will be a toilet used and ‘owned’.

References:

Bill Gates: Complete speech from Reinvented Toilet Expo in Beijing

https://www.gatesfoundation.org/Media-Center/Speeches/2018/11/Reinvented-Toilet-Expo

Water, sanitation & hygiene: Reinvent the toilet challenge fact sheet

https://docs.gatesfoundation.org/Documents/Fact_Sheet_Reinvent_the_Toilet_Challenge.pdf

The post World Toilet Day: How can ‘Reinvented Toilets’ address the global sanitation crisis? appeared first on CLTS Foundation Global.

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

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Views of participants on the CLTS Hands-On Training Workshop at Gurgaon, Haryana:

The post 7 awesome quotes from CLTS hands-on Training Workshop in Haryana appeared first on CLTS Foundation Global.

Haryana: Paving the Pathway towards an Open Defecation Free State through CLTS 

1st intervention by World Bank and CLTS Foundation Global kicks-off in state

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This ToT workshop is organised under the aegis of the World Bank’s intervention on Swachh Bharat Mission in India. This was the first such high level institutional workshop in the state of Haryana in association with CLTS Foundation Global and Government of Haryana. The training participants consisted of block coordinators, village motivators, social work professors, students and other stakeholders. Participants came from nine districts of Haryana namely Karnal, Hisar, Sonipat, Gharunda, Rohtak, Jind, Ambala, Bhiwani.

The 5-day institutional triggering intervention in Karnal district of Haryana was conducted with the following objectives:

1. Gain clear understanding and knowledge on the principles, rationale, methodology, applicability and limitations of Community-Led Total Sanitation (CLTS) in order to achieve Open Defecation Free (ODF) environments with special reference to respective districts and Haryana context.
2. Understand the importance of all four stages of the CLTS process:pre-triggering, triggering, post triggering follow up and post ODF activities.
3. Understand the importance of triggering usage of toilets through collective behaviour change and achieving ODF instead of focusing on mere latrine construction with no tangible outcomes.
4. Understand the importance of engaging diverse set of stakeholders in the CLTS scaling up process.
5. Discussion and presenting an action plan for expediting CLTS implementation and scaling up process across respective districts in Haryana with a clear emphasis on engaging with Natural Leaders (NL) and a focus on community empowerment.

Participants in the workshop

The initial two days of the training covered the theoretical aspects and preparation for the field work for implementation of the learning in the field. It was observed that many of the participants have been attending numerous trainings before and one of the main challenges during the training was unlearning what they had learnt to focus on the main idea of CLTS approach. Emphasis was given on the quality rather than quantity of ODF.

Many of the participants also shared the failures or challenges of many of the sanitation schemes and the subsidy approach.

Those learnings have been noted down to be presented on the last day of the training when some of the senior Govt. officials of the state are expected to be present and discuss the action plan for carrying out the in their respective districts.

The participants showed ample enthusiasm and dedication during the first two days of the workshop. The participants will be visiting 12 villages of nearby districts on the 17^th and19^th Nov and carry out triggering exercise. These villages are untouched by CLTS approach and we are expecting some of these to be Open Defecation Free (ODF) in coming days.

The post Haryana: Swachh Bharat Mission tackles Open Defecation through Behaviour Change approach appeared first on CLTS Foundation Global.

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.

Kajal Basfore and Seema Basfore of Harijan Para are two young 20 year-old girls, who have been changing lives in Kalyani slums by spreading the message of good sanitation and hygiene through street plays and dramas. “Everything changed dramatically for us after 2006”, say the two young women, recalling the Community-led Total Sanitation (CLTS) exercise conducted by Dr. Kamal Kar from CLTS Foundation Global in partnership with Kalyani Municipality to stop the practice of open defecation in the slums of Kalyani earlier in 2006. Harijan Para, one of the 52 slums of the Municipality was the filthiest of the lot. “Earlier our friends would not even come to our para, because it used to be so dirty and smelly. Now we feel great pride when these same friends say that our para is cleaner than many of the other paras in Kalyani.”

Kajal and Seema: Photo Credit: Preetha Prabhakaran/CLTS Foundation Global

Kajal and Seema state that the change that took place in Harijan Para after the CLTS triggering was nothing short of a miracle. Kajal says, “Being from the Harijan community, cleaning other people’s houses and toilets was a profession followed by our male members. It was only after the triggering that we realised that while we kept other people’s houses clean, our own houses and surroundings in which we lived were so filthy. We were literally living on shit.” Soon after the triggering, all the community members got together and pledged to put an end to open defecation. Many members actively took the lead and built their own toilets. They formed a committee, held regular meetings and followed up with the rest of the community to ensure that each one built their own toilet, so that the entire community would become open defecation free (ODF). A few of Kajal and Seema’s family members emerged as these proactive ‘Natural Leaders’, thus providing a platform for the young women to get involved as well.

Talking about how the events after the triggering were life-changing for them, they said, “The main change began with each of us building toilets and stopping open defecation, which directly reflected on our better health. We were able to work better and children started doing well in schools. This in turn, initiated many other social changes in the community which was unimaginable earlier. For e.g. men started realising that they were wasting their health and affecting their family’s well-being because of their drinking habits. Slowly, they began to give it up. Alcoholism was a huge social problem in our community earlier. These days, you will hardly find two or three people who still drink. All this was emphasised in the street play that we developed after the triggering to campaign for an open defecation free para. In it, we also included other social messages “

For the girls, acting in the play was a very powerful experience, they say, “Our mama (uncle) asked us to take part in the play to spread the message of good hygiene. We were petrified. Because earlier we had never gone out of our houses or spoken in public. Being girls, we had been brought up in a very restricted manner, given limited opportunities to study or to be seen in public. Nobody had ever asked for our opinion on anything and we were never given the chance to have our voices heard. So for us acting in a play was unimaginable.” As expected, the girls faced stiff resistance from their parents in the beginning who would not allow them to travel outside the para but the Natural Leaders in the community convinced their parents that this was for a larger cause. “The play allowed us to take centre stage. At first we were very frightened and kept mucking up our lines, but soon we gained confidence and took control of the play. We realised that this was not just a play, we were part of something bigger and very important. We were part of the change that was happening in our society.”

Kajal and Seema’s foray into the public space and their role in bringing about positive social changes in the community, acted as a catalyst in influencing an open and progressive outlook towards the role of women and girls in the community. “We have come a long way over the last few years and a lot of changes have taken place in our para. People now recognise us on the streets and they appreciate our work, which makes our parents very proud. All families in our para now allow their girl children to study as much as they want. The girl now decides when she wants to marry. Earlier they would be married off by 14-15 years, but today girls in our para are studying for law, education etc.” When asked what has been their greatest learning through all of this, they say, “It doesn’t matter if you are girl or a boy, we can do whatever we want to do, if we put our mind to it. We realised this when we changed our sanitation situation. From the outside nobody can tell which caste or community we belong to, because we look clean, we look like anyone else. Nobody discriminates against us anymore because of our caste or because we are girls. We finally understood what our real identity is.”

By Preetha Prabhakaran – Programme Manager, CLTS Foundation Global

This case story is part of a study titled “The impact of CLTS on women’s health in urban slums – A case study of Kalyani Municipality”, a joint collaborative effort between the Institute of Development Studies, University of Sussex and the CLTS Foundation Global as part of a project within an Accountable Grant funded by UK Aid from the UK’s Department for International Development.

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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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