CLTS sharing and learning workshop 14th September 2014

ContentsCLTS sharing and learning workshop 14th September 2014...................................................................1

Introductions: who are we?...............................................................................................................2

Filling charts, informal discussions....................................................................................................2

Challenges and key burning issues....................................................................................................3

Sharing experiences to help face the challenges...............................................................................6

How to reach the poorest and most vulnerable groups..................................................................10

Research: what is happening and how to get involved?..................................................................11

Conclusion and thanks.....................................................................................................................13

Annexes.......................................................................................................................................15

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Introductions: who are we?

On 14th September 2014, CLTS Knowledge Hub, Plan International and WaterAid convened a ‘CLTS Leaning and Sharing Workshop’ in Hanoi, Vietnam, ahead of the WEDC Conference. The event brought together some 60 CLTS practitioners from NGOs, international agencies, governments and research institutions from 17 countries, in which CLTS is being implemented, plus participants from the UK, Australia and the USA.

Opening remarks were made by Robert Chambers (CLTS Knowledge Hub, IDS) and James Wicken (WaterAid Cambodia). They welcomed all the participants and acknowledged the hard work put in by Hilda Winartasaputra and her colleagues in Plan International to convene the workshop. This was followed by remarks from Robert who urged everyone to pool their experiences and ideas with the aim of identifying burning issues and challenges and finding ways of tackling them.

Participants introduced themselves according to the organisation and the country they worked in as well as their area of professional expertise. Many NGO officers attended as well as UNICEF officials and consultants; from multiple countries in Asia, Africa, Australia, Europe and North America; engineers and health professionals were the two largest groups.

See Table 1 in the Annex for the complete list of participants.

Filling charts, informal discussionsParticipants sat in small groups and discussed what they hoped to learn and take away from the workshop before filling in the various wall charts put up around the room.

Ahead of the workshop, participants were asked to prepare answers to the questions listed below in Box 1. For each country in the region, this information was added to the wall chart together with the other practical experience participants had to contribute.

Box 1: Facts and Figures on CLTS in the region

Participants were asked to report the following information:

Year of first CLTS training/start-up of CLTS in your country Government Policy on CLTS (Is CLTS explicitly included in official policy/strategy documents? Is CLTS

being implemented in governmental programmes but not included in official policy/strategy? Is a national policy/strategy currently being elaborated/validated?)

Number of people actively working as CLTS trainers part-time/full-time Number of districts in your country, number of districts with CLTS activities, number of districts

which have some ODF communities Total number of communities triggered Total number of communities certified ODF

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See Table 2 on the Facts and Figures on CLTS in the region provided by provided by the participants.

Challenges and key burning issues

Ahead of the workshop, participants were asked the following question:

What are the three main challenges for CLTS in your country?

Participants wrote the 3 key challenges and burning issues they identified from their experience with CLTS on cards and put them on the sticky wall.

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Robert and James then classified the cards into the following key burning topics:

Pressure of speed and scale Government policies and subsidies Areas with physical problems (flooding, hard rock, collapsing sand etc) Responsibility and ethics Duration of process Sanitation marketing and its phasing Verification, certification and monitoring Hygienic conditions – still least understood and yet a major issue

See Table 3 in the Annex for all the challenges and key burning issues identified by the participants.

Participants voted on the issues they wanted to discuss: one person could tick up to 3 key topics. The topics with the most ticks were selected for discussion. These were as follows:

sustainability; government policies; pressure for speed and scale; post ODF; equity and inclusion.

This session created the agenda for the rest of the workshop.

In the plenary before lunch, James led a discussion on 2 topics. Sustainability and Post-ODF. These issues were selected based on the likelihood that the challenges would have common solutions across the region.

Conversation on Sustainability: Eka (Plan Indonesia) and Vinod (WSSCC, India)

Eka and Vinod began by outlining the problems they have faced on sustainability in their programmes in their countries (Indonesia and India), sharing ideas of how they have solved the challenge. Others added their contributions and ideas for solutions to the issues raised.

Eka (Indonesia): Plan International started its work on CLTS 2003 and government began in 2005. Communities were declared ODF over the last 9 years. There is problem with sustainability and we have done some research on why there is slippage. In 2005 there was no standards for CLTS or for verification. Now we have created verification standards and local government is monitoring and keeping the status valid and withdrawing the status if there is slippage.

Vinod (India): there is a big challenge in collecting data. According to the government coverage based on disbursements was 72% but the 2011 census reported 32% and this year another figure is 49%. Government agencies and NGOs have been giving awards to communities. WSSCC is implementing the Global Sanitation Fund programme in 517 communities. There are reports of slippage in ODF communities, if there is a gap and follow up is not done people haven’t changed their behaviour. Programmes have been looking at how much slippage and the factors that contribute towards more slippage than others. The SQUAT Survey conducted by Dean Spears and

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his colleagues from the Rice Institute (www.riceinstitute.org ) in 5 North Indian States (Haryana, Rajasthan, UP, MO and Bihar) visited households with toilets and found that many people have toilets but don’t use them. We have a new Prime Minister who wants to make whole country ODF by 2019 and at the moment is proposing to increase the subsidy.

Plan UK and Plan Netherlands ran an ODF sustainability study in 4 countries – Sierra Leone, Ethiopia, Kenya and Uganda – in villages which had been declared ODF two or more years earlier. The study was done in 2 phases: 1st phase was reverification of ODF. The study found that there were different definitions of ODF for the countries involved but 87% of households remained ODF. The study looked at the motivations and barriers to staying ODF: the single most significant motivator in triggering was disgust, but after ODF health became more significant; barriers included flood prone areas, hard ground, collapsing soil or lack of access to finance. Handwashing was a key issue to emerge. Another very important point is that over the 2 year period hardly anyone moved on the sanitation ladder. There were was little or no link to sanitation marketing or finance institutions. The research methodology included the innovation of a household toilet timeline, prepared on the ground. This is a very important study, Plan are to be congratulated to make it public. It has many implications for practice and policy [http://www.communityledtotalsanitation.org/resource/odf-sustainability-study-plan]

SNV in Laos: convincing the government on the need CLTS and improving their understanding of the approach (as well as the understanding of facilitators and the trainers) will improve sustainability. Sustainability depends not just on training on the components of CLTS but also attitudes at the higher levels (government attitude, donor perspectives) and understanding the demands for products (what is available, what people can and will pay for). The post-ODF steps for SNV programmes are decided with the community, for example children and Union Heads have monitored schools toilets on Saturdays.

Plenary discussion on steps post-ODF

Participants discussed in plenary their experience of monitoring of post ODF

Nepal: After ODF communities go on to be totally sanitised (i.e. household level waste management, cleaning compounds and so on). Behaviour change activities include media mobilisation, child clubs, WASH committees, village level activities through the committee. The government has budget for village level WASH coordination committee and Action Plans.

India: There have been developments in public pledging, where all members of a community commit with a signature and/or public statement not to do OD. In a revisit two years later, there was a high level of recall (which contrasts with much lower recall of triggering). Pledging can change the social norm. Collective public pledges – with political leaders, administrators, the media, and children all witnessing – by all men and women in the community, individually, can be made that they will stop open defecation[http://www.communityledtotalsanitation.org/resource/public-pledging-collective-behaviour-change]

Pakistan: Plan found that attention to the pre-triggering phase is critical to sustainability post-ODF

Vietnam: UNICEF worked together with MoH and others in introducing CLTS in 2009 – first with a CLTS training, then designing the training manual and then rolling out a standard training on CLTS and sanitation marketing. CLTS is included in the national target programme for rural WASH and the government strategy for WASH and the guideline for verification and certification. CLTS raises demand and then sanitation marketing comes in to sustain ODF – the follow up

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monitoring is a must with the community level and higher leaders. There are only 25 villages where certification happened

Indonesia: A verification guideline has been produced for government and others in the sector – The Guidance Book on the Regulation of Sanitation. Once every 2 years we go back to the village to check and there is the possibility to revoke the certificate of ODF [http://www.stbm-indonesia.org/]

UK: The global evaluation the CATs programmes looked at how to create social norms as well as the importance of getting everyone from the community at the triggering event rather than telling friends or family about it. The evaluation found the introduction by the community/natural leader of sanctions for not complying with the social norm was a factor in the success but can be extreme (i.e. in Mozambique open defecators were threatened with banishment from the village). [http://www.unicef.org/evaluation/files/Evaluation_of_the_WASH_Sector_Strategy_FINAL_VERSION_March_2014.pdf]

Bangladesh: partnerships with the UP local government and leadership has been a successful in conducting continuous follow-up and monitoring. On-going mobilisation of communities through Global and National sanitation days has also been successful.

Vietnam: CLTS was implemented by SNV in 2008 but there isn’t much experience on verification after ODF. Vietnam needs a national policy like Indonesia as well as different approaches in the low and highlands

Indonesia: government should provide budget for field level monitoring and verification post ODF. Budget is also needed for sanitation marketing to upgrade and improve latrines. More attention is required on how to empower the natural leaders who influence change behaviour in the community.

Timor Leste: Kamal Kar reviewed the triggering and found that there should be 80% representation to do the CLTS trigger (rather than the usual 30%). Another problem is Timor Leste is that CLTS is not led by the community but led by donors and governments

Bangladesh: experience is emerging of what happens when pits fill up – how to make the service available, safe and then sustainable, which is linked to the livelihoods of pit emptiers [in Laos the cost of pit emptying is high].

Sharing experiences to help face the challenges

See Table 4 in the Annex for participants list of innovations, solutions, research findings that they wanted to share

Based on the experienced shared, participants split into thematic groups to discuss the key issues that surfaced and provide recommendations for other practitioners. Participants discussed the following challenges:

o Problem areas, challenging environments and difficult geographical locations o Government policies and subsidies – how to include CLTS in the policies o Facilitators – how to build capacity, how to support natural leaders at scaleo Speed and scale o Sanitation marketing – how to sequence with CLTSo Hygiene and hygienic conditions

Please see the suggestions on how to overcome the challenges summarised in the table below:

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Challenge Solutions suggested by the participants Challenging geographical and social settings

Environments where we work Language barriers to work with ethnic minority groups CLTS in disaster prone areas Triggering in flooding areas

Select local leaders to influence people – to work with and learn the culture of the minority groups to work better

Social norm – change demand into social norm of the minority groups CLTS in disaster prone communities – examples in Pakistan to improve the risk

assessment in the triggered for instance using community- based DRR –to avoid losing the infrastructure in future

Latrine technology designs in the flooding areas (disasters or climate change) – low cost design and training the local masons – water proof pit technology and design and can roll out after triggering

Myanmar – after the building the latrines, use a revolving fund so that it is more sustainability and move up the sanitation ladder

Government policies and subsidies

Concerned with subsidy to improve the sanitation

For India, Indonesia and Viet Nam: rural households to build a latrine – 50/50 Viet Nam and Indonesia and 100%in India. Try to find another way to promote latrine for example in Viet Nam a household build a latrine first and then get a subsidy later, P4 Results Based Programme.

In Viet Nam loan to help rural people and the poor people to get a latrine Verification of CLTS – Indonesia has developed a simple form and some information to

check out the CLTS activities and Research on how, when and in what form subsidies are most effective

Facilitators Numbers confidence and capacity building Facilitation is the key – we don’t have skill mix

required in some countries

Develop facilitators from the communities – hand over the stick to the communities Staff drop out is crucial, then the process stops We need more community facilitators, develop their capacity and confidence Water Aid and Save – Child Rights – involvement and engagement of the community Training alone cannot produce the skilled facilitators –hand holding support is needed to Incorporate critical issues like accountability and disability

Speed and scale

Government targets can be ambitious, implementers are under pressure to scale up

Communities are under pressure to meet the government targets

Sometime the community needs doesn’t match the government targets

Make a huge national campaign Find out more about the natural leaders at the community level – religious leaders, monks

and priests & engage them in triggering Intensive CLTS with multiple interventions in selected areas and involve non-WASH actors

Sanitation marketing

Availability of affordable toilets San mark for CLTS

Experience from Lao, Cambodia, Bangladesh In Cambodia, sanitation marketing with CLTS – private entrepreneurs have only 1 option

that is costly and doesn’t help poor people;

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Bangladesh post CLTS - building improved types of latrine and move up the ‘sanitation ladder’

Indonesia - promoting sanitation marketing but should be a range of options Local entrepreneurs have established their production centre in peri-urban areas, but

need market promotion for their activities When sanitation marketing is linked with CLTS need a market provider

Hygiene Adopted ODF + (the second level) that includes environmental cleanliness, hygiene

Social norm issue – collective social norm vs. handwashing as a private issue

Triggering different for private behaviours

Schools are obvious place to start for hygiene practices: School led total sanitation for greater promotion of hygiene

Proxy indicators– risk that we take the proxy indicators for granted but don’t always do more observational studies to validate the proxy indicators

If you wanted to encourage handwashing need more water; more advocacy for prioritisation for spending on water rather than other areas of preventative health care

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Participants were encouraged to exchange and share innovations and solutions so that relevant ideas could be adopted in programmes back home.

On the wall charts, participants indicated what they’d like to share with the group (including innovations, success, failures, research findings, excitements and surprises). These issues were presented by the participants in short presentations in 2 slots.

Things to share: innovations, success, failures, research findings, excitements and surprises

Part 1

SNV Cambodia: The monks in the pagoda have been asked to help promote 3 key message – drink safe water, handwashing and construct latrine. The monk gets the training to share with community in the pagoda and the monk is also asked to share the messages with the people who give him food. SNV is also working with the local authorities (provincial dept. sub national and commune level). There have also been ceremony to collect money for the poorest people who cannot save for the latrine (http://www.snvworld.org/en/countries/cambodia; http://www.snvworld.org/en/regions/asia/news/ssh4a-success-first-full-commune-odf-ceremony-in-banteay-meas-district)

Plan Myanmar: IEC material (such as a game of snakes and ladders where progress on the board depended on sanitation and hygiene behaviours) has been developed through community participation including Focus Group Discussions with women and children (e.g. the children thought the poo looked like ice-cream and the picture on the snakes and ladders game was changed)

SNV Laos: Monks in Laos have a great deal of influence and are being used to promote handwashing; SNV have trained the monks, taken a baseline and monks are now triggering behaviour change. http://www.snvworld.org/en/countries/lao-pdr/our-work/water-sanitation-and-hygiene/sustainable-sanitation-and-hygiene-for-all-plus

WaterAid Timor Leste: Access to materials for sanitation and handwashing (like soap) is difficult in rural areas, WaterAid is working with the local authority to improve sanitation in the community.

Plan USA: research with UNC on the effectiveness of 3 actors at different levels (government, intermediary and community level). One innovation in Kenya was to empower the government officials in CLTS management to take the lead in budget allocation, monitoring and supervision. Activities include training of sub-county actors and development of an MOU; In Ghana natural leaders have led the post-ODF and post-triggering activities to ensure sustainability of CLTS outcome (http://scalingclts.web.unc.edu/)

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How to reach the poorest and most vulnerable groupsOne of the attractive aspects in the theory of CLTS is that, at the time of triggering, the people who are least able to help themselves – weak, sick, old, special needs - are identified and the community takes responsibility for helping them to become ODF the same as everyone else. We’ve all heard of such stories but when it comes to it – what happens in reality? Who are these people? Are they pressurised to do something they can’t afford or can’t do? We need to know more: these groups will be more prominent in the 2015 agenda. Examples of what can be done at scale with a CLTS approach to help those people? We need to learn more about what is known, and what can be done.

Points from participants:

Sanctions may present a risk for vulnerable people but if ODF is an accepted convention, a social norm, then asking people to build a toilet not coercing people.

Having 80% of the community present at a triggering has been suggested as a working target, but it might be the marginalised people who are always in the 20% left out. For example, DRC accepted 80% as the target but discovered that it was the pygmies who were left out and so have moved towards a 100% target.

Plan Indonesia worked to make 599 villages ODF but there are villages where the verification teams couldn’t record 100% ODF, because people with a disability that couldn’t access latrines. Socialisation meetings were conducted at the district level, and with government officials on the needs of people with disability as well as older people in using latrines. Plan is training the planners on how to provide a service for people with a disability and sanitation entrepreneurs to design appropriate technology

WEDC and WaterAid are doing research in Uganda and Zambia on how to make sure everyone has access i.e. ramps for people with a wheelchair and guides for the blind people. But we also need to make sure the process is inclusive and whether the toilet designs can be used, are comfortable and convenient

WaterAid study on the sustainability of CLTS in Nepal showed that community members volunteered to dig pits for vulnerable community members but after the initial enthusiasm following triggering there was little intra-community support 4-5 yrs post-ODF, when pits were getting full.

In Rajasthan there were 2 factors that ensure 100% inclusion: 1) monitoring to ensure that the poorest of the poor are not excluded and 2) recognition of government and incentives – funds to local government for projects

It’s not just the poor who practice OD: they can be the rich and powerful people too. Natural leaders often don’t feel empowered to challenge these people – meaning that officials from the district should tackle this group.

Communities with high levels of inclusion are more likely to be ODF; more examination is needed with the link to social cohesion

We don’t need to become experts on inclusion, we can partner with organisations that are specialists on disability and integrate their expertise in the WASH community so that everyone has access

Example: How to design an inclusive pit latrine slab

Hazel Jones led a practical exercise to stimulate discussion about technical design of a pit latrine slab. Participants were asked to demonstrate how they would squat on a pit latrine, their foot placement was marked on the paper in relation to the squat hole [one participant wore a rucksack

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on his chest to illustrate the difficulties a heavily pregnant woman might face in squatting]. The exercise showed that people squat in different ways, depending on their sex, age, physical attributes (e.g. shape, size, strength, impairments, ailments or injuries). Thus the design of latrines can be improved if users are consulted and/or people improvise their own designs.

Source: Facilitator notes: Designing a pit latrine slabhttp://wedc.lboro.ac.uk/resources/learning/EI_FN1_Squatting_activity_final.pdf

For more information, please also see: ‘Frontiers of CLTS Issue 3: Disability- making CLTS fully inclusive’ with CLTS Knowledge Hub: http://www.communityledtotalsanitation.org/resource/frontiers-clts-issue-3-disability-making-clts-fully-inclusive

Things to share: innovations, success, failures, research findings, excitements and surprises

Part 2

WaterAid Bangladesh: Recognising the children are most vulnerable from poor sanitation, WaterAid Bangladesh is working with rights holders and duty bearers. WAB has developed a methodology to bring stakeholders (teachers, partners, etc) together face to face to discuss the issue, then created a space for the stakeholders to think about how they can address the issue before organising another meeting to bring them together again to discuss the way forward.

CLTS sustainability research in Indonesia (2012) suggests that when you have 80% of the community at a triggering there tends to be less slippage in those communities. To be available on the website: http://www.stbm-indonesia.org/

See Table 5 in the Annex for the full list of ‘innovations, successes, failures, research findings, excitements and surprises’ identified by the participants.

Research: what is happening and how to get involved?

What CLTS-related research is completed/ongoing/planned in your country organisation?

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Participants were asked to share information on CLTS research underway or planned. The examples that participants discussed included:

CLTS study in Mali: RCT on the UNICEF/government programme compared CLTS villages where coverage was up 65 per cent over a period of 10-19 months, with non-CLTS villages with coverage up 35 per cent. The CLTS villages were much cleaner, more likely to have water in toilets and lids on holes, fewer flies etc. Diarrhoea-related deaths were reduced. However, although there was no significant different in self-reported cases of diarrhoea, stunting of children was down 13.6 per cent, perhaps associated with a reduction in environmental enteropathy. Publication of the full study continues to be eagerly awaited.

Inclusive CLTS studies : o WEDC, WaterAid and SHARE are looking at how ordinary WASH programme –

including CLTS - can be made more inclusive for disabled and older people: http://www.shareresearch.org/Resource/Details/undoing_inequity_baseline_findings

o WEDC is also working with LSHTM on an inclusive WASH project in Malawi and Bangladesh

o WEDC is also building learning into the DFID results programme in Bangladesh and Pakistan through the DFID Results Challenge Fund with Plan and WaterAid.

o WEDC and WaterAid have recently published the ‘Frontiers of CLTS Issue 3: Disability- making CLTS fully inclusive’ with CLTS Knowledge Hub: http://www.communityledtotalsanitation.org/resource/frontiers-clts-issue-3-disability-making-clts-fully-inclusive

Ministry of Health, UNICEF Vietnam and WSP: The use of unimproved latrines in rural villages in mountainous regions of Vietnam leads to five-year-old children being 3.7 cm shorter than healthy children living in villages where everybody practices improved sanitation. Research found a significant negative correlation between hygienic household latrine and child malnutrition (measured by weight for age and weight for height). There is a strong correlation between malnutrition and water quality but no significant correlation between malnutrition and handwashing with soap. The research concludes that children grow taller, and smarter, in rural, mountainous villages of Vietnam where community members use improved sanitation. See this brief for more information: http://wsp.org/sites/wsp.org/files/publications/WSP-Vietnam-Stunting-Research-Brief.pdf

The Squat survey/Dean Spears : The survey shows that having a toilet doesn’t mean it is being used, thus illustrating a social preference for OD. It also shows that some people believe that it is healthier for children for OD. See this link for more details on the survey: http://squatreport.in/

WaterAid’s research on sanitation coverage in 4 Asian Tigers (Singapore, Korea, Malaysia and Thailand): WaterAid research on how several counties in East Aid achieved universal access to sanitation in a rapid timeframe. The research was presented at Stockholm Water Week on how the first two of these countries became OD so quickly. WaterAid identified the key less that may apply in other country contexts. The 5 factors include: 1) massive sustained national campaign with political leadership 2) emphasised hygiene more than sanitation; 3) multi-sectoral & multi-stakeholders involved over time with a clear vision and strategy all the way through; 4) there was a continuous monitoring e.g. in Korea parasitic load of children measured in school; 5) the standards were raised as the campaign moved on – so there was continual improvement all the way through. http://programme.worldwaterweek.org/event/how-did-asian-3935

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WSP India is looking at the current performance of ODF and instances where ODF failed, and how strong delivery practices contribute to sustainability i.e. comparing ODF outcomes in those high-performing districts with better institutional arrangements and monitoring systems with low performing districts (i.e 50% coverage)

UNICEF Regional Office for East Asia and the Pacific h ave a couple of pieces of work in the pipeline including a collaboration with WSP, WaterAid and Plan - following on from the East Asia Ministerial Conference on Sanitation and Hygiene Conference (Easan-3). The research will provide a variety of country case studies on sanitation from the region to support the discussions at Easan.

WSSCC and SHARE : Life course approach for exploring the impact of sanitation access and menstrual hygiene management on psychosocial stress, behaviour and health among girls and women in Odisha. This study is funded through SHARE in India. The study is a collaboration between the Asian Institute of Public Health, Emory University and the London School of Hygiene and Tropical Medicine (LSHTM). The goal of this study is to describe how poor WASH conditions impact hygiene and sanitation practices among Indian girls and women (14-45 years) during specific life-course experiences and whether behaviours and conditions influence mental, physical and reproductive health. Results should be available in December 2014 http://www.shareresearch.org/Page/Detail/India#Four studies on WASH and women and girls

IDS : Short (2 month) A short comparative study is planned on natural leaders and autonomous natural leader organisations in MP and Chattiskar – it will compare findings with the Ghana study supported by the Gates Foundation.

Plan International and The Water Institute at UNC , with funding from the Bill & Melinda Gates Foundation, have been collaborating on research project – Testing CLTS Approaches for Scalability – the results will be presented at UNC Water and Health Conference. For more information see: http://scalingclts.web.unc.edu/

WEDC is researching Faecal Sludge Management in urban settings with World Bank funding

See Table 6 in the Annex for the list participants provided on the CLTS research planned/underway.

Conclusion and thanksTo conclude Robert encouraged the participants to keep up the good work. New research and evidence is showing that the importance of sanitation is more significant than we thought previously. There is a very strong association between stunting and OD and between stunting and the density of OD. If we can eliminate OD then rates of undernutrition would halve. Although the challenges are enormous (these challenges include sustaining access post ODF and inaccurate statistics), the impact of sustained access to sanitation will be huge.

Wrapping up: What is the one thing to take away from today that you will do when you get home? Think about public pledging!

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Robert thanked the hotel, staff and management, and Hilda for organising the event. He thanked James for the facilitation and the participants for entering into the spirit of the workshop, which resulted in a rich harvest of ideas that can be shared with others.

Before you go:

Frontiers of CLTS: these are short, accessible booklets documenting innovations and insights.

Frontiers of CLTS Issue 1: Participatory Design Development for Sanitation: http://www.communityledtotalsanitation.org/resource/frontiers-clts-issue-1-participatory-design-development-sanitation

Frontiers of CLTS Issue 2: How to Trigger for Handwashing with Soap: http://www.communityledtotalsanitation.org/resource/frontiers-clts-issue-2-how-trigger-handwashing-soap

Frontiers of CLTS Issue 3: Disability- making CLTS fully inclusive: http://www.communityledtotalsanitation.org/resource/frontiers-clts-issue-3-disability-making-clts-fully-inclusive

Others will be available shortly on: sustainability; CLTS and human rights; words of faith relevant for WASH and Violence, Gender and WASH.

Sign up for the bimonthly newsletter at the following link: http://www.communityledtotalsanitation.org/webform/newsletter

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Annexes

Table 1: Participant list

Title Name Job Title Organisation Country Email

Mr Nabin Pradhan Water, Sanitation and Hygiene Advisor

Plan Nepal Nabin.Pradhan@plan-international.org

Ms Rebecca Scott Research Associate WEDC UK R.E.Scott@lboro.ac.uk

Mr Hang Hybunna WASH Specialist Plan Cambodia Hybunna.Hang@plan-international.org

Ms Hilda Winarta Regional WASH Specialist Plan Vietnam Hilda.Winartasaputra@plan-international.org

Mr Rafael NF Catalla Programme Manager Plan Cambodia Rafael.catalla@plan-international.org

Mr Chhorn Chhoern Officer Ministry of Rural Development- Department of Rural Health Care

Cambodia chhoeurnsv@gmail.com

Mr On Kea Officer Provincial Department of Rural Development

Cambodia n/a via Hybunna

Mr Kao Tharith Officer Provincial Department of Rural Development

Cambodia n/a via Hybunna

Mr Poy Dy Field Coordinator Santi Sena Cambodia dypoyibo@gmail.com

Mr Yin Samay Field Coordinator Nak Akphivath Sahakum (NAS) Cambodia n/a via Hybunna

Mr Eka Setiawan WASH Advisor Plan Indonesia eka.setiawan@plan-international.org

Mr Robertus Rio Putra Community Led Total Sanitation District Supervisor

Plan Indonesia Robertus.Rio@plan-international.org

Mr James Wicken WaterAid Australia james.wicken@wateraid.org.auMr Robert Chambers Research Associate Institute of Development Studies UK r.chambers@ids.ac.uk

Ms Sue Cavill Independent consultant UK suecavill@hotmail.com

Ms Hazel Jones WEDC UK H.E.Jones2@lboro.ac.uk

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Jitlada Rattanapan Manager of Indigenous and Isolated Children project

Plan Thailand jitlada.rattanapan@plan-international.org

Vu Thuy Anh WASH specialist Plan Vietnam ThuyAnh.Vu@plan-international.org

Mr Aleixo Araujo Santos WASH Manager Plan Timor Leste Aleixo.Santos@plan-international.org

R K Srinivasan WASH Advisor Plan India rk.srinivasan@planindia.org

Ms Corrie Kramer WASH Senior Program Associate Plan USA corrie.kramer@planusa.org

Mr Mulugeta Balecha WASH/Health Programs Manager Plan USA Mulugeta.Balecha@planusa.org

Binu Arickal Regional Manager WaterAid India BinuArickal@wateraid.org

Theitdi Thein WASH Programme Manager Plan Myanmar Theitdi.Thein@plan-international.org

Mahfujur Rahman Programme Officer WaterAid Bangladesh Mahfuj-urRahman@wateraid.orgMs Mascha Singeling WASH Programme Manager Plan The Netherlands

mascha.singeling@plannederland.nl

Mr Glenn Gibney Country Director Plan Vietnam glenn.gibney@plan-international.org

Dai Luu Quang Plan Vietnam Dai.LuuQuang@plan-international.org

Ketsadasack Kiettisak WASH Program Manager Plan Lao PDR Ketsadasak.kiettisak@plan-international.org

Lalit Patra Head of WASH team UNICEF Vietnam lpatra@unicef.org

Nguyen Thanh Hien WASH Specialist UNICEF Vietnam nthien@unicef.org

Ms Tran Thu An WASH Officer UNICEF Vietnam ttan@unicef.org

Nali Senthavong Provincial WASH Program Manager

Plan Lao PDR nali.senthavong@plan-international.org

Ms Chelsea Huggett Equity and Inclusion Officer/Regional Program Manager Southeast Asia

WaterAid Australia Chelsea.huggett@wateraid.org.au

Dr Kamal Kar Chairman CLTS Foundation India kamalkar@yahoo.com

Ms Preetha Prabhakaran CLTS Foundation India preethapb@gmail.com

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Ms Nguyen Bich Thuy Vice Head, Division of Environmental and Community Health, Health Environment Management Agency

Ministry of Health Vietnam thuynioeh@yahoo.com

Mr Do Manh Cuong Vice Head, Division of Environmental and Community Health, Health Environment Management Agency

Ministry of Health Vietnam cuong_ytdp@yahoo.com

Mr Md. Zillur Rahman WASH Advisor Plan Bangladesh zillur.rahman@plan-international.org

Azeem Barat DACAAR Afghanistan azeem@dacaar.org

Betman Bhandari WASH Advisor DACAAR Afghanistan betman.bhandari@dacaar.org

Nguyen Thi Le Hang WASH project officer Plan Vietnam hang.nguyenthile@plan-international.org

Mr Jean Jacques Kamsu Tchuenteu

Water and Sanitation Advisor Plan Cameroon JeanJacques.Kamsu@plan-international.org

Yusak Subanafeu Community Lead Total Sanitation Monev Supervisor

Plan Indonesia yusak.subnafeu@plan-international.org

Geetika Anand Senior Associate Indian Institute for Human Settlements

India ganand@iihs.ac.in

Mr Muhammad Asim Saleem Country Program Advisor Water, Environment and Sanitation

Plan Pakistan Asim.Saleem@plan-international.org

Mr Chander Badloe Regional Adviser, East Asia and Pacific Office

UNICEF East Asia and Pacific Regional Office

Thailand cbadloe@unicef.org

Ms Maya Igarashi-Wood WASH Officer UNICEF East Asia and Pacific Regional Office

Thailand migarashiwood@unicef.org

Mr Nguyen Quy Hoa WASH Manager Plan Vietnam hoa.nguyenquy@plan-international.org

Mr Manfred Arlt WASH Advisor Norwegian Church Aid Norway manfred.arlt@nca.noMr Hakim Hadjel Senior Programme Officer GSF WSSCC Switzerland hakim.hadjel@wsscc.org Mr Vinod Mishra Country National Coordinator,

India WSSCC India vinodmishra2810@gmail.com

Mrs Jane Bevan Senior Water and Sanitation Specialist

WSP India jbevan1@worldbank.org

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Mr Sophornn Khaim Program Coordinator SNV Cambodia skhaim@snvworld.org

Mr Aftab Opel Senior Advisor WASH SNV Lao PDR aopel@snvworld.orgMs Thea Bongertman Sector Leader, WASH SNV Lao PDR tbongertman@snvworld.org

Phetmany Cheuasongkham WASH Advisor SNV Lao PDR pcheuasongkham@snvworld.org Ms Kavita Wankhade Lead Practice Indian Institute for Human

SettlementsIndia kwankhade@iihs.co.in

Mr James Robertson Programme Management Plan UK James.robertson@plan-uk.org Mr Domingos Alves WaterAid Timor Leste Mr Samnang Pheng DDSP Cambodia ddsp@caminter.com

samnang65@yahoo.com

Mr Pasuong Saokum PDRD KSP Cambodia Pasuong.saokun2@gmail.com Mr Unt Ty PDRD Prey Veng Cambodia Ungty.pdrd@gmail.com Mr Nguyen Quy Hoa WASH manager Plan Vietnam Hoa.nguyenquy@plan-

international.org Mrs Nguyen Bi’Ch Thuy MoH Vietnam

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Table 2: Facts and Figures on CLTS in the region

Country Year of first CLTS start up

Government policy on CLTS

# of people as CLTS trainers

Districts in your country Number of communities triggered

Number of ODF communities (certified)

Comments/remarks

Total no No wt CLTS

No wt ODF comm.

Cambodia 2005 by Concern worldwide

Being implemented by government programme

25 master trainers

159 districts

60 districts

730 villages

2800 villages 220 villages Complement San mark

Laos 2007 by concern Worldwide

National plan of action on WASH incudes CLTS ad approved 2012

3 master trainers20 trainers >200 facilitators

Myanmar 2009-2010 UNICEF and government

In national health stargey

20-35 Master trainers

Viet Nam 2009 by UNICEF nad MoH

Under RWSS NTP3

ToT trainer to >4 5> 160 facilitators

25 villages certified

Indonesia Plan – 2008Govt – 2005

Permenkes No 3 2014 Kepmenkes 2008

National 50 (full time) Provincial 60 (part time) Districts ~ 200

550 district

203 applied CLTS

13.964 villages triggered in 2003

14,641 villages triggered2094 ODF

Active national watsan working group (as enabler)

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trainers (P/T)

Pakistan WSP – 2004Plan – 2008

National Sanitation policy

> 400 112 40 40 Triggered communities (10,000); ODF cert. 8,20008 million population triggered

Pakistan approach to total sanitation (PATS) – CLTS, SLTS, SanMark, Hyg promotion)

SLTS progress really slow because government provide subsidy with the vulnerable households

Timor Leste

2009 – by Concern WaterAid and Plan

Government strategy

10-15 Master trainers 70-90 CLTS facilitators

Nepal 2004 Plan and WaterAid

In government sanitation and hygiene master plan

> 750 Master Trainers

75 75 15 2000 village development committees (VDC)

1671 VDC and 18 municipalities

India 2003, UNICEF, GSF, Govt 2 states

No Only 2 agencies

632 More than 200/ no report

Incentive subsidy is problem

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Table 3: Challenges and key burning issues for discussion.

The table shows the card written and posted up by participants. The categories were not predetermined but emerged from the cards.

Pressure for speed and scale

Government policies and subsidies

Problem areas

Duration of the process

Sanitation marketing

Verification, certification, monitoring

Sustainability Inclusion of those least able

Hygiene/hygienic conditions

Facilitators – numbers, capacity

Government pressure versus behaviour change

Don’t have common approach on sanitation, government need to support subsidy

CLTS in disaster prone communities

Period to achieve ODF is too long

Phasing of sanitation marketing

Continued monitoring by government

CLTS slippage Lack of strategy to reach the poorest

CLTS – fix point defecation

Not enough good facilitators from local areas

CLTS versus government target

How CLTS with subsidy incentive

Latrine technology in flooding

Project time frame too short to achieve and sustain ODF

Where to start on the sanitation ladder

Post CLTS triggering monitoring is an issue

How to follow up to sustain ODF still not clear

Inclusion marginalised groups (PWD, elderly)

Hygiene tools still lacking

Attitudes of field facilitators

Government policy still promotes subsidies for toilets

Triggering in floating areas

Very slow progress towards ODF in some villages in TML

Supplies to remote areas in TML difficult – expensive

CLTS quantity construction

No financing mechanism for poor families

Low capacity of local managers at district and commune level

The autonomy of district head to determine program priority

Latrine design in flooding area

Rate of ODF achievement is still low

Competition among suppliers caused some to stop business

Pit emptying services not available – risk of going back to OD

Very poor area, very long tradition of ODNot prioritised

Lack of understanding of development and CLTS

Government is less support to WASH (not priority(

Language barrier to work with minority ethnic groups

Availability of affordable toilets remains an issue in Laos

How to sustain ODF stats if the poorest households can’t go up the sanitation latter

CLTS vs the poor

Lack of strategy to build capacity of locals to serve as facilitators

Expensive sanitation products

CLTS the cheapest approach to increase sanitation coverage

Some villagers don’t want to build a toilet, they say no money, the

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ask for subsidy

Sanitation marketing government support n district level for sanmark and CLTS; private sector engagement

Sustainability empowering natural leaders

Competition among suppliers caused some to stop business

Pt emptying services not available – risk of going back to OD

CLTS sustainability Empowering the natural leaders Is there a common understanding of what successful, sustainable CLTS outcomes – are; could be; should be?

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Table 4: Things you can share – innovations, solutions, research findings (in 2 minutes)

What Who Contact A VDO ‘A Village Clean Up’ SNV Laos laos@snvworld.orgMenstrual Hygiene Management Research in Rural Areas SNV Laos laos@snvworld.orgWASH Practice Brief ‘A New approach to improve WASH Awareness in School’

SNV Laos laos@snvworld.org

An article “A road map to maser CLTS trainer” SNV Laos laos@snvworld.orgA review of SSHAA (CLTS) ‘Learning from experience in the field’

SNV Laos laos@snvworld.org

Learning brief of sustainable commune ODF in Cambodia SNV Cambodia cambodia@snvworld.orgSSHUA fact sheet SNV Cambodia cambodia@snvworld.orgInclusion sanitation experience (tackling exclusive: people with disability)

Plan Indonesia https://plan-international.org/where-we-work/asia/indonesia

SME monitoring system Indonesia https://plan-international.org/where-we-work/asia/indonesia Waste management is one of 5 components of WASH Indonesia https://plan-international.org/where-we-work/asia/indonesia School WASH Awareness – using ‘child agents’ approach Plan Ethiopia Involvement of monks or leaders in hygiene promotion SNV Cambodia and Laos cambodia@snvworld.org

laos@snvworld.orgKids keep an eye on adults toilet (M&E) SNV Laos and Cambodia laos@snvworld.org

cambodia@snvworld.orgMutli-stakeholder platform (WASH working group) Bangladesh, Laos and Cambodia Effectiveness of different actors in CLTS implementation US Plan https://plan-international.org/ IEC Development by community on safe water, ODF and handwashing with soap

Plan Myanmar https://plan-international.org/where-we-work/asia/myanmar

3Behaviour 1 Hour (3B1H) triggering NAS/Santi Sena Cambodia http://www.santisena.org/ Scaling up sanitation in Vietnam Lalit Patra UNICEF hanoi.registry@unicef.org  Empowering of Natural Leaders ensures sustainability of CLTS Plan https://plan-international.org/ Approaches/strategies – progress – scaling up Lalit Patra, UNICEF hanoi.registry@unicef.org  

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Table 5: Innovations, success, failures, research findings, excitements and surprises

What Who Public pledging Contact Robert Chambers r.chambers@ids.ac.uk Scaling up sanitation – govt and unicef Lalit Patra UNICEF Vietnam TML govt almost finalise national basic sanitation policy Plan and Wateraid and MLTriggering process improved in TMLs based on Kamals recommendation / 80% must attend Prey Vening will join CR-Ship/ GSF program PDRD PRV Cambodia MRD UNCIEF Plan Improved CLTS guideline in 2014 Plan/MRD/BCC approach by Buddhist monks SNV Cambodia CLTS and sanitation marketing work will together in Kampoing Spu province Sustainability – empowering natural leaders, sanitation marketing, government support at district level for sanitation marketing an CLTS – private sector engagement; strong post triggering M&E

UNICEF Vietnam

In sub-villages kiosks now operational and provide spare parts and sanitation materials Wateraid TML

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Table 6: CLTS research planned/underway

Topic Countries (places) Organisation Funder Start End Source Health/nutrition impacts of CLTS

Mali Govt of Mali + UNICEF GOM and UNICEF

Sept 2011 June 2013 UNICEF (not yet published)

How to include disabled and older people in CLTS

Uganda and Zambia Wateraid/WEDC/DAPP/WEDA/TEDDO

DFID (SHARE) 2012 2015 Frontiers # 3 Disability and CLTS Hazel Jones, WEDCJane Wilbur, WaterAid

Malawi, LSHTM, WEDC, Mzuzu AusAid 2014 2016 Hazel Jones, WEDCAdam Biran, LSHTMLisa Danquah, LSHTM

Testing CLTS Approach for scalability

Ghana, Ethiopia, Kenya

Plan & UNC BMGF 2011 2015 Darren Saywell, Plan International

CLTS sustainability research Indonesia Plan, CLTS Foundation, Akademika

AusAid 2010 2012 Plan Indonesia

Squat Survey of Rural Households in North India

North India (Haryana, UP, Rajasthan, MP, Bihar)

Rice Institute BMFG Early 2014 May 2014

How did the Asian Tigers Achieve ODF

Covering Korea, Singapore, Malaysia, Thailand

WaterAid WaterAid ?2013 ? end of 2014

Tim Brewer WaterAid

Relation between water, sanitation and mothers behaviour and under 5

Vietnam UNICEF – MoH UNICEF 2011 2011 UNICEF and VIHEMA

Water, Sanitation and health of children under 5

Vietnam UNICEF, MoH UNICEF 2014 Ongoing

Low cost latrine options Vietnam UNICEF, MoH UNICEF 2014 Ongoing Formative research on: policies, BCC, supply chain and applied sanitation approaches

Vietnam MoH WSP (WB) 2013 2013

Impact of CLTS on diarrhoeal disease

Nepal Plan Plan 2013 2013 Plan Nepal

Risk and benefit of children’s participation in CLTS

Nepal Plan Plan 2014 Ongoing Plan Nepal

Service delivery process and India WSP WSP 2013 2013 Wsp.org

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outcomes 56 districts Words of Faith (Collecting from the great religions)

Global UNICEF India Unicef India and IDS

2014 Dec 2014 UNICEF India/IDS knowledge Hub

Follow up to UNICEF, WSP, EASAN study – sanitation & CLTS

Regional – East Asia UNICEF Chander Badloe

MHM and human rights India WSSCC End 2014 Comparative Study on natural leaders

India IDS Gates

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Pictures, photos, graphics and posters to illustrate information, innovations, challenges Cambodia

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Poster on CLTS Triggering Tools from Cambodia

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Flip chart from Indonesia

The 3 big challenges to CLTS

The big geographic area of Indonesia where only 57% has access spread all over Indonesia (means there are still 103 million people that do not have access to improved sanitation and only around 50 million still do open defecation)

In Indonesia system, the autonomy foes to each head of districts. And average from all districts, less than 1.5% districts budget is allocated for water and sanitation this means the water and sanitation is not priority in their programme

Urban area or dense populated area are difficult to achieve ODF since they are not originally from their area but the neighbouring districts

The innovations related to CLTS

Indonesia has established a national STBM secretariat that have the task to coordinate all the tasks and efforts in sanitation movement especially CLTS

CLTS related research in our country: CLTS sustainability research Kamal Kar 2011 (completed); Study on entrepreneurship in WAS-PLAN-u6M-ISF Sydney

CLTS first training start up in year 2005

Government policy on CLTS – Permenkes No 4 2014 Sanitaasi Total Berbasis Masyarakat Total district In Indonesia: 506 (203 apply CLTS) Total sub district: 7.793 Total villages: 79.075 Total number of communities triggered = 13.964

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