Feedback from countries:• Kenya• Lesotho• Malawi• Sudan• Burundi• Uganda• Kenya• Ethiopia• Ivory Coast• Benin• Haiti

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• Philippines• Indonesia• Yemen• Myanmar• DPRK• Afghanistan• Bangladesh• Vietnam• Turkmenistan

Approaches• PHAST – Participatory Hygiene and sanitation Transformation: Indonesia,

Nepal, Sudan, Philippines, Ethiopia, Burundi, Ivory Coast, Myanmar, Vietnam, Haiti, Afghanistan, DPRK, Bangladesh, Turkmenistan, Lesotho

• CLTS - Community Led Total Sanitation (No subsidy): Malawi, Ivory Coast, Zambia, Kenya, Nepal (sanitation fund/loans), Ethiopia (slab distribution)

• PHAST/CLTS combination: Malawi, Ivory Coast, Ethiopia (POS Post ODF support),

• SLTS – School Led Total Sanitation: Nepal, Kenya, • ULTS – Urban Led Total sanitation: Kenya, • CATS - Community Approaches to Total Sanitation: Sudan (slab distribution), • Sanitation Marketing (SanMark): Nepal, Ivory Coast, Kenya• Social Marketing: Bangladesh• RANAS Model - Malawi

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Approaches• Hygiene Clubs: Nepal (Child club/ Junior Red Cross circle), Ivory Coast, Benin,

Bangladesh (Mother Club), Lesotho (Health Clubs)• Child to child approach: Kenya• Model Home approach: Burundi, Uganda, • CHAST – Children Hygiene and Sanitation Transformation: Ivory Coast,

Burundi, Philippines, Malawi, Sudan, Bangladesh, • School Hygiene Education Promotion Programme (SHEPP): Kenya• Hygiene promotion within CBHFA approach • National Events: Global handwashing day• Community-based O&M packages (national policy) for rural projects

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Challenges – PHAST1. PHAST is long and demanding process. Participation of community in all session becomes a

challenge.

2. PHAST requires skilled and experienced, motivated facilitators as well as in-depth training of community workers. It is difficult to sustain the network.

3. PHAST is limited to specific contexts - mainly rural and in countries with culture of participation by civil society. It is difficult to adapt to urban settlements and countries with authoritarian systems.

4. Participatory methodologies are often facilitated in a prescriptive way. PHAST sessions for example are delivered as formal, educational lectures using mainly health-based messages.

5. PHAST has been adapted and changed over the years. The tool is currently eroded and in most countries, the original philosophy of PHAST is absent.

6. CLTS propaganda has irreversibly damaged the PHAST approach. It is perceived as an old, out of date, educational tool that need to be replaced. Donors have invested in CLTS (undermining other approaches, dictating selection of specific method)

7. PHAST equals delivering subsidies

8. PHAST in emergency: prescriptive, educational tool, mistaken with traditional PHAST,

9. PHAST based on health believe theory – lack using different triggers for behaviour change

10. Lack of harmonization with other approches in RCRC

11. Government policies promotion CLTS approach

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Challenges - Methods, BC1. Limited availablity & use of adapted IEC materials packages. Tendency to replicate standard materials from the MoH

or global packages.

2. WASH software is not aligned with other health interventions implemented under the CBHFA approach (maternal and child health).

3. Low access to large scale funding opportunities (with extended project time frame) limit real application of software approaches. Difficult to have an extension period for low cost software activities at the end of project implementation.

4. Socio-cultural dynamics matter - no methodology is a ‘one size fits all ’.

5. The health believe model (‘changing behaviour to obtain health gains’) is still the predominant framework for behaviour change. New approaches which embraces emotional, habitual and cultural factors is needed (Social Marketing, Behaviour Change Communication, etc.).

6. Target audience often remains unknown. Promotional activities in WASH projects do not respond to the specific needs of different audience groups.

7. No formative research – no real prioritization of hygiene needs and risks. Formative research not being the starting point.

8. Addressing needs of vulnerable groups (elderly, HIV AIDS, etc.)

9. Behaviour- centered designed: 7 motivators (LSHTM approach).

10. IFRC BCC framework. CBHFA revitalised with a stronger BCC component.

11. Link to the private sector (going to scale). Uniliver, Procter & Gamble, Nestle…

12. Combining methodologies: taking elements from different models, open menu of tools

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Challenges - Sanitation1. Sustaining ODF status in the community after project ends is challenging.

2. What happens with communities that do not reach ODF status?

3. No clear policy on subsidies by Government: Using subsidy and non-subsidy approaches simultaneously in the same district / province undermines the achievement of ODF status.

4. Non-subsidy approach in sanitation limits the health impact on ultra poor groups. They either reverse to ODF or remain at the bottom of the sanitation ladder.

5. There is lack of micro-financing approach in sanitation sector. It is necessary to strengthen the supply chain up to community level. Slow return of sanitation investment (example of Vietnam, low request from community, demand creation, linking to livelihoods).

6. No innovation in HH Latrine designs. National household latrine model is either very basic (often not sustainable and not appropriate for challenging contexts) or either very expensive and difficult to maintain. There is need for intermediary models in the sanitation ladder. Burundi: flexible catalogue of sanitation options (with elements that can be moved across the different steps of the ladder; by NLRC, BRC ad NRC).

7. Organizations with more experience in sanitation marketing.

8. SDGs: Universal access. Scaling up?

9. CLTS being complemented

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Challenges – Water supply1. Establishing and sustaining water safety plans in the community is difficult, especially ensuring

water quality at the point of use (household).

2. Funding for hygiene promotion and sanitation is still low as most of the budget allocation goes to water supply infrastructure.

3. WASH committees often keep collecting funding in a reactive manner – only when pumps need repair. Common when collecting funding is a pre-condition for hardware implementation.

4. In rural areas, communities might not be aware of the economic value of water services. Willingness to pay is often not measured in the project inception phase.

5. Traditional community-based O&M packages for rural areas have become standard in projects and show poor results (spare parts supply chain). More knowledge and experience is needed for O&M packages in peri-urban & urban schemes.

6. Poor access to banking / accountant systems. Cultural concept of long term saving / insurance.

7. Service providers in urban context more effective in O&M.

8. Setting up establih /re-establish community structures responsible for O&M. Long term sustainability of those structures.

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Research / Reviews / Initiatives / Events1. Belgium RC (IFRC): Systematic review on the effectiveness and applicability of

interventions aiming to promote sanitation and hygiene. In collaboration with the Centre for Evidence-Based Health Care (University of Stellenbosch). Funded by 3iE (International Initiative for Impact Evaluation).

2. IFRC (supporte by British Red Cross): Development of a hygiene promotion framework in emergency. Sharing the 1st draft.

3. IFRC: Tentative review of the IFRC WatSan Software Guidelines. Sharing ToR by 15th feb.

4. IFRC: 2 days Training in RANAS model by Eawag in Nepal Sanitation Workshop (March 2016). Webinar on urban sanitation / BC on the 9th Feb.

5. Cholera forum (April 16-17 Feb in Nairobi) by IFRC/NorCRoss. Africa focused. Sponsoring HNS to participate.

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