CLTSEarly Lessons from

The Western Sumatran Islands

MULTI-USES OF RIVER BASINS:Tools to Harmonize Conflicting Interests, Davao City November 2009

Did you know

• Just one gram of human faeces can contain 10,000 viruses

• Open defecation means that deadly diseases are quickly spread through a community

• Water can become contaminated and a vector for diseases

Who suffers?

• Children are often exposes to faeces in areas that they play

• Many children miss school because of illness

But…• There are thousands of communities making

their villages free from defecation

How?

CLTSCommunity Led Total Sanitation

Summary• IHP, Water & Health, sanitation • CLTS a low cost tool• Reflection on process and

impacts from West Sumatra Islands

• Conclusions & recommendations

Water and health

• IHP VII Sanitation tackled under Section 4: Water and life support systems

• this theme includes protecting water quality from natural and anthropogenic sources of contamination.

• Here we will view if from a human health perspective

Sanitation: A high impact intervention

• Bang for buck• Reduces human

suffering• Improves

environmental quality• Estimated the annual

economic loss caused by poor sanitation is P77.8 billion.

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West Sumatra Islands Basin

• Joined the HELP UNESCO River Basin Network thorough the third call in 2008

• The Basin is at early stage in development • Stakeholder participation is ongoing at the

village and local government levels • Strives to become a leader in the global

network with a focus on water and health.

West Sumatra Islands

• maps

SurfAid International

• Vision is to improve the health, well-being and self-reliance of people living in isolated regions.

• Mission is to develop and synthesize a series of proven, high impact and cost effective approaches that create lasting improvements in the health and wellbeing of individuals and communities at increasing scale.

• CLTS is one such approach.

CL TS

Community Led

not SurfAid led! We only provide tools and provoke!

Individuals who volunteer their time from the community – Natural Leaders

Total Sanitation

Is only achieved once the burned of sanitation related diseases are minimised.

Diarrhoea is the single biggest disease burden from poor sanitation

[ODF, Diarrhoea, waster water, composting]

Community Led Total Sanitation (CLTS)

• is an innovative methodology where communities are facilitated to conduct their own appraisal and analysis of open defecation (OD)

• Decide to take their own action to become ODF (open defecation free).

Behavior not hardware

• Traditional approaches mainly subsidy driven

• Providing toilets does not guarantee their use,

• Creates a culture of dependence on subsidies.

• Open defecation and the cycle of fecal–oral contamination continued to spread disease.

Diarrhea prevalence v’s latrine usage

Individual Sanitation Practices Affect the Entire Community

0

20

40

60

80

100

120

=Prevalence of diarrhea

users of latrines

History

• CLTS was pioneered by Kamal Kar in Bangladesh, in 2000.

• WB, Plan International, WaterAid and UNICEF have become important disseminators and champions of CLTS.

• Today CLTS is in more than 20 countries in Asia , Africa, Latin America and the Middle East.

• No reference of CLTS being implemented in the Philippines.

MDGs Seriously off track

20 million people do not have access to improved sanitation.Economic Impacts of Sanitation in the Philippines, WB

An approach that works:CLTS Lessons from Sumatra

Sumatran Islands Context

• Funded by Oydimar Network with NZAID and AusAID.

• Post earthquake reconstruction environment

• Committed delivery of 64 improved water and sanitation facilities. (21 latrines)

• HELP UNESCO partner for technical learning

CLTS PROCESS

As refined by team SAI

5 major steps

1. Prepare2. Trigger3. Action Planning4. Tracking 5. Sustaining

Step 1. Prepare

Outside In (Before Day 1)• Training on 5 steps

process.• CLTS is build on

feelings so technical know how is not enough!

• You have to build a cultural in your field team to ‘feel and live the process”

Outcomes

behaviours

actions

barriers

Causes

Step 2 Triggering

“Triggering is based on stimulating a collective sense of disgust and

shame among community members as they confront the crude fact about mass open defecation and its negative

impacts on the entire community.”

Team Huddle

And action

Step 2. Ice breaker

Step 3. Discussion

Who actually has a latrine here?

Step 4. Mapping

Step 4. Mapping

Step 5. Walk of Shame

Step 6. Discussion

Amount of defeaction the village can produce

Observe! Who is really engaged!?Who is contributing!?

Step 7. Clean water drink

And then not so clean…

First person to decide & act…

Village commitments

Results to Date CLTS

• Is possibly the most powerful experience of community led development SurfAid has touched!

• program had funds to build 21 latrines• 8 communities have built 191 units over a

four month period• Zero subsidy!

Latrine built

5 1

7 5

1 6 2

1 9 1

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

1 6 0

1 8 0

2 0 0

N b o f l a t r i n e s

M a y J u n e J u l y A u g u s t

M o n t h

G r a p h 3 . T o t a l C L T S L a t r i n e s w a s b u i l t

T o t a l L a t r i n e s w a s b u i l t

Human impact

0 0

3

0

2

0

3

00

0

3

0

1 3

0

1 5

0

3

0

5

0

0

2

4

6

8

1 0

1 2

1 4

1 6

# D i a r h e a c a s e

H i l i h o y a H i l i g a w o n o S i t o b a ' a B o y o l a l a H i l i n a ' a

N a m e o f D u s u n

G r a p h 6 . P r o g r e s s o n D i a r h e a C a s e : B a s e l i n e V s C u r r e n t

A d u l t B a s e l i n e

A d u l t C u r r e n t

U n d e r f i v e B a s e l i n e

U n d e r f i v e C u r r e n t

Challenges

1. Maintaining health improvements

2. with wide scale community construction of basic pit latrines across the villages the potential risk of ground water contamination is high

Pig pen

Pig pen

Pig pen 3

Pig pen4

Conclusion and Recommendations

Conclusion1. CLTS is an effective low cost solution to reduce

anthropogenic sources of contamination and thereby reducing pressure on water and human health

2. True community empowerment approaches suffer in dole-out environments– If you are willing to tap the social entrepreneurial

spirit in communities they can find solutions from within and

– overcome dependences on dole out aid.

Recommendations

• 1. CLTS for adoption by other HELP Basins• 2. Develop a focus group on water, health

and risk reduction to refine lessons across HELP• 3. to host technical cross visits to share

experiences and engage technical reviews of water & health community programs

Questions?