SUSTAINABLE SANITATION & HYGIENE FOR ALL … · SSH4A is supported by the Australian Government and...

SSH4A is supported by the

Australian Government and DGIS.

SUSTAINABLE SANITATION & HYGIENE FOR ALL (SSH4A)

PROGRAMME

Baseline Study Report, Nepal

July 2015

…………. ………………

Netherlands

Development

Organization

Baseline Study

Sustainable Sanitation & Hygiene for All (SSH4A) Programme

Nepal

(Project districts supported by Civil Society WASH Fund, DFAT)

Submitted to:

SNV/Netherlands Development Organisation Nepal

Jawalakhel, Lalitpur, Nepal

Submitted by:

Surya Binod Pokharel (Team Leader)

Deependra Kaji Thapa (Survey Coordinator)

Research Centre for Integrated Development Nepal

Gausala, Kathmandu

[email protected]

mailto:[email protected]

Acknowledgement

RECID Nepal is grateful to SNV Nepal for offering the opportunity to conduct out the Baseline Survey of

SSH4A Programme. We would like to express our deepest appreciation to Ms. Nadira Khawaja, WASH Sector

Leader and Mr. Anup Regmi, Project Leader, from SNV Nepal for their continuous support and guidance in

the finalization of study methodology, field plans as well as finalization of baseline study report. We are also

grateful to Erick Batings from IRC for his invaluable guidance through training, and mentoring.

RECID Nepal would like to thank a wide range of individuals who supported this baseline survey. We are

grateful to the district advisors of SNV Nepal for supporting to commence the field work in the districts.

Special gratitude goes to all the participants and respondents including the staff and representatives of DDC,

DWASHCC, WSSDO, RMSO, VDCs and schools for their patience, cooperation and valuable time in sharing

their insights and experiences. We express our deep appreciation to all the supervisors and enumerators for

their hard work and timely completion of field levels.

Surya Binod Pokharel

Deependra Kaji Thapa

Research Centre for Integrated Development (RECID) Nepal

Executive Summary

Introduction and Objectives

SNV Nepal is implementing its Sustainable Sanitation and Hygiene for All (SSH4A) Programme in eight

districts of Nepal with funding from the Civil Society WASH Fund of DFAT, Australian Government and the

Ministry for Foreign Affairs (DGIS), The Netherlands. The districts include Jumla, Dolpa, Kalikot, Rukum,

Rolpa, Salyan, Sarlahi and Mahottari. The major objective of the study was to establish the current status of

sanitation and hygiene in the target districts as well as to understand the capacities of key stakeholders to

steer processes and deliver services.

Methodology

The study was carried out to measure the existing status of pre-determined programme indicators. The

SSH4A programme has four impact indicators measuring the status of sanitation and hygiene at the

household level out of which three indicators are also used to measure the status in schools. Eight outcome

indicators are being used to assess sector capacities including sector steering and implementation

capacities, private sector engagement, sector alignment, and empowerment. The baseline survey used

Qualitative Information System (QIS) tool assessing for impact indicators (which provides a progressive

scale from level 0 to level 4 with benchmark being at level 2) and Scorecard tool for the outcome indicators

as performance monitoring frameworks.

Household survey: A total of 2,979 households from 47 sampled VDCs in eight project districts were

surveyed using Akvo FLOW mobile application software. Data were collected by trained enumerators from

the head of household and/or the adult member of the sampled households using structured questionnaire.

Guided self-assessment: Outcome indicators were measured at district level through Focus Group

Discussions (FGDs) and interaction with key district stakeholders using self-assessment scorecards. FGDs

and interactions were made with persons from related authorities responsible for sanitation and hygiene

activities in the districts (WSSDO, DWASHCC, and DDC etc.).

Major Findings on Impact Indicators

Socio-demographic Characteristics

The socio-demographic data provides the context of the project area and an insight into potential factors

that may influence the sanitation and hygiene situation. The findings confirmed that Nepal is a patriarchal

society and 81.4% of the households were headed by men. The project area had an average household size

of 6.7. The survey revealed that 13.8% of the households had at least one member living with a disability.

The sampled households were distributed into one of five wealth quintiles relative to national wealth

ranking: poorest, poor, medium, rich, or richest. The findings showed that the respondents belonged mostly

to the poor wealth category followed by medium and poorest categories. Differentiation according to the

ecological zones showed a clear distinction between the three zones with the mountain districts being the

poorest, followed by the hills, and then the terai.

Households with Access to a Sanitary Toilet (Indicator 1.1)

Impact indicator 1.1 of the programme assesses access of households to a sanitary toilet. This indicator

looks at the existence of toilets as well as the toilet structure. The infographic below shows that 42.8% of

the housheolds did not have access to a toilet and a further 12.9% had access to a basic latrine or a shared

facility. 44.3% of the households were at or above the benchmark of having an improved toilet. The

majority of households that had an improved latrine had reached level 3 or 4 of the QIS scale for the

indicator and therefore had an improved toilet in which excreta were contained and were also not accessible

to flies.

Notably, the terai, which was comparatively wealthier than the other ecological zones, had the highest

proportion of households defecating in the open, 97%, as compared with the hills where 19% had no access

to a toilet and the mountains where 29% had no access to a toilet.

Kalikot, Rukum, Rolpa, and Salyan districts had between 41% to 62% of households with an

environmentally safe toilet that was not polluting surface or groundwater sources. This can be attributed to

the high prevalence of water-seal flush toilets and therefore excreta are contained and there is no access to

flies. Also, the hill and mountain areas have permeable soils and in many locations the ground and surface

water sources are far away; therefore, pits do not fill up or overflow easily and the chances of contaminating

groundwater tend to be low. In the terai, on the other hand, environmental contamination is a high risk due

to the flat land, high population densities, high groundwater table in many areas, and regular flooding

events. Therefore, although currently the sanitation coverage in the terai is low, achieving level 4 with

environmentally safe toilets is a considerable challenge for this area.

Indicator #1 “Access to sanitary toilet”

44.3% of the

households in the project area have an improved toilet (at or above benchmark) 42.8% of the households

in the project area do not have access to a toilet

12.9% of the households in the project area have a basic toilet or a shared latrine

Households with Use of Hygienic Toilet (Indicator 2.1)

Impact indicator 2.1 of the programme assesses dual aspects of whether a toilet is being used and whether

it is used and maintained in a hygienic condition. The infographic shows that 44.6% of the households in

the project area were not using a toilet either because they did not have access to a toilet or because a

toilet existed but it was not in use as a toilet. However, considering that 42.8% of households did not have

access to a toilet (indicator 1.1), only a small number of households were not using a facility that existed as

a toilet. This high usage rate can perhaps be attributed to the no-subsidy approach adopted by the

Government of Nepal where households that were investing in making a toilet were also using that facility.

The infographic also shows that 53.0% of the households were at or above benchmark and were using a

toilet which was functioning as intended. As most of the facilities were flush toilets, this meant that the

toilets had a functioning water seal.

Results for indicator 2 showed that the overwhelming bottleneck in use of a hygienic toilet was cleanliness.

The majority of households that were at or above benchmark for the indicator were at level 2 (benchmark

level) itself indicating that the toilet was maintained in a functional condition. However, only 2.2% of the

households were using a toilet that was clean (level 3 or higher). Notably, this trend was seen across

ecological zones, individual districts, wealth quintiles, as well as gender of household head.

Households with Hand Washing Facility In or Near Toilet (Indicator 3.1)

Indicator 3.1 of the programme assesses the existence and quality of hand washing facilities in or near a

toilet as a proxy indicator for the behaviour of safe practice of hand washing with soap after defecation. The

infographic shows that a high proportion of households, 84.5%, did not have access to a hand washing

facility, 7.5% of households had access to a hand washing facility but without soap, and that only 8.1% of

household were at or above benchmark where a hand washing facility exists and soap (or soap substitute) is

available.

53.0% of the

households in the project area use a toilet which is functioning as intended (at or above benchmark)

44.6% of the households

in the project area do not have or do not use a toilet that exists


in the project area use a toilet

Indicator #2 “Use of hygienic toilet”

There was little difference in findings between the three ecological zones. So, even though in the terai most

of the households had yet to construct a toilet and therefore would by default have no hand washing facility

near a toilet (97%), notably even for the other two eco-zones, a high proportion of households had no hand

washing facility (81% for mountains and 78% for hills).

There was a clear trend across wealth quintiles for the indicator with the highest proportion of households

from the poorest quintiles being below benchmark for the indicator followed by the poor, medium, rich and

richest wealth quintiles. The richest also had the highest percentage of households that had a hand washing

facility with soap and running water. Therefore it appears that people have a higher tendency to establish a

hand washing facility if they have a better economic status.

Households with Use of Toilet by All at All Times (Indicator 4)

Indicator 4 of the programme assesses whether households use their toilet consistently when they are in or

around the house and whether all members of the household use the toilet, including the elderly and

disabled. To reach the highest level on the QIS scale, the indicator also looks at whether children’s faeces

are being disposed safely. The infographic shows that 44.6% of households do not use a toilet because they

either do not have access to a toilet or they do not use a facility that exists (this is the same as for indicator

2.1).

It further shows that 10.7% of households use the toilet as a toilet but it is not accessible to all.

Considering that 13.8% of households in the project area have a member living with a disability (i.e. they

have difficulty in seeing, walking or climbing steps, or self-care such as washing or dressing), it means that

a lot of the households who have a member with disabilities do not have a toilet which is accessible for

them.

44.6% of households are at or above benchmark and have a facility that is being used and is accessible by

all household members. Almost all of these households were at level 3 or 4 and therefore were using toilets

8% of the

households in the project area have a handwashing facility with soap (at or above benchmark)


in the project area do not have a hand washing facility in or near the toilet


in the project area have a basic handwashing facility (no soap)

Indicator #3 “Access to handwashing facilities in or near toilet”

that were accessible and providing convenience and privacy to all household members. Hence, the toilets

provide a secure environment for women and children to be able to use the toilet. However, analysis of

level 4 of the indicator showed that only 15% of households had reached the highest level where in addition

to a toilet being used by all, children’s faeces were also being disposed safely. This may perhaps be due to

the thinking that children’s faeces are considered as less dangerous.

Findings from School Survey

Ninety five schools of the project districts were also surveyed where two-fifth (41.1%) of them were primary

level. On average, 384 students and ten teachers were found in a school. On average, 4.7 toilets with

urinals and 2.9 toilets without urinals were found in a school. Amongst the sampled schools, the ratio of girls

and boys to a toilet was 137 girls and 142 boys. On average 13 teachers used one toilet.

Regarding access to sanitation facilities in schools, around half of the schools had toilets with enclosed and

covered pits and only few schools in Rolpa and Salyan had toilets with water seal or squatting hole covered

and at least 10 meter away from water source. A higher percentage of schools in the mountain and hill

districts had access to toilets as compared with schools in the terai region. This may be due to low

awareness level of school management committee/implementing body, unavailability of space or because it

was not thought of as a major issue.

Regarding the hygienic use of toilets in schools, a higher proportion of schools had toilets with water seal or

lid covering squatting hole whereas no schools had reached level 4 (no cleansing materials were visible).

However, very few schools had no visible excreta on pan and walls of a toilet; it could be a result of low

level of awareness on hygiene and sanitation and unavailability of water in toilets.

Half of the schools had no hand washing facilities in or near toilets and only five percent of the schools had

hand washing facilities with running water. It showed that many schools were far behind in providing hand

44.6% of the

households in the project area have a toilet that is accessible to all at all times (at or above benchmark)


in the project area do not have or do not use a toilet that exists


in the project area have a toilet that is visibly in use

Indicator #4 “Use of toilet by all at all times when at home”

washing facilities which directly impacts the health of students and teachers. Higher proportion of schools in

the terai had hand washing facilities in or near toilets compared to the mountain and hill eco-zones. This

may be due to easy access of water in the terai.

Major Findings on Outcome Indicators

Outcome Indicator 6. Progress in Sanitation Services and Business Development

In the terai districts, with better road connectivity and high population density, more number of supply chain

actors was engaged in supply chain than in the hills and mountains. In the terai districts, private sectors

also engaged to manufacture a large volume of cement. Concrete ring producers, high number of

wholesalers/retailers of sanitary and hardware materials from district head quarter and sub-district level

business centres sold their products through their own outreach and/or supplied materials to community

level retailers and grocery shops. In the hill and mountain districts, there were a few number of private

sectors engaged in supply chain. They mostly engaged in district head quarter and very few business

centres were developed in rural area. Transportation of sanitation materials was difficult in the mountain

and hills due to geographical difficulties.

Outcome Indicator 7. Progress with Regards to Increased Capacity of Line Agency to Steer

Behaviour Change Communication at Scale and with Quality

Jumla, Kalikot and Dolpa districts had developed BCC strategy that included sanitation and hygiene focused

behaviour change interventions. Some of the districts (e.g. Rolpa, Rukum, Jumla and Kalikot) were

providing training to local facilitators in BCC approaches. Specific standards were set on training; however,

no hard copies of training reports and tools used were found. Different organisations (e.g. DPHO, DWSSDO,

I/NGOs) were implementing health education and behaviour change activities at district and community

level on their own. Awareness programmes related to sanitation and hygiene were launched through

different medias such as radio/FM, posters, pamphlets, wall paintings, etc. Different organisations (I/NGOs)

were supporting such awareness raising activities. But these activities were not guided by BCC strategy.

DWSSDO was yet to take lead role in developing BCC strategy in most of the districts. Despite the

increasing sanitation coverage in recent years, the implementation of concrete strategic steps on BCC is a

most desired area of intervention to sustain sanitation and hygiene behaviour.

Outcome Indicator 8. Progress in Capacity of Local Line Agencies to Steer and Monitor

Performance in Rural Sanitation and Hygiene

All eight districts, except Sarlahi, had developed district level sanitation and hygiene strategic plan in local

context with the spirit of National Sanitation and Hygiene Master Plan (NSHMP), 2011. However, the

implementation of strategic plan by developing common understanding among the district WASH sector

stakeholders and mobilisation of their respective resources (such as staff, fund, etc.) were not sufficiently

stimulated in all the districts. None of the districts had a system to generate or maintained yet the

disaggregated data that provides information on the groups of beneficiaries and people that include socially

excluded groups and people living with disability and special needs. None of the studied districts had pro-

poor policy to enhance the access of poor and excluded groups of the society to sanitation facilities.

Promoting standards and follow-up mechanism of sanitation and hygiene statement was another area of

improvement. The terai districts lagged behind the hill and mountain districts. The DWASHCCs in the terai

districts were newly formed and their respective meetings were not held regularly.

Outcome Indicator 9. Progress with Regards to Improved Rural Sanitation and Hygiene Sector

Alignment

Sector alignment was strongest in statements 1 (multi-stakeholder dialogue has started) and 6 (sector

priorities are set jointly). In all the study districts, a multi-stakeholder dialogue had been started by

establishing DWASHCC. Participants from the districts mentioned that the meetings of DWASHCC were being

held at least once a month. The districts, on average, could not meet the benchmark score in five out of ten

statements which include statements 3 (donor involvement), 4 (civil society and private sector

involvement), 5 (sharing of information and data), 9 (approach alignment) and 10 (alignment of standards

and norms). Alignment of standards and norms (statement 9) got the least score on average, followed by

approach alignment (statement 8). Overall, Jumla, Rukum and Rolpa obtained higher scores, while Salyan,

Dolpa, Sarlahi and Mahottari were found to be lacking behind in sector alignment.

Outcome Indicator 10. Progress in Development of Pro-poor Support Mechanisms

None of the studied districts had pro-poor policy to enhance the access of poor and excluded groups of the

society to sanitation facilities. The district sanitation strategy does not clearly tell about any type of pro-poor

support mechanism. There was no practice of including disaggregated data in monitoring and no practice of

identifying excluded groups and their specific needs. However, some districts (e.g. Jumla, Dolpa and

Mahottari) had provision for some kind of support (materials: e.g. pan, pipe, cement, etc.) to ultra-poor

households. These ultra-poor households were identified and approved by VDC and VWASHCC. However,

there was no systematic way to collecting and analysing inclusion data.

Outcome Indicator 11. Influence of Women during Planning and Implementation of

Sanitation and Hygiene Programmes

Rukum, Jumla and Kalikot districts were found in better position in this indicator. Women participated in

FGDs mentioned that they participated in meetings, spoke and influenced decision. They were actively

participating in sanitation and hygiene development activities in their location. Some of the participants in

the FGDs mentioned that they had participated in VWASHCC meetings where they were involved in planning

process. It seemed there was good participation of women in development work group and they were

involved in ward citizen forums, women groups, saving and credit groups, and mother groups. Rolpa district

scored 2 in QIS score indicating that women attended meetings and spoke; however, they had no influence

in decision making. On the other hand, Dolpa and Salyan districts obtained score 1 (women participate in

meetings but do not speak). The terai districts, Mahottari and Sarlahi were found the weakest in comparison

to other districts with total average score of 0 (women do not participate in meetings) in outcome indicator

11.

Outcome Indicator 13. Influence of Socially Excluded Groups during Planning and

Implementation of Sanitation and Hygiene Programmes

All of the study districts were found poor in indicator 12 and 13 indicating low influence of socially excluded

groups in sanitation and hygiene programmes. None of the district could achieve score 3 or above.

Participants believed that they belonged to poor and uneducated group and others would not listen to them.

Sometimes, they attended meetings but did not talk. As compared with other districts, Rolpa and Kalikot

were at a better position in this indicator. On the contrary, Mahottari, Sarlahi and Dolpa districts were the

weakest among all with a total average score of 0 in this indicator.

Conclusion

The mountain and hill districts, Kalikot, Rukum and Rolpa were comparatively in a better position. Similarly,

Salyan, Dolpa and Jumla (the hill and mountain districts) were relatively in a moderate position, whereas

the terai districts (Sarlahi and Mahottari) lagged behind and need to make many efforts to improve their

sanitation status. The terai districts had more than 95 percent of the households practicing open defecation.

WSSDOs of these districts were leading the WASH promotion activities with clear strategic plan and better

sectorial alignment and also ensuring resources for implementing the plan. Women at community level were

better involved in sanitation and hygiene related programmes. This ultimately resulted to higher sanitation

coverage, better use and maintenance of sanitation facilities, and hand washing practice. The findings

showed the increased capacity of district line agencies, especially DWSSDO, was a pre-requisite for

improved sanitation and hygiene. In addition to intuitional strengthening of the WSSDOs and other WASHCC

structures, the pre-determined concept of subsidy among the sector actors as well as communities had

played a vital role in lagging the districts’ capacity to promote sanitation demand creation. The study team

also realised that the leadership of WSSDO/SDOs and DDC made a considerable difference in the districts’

status in these dimensions. Besides, the frequent changes of government officials also affected the

functioning of the districts.

Table of contents

Acknowledgement ................................................................................................................ ii

Executive Summary .............................................................................................................. iii

Table of contents .................................................................................................................. xi

List of tables ........................................................................................................................ xvi

List of figures ....................................................................................................................... xix

List of Abbreviations and Acronyms ................................................................................... xxiii

Operational Definitions ..................................................................................................... xxiv

Section I. Introduction ......................................................................................................... 25

1.1 Country Context ................................................................................................. 25

1.1.1 Overview of Sanitation in Nepal ................................................................................... 26

1.1.2 Institutional Set-up for WASH Sector in Nepal ............................................................ 27

1.2 SSH4A Programme in Nepal ................................................................................ 28

1.2.1 SSH4A Programme Introduction and Approach........................................................... 28

1.2.2 SSH4A Programme in Nepal ......................................................................................... 29

1.3 Objectives of the Baseline Study ......................................................................... 30

1.4 Report Structure ................................................................................................. 31

Section II. Methodology of the Baseline Survey .................................................................... 32

2.1 Indicators Measured in the Baseline ................................................................... 32

2.2 Use of Qualitative Information System (QIS) and Capacity Development Scorecards ......................................................................................................................... 34

2.3 Data Collection Tools Used in the Baseline Study ................................................ 35

2.3.1 Household Survey ......................................................................................................... 35

2.3.2 School Survey ............................................................................................................... 35

2.3.3 Focus Group Discussions and Guided Self-assessment................................................ 35

2.4 Sampling ............................................................................................................ 36

2.4.1 Sampling for Household Survey ................................................................................... 36

2.4.2 School Survey ............................................................................................................... 38

2.5 Training and Supervision of Enumerators ............................................................ 39

2.6 Methodology for Data Processing and Analysis ................................................... 41

Section III. Results of the Household Survey ......................................................................... 42

3.1 Characteristics of the Respondents ..................................................................... 42

3.1.1 Sample Distribution by Development Region and District........................................... 42

3.1.2 Gender of Respondent and Household Head .............................................................. 43

3.2 Household Characteristics .................................................................................. 44

3.2.1 Basic Demographic Characteristics .............................................................................. 44

3.2.2 Household Economic Status - Wealth Index ................................................................ 45

3.3 Households with Access to a Sanitary Toilet (Impact Indicator 1.1) ...................... 49

3.3.1 Overall Access to a Sanitary Toilet ............................................................................... 50

3.3.2 Access to a Sanitary Toilet by Ecological Zone ............................................................. 51

3.3.3 Access to a Sanitary Toilet by Project District .............................................................. 53

3.3.4 Access to a Sanitary Toilet by Wealth Quintile ............................................................ 55

3.3.5 Access to a Sanitary Toilet by Gender of Household Head .......................................... 57

3.3.6 Types of Toilets Found in the Project Area .................................................................. 58

3.4 Households that Use a Hygienic Toilet (Impact Indicator 2.1) .............................. 59

3.4.1 Overall Use of a Hygienic Toilet ................................................................................... 61

3.4.2 Use of a Hygienic Toilet by Ecological Zone ................................................................. 62

3.4.3 Use of a Hygienic Toilet by Project District .................................................................. 63

3.4.4 Use of a Hygienic Toilet by Wealth Quintile................................................................. 65

3.4.5 Use of a Hygienic Toilet by Gender of Household Head .............................................. 66

3.5 Households with Access to a Hand Washing Facility in or near the Toilet (Impact Indicator 3.1) ..................................................................................................... 68

3.5.1 Overall Access to a Hand Washing Facility in or near the Toilet .................................. 69

3.5.2 Access to a Hand Washing Facility in or near the Toilet by Ecological Zone ............... 70

3.5.3 Access to a Hand Washing Facility in or near the Toilet by Project District ................ 71

3.5.4 Access to a Hand Washing Facility in or near the Toilet by Wealth Quintile ............... 73

3.5.5 Access to a Hand Washing Facility in or near the Toilet by Gender of Household Head

........................................................................................................................................ 75

3.6 Households with Use of Toilet by All at All Times at Home (Impact Indicator 4) ....... 76

3.6.1 Overall Use of Toilet by All at All Times at Home ......................................................... 78

3.6.2 Use of Toilet by All at All Times at Home by Ecological Zone ...................................... 79

3.6.3 Use of Toilet by All at All Times at Home by Project District ....................................... 81

3.6.4 Use of Toilet by All at All Times by Wealth Quintile .................................................... 82

3.6.5 Use of Toilet by All at All Times by Gender of Household Head .................................. 84

3.7 Discussion of Results of the Household Survey .................................................... 86

SECTION IV. Findings of School Survey ................................................................................. 91

4.1 General (demographic) Findings .............................................................................. 91

4.2 Defecation Practice in School .................................................................................. 93

4.3 Schools with Access to Sanitary Toilets (Impact Indicator 1.2).................................. 97

4.4 Hygienic Use of Toilets in Schools (Impact Indicator 2.2) ........................................ 100

4.4.1 Hygienic Use of Toilet in School ................................................................................. 100

4.4.2 Hygienic Use of Toilet in School by District ................................................................ 102

4.5 Access to Hand Washing Facilities at School .......................................................... 103

4.5.1 Hand Washing Facilities at School .............................................................................. 103

4.5.2 Schools with Access to Hand Washing Facilities in or near the Toilets (Impact

Indicator 3.2) ................................................................................................................ 105

4.5.3 Hand Washing Facilities at School by Ecological Region ............................................ 107

4.5.4 Hand Washing Facilities at School by District ............................................................ 107

4.5.5 Findings Related to Menstrual Hygiene Management at School ............................... 108

4.6 Discussion of Results of Schools Survey ............................................................. 110

Section V. Findings of outcome indicators .......................................................................... 111

5.1 Outcome Indicator 6. Progress in Sanitation Services and Business Development .. 112

5.1.1 Data Collection Methods ............................................................................................ 112

5.1.2 Findings ....................................................................................................................... 112

5.1.3 Scoring of Outcome Indicator 6 ................................................................................. 118

5.1.4 Discussion on Outcome Indicator 6 ........................................................................... 121

5.2 Outcome Indicator 7. Progress with Regards to Increased Capacity of Line Agency to Steer Behaviour Change Communication at Scale and with Quality .................. 122

5.3 Outcome Indicator 8. Progress in Capacity of Local Line Agencies to Steer and Monitor Performance in Rural Sanitation and Hygiene ..................................... 128

5.4 Outcome Indicator 9. Progress with regards to Improved Rural Saniation and Hygiene Sector Alignment ............................................................................... 138

5.5 Outcome Indicator 10. Progress in Development of Pro-poor Support Mechanisms 151

5.6 Outcome Indicator 11. Influence of Women during Planning and Implementation of Sanitation and Hygiene Programmes ........................................................... 152

5.7 Outcome Indicator 13. Influence of Socially Excluded Groups during Planning and Implementation of Sanitation and Hygiene Programmes ................................. 154

5.8 Discussion of Results of Outcome Indicators .......................................................... 157

Section VI. Conclusions and Recommendations .................................................................. 159

6.1 Conclusion ............................................................................................................ 159

6.2 Recommendations ................................................................................................ 159

Annex I. Household questionnaire .............................................................................. 162

Annex II. Outcome indicator tools/Focus Group Discussion Forms ............................... 187

Outcome indicator 6. .................................................................................................. 187

Annex III. Training schedule to the enumerators ......................................................... 196

List of tables

Table 1. Impact Indicators of SSH4A Consumer Preference Programme..................................... 32

Table 2. Outcome Indicators ......................................................................................................... 33

Table 3. Number of sampled VDCs and households by district .................................................... 37

Table 4. Sampling methodology for the VDCs and households ................................................... 38

Table 5. Number of sampled public schools by school level and district ..................................... 39

Table 6. Akvoflow data management training to enumerators ................................................... 41

Table 7. Distribution of sampled households by development region and district ..................... 42

Table 8. Distribution of household size ........................................................................................ 44

Table 9. Age distribution of household members ........................................................................ 45

Table 10. Distribution of households by wealth quintiles ............................................................ 45

Table 11. Wealth quintile distribution by district ......................................................................... 47

Table 12. Wealth quintile distribution by household characteristics ........................................... 48

Table 13. QIS scale for impact indicator 1 and benchmark level ................................................. 49

Table 14. Access to a sanitary toilet as per QIS Scale (with benchmark, level 2) ......................... 51

Table 15. Prevalence of different types of toilets in the project area .......................................... 59

Table 16. QIS scale for impact indicator 2 and benchmark level. ................................................ 60

Table 17. Use of a hygienic toilet as per QIS Scale (with benchmark, level 2) ............................. 61

Table 18. QIS scale for impact indicator 3 and benchmark level ................................................. 68

Table 20. Access to a hand washing facility in or near the toilet ................................................. 70

Table 21. QIS scale for impact indicator 4 and benchmark level. ................................................ 77

Table 22. Use of toilet by all at all times at home as per QIS Scale (with benchmark, level 2).... 79

Table 23. Percent of households and percent of people (household members) living with a

disability in the project area ......................................................................................................... 79

Table 24. Distribution of Sample Schools by District .................................................................... 91

Table 25. Distribution of Students by Type of School .................................................................. 92

Table 26. Number of Students and Teachers ............................................................................... 93

Table 27. Defecation and Urination Practices (multiple response) .............................................. 94

Table 28. Access to Sanitation Facilities at Schools (number of toilet) ........................................ 95

Table 29. Access of Students to Sanitation Facilities+ .................................................................. 96

Table 30. Number of Schools with Access to Sanitary Toilets ...................................................... 97

Table 31. Schools Access to Sanitary Facilities by District ............................................................ 99

Table 32. Schools that use hygienic toilet .................................................................................. 101

Table 33. Schools that use hygiene toilets by districts ............................................................... 102

Table 34. Hand washing facilities at schools............................................................................... 104

Table 35. Number of Hand washing facilities ............................................................................. 105

Table 36. Schools with Access to Hand Washing Facilities In or Near Toilets ............................ 106

Table 37. Availability of Sanitary Pad to Girls When Needed ..................................................... 109

Table 38. Outcome Indicators of SSH4A Consumer Preference Programme ............................. 111

Table 39. Private Sector Actors Engaged in Sanitation Businesses or Related Supply Chains in the

District ......................................................................................................................................... 113

Table 40. Ladder Level and Criteria for Outcome Indicator 6 .................................................... 118

Table 41. District Score of Outcome Indicator 6 ......................................................................... 119

Table 42. Statements and Score Criteria for Outcome Indicator 7 ............................................ 123

Table 43. Outcome Indicator 7, District Wise Score ................................................................... 126

Table 44. Statements and Capacity Score Criteria for Outcome Indicator 8 .............................. 128

Table 45. Indicator 8, District Wise Score ................................................................................... 137

Table 46. Statements and Scoring Criteria for Outcome Indicator 9 ......................................... 139

Table 47. Outcome Indicator 9, District Wise Score ................................................................... 149

Table 48. QIS Scorecard for Outcome Indicator 11 .................................................................... 153

Table 49. QIS Scorecard for Outcome Indicator 13 .................................................................... 155

List of figures

Figure 1. Map of Nepal ................................................................................................................. 25

Figure 2. Components of SSH4A ................................................................................................... 28

Figure 3. SSH4A project districts in Nepal (Civil Society WASH funded) ...................................... 30

Figure 4. Distribution of sampled households (%) by ecological zone ......................................... 43

Figure 5. Gender of respondent and household head ................................................................. 43

Figure 6. Wealth quintile distribution (% of households) by ecological zone .............................. 46

Figure 7. Access to a sanitary toilet (%) as per benchmark level of QIS scale. ............................. 50

Figure 8. Access to a sanitary toilet (% of households) as per benchmark level of QIS scale, ..... 52

Figure 9. Access to a sanitary toilet (% of households) as per QIS scale by ecological zone ....... 53

Figure 10. Access to a sanitary toilet (% of households) as per benchmark level of QIS scale, ... 54

Figure 11. Access to a sanitary toilet (% of households) as per QIS scale by district ................... 55


Figure 13. Access to a sanitary toilet (% of households) as per QIS scale by wealth quintile ...... 57


Figure 15. Access to a sanitary toilet (% of households) as per QIS scale .................................... 58

Figure 16. Use of a hygienic toilet (%) as per benchmark level of QIS scale. ............................... 61

Figure 17. Use of a hygienic toilet (% of households) as per benchmark level of QIS scale, ....... 62

Figure 18. Use of a hygienic toilet (% of households) as per QIS scale by ecological zone .......... 63


Figure 20. Use of a hygienic toilet (% of households) as per QIS scale by district ....................... 64


Figure 22. Use of a hygienic toilet (% of households) as per QIS scale by wealth quintile .......... 66


Figure 24. Use of a hygienic toilet (% of households) as per QIS scale, ....................................... 67

Figure 25. Access to a handwashing facility in or near the toilet (%) ........................................... 69

Figure 26. Access to a hand washing facility in or near the toilet (% of households) as per

benchmark level of QIS scale, by ecological zone ........................................................................ 70

Figure 27. Access to a hand washing facility in or near the toilet (% of households) as per QIS

scale by ecological zone ................................................................................................................ 71


benchmark level of QIS scale, by district ...................................................................................... 72


scale by district ............................................................................................................................. 73


benchmark level of QIS scale, by wealth quintile ......................................................................... 74


scale by wealth quintile ................................................................................................................ 75


benchmark level of QIS scale, by gender of household head ....................................................... 75


Scale by gender of household head .............................................................................................. 76

Figure 34. Use of toilet by all at all times at home (%) as per benchmark level of QIS scale ....... 78

Figure 35. Use of toilet by all at all times at home (% of households) as per benchmark level of

QIS scale, by ecological zone ........................................................................................................ 80

Figure 36. Use of toilet by all at all times at home (% of households) as per QIS scale ............... 80


QIS scale, by district ...................................................................................................................... 81

Figure 38. Use of toilet by all at all times at home (% of households) as per QIS Scale by district

....................................................................................................................................................... 82


QIS scale, by wealth quintile ......................................................................................................... 83

Figure 40. Use of toilet by all at all times at home (% of households) as per QIS Scale............... 84


QIS scale, by gender of household head ....................................................................................... 84

Figure 42. Use of toilet by all at all times at home (% of households) as per QIS Scale............... 85

Figure 43. Type of School .............................................................................................................. 92

Figure 44. Number of Students/Teachers per Toilet (excluding urinals) ..................................... 96

Figure 45. Schools with Access to Toilet (Indicator 1.2) ............................................................... 98

Figure 46. Indicator 1.2 by Ecological Region ............................................................................... 98

Figure 47. Impact Indicator 1.2 by Districts ................................................................................ 100

Figure 48. Hygienic use of toilet in school .................................................................................. 101

Figure 49. Impact indicator 2.2 by district .................................................................................. 103

Figure 50. Schools with Access to Hand Washing Facilities In or Near Toilets ........................... 106

Figure 51. Hand Washing Facilities In or Near Toilets across Ecological Region ........................ 107

Figure 52. Hand Washing Facilities In or Near Toilets by District ............................................... 108

Figure 53. Private Sector Engagement in Sanitation (district wise score) .................................. 119

Figure 54. Outcome Indicator 8, Rolpa District .......................................................................... 129

Figure 55. Outcome Indicator 8, Rukum District ........................................................................ 130

Figure 56. Outcome Indicator 8, Salyan District ......................................................................... 131

Figure 57. Outcome Indicator 8, Jumla District .......................................................................... 132

Figure 58. Outcome Indicator 8, Kalikot District ........................................................................ 133

Figure 59. Outcome Indicator 8, Dolpa District .......................................................................... 134

Figure 60. Outcome Indicator 8, Sarlahi District ......................................................................... 135

Figure 61. Outcome Indicator 8, Mahottari District ................................................................... 136

Figure 62. District Wise Average Score of Outcome Indicator 8 ................................................ 138

Figure 63. Outcome Indicator 9, Rolpa District .......................................................................... 141

Figure 64. Outcome Indicator 9, Rukum District ........................................................................ 142

Figure 65. Outcome Indicator 9, Salyan District ......................................................................... 143

Figure 66. Outcome Indicator 9, Jumla District .......................................................................... 144

Figure 67. Outcome Indicator 9, Kalikot District ........................................................................ 145

Figure 68. Outcome Indicator 9, Dolpa District .......................................................................... 146

Figure 69. Outcome Indicator 9, Sarlahi District ......................................................................... 147

Figure 70. Outcome Indicator 9, Mahottari District ................................................................... 148

Figure 71. Outcome Indicator 9, All Districts .............................................................................. 150

Figure 72. Mean Score of Outcome Indicator 9 of All Districts .................................................. 151

Figure 73. Outcome Indicator 11 by District ............................................................................... 153

Figure 74. Outcome Indicator 13 by District ............................................................................... 156

List of Abbreviations and Acronyms

BCC Behaviour Change Communication

CBO Community Based Organisation

CDO Chief District Office

CSO Civil Society Organisations

DAG Disadvantaged Group

DCWDO District Children and Women Development Office

DDC District Development Committee

DEO District Education Office

DHO District Health Office

DTO District Technical Office

DWASHCC District WASH Coordination Committee

DoLIDAR Department of Local Infrastructure Development and Agricultural Roads

FCHV Female Community Health Volunteer

FGD Focus Group Discussion

FSM Faecal Sludge Management

GO Government Organisation

GoN Government of Nepal

HWWS Hand Washing With Soap

I/NGO International/Non-governmental Organisation

LCB Local Capacity Builder

LDO Local Development Officer

MoFALD Ministry of Federal Affairs and Local Development

NPR Nepalese Rupee

NSHMP National Sanitation and Hygiene Master Plan

NSHCC National Sanitation and Hygiene Coordination Committee

NSHSC National Sanitation and Hygiene Steering Committee

NSSSAP National Strategy and Sectorial Strategic Action Plan

ODF Open Defecation Free

KII Key Informant Interview

LAO Local Administrative Office

QIS Qualitative Information System

RECID Research Centre for Integrated Development

RMSO Regional Monitoring and Supervision Office

RWSSFDB Rural Water Supply and Sanitation Fund Development Board

RWSNP Rural Water Supply and Sanitation National Policy

SSH4A Sustainable Sanitation and Hygiene for All

VDC Village Development Committee

VWASHCC Village WASH Coordination Committee

WASH Water Sanitation and Hygiene

WSSDO Water Supply and Sanitation Divisional Office

Operational Definitions

Term Definition / explanation

Household

A household is often defined as a group of related people living under

same roof or close buildings, preparing and sharing food together and

members accepting one member of their group as the head of the

household. A household can consist of one or more families but with

common kitchen.

Coverage

Access of people/household of any geographical area to basic sanitation

facilities as defined by the national government which reflects the sanitation

status of that particular area.

Hygiene Hygiene in Wash refers to blocking the faecal oral transmission route.

Performance monitoring

Performance monitoring is a means to support the supervision of

programme activities in progress to ensure that they are on-course and on-

schedule in meeting the programme objectives and performance targets.

Sanitary toilet versus

hygienic toilet

‘Sanitary toilet’ refers to sanitary quality of construction (facilities).

‘Hygienic toilet’ refers to the hygienic status of a toilet which means that

it is well-operated and clean (behaviour).

Toilet with pit/tank

The term ‘toilet with pit/tank’ is used to describe any container above or

below ground, wet or dry, watertight or not, in which human waste is

contained temporarily.

Physical disability The term physical disability is understood to mean a disability that could

be assumed to impact on access to sanitation and hygiene services.

Shared toilet

Shared toilet is a toilet with one cubicle used by two to four households

with an average family size of five. They have separate key for each

household in urban set up whereas one toilet is used by extended family

members with no key in rural areas. Its cleaning is done on rotation basis.

Wealth quintile

Wealth index is categorised into five groups (quintiles): poorest, poor,

medium, rich and richest.

Households were distributed into quintiles relative to national ranking.

The calculation is asset-based and uses the factor loadings of the DHS

method. (Livestock, television, radio and cassette, watch, house roof

and wall, sleeping rooms, horse, donkey, goat, sheep and chicken for

example).

Section I. Introduction

1.1 Country Context

The Federal Democratic Republic of Nepal is located in South Asia, between the Republic of India to the

south, east and west and the People’s Republic of China to the north. Nepal, having land area of 147,181 sq.

km., stretches about 855 km from the north-west to the south-east and varies in its width from around 145

to 241 km.

The country is divided into three ecological regions – the terai (plains), the hills and mountains with 21, 42

and 12 districts respectively. Nepal has five main physiographic zones running parallel to the Himalayan

range. These are lowland plains of the terai, the Siwalik Hills, the Middle Hills, the High Hills and the High

Mountains. Administratively, Nepal is divided into five development regions (Eastern, Central, Western, Mid-

western and Far-western), 14 zones, and 75 districts (58 municipalities and 3915 Village Development

Figure 1. Map of Nepal

Committees (VDCs)1. The smallest administrative and political unit is VDC/ Municipality. The

VDCs/Municipalities, in turn, constitutes smaller wards.

Nepal has a population of 26.66 million with an annual growth rate of 1.35 percent. The population density

is 180 per square km and the literacy rate is 65.9 percent. The male literacy rate is 75.1 percent and that of

female is 57.4 percent. The life expectancy rate of male is 68 years and that of female if 69 years (CBS

2011).

According to the Local Self Governance Act 1999, Nepal has two-tier system of local governance with village

and municipal bodies as the lower tier and district bodies as the higher. The village bodies are called Village

Development Committees (VDCs) serving the same function as municipalities in town areas. The district

bodies are the District Development Committees (DDCs)2. Currently, the local government bodies in Nepal

are without elected bodies and are taken care of by the government officials of Ministry of Federal Affairs

and Local Development (MoFALD). This type of ad-hoc arrangement has been in place since nearly more

than 15 years ago. As the local body institutions are being administered by civil servants in the absence of

elected local bodies, there is very little accountability towards the people. However, Nepal, at present, is

administratively and politically in a transition phase and is in the process of developing a new constitution.

Once the new federal structure is in place after the promulgation of Nepal’s new constitution, names and

sizes of the administrative units are likely to change.

1.1.1 Overview of Sanitation in Nepal

According to the 2011 census, sanitation coverage in Nepal at that time was 62%3 (CBS Nepal 2012). In

2011, Nepal launched the National Sanitation and Hygiene Master Plan (NSHMP), which has laid down clear

guidelines for sanitation promotion and called for multi-sectoral coordination committees at the national,

regional, district and VDC or municipal levels to lead the sanitation movement in the country. The plan aims

to achieve universal sanitation coverage by 2017. In recent years, the sanitation movement in the country

has thus been led by local bodies while ensuring active participation of all stakeholders and ownership of

local communities. In the recently conducted annual sector stakeholders’ group meeting by government

officials on 23rd Sept. 2014, it was estimated that the current national coverage was 70 percent

approximately. The rate of VDCs and municipalities achieving ODF status has increased rapidly mainly

because of the sanitation movement that is happening throughout the country. However, these

improvements in the sanitation situation of the country are unevenly distributed across the development and

ecological regions as well as rural and urban areas.

While the progress in access to sanitation and ODF declarations is encouraging, the country still faces many

challenges as it aims to reach the national target of 100% sanitation coverage by 2017. Disparities in

sanitation coverage across the country, weak institutional capacities and linkages, rapid and unplanned

1 Recently, the Government of Nepal made a decision to increase the number of municipalities to 130 municipalities thereby increasing 72 municipalities to the existing 58 municipalities. As of this decision, total number of VDCs in Nepal reduced to around 3633 from existing 3915 VDCs. Again, GoN is preparing further to announce additional 46 municipalities by decreasing the existing number of VDCs. This decision will have impact on targeted VDCs as some of them are/might get merged into the municipaliites thus reducing the number of our VDCs. 2 http://www.nepaldemocracy.org/institutions/local_governance.htm

3 CBS, 2012: National Population and Housing Census 2011, Central Bureau of Statistics, Kathmandu.

urbanisation, inadequate finance, threat from natural disasters, and sustainability of the efforts made are

some of the major challenges.

1.1.2 Institutional Set-up for WASH Sector in Nepal

The institutional set-up for the WASH Sector in Nepal has a dual structure consisting of the technical line

ministry, the Ministry of Urban Development (MoUD), and the local government system headed by the

Ministry of Federal Affairs and Local Development (MoFALD). Additionally, there are a series of coordination

committees established for coordination in the Sector at the national, regional, district, and

municipality/VDC levels respectively.

Ministry of Urban Development and Department of Water Supply and Sewerage

The MoUD and its Department of Water Supply and Sewerage (DWSS) guide the WASH sector of Nepal. The

DWSS functions in all 75 districts through its 5 Regional Monitoring and Supervision Offices (RMSOs) and 75

Water Supply and Sanitation Division/Sub-division Offices (WSSD/SDOs). The RMSOs in five development

regions are established for monitoring and supervision; whereas, the WSSD/SDOs are responsible for

execution of policies for water, sanitation, and hygiene at the district level. The WSSD/SDOs are also

responsible for implementing water supply schemes for a population of over 1,000 people.

Ministry of Federal Affairs and Local Development

As per the Local Self Governance Act, 1999, the Ministry of Federal Affairs and Local Development (MoFALD)

has been placed at the apex of the local bodies structural framework – the District Development Committee

(DDC) at the district level, and the Municipality and the Village Development Committee (VDC) at the local

levels and accredited with the role of coordination, cooperation, facilitation and monitoring and evaluation of

activities undertaken by these local bodies. Local bodies have responsibility for ensuring that services are

provided, including water supply and sanitation. MoFALD also functions in all 75 districts through its

technical department named Department of Local Infrastructure Development and Agricultural Roads

(DoLIDAR) whose district unit is called District Technical Offices (DTO). The DTOs look after rural

infrastructure and rural roads in addition to the implementation of small scale rural water supply schemes

for populations of less than 1,000 people.

Existing National and Sub-national WASH Committees

The National Sanitation and Hygiene Master Plan (NSHMP) of 2011 has set up a steering committee and

various coordination committees at national, regional, district, and municipality and VDC level. The

composition and functions of these committees are clearly stated in the NSHMP (2011) and aim at

coordination between government, civil society and private sector stakeholders linked to the WASH sector

including from the health and education sector actors.

The National Sanitation and Hygiene Steering Committee (NSHSC) is chaired by the Secretary of

MoUD whereas the joint secretary of MoUD (WASH division) is the member-secretary.

The National Sanitation and Hygiene Coordination Committee (NSHCC) is chaired by the joint

secretary of MoUD (WASH division) while the chief of the Environmental Sanitation and Disaster

Management Section of DWSS is the member-secretary.

The Regional Water, Sanitation and Hygiene Coordination Committee (RWASHCC) is chaired by the

Regional Administrator. The chief of the Monitoring and Supervision Office of DWSS is its member-

secretary.

The District Water, Sanitation and Hygiene Coordination Committee (DWASHCC) is chaired by the

District Development Committee (DDC) chairperson, and the chief of the WSSDO/WSSSDO is the

member-secretary.

The VDC Water, Sanitation and Hygiene Coordination Committee (VWASHCC) is chaired by the VDC

chairperson, and the health post in-charge is the secretary.

The Municipality Water, Sanitation and Hygiene Coordination Committee (MWASHCC) is chaired by

the mayor of the municipality.

1.2 SSH4A Programme in Nepal

1.2.1 SSH4A Programme Introduction and Approach

SNV’s Sustainable Sanitation and Hygiene for All (SSH4A) programme aims to strengthen the capacity and

performance of local government, local

capacity builders and private sectors to

improve access to sustainable sanitation

and hygiene in scale with quality. The

programme is being implemented in

Bhutan and Nepal with funding of the Civil

Society WASH Fund of DFAT (Department

of Foreign Affairs and Trade) of the

Australian Government and the Ministry

for Foreign Affairs (DGIS), The

Netherlands. The main objective is to

improve people’s health and quality of life

through enhanced access to improved

sanitation and hygiene practices. The

programme aims to promote hygiene,

encourage communities to commit

themselves to becoming ODF, increase the

number of people practicing hand washing

with soap, assist preparation of district sanitation plans and improve local governments’ capacity for steering

improved sanitation. The programme has four components which include:

1. Strengthening capacity for steering and implementation of sanitation demand creation

Objective: Local organisations are capable to implement and steer sanitation demand creation at scale.

2. Strengthening capacity for sanitation supply chains and finance

Objective: Appropriate affordable market-based solutions for a variety of sanitation consumer needs are

implemented at scale.

Figure 2. Components of SSH4A

3. Strengthening capacity for behavioural change communication (BCC) for hygiene promotion

Objective: Anchor effective hygiene behavioural change communication in local practice

4. Strengthening capacity for WASH governance

Objective: Improving local WASH governance in terms of alignment of stakeholders, sector planning and

monitoring, transparency and social inclusion

In addition, there is a fifth component related to analysis, dissemination and learning of the project

experiences. Within the SSH4A approach, SNV has integrated insights into community-led sanitation

promotion, private sector development for sanitation, hygiene behaviour change communication and WASH

governance including strengthening district-wide local capacities for rural sanitation service delivery.

1.2.2 SSH4A Programme in Nepal

SNV is implementing the SSH4A programme in eight districts in Nepal through the funding of the Civil

Society WASH Fund (Figure 3). The eight districts are Jumla, Kalikot, Dolpa, Salyan, Rolpa, Rukum,

Mahottari and Sarlahi. They span all three main ecological zones of the country, namely the mountain, hill

and terai (the flatlands) eco-zones and are situated in two of the five development regions, namely the Mid-

Western and Central Development Regions.

Six project districts (Jumla, Kalikot, Dolpa, Salyan, Rukum and Rolpa) fall in the Mid-Western Development

Region, out of which three districts (Jumla, Kalikot, and Dolpa) are broadly situated in the mountain eco-

zone and three districts in the hills (Salyan, Rukum, and Rolpa). Two project districts (Saralhi and Mahottari)

fall in the Central Development Region and are in terai eco-zone.

The project is being implemented in 130 selected VDCs in 8 districts. The project will also intervene with

schools. The project aims at enhancing the access of 270,000 (including 3100 PLWD) people from above

mentioned eight districts to cease open defecation practise and have access to basic sanitation.

Figure 3. SSH4A project districts in Nepal (Civil Society WASH funded)

1.3 Objectives of the Baseline Study

The main objective of the baseline survey was to determine the existing rural sanitation and hygiene

situation before intervention of the SSH4A project so that the change attributed from the project can be

measured. Other objectives were to contribute to a better understanding of sanitation and hygiene situation

and understand the capacities of key stakeholders to steer processes and deliver services in the project

districts.

More specifically, the objectives of the baseline survey were to:

Analyse the resulting data, identifying trends and patterns in current levels of sanitation

facilities/services accessed by households by wealth, education, caste/ethnicity, disabilities, and

other demographic, social or geographical factors.

Identify the needs and interests of women, excluded groups and people with special needs at

different levels and their access to services offered by public and private service providers.

Collect information on existing behaviour and knowledge on sanitation access, usage and hygiene

practices.

Collect information on involvement of private sector in sanitation.

Assess capacities of stakeholders related to their roles in sector steering and alignment.

1.4 Report Structure

The baseline report consists of major five sections.

Section I presents a brief country context and summarises the SSH4A project in Nepal. This section

also outlines the objectives of the baseline survey,

Section II describes the methodology and approach undertaken for the study. It includes the

programme indicators, use of QIS system, data collection tools and techniques, sampling, and

summary of the survey work plan,

Section III presents the results of the impact indicators based on the household survey,

Section IV presents the result of the school survey,

Section V presents the results of the outcome indicators that assess capacities, and

Section VI presents concluding remarks and offers recommendations to inform future project

activities.

Section II. Methodology of the Baseline Survey

2.1 Indicators Measured in the Baseline

The survey was carried out to measure the pre-intervention status for the SSH4A programme at the impact

level as well as the outcome level. The impact indicators are oriented towards results to be achieved for the

population or a target group and measure progress in access and use of sanitation and hygiene facilities by

households and schools. The outcome indicators are oriented towards results to be achieved for sector

organisations and measure extent and effectiveness of capacity development. The outcome indicators were

adjusted for the context of Nepal. Tables 1 and 2 describe the impact and outcome level indicators of the

programme respectively.

Table 1. Impact Indicators of SSH4A Consumer Preference Programme

Indicator # Indicator Explanation

Impact indicator 1 Access to sanitary toilet Progress in access to a sanitary toilet

Impact indicator 1.2 Households with access to

sanitary toilet

Progress in number of households with access to

sanitary toilet

Impact indicator 1.2 Schools with access to sanitary

toilet

Progress in number of schools and number of

students (boys and girls) with access to a

sanitary toilet

Impact indicator 2 Use of hygienic toilet Progress in using a hygienic toilet at home

Impact indicator 2.1 Households that use hygienic

toilet

Progress in number of households that use

hygienic toilet when at home

Impact indicator 2.2 Schools that use hygienic toilet


students (boys and girls) that use a hygienic

toilet

Impact indicator 3 Access to hand washing

facilities Progress in using hand washing with soap

Impact indicator 3.1

Households with access to hand

washing facilities in or near the

toilet

Progress in number of households with adequate

hand washing facilities in or near the toilet

Impact indicator 3.2

Schools with access to hand

washing facilities in or near the

toilet


students (boys and girls) with adequate hand

washing facilities with soap in or near the toilet

Impact indicator 4 Use of toilet by all at all times Progress in number of households using a

sanitary toilet when at home

Table 2. Outcome Indicators

Indicator # Indicator4 Explanation

Outcome

indicator 6

Sanitation service and business

development

Progress in sanitation services and business

development

Outcome

indicator 7

Capacity to steer BCC at scale

with quality

Progress in the capacity of local organisations to

steer behaviour change communication at scale

with quality

Outcome

indicator 8

Capacity of local line agencies to

steer and monitor rural sanitation

and hygiene

Progress in the capacity of local line agencies to

steer and monitor performance in rural sanitation

and hygiene

Outcome

indicator 9

Improved enabling environment

in terms of sectorial alignment

Progress in rural sanitation and hygiene sector

alignment

Outcome

indicator 10 Pro-poor support mechanisms Progress in pro-poor support mechanisms

Outcome

indicator 11 Influence of women in WASH

Progress in the degree of influence of women

during planning and implementation of sanitation

and hygiene programmes

Outcome

indicator 13

Influence of socially excluded

groups in sanitation and hygiene

programs

Progress in the degree of influence of people from

socially excluded groups during planning and

implementation of sanitation and hygiene

programmes

4 Note: Outcome indicator 5 of the SSH4A programme looks at implementation of sanitation demand creation. The outcome indicator is to be used with the lead agency responsible for implementing sanitation demand creation at the district or sub-district level depending on which level is responsible for implementing demand creation

activities. However, in Nepal there is no single agency responsible for implementing demand creation. Government and local and international NGOs have been implementing demand creation at scale.

Outcome indicator 12 of the SSH4A programme looks at the degree of influence of the poor during planning and implementation of sanitation and hygiene programmes. As there was no wealth ranking in VDCs, it was difficult to identify poor households. In addition, people from socially excluded groups (e.g. Dalit the lower caste, ethnic and religious minorities, and indigenous groups) belonged to poor category. Hence, FGDs were conducted with socially excluded groups only.

2.2 Use of Qualitative Information System (QIS) and Capacity Development

Scorecards

The baseline survey used Qualitative Information System (QIS) and capacity development scorecard for

performance monitoring. The QIS tool was used to assess the impact indicators and the score card was used

to assess outcome indicators.

QIS

The Qualitative Information System methodology was developed by IRC (International Water and Sanitation

Centre) and WSP (Water and Sanitation Program) at the end of the 1990s. QIS methodology is used to

quantify qualitative information. This is done with the help of progressive scales called ‘ladders’. Each step

on the ‘ladder’ has a short description, called a “mini-scenario”, which are factual statements that describe

the situation (requirements / conditions) for a particular score.

Each scale ranges from:

The absence of particular indicator at the lowest level (score 0) to the optimal mini-scenario at the

highest level (score 4).

Levels 1, 2 and 3 describe scenarios between levels 0 and 4 for each specific indicator, and

The benchmark is indicated at level 2.

A typical QIS scale looks like:

Level Description

0 None of the characteristics are present (Condition or practice is not present)

1 One (easiest) characteristic is present

2 BENCHMARK: Two (easiest + next easiest) characteristics are present

3 Three (easiest + next easiest + then next easiest) character istics are present

4 IDEAL: All four (key) characteristics are present

Scorecard

The scorecard methodology is a guided self-assessment methodology that consists of a series of statements

relevant to the topic being addressed and scores the capacity of the target organisation or stakeholder in

fulfilling the conditions of the statement. A score of 0 indicates an absence of capacity and score of 4

indicates fully present capacity with in-between scores of 1-3 describing progressive increase in capacity.

0 1 2 3 4

None / Absent Area of

weakness Acceptable

Positive

strength Strong

2.3 Data Collection Tools Used in the Baseline Study

2.3.1 Household Survey

A structured questionnaire survey was conducted with households from all project districts. The survey was

carried out from sample VDCs and sample Wards. A total of 2,979 sample surveys were successfully filled.

The survey generated quantitative data for impact indicators 1 to 4 relating to households.

The survey was done with mobile phones using Akvo FLOW mobile application software; the data were then

transferred to a central dashboard. Data were collected from the head of household and /or an adult

member (18 years or older) who could give information from the respective household.

The questionnaire (Annex 1) consisted of six main modules with the following sequence:

1. Household information panel (HH)- background information for identification and general

characteristics relevant to the area

2. Household members (HM)- to understand who uses the sanitation facilities and who are the target

audiences for hygiene behaviour

3. Household characteristics /wealth index (W)- to be able to analyse data for the topics below (4-6)

according to wealth quintiles

4. Sanitation (SAN)- to understand the design and construction of the sanitation facilities (where they

exist) and its suitability from health and environment perspectives

5. Use of Sanitation (USAN)- to understand if latrines are being maintained and used

6. Hand washing (HW)- to understand hand washing behaviour

2.3.2 School Survey

The baseline study included a sample-based survey of public schools, which consisted of a semi-structured

questionnaire relating to the availability of sanitation facilities, hand-washing stations and menstrual hygiene

management. A total of 96 schools were surveyed to generate data for impact indicators 1 -3 relating to the

school population. The questionnaire was administered by interviewing the head-teacher or any other

teacher referred to by the head master (preferably the teacher appointed for Environment and Health).

These teachers could be male or female, depending on their appointment. Sanitation facilities and hand

washing station in the sample schools were also observed.

2.3.3 Focus Group Discussions and Guided Self-assessment

Outcome indicators were measured at the district level for all project districts through interaction and key

informant interviews with relevant district stakeholders using self-assessment scorecards. Interactions were

made with persons from related authorities responsible for sanitation activities at the district (WSSDO,

DWASHCC, and DDC). At the district level the chief of the WSSDO and/or the person(s) assigned by him/her

was interviewed using self-assessment scorecard. In addition, discussions were held with the Local

Development Officer (LDO) from the DDC, project LCBs and women representative(s) of DWASHCCs. All the

project districts were included for the district level capacity assessment exercise.

2.4 Sampling

The study area for the baseline survey comprised all eight project districts. Within each district, a set

number of VDCs were considered as project VDCs in accordance with the initial planning of the project and

agreement of district stakeholders, and these were used as the basis for sampling in each district. The

sampling methods, process and tools were designed in consultation with SNV WASH team and IRC. The

following sections describe the sampling process for each of the baseline survey methods.

2.4.1 Sampling for Household Survey

Each of the project districts was considered as the primary sampling unit [PSU] and thus no sampling is

performed at this level. Considering the total number of households in the project VDCs within the districts,

the total number of households to be sampled from each district was selected using the Krejcie, R. V., and

Morgan, D. W. (1970) table5.

Stratified proportional sampling methodology was then used for selecting the sampled VDCs. Depending

upon the number of project VDCs in each district, 4 to 8 VDCs were selected from each of the districts

proportionately to the number of target households in the district. The following four criteria were used to

select sample VDCs:

a. Sanitation coverage of the district,

b. Poverty index (approximated by disadvantaged groups -DAG ranking),

c. Remoteness/ accessibility of road, and

d. Spatial distribution (geographical spread).

Based on these set criteria, 47 VDCs were selected from 8 districts. Table 3 below illustrates the details of the

sampled VDCs and households.

5 http://opa.uprrp.edu/InvlnsDocs/krejcieandMorgan.pdf

http://opa.uprrp.edu/InvlnsDocs/krejcieandMorgan.pdf

Table 3. Number of sampled VDCs and households by district

In each of the selected VDCs, three wards were selected with the application of systematic random sampling

for household survey. The list of households of the selected ward was collected from the respective VDC

office. If the list of households was not available from the VDC office then the Female Community Health

Volunteers (FCHVs) were consulted for the household list in her ward. The household to be surveyed was

selected using by probability proportionate method using systematic random sampling. If the household list

of the sampled ward could not be obtained, then the total households and sampled households in each of

the VDCs were equally divided to estimate the total households and sampled households in each of the

wards. From this, a sample interval was calculated in each ward. One household was randomly selected and

the next household was selected adding the sample interval, and the process was repeated till the enrolment

of required number of households. If the respondents in the selected household could not be contacted, the

household was replaced by the immediate next household. Table 4 summarises the sampling procedure

adopted for the household survey.

District

VDCs Households

Total project VDCs Sampled VDCs Total Sampled

Dolpa 11 4 3,496 340

Jumla 13 5 10,321 400

Kalikot 13 5 9,450 366

Rolpa 22 8 21,311 403

Rukum 8 4 7,668 383

Salyan 20 6 20,837 307

Sarlahi 17 8 16,149 386

Mahottari 13 7 18,918 394

Total 117 47 82,122 2,979

Table 4. Sampling methodology for the VDCs and households

Sampling steps Description

1 Determine survey cluster All project districts (8)

2 Determine sample size per district

Sample size determined individually for each district,

considering total number of households in all project

VDCs in the district, by using Krejcie and Morgan table

Total sample size: 2,979

4 Select sample VDCs

Stratified proportional sampling methodology depending

on number of VDCs/households on the basis of 4

characteristics (sanitation coverage; poverty = DAG

index; accessibility = distance of VDC from the district

HQ in hours; and geographical spread)

Total 47 VDCs

5 Determine sample size per VDC Proportionally, based on total number of household in the

sampled VDCs

6 Select sample wards

Systematic random sampling by calculating the interval,

2 to 3 wards per VDC with a minimum of 10 sample units

(households) per ward

7 Select sample units (household) Systematic random sampling by calculating the sample

interval

2.4.2 School Survey

In each of the sampled VDCs, two schools- one primary and one above primary level- were randomly

selected. Altogether 95 public schools were selected. Table 5 below gives the distribution of sampled schools

in the baseline study districts.

Table 5. Number of sampled public schools by school level and district

District

Level of School Total no. of

schools

sampled

Primary

level

Lower

secondary level Secondary level

Higher

secondary level

Salyan 5 2 3 1 11

Rukum 1 4 2 3 10

Rolpa 8 2 4 2 16

Kalikot 4 1 5 0 10

Dolpa 3 2 3 2 10

Jumla 1 4 2 3 10

Mahottari 9 1 2 4 16

Sarlahi 8 0 1 3 12

Total 39 16 22 18 95

2.5 Training and Supervision of Enumerators

A series of interaction between RECID Nepal (core study team) and SNV Nepal was carried out to reach a

common understanding of the survey objectives and methodology. SNV Nepal organised a baseline

preparation workshop to orient consultants and supervisors about the baseline survey methods and tools,

which was followed by a training on Akvo FLOW mobile application. The core study team provided further

orientation to district supervisors, especially focusing on the household and school survey questionnaires,

QIS scale, dashboard handling and other issues.

Baseline Preparation Workshop

A four-day baseline preparation workshop was organised from 25th to 29th May, 2014 in Kathmandu. A total

of 18 people (10 SNV advisors, IRC, 2 core study team consultants and 6 supervisors) participated in the

workshop. The workshop was facilitated by Erick Baetings, Senior Sanitation Specialist of IRC. The workshop

focused on indicators of the programme (impact/outcome indicators), tools for measuring indicators (Akvo

FLOW master questionnaire, school survey questionnaire, QIS methodology and scorecard) and sampling

methodology (sample size, sample selection, etc.).

Akvo FLOW Training Workshop

A three-day training on managing data through mobile phone application was organised in from 10th to 13th

June, 2014 in Kathmandu. Two consultants and 14 supervisors including SNV advisors participated in the

training. The training focused on using the mobile application, GPS data gathering, flow of questionnaire in

the mobile, and data management on the dashboard. During the training course a half-day field exercise

was also carried out and practical issues and remedial measures were discussed in plenary.

Orientation to Supervisors

A total of 15 supervisors (2 female, 13 male) were recruited for the baseline survey. RECID Nepal organised

a one-day training for the district supervisors in Kathmandu on 14th June, 2014 whereby the roles and

responsibilities of the supervisors were explained. The supervisors were also trained in the QIS scale and

scorecard measurement methodologies as well as handling the dashboard and assuring the quality of data

and information collected by the enumerators.

Finalisation of Study Tools

Based on the indicators of the programme to be measured, the study team together with SNV WASH

team/advisors developed and finalised the study tools. During the preparatory workshop, the Akvoflow

Master Questionnaire was tested using mobile application. Annexes I and II include the details of the study

tools used for the baseline survey.

Training to Enumerators and Field Work

RECID Nepal organised a two-day mobile application training on household data collection for enumerators

in the project districts. The criteria for selecting enumerators were having certificate level or above academic

qualification and prior experience in data collection. The enumerators were selected in consultation with the

DDC, SNV LCBs and NGOs who were engaged in WASH related activities in the project districts. Most of the

enumerators were social mobilisers and community facilitators in WASH activities. For enumerators’ training,

four events were organised, involving a total of 47 enumerators (12 females and 35 males). The

enumerators’ trainings were facilitated by RECID team and supported by SNV advisors. The trainings

consisted of sessions related to understanding of WASH context, household questionnaire, mobile use,

practicing Akvo FLOW mobile application, interview techniques, research ethics and quality assurance. The

consultants and supervisors guided and supported the enumerators to perform quality work in the field and

provided timely feedback based on regular monitoring of data uploaded on the dashboard.

Table 6 shows the schedule of the training to enumerators in the project districts. The agenda of the training

schedule is attached in Annex IV. The field work (data collection) was started immediately after the

trainings. Data collection for the study was conducted in the field in July and August 2014. District level

interactions with stakeholders to assess the outcome indicators were conducted by the core consultants

together with SNV advisors.

Table 6. Akvoflow data management training to enumerators

Date Participating

District

Training

venue

No. of

Enumerators Facilitation

SNV Advisor

Support

4-5 July 2014 Sarlahi and

Mahottari Bardibas 8

Surya Binod

Pokharel, Prativa

Shrestha, Shanta

Bara

Harishova

Gurung

4-5 July 2014 Salyan and

Rukum Salyan 15

Deependra Thapa,

Ramesh Gautam,

Kshitij Gartoulla

Lek Shah

4-5 July 2014 Rolpa Rolpa 8 Kumar Pokhrel Katak Rokaya

4-5 July 2014 Kalikot Kalikot 8 Balaram Nepali Govinda Rokaya

4-5 July 2014 Jumla Jumla 8 Raju Rana Kapil Gyawali

22-24 July 2014 Dolpa Dolpa 7 Balaram Nepali

2.6 Methodology for Data Processing and Analysis

After completion of the fieldwork, all e-forms submitted to the Akvo FLOW dashboard were adequately

checked for accuracy and completeness before analysis. The data were cleaned and verified for

inconsistency, missing values and errors. After data cleaning, the second step of analysis involved

generation of syntax commands to ensure that variables were transformed appropriately for ease of

analysis.

The data processing and analysis entailed the following steps: downloading Nepal’s data from the Akvo

FLOW application and performing exploratory analysis to check for accuracy, completeness, relevance and

consistency of critical data elements; converting the downloaded data from excel to the standard SPSS

format file; performing data cleaning using a set of SPSS manipulation commands to ensure that data were

aligned to the data analysis plan and the agreed reporting template; creating a log file and performing

actual data analysis using descriptive statistics. Descriptive analysis entailed computing frequency

distributions, means and cross tabulations with chi square statistics.

Section III. Results of the Household Survey

This section describes the quantitative results of the study based on the household survey. It contains the

description of study variables including socio-demographic characteristics of the respondents and findings

related to the four impact indicators looking at access to sanitation facilities, use of sanitation facilities, hand

washing practices, and use of toilet by all at all times. It also assesses these variables with respect to other

factors including wealth quintiles and gender of household head. The results apply to the target VDCs of the

project from which sampling for the study was carried out.

3.1 Characteristics of the Respondents

This section describes basic characteristics of the survey respondents.

3.1.1 Sample Distribution by Development Region and District

The survey was carried out in two out of the five development regions of Nepal. Mid-Western Development

Region (MWDR) had comparatively higher proportion of respondents (73.8%) as compared to the Eastern

Development Region (EDR) (Table 7). The reason for such distribution was that six out of eight project

districts belong to MWDR, which include Dolpa, Jumla, Kalikot, Rolpa, Rukum and Salyan. The remaining two

districts, Mahottari and Sarlahi, are from EDR.

Table 7. Distribution of sampled households by development region and district

Frequency Percentage

Development region

Mid-Western Development Region (MWDR) 2199 73.8

Eastern Development Region (EDR) 780 26.2

District

Kalikot 366 12.3

Jumla 400 13.4

Dolpa 340 11.4

Rolpa 403 13.5

Rukum 383 12.9

Salyan 307 10.3

Mahottari 394 13.2

Sarlahi 386 13.0

Total 2979 100.0

37.1

36.7

26.2

Mountain

Hill

Terai

43.8

81.4

56.2

18.6

0%

20%

40%

60%

80%

100%

Gender of respondent Gender of the Household head

Female

Male

Figure 4. Distribution of sampled households (%) by ecological zone

Figure 5. Gender of respondent and household head

The distribution of sample households across the three ecological zones (Figure 4) shows that the

percentage of sample households from the terai ecological zone was lower than the mountains and hills.

The mountains and hills each consisted of three project districts, while there were two districts from the

terai.

3.1.2 Gender of Respondent and Household Head

Figure 5 shows the distribution of sampled households by gender of the respondent and gender of the

household head. More than half of the respondents (56.2%) were female and the remaining 43.8 percent

were male. The majority of household heads (81.4%) were male. The female-headed households in the

study area were only 18.6 percent, which also supports the fact that Nepal is a patriarchal society.

3.2 Household Characteristics

3.2.1 Basic Demographic Characteristics

There were a total of 20,058 people living in the sampled households. Almost half of the population was

male. The average household size was 6.7. More than half of the respondents (57%) had 4-8 members in

their household followed by less than 4 members (21.6%), 8-12 members (15.5%), and 12-16 members

(3.9%) and very few had greater than 16 members (1.1%) (Table 8).

Table 8. Distribution of household size

Household Size Frequency Percent

Less than 4 members 642 21.6

4-8 members 1725 57.9

8-12 members 462 15.5

12-16 members 117 3.9

More than 16 members 33 1.1

Total 2979 100.0

Age Distribution of Population

More than one-fourth (31.2%) of the households had children below 2 years of age. Nearly half (43.5%) of

the households had children under the age of 5 years. Out of the total sampled households, 94.3 percent

had women aged between 15-49 years (i.e. in their fertility years) and 58.7 percent of the households had

people older than 50 years of age (Table 9).

Table 9. Age distribution of household members

Characteristic Frequency Percent

Households with children less than 2 years 928 31.2

Households with children less than five years 1297 43.5

Households with women of reproductive age (15-49 years) group 2808 94.3

Households with people elder than 50 years 1749 58.7

Households with people with disability 410 13.8

Households with People Living with a Disability (Special Needs)

Disability is one of the major factors that determines utilisation of hygiene and sanitation facilities.

Households were asked whether any member had difficulty in seeing, walking or climbing steps, or self-care

such as washing or dressing. Nearly 2.6 percent of the population faced some form of difficulty and 13.8

percent households had at least one member with some form of disability or special needs.

3.2.2 Household Economic Status - Wealth Index

The wealth index was categorised into five groups (quintiles): poorest, poor, medium, rich and richest.

Households were distributed into quintiles relative to national ranking. Table 10 depicts the distribution of

households by wealth quintiles. The majority of the population fell in the first three wealth quintiles with

wealth ranking from poorest to medium. Half (50%) of the households belonged to the poor wealth quintile,

followed by medium (25.5%), and then the poorest (16.8%). 7.3 percent belonged to the rich category and

only 0.3 percent (10 households) was from the richest wealth quintile.

Table 10. Distribution of households by wealth quintiles

Wealth Quintile Freq. Percent

Poorest 501 16.8

Poor 1489 50.0

Medium 761 25.5

Rich 218 7.3

Richest 10 0.3

Total 2979 100.0

Analysing wealth quintiles by ecological zones showed that a smaller proportion of households from the terai

belonged to the poorest wealth quintile, as compared with the mountains and hills. Nearly half of the

households in the terai were from the medium (3rd) wealth quintile. Although the mountain and hill districts

had similar fraction of households in the poorest quintile (22.8% and 21.3% respectively), the mountain

areas had a much higher percentage of households in the second lowest- poor- quintile (63.7%) than the hill

districts (44%). There was a significant difference in the distribution of households by ecological zones. This

shows that the terai ecological zone generally had wealthier households.

Figure 6. Wealth quintile distribution (% of households) by ecological zone

Table 11 shows the distribution of households by wealth quintile for each district. The proportion of poorest

households was higher in Jumla (28.3%) followed by Rolpa (24.8%), Kalikot (23.5%), Salyan (21.8%),

Rukum (17.2%), Dolpa (15.6%), Sarlahi (3.4%) and Mahottari (0.8%). More than half of the households in

Jumla (67.5%), Kalikot (66.1%), Rolpa (58.3%), Dolpa (56.8%) and Sarlahi (51.3%) districts belonged to

the poor wealth quintile. A higher proportion of households in the two terai districts (Mahottari and Sarlahi)

were from medium and rich wealth quintiles; one of the reasons for such findings is the higher prevalence of

22.8 21.3

2.1

16.8

63.7

44

38.8

50

11.8

23.9

47.3

25.5

1.6

10.1 11.5 7.3

0.7 0.3 0.3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mountain Hill Terai Total

5th (richest)

4th

3rd

2nd

1st (poorest)

household items and assets among the wealthier households. The distribution of households by wealth

quintile is significantly different among the study districts (Pearson chi-square, P value < 0.001).

Table 11. Wealth quintile distribution by district

Quintile

Kalikot Jumla Dolpa Rolpa Rukum Salyan Mahottari Sarlahi Total

% % % % % % % % n %

Poorest 23.5 28.3 15.6 24.8 17.2 21.8 0.8 3.4 501 16.8

Poor 66.1 67.5 56.8 58.3 38.6 31.9 26.6 51.3 1489 50.0

Middle 9.0 3.3 25.0 15.6 34.5 21.5 55.6 38.9 761 25.5

Rich 1.4 1.0 2.6 1.2 9.1 22.8 16.8 6.2 218 7.3

Richest 0.0 0.0 0.0 0.0 0.5 2.0 0.3 0.3 10 0.3

Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2979 100.0

Pearson chi2, P value < 0.001

Wealth Index by Household Characteristics

Table 12 presents the wealth quintile of households by gender of household head, by presence of different

population age groups, and by presence of a member with a disability in the households. Gender of

household head was significantly associated with household wealth distribution (p < 0.001); female-headed

households had comparatively higher percentage of households on the one hand from the poorest quintile

and on the other hand from the rich wealth quintile while male-headed households had comparatively higher

percentage of household from the medium wealth quintile. Households with children less than 5 years of age

were distributed in poorest (18.9%), poor (52.3%) and medium (22.6%) quintiles. Households having a

member with a disability were more prevalent in the poorest (22.2%) and poor quintiles (59.0%) (p <

0.001).

Table 12. Wealth quintile distribution by household characteristics

Characteristics

Poorest Poor Medium Rich Richest Total Chi-

square, P-

Value % % % % % N %

Gender of household head

Male 16.0 49.9 27.1 6.6 0.2 2425 100.0

<0.001

Female 20.2 50.2 18.6 10.3 0.7 554 100.0

Households with children less than 2 years of age

Yes 19.8 53.1 20.2 6.6 0.3 928 100.0

No 15.5 48.6 28.0 7.7 0.3 2051 100.0

Households with under-five children

Yes 18.9 52.3 22.6 6.0 0.2 1297 100.0

<0.001

No 15.2 48.2 27.8 8.3 0.4 1682 100.0

Households with women of the reproductive age group (15-49 years)

Yes 16.8 49.7 25.6 7.5 0.4 2808 100.0

0.536

No 16.4 54.4 24.6 4.7 0.0 171 100.0

Households with members elder than 50 years of age

Yes 18.2 49.2 25.6 6.7 0.4 1749 100.0

0.089

No 14.9 51.1 25.5 8.2 0.2 1230 100.0

Households with people with a disability

Yes 22.2 59.0 15.1 3.2 0.5 410 100.0

<0.001

No 16.0 48.5 27.2 8.0 0.3 2567 100.0

3.3 Households with Access to a Sanitary Toilet (Impact Indicator 1.1)

Impact indicator 1.1 of the programme assesses access of households to a sanitary toilet. This indicator

looks at the existence of toilets as well as the toilet structure using a QIS scale (Table 13). The scale

reflects progressive improvement in the quality of a toilet from no toilet; a basic toilet structure where

human excreta is exposed to the environment and therefore humans and animals can come in contact with

faeces; an improved toilet that contains the faeces and prevents contact by humans and animals but may

still be accessible to flies, which are a vector for disease; an improved toilet that contains excreta and does

not allow flies to go in and out of the pit or tank by, for example, a lid or a water seal; and an improved

toilet which is also environmentally safe because it does not allow contamination of surface or ground water

sources.

Contamination of water sources takes into account various factors such as risks from overflow, leakage, or

inundation of pits and tanks, water tightness of the pit/tank, infiltration and distance to ground water table,

soil type, and location of the pit/tank with respect to water source.

Table 13. QIS scale for impact indicator 1 and benchmark level

Level Criteria Description

0 No toilet There is no toilet

1

Has toilet

Or shared toilet

There is a toilet

(i) where human excreta is exposed to the environment

Or toilet is shared between one or more households

2

BENCHMARK

Has improved toilet

(JMP definition)

There is a toilet

(ii) Where human excreta is contained in an enclosed and

covered pit or tank so that humans and animals can NOT

get in contact with human excreta (but is accessible by

flies)

3 Has improved toilet with no access to

flies

There is a toilet

(ii) where human excreta is contained in an enclosed and


get in contact with human excreta; and

(iii) where the pan has a water seal or a lid to cover the

squatting hole so that flies cannot enter or leave the pit


4 Has environmentally safe toilet

There is a toilet

(ii) where human excreta is contained in an enclosed and


get in contact with human excreta; and

(iii) where the pan has a water seal or a lid to cover the

squatting hole so that flies cannot enter or leave the pit

(iv) where human excreta is contained in such a way that it

cannot contaminate surface or ground water

In the scale, a household that does not have its own toilet but uses a shared toilet is placed at level 1 as

they are not defecating in the open. Table 13 shows the progressive levels in the QIS scale and also

describes the benchmark at level 2, which is the desired minimum standard to achieve in access to a

sanitary toilet. Therefore, the benchmark for Indicator 1.1 is to have an improved toilet as per the JMP

definition where human excreta is contained and humans and animals cannot get in contact with the

excreta; it may still however be accessible to flies.

3.3.1 Overall Access to a Sanitary Toilet

At the time of the baseline, 55.7 percent of the households were below benchmark with regards to having

access to a sanitary toilet. Under half of the households (44.3%) were at benchmark (level 2) or higher

(Figure 7).

Figure 7. Access to a sanitary toilet (%) as per benchmark level of QIS scale.

55.7

44.3

0.0

25.0

50.0

75.0

100.0

Households

At or above benchmark

Below benchmark

Table 14 shows the distribution of households according to the QIS scale. In total, 42.8 percent of the

respondents did not have access to a toilet while 12.9 percent of the households had access to either basic

sanitation in terms of a toilet in which excreta was exposed to the environment or a shared toilet (level 1).

Looking at the distribution at or above benchmark, only 0.9 percent of the households had access to an

improved toilet where excreta were contained but accessible to flies (level 2), 15.0 percent had an improved

toilet with a water seal or covered squatting hole to prevent access to flies (level 3), and 28.4 percent had

already reached the highest level (level 4) of the ladder having all the characteristics of an environmentally

safe toilet that cannot contaminate surface or ground water.

Table 14. Access to a sanitary toilet as per QIS Scale (with benchmark, level 2)

Level Criteria Frequency Percent

0 No toilet 1275 42.8

1 Has toilet or shared toilet 385 12.9

2 Improved toilet (access to flies) 26 0.9

3 Improved toilet (no access to flies) 447 15.0

4 Environmentally safe toilet 846 28.4

Total 2979 100

3.3.2 Access to a Sanitary Toilet by Ecological Zone

There was a distinct difference in level of access to a sanitary toilet across the three ecological zones.

Figure 8 shows that households in the terai were worst off with almost all (97.3%) households below

benchmark. The hill districts fared best with 69.5 percent of households at or above benchmark followed by

the mountain districts with 48.6 percent of households at or above benchmark.

Figure 8. Access to a sanitary toilet (% of households) as per benchmark level of QIS scale,

by ecological zone

Distribution as per the QIS scale for the three ecological zones showed that 96.7 percent of households in

the terai, 28.8 percent in the mountains and 18.5 percent in the hills had no access to a toilet. In the hills,

almost half of the households (46.8%) had already achieved the highest level of environmentally safe toilet,

whereas for the mountains, this number was 29.5 percent (Figure 9). Notably, for all three ecological

zones, a negligible proportion of households were at level 2 which depicts an improved toilet that has access

to flies; households who had improved toilets were toilets that were not accessible to flies or were

environmentally safe.

51.4

30.5

97.3

48.6

69.5

2.7

0.0

25.0

50.0

75.0

100.0

Mountain Hill Terai


Below benchmark

Figure 9. Access to a sanitary toilet (% of households) as per QIS scale by ecological zone

3.3.3 Access to a Sanitary Toilet by Project District

Figure 10 shows the situation of each district according to benchmark level for access to a sanitary toilet.

For Kalikot, Rolpa and Rukum districts, more than seventy percent of the households were at benchmark

level or above for the indicator. Mahottari and Sarlahi, being the two terai districts were almost completely

below benchmark. Jumla, Dolpa and Salyan had 67.0 percent, 58.2 percent and 48.9 percent of

households below benchmark respectively.

28.8

18.5

96.7

22.5

12.0

0.6

1.1

1.1

0.3

18.5

21.2

1.3

29.0

47.2

1.2

0

25

50

75

100

Mountain Hill Terai

Environmentally safe

Improved toilet (noflies)

Improved toilet (flies)

Toilet/Shared toilet

No toilet


by district

Looking at the levels of the QIS ladder, Kalikot district had comparatively higher proportion of households

(61.7%) at level 4 (environmentally safe latrine), followed by Rukum (56.1%), Rolpa (43.7%) and Salyan

(40.7%). Almost all households in the two terai districts, Mahottari and Sarlahi, were defecating in the open

at the time of the baseline (95.4% and 97.9% respectively). In Jumla, Dolpa and Salyan districts, more

than one-third of the households were defecating in the open (44.0%, 37.9%, and 33.9% respectively).

Notably, Kalikot district was an Open-Defecation-Free district at the time of the baseline but still 3.8% of the

households were defecating in the open (Figure 11).

27.9

67.0 58.2

27.5 18.8

48.9

96.2 98.4

72.1

33.0 41.8

72.5 81.2

51.1

3.8 1.6

0.0

25.0

50.0

75.0

100.0


Below benchmark

Figure 11. Access to a sanitary toilet (% of households) as per QIS scale by district

3.3.4 Access to a Sanitary Toilet by Wealth Quintile

As shown in Figure 12, more than half of the households in the poorest (51.5%), poor (54.1%), medium

(62.5%) and rich (53.7%) wealth quintiles were below the benchmark whereas only 30.0 percent of the

richest households were below the benchmark (level 2) at the baseline for Indicator 1.1.

3.8

44.0 37.9

15.4 9.4

33.9

95.4 97.9

24.0

23.0

20.3

12.2

9.4

15.0

0.8 0.5

1.1

1.5

0.6

1.5

1.0

0.7

0.3 0.4

9.3

24.3

21.8

27.3

24.0

9.8

2.0 0.4

61.7

7.3

19.4

43.7

56.1

40.7

1.5 0.8

0

25

50

75

100


Improved toilet (noflies)



No toilet


by wealth quintile

Further looking at each QIS level, only 10.0 percent of households from the richest wealth group did not

have access to a toilet. For each of the other four wealth quintiles, the highest proportion of households

were at level 0 with no access to a toilet where the largest group defecating in the open (53.9%) was from

the medium wealth quintile. Notably, the proportion of households achieving level 4 (environmentally safe

toilet) was found amongst all five wealth quintiles, although the highest proportion was from the richest

quintile: with 34.3 percent, 28.6 percent, 22.2 percent, 33.9 percent and 50.0 percent in poorest, poor,

medium, rich and richest wealth quintiles respectively (Figure 13).

51.5 54.1 62.5

53.7

30.0

48.5 45.9 37.5

46.3

70.0

0.0

25.0

50.0

75.0

100.0

Poorest Poor Medium Rich Richest

Above Bench mark

Below Bench mark

Figure 13. Access to a sanitary toilet (% of households) as per QIS scale by wealth quintile

3.3.5 Access to a Sanitary Toilet by Gender of Household Head

Looking at households headed by men and women respectively, there was a smaller proportion of female-

headed households that was below benchmark (39.4%) than male-headed households (59.5%) for the

indicator (Figure 14).


by gender of household head

36.9 40.4

53.9

35.8

10.0

14.6 13.8

8.7

17.9

20.0

0.6 0.6

1.4

0.9

10.0

13.6 16.7

13.8

11.5

10.0

34.3 28.6

22.2

33.9

50.0

0

25

50

75

100



Improved toilet (no flies)



No toilet

39.4

59.5

60.6

40.5

0.0

25.0

50.0

75.0

100.0

Female Male

Above Bench mark

Below Bench mark

Furthermore, the different levels of the QIS scale show that a greater proportion of households headed by

women had reached the highest level of having an environmentally safe toilet (37.5%) than households

headed by men (26.3%) (Figure 15).

Figure 15. Access to a sanitary toilet (% of households) as per QIS scale


3.3.6 Types of Toilets Found in the Project Area

In summary, 42.8 percent of the households had no toilet and practiced open defecation whereas 57.2

percent used their own or a shared toilet. Table 15 shows the prevalence of different categories of toilets,

with flush toilets being by far the dominant type. 50.6 percent of all households had a flush toilet; from the

total number of households having access to their own or a shared facility (1,704 households), 88.5% had

access to a flush toilet.

25.6

46.7

13.7

12.7

1.8

0.7

21.3

13.6

37.5 26.3

0.0

25.0

50.0

75.0

100.0

Female Male


Improved toilet (no flies)



No toilet

Table 15. Prevalence of different types of toilets in the project area

Type of Toilet Frequency Percent

No facility/bush/field 1275 42.8

Flush toilet 1507 50.6

Traditional pit toilet 159 5.3

Ventilated improved pit toilet 31 1.0

Others 7 0.2

Total 2979 100.0

3.4 Households that Use a Hygienic Toilet (Impact Indicator 2.1)

Impact indicator 2.1 of the programme assesses dual aspects of whether a toilet is being used and whether

it is used and maintained in a hygienic condition (Table 16).

Table 16 shows that the indicator is measured on a QIS scale where the lowest level is the condition where a

toilet is not being used either because it does not exist or it exists but nobody in the household uses it as a

toilet. The scale progresses upwards with a toilet being visibly in use for defecation; to being functional as

intended depending on the technology, for example with a working water seal or a covered squatting hole;

to having some form of superstructure and being clean inside with no faecal smears on pan wall or floor, no

used anal cleansing materials in the open, and water being available if water is used for anal cleansing or if

it is a flush toilet; and finally to having a superstructure which provides privacy. Table 16 describes the

levels from 0 – 4 of the QIS scale with the minimum benchmark at level 2 being a toilet that is used and

functional.

Table 16. QIS scale for impact indicator 2 and benchmark level.


0 No toilet or toilet is not used as

a toilet

There is no toilet, or

a toilet exists but is not in use as a toilet

1 Toilet is in use as a toilet

Toilet is visibly in use

(i) is used for defecating

2

BENCHMARK

Toilet is used and is functional


(i) is used for defecating, and

(ii) is functional as intended depending on the type of toilet (e.g.

flush toilet has a functioning water seal (not blocked) and pit

latrine has a lid that is in use and that completely covers the

squatting hole)

3 Toilet is used, functional and

clean



(ii) is functional as intended depending on the type of toilet (e.g.

flush toilet has a functioning water seal (not blocked) and pit

latrine has a lid that is in use and that completely covers the

squatting hole), and

(iii) there are no fecal smears, walls and doors are in place (any form

of superstructure), used anal cleansing materials and or sanitary

materials are not exposed, and water is available where anal

cleansing is practiced or in case of a flush toilet

4 Toilet is used, functional,

clean, with privacy



(ii) either has a functioning water seal (not blocked) or a lid that is

in use and that completely covers the squatting hole so that

rodents and or flies cannot get into the pit or tank, and

(iii) there are no fecal smears, walls and doors are in place (any form

of superstructure), used anal cleansing materials and or sanitary

materials are not exposed, and water is available where anal

cleansing is practiced or in case of a flush toilet, and

(iv) superstructure of toilet provides privacy (door can be

closed/locked)

3.4.1 Overall Use of a Hygienic Toilet

The survey revealed that slightly more than half of the total households were above benchmark (53.0%)

and slightly less than half of the households were below benchmark (47.0%) for the indicator on use of a

hygienic toilet (Figure 16).

Considering only the households that had access to a toilet (1704 out of 2979 households), most of the

households (92.6%) were at benchmark or above for the indicator and therefore were using a toilet that was

at least functional.

Figure 16. Use of a hygienic toilet (%) as per benchmark level of QIS scale.

A further look at the QIS scale shows that the largest proportion of households lay exactly on the

benchmark (50.8%) and a very small percentage was at a higher level addressing cleanliness (0.1%) or

being clean and providing privacy (2.1%) (Table 17).

Table 17. Use of a hygienic toilet as per QIS Scale (with benchmark, level 2)

Level Hygiene use and management Frequency Percent

0 No toilet or toilet is not used as a toilet 1330 44.6

1 Toilet is used as a toilet 71 2.4

2 Toilet is used and functional 1512 50.8

3 Toilet is used, functional, and clean 2 0.1

4 Toilet is used, functional, clean, with

privacy 64 2.1

Total 2979 100.0

47.0

53.0

0.0

25.0

50.0

75.0

100.0

Household


Below benchmark

From the households that had a toilet, only 3.2 percent of the households were not using the facility as a

toilet. Therefore, most of the households shown at level 0 in Table 17 (44.6%) were households who were

not using a toilet because they did not have access to a toilet.

3.4.2 Use of a Hygienic Toilet by Ecological Zone

Looking across the ecological zones shows that there was a notable difference between the zones with the

terai having the highest proportion of households below benchmark (96.9%) followed by mountain districts

(35%) and then the hill districts (23.9%) (Figure 17).

However, considering only the households which had access to a toilet, there was almost no different across

the zones with 7.7 percent, 8.6 percent, and 6.3 percent of households from the terai, mountain, and hill

eco-zones respectively being below benchmark. Therefore, a large part of the difference between eco-zones

shown in Figure 17 is because of the households who do not have access to a toilet and therefore are not

able to use a toilet.

Figure 17. Use of a hygienic toilet (% of households) as per benchmark level of QIS scale,

by ecological zone

A breakdown of the QIS scale further confirms the above as it shows that the difference between the eco-

zones for households below the benchmark was mostly at level 0 with the terai having the highest

proportion and the hills the lowest proportion in this category (Figure 18).

Separating the households for level 0 into those which had no access to a toilet versus those which had

access to a toilet but were not using it as a toilet, showed that for the terai, the few households that had

constructed a toilet were infact all using the facility as a toilet.

35.0 23.6

96.9

65.0 76.4

3.1

0.0

25.0

50.0

75.0

100.0

Mountain Hill Terai


Below benchmark

Figure 18. Use of a hygienic toilet (% of households) as per QIS scale by ecological zone

3.4.3 Use of a Hygienic Toilet by Project District

District-wise analysis shows that Rukum and Kalikot districts were faring best with 86.2 percent and 85.0

percent of households at or above benchmark for the indicator. Rolpa and Salyan districts were next best

with 76.4 percent and 64.2 percent and in Dolpa and Jumla just over half of the households were at or

above benchmark (Figure 19).


by district

31.4 21.0

96.7

3.6

2.7

0.3

62.7

72.7

2.9 0.1 2.2 3.7

0.0

25.0

50.0

75.0

100.0

Mountain Hill Terai

Toilet is used, functional, clean,with privacy

Toilet is used, functional, andclean

Toilet is used and functional

Toilet is used as a toilet

No toilet or toilet is not used asa toilet

15.0

46.3 43.2

23.6 13.8

35.8

95.9 97.9 85.0

53.8 56.8

76.4 86.2

64.2

4.1 2.1

0.0

25.0

50.0

75.0

100.0


Below benchmark

The two terai districts, Mahottari and Sarlahi, were largely below benchmark owing to the small percentage

of households having access to a toilet (Figures 19 and 20).

Figure 20 shows that from the hill and mountain districts, most of the households had toilets that were being

used and were functional, but very few had toilets that were being kept clean. Where toilets were being

kept clean, they also fulfilled the criteria of the highest rung on the scale of providing privacy (Figure 20).

Considering only the households which had a toilet, from the hill and mountain districts, all districts had

some households, albeit a small proportion (ranging between 1 and 6 percent across the districts), that were

not using the toilet facility as a toilet.

Figure 20. Use of a hygienic toilet (% of households) as per QIS scale by district

7.7

45.3 40.6

20.3 10.7

34.5

95.4 97.9

7.4

1.0

2.6

3.2

3.1

1.3

0.5

85.0

49.0 55.0

74.7

79.6

61.6

3.8 2.1

0.3 0.3

4.8 1.5 1.7

6.5 2.6

0.0

25.0

50.0

75.0

100.0

Toilet is used, functional,clean, with privacy

Toilet is used, functional,and clean

Toilet is used andfunctional


No toilet or toilet is notused as a toilet

3.4.4 Use of a Hygienic Toilet by Wealth Quintile

Wealth disaggregated analysis for the indicator showed that the rich class had the highest proportion of

households at or above benchmark (90%) followed by the rich (61.0%), poorest (58.1%), poor (55.0%) and

medium (42.8%) wealth categories (Figure 21).

However, a look at only the households having toilets showed that more than ninety percent of households

across all wealth categories were at or above benchmark with little difference between the wealth quintiles.

Therefore, as was the case with the eco-zones, a large part of the difference shown across wealth categories

in Figure 21 is owing to the households that are not able to use a toilet because they do not have access to

a toilet.


by wealth quintile

The QIS scale for the wealth quintiles shows that for all wealth quintiles, from the households that were

using a toilet, the highest proportion of households were at level 2 with the toilet being functional. Keeping

toilets clean was hardly seen (levels 3 and 4) in the lower four wealth categories. The richest category had

20 percent of households that were keeping their toilet clean and the toilet also provided privacy (Figure

22).

41.9 45.0

57.2

39.0

10.0

58.1 55.0

42.8

61.0

90.0

0.0

25.0

50.0

75.0

100.0



Below benchmark

Also in the richest category all households that had a toilet were using the facility for defecation. The other

four wealth categories had 2 – 4 percent of households that had access to a toilet but were not using it as a

toilet.

Figure 22. Use of a hygienic toilet (% of households) as per QIS scale by wealth quintile

3.4.5 Use of a Hygienic Toilet by Gender of Household Head

Figure 23 shows that a higher proportion of households with a female household head were at or above

benchmark for the indicator (69.5%) than households with a male household head (49.2) (Figure 23).

However, analysis of only those households that have a toilet shows that the proportion of households at or

above benchmark was almost the same for the two categories with 93.4 percent for female-headed

households and 92.3 percent for male-headed households. Therefore, as with the assessment by eco-zones

and wealth quintiles, the difference show in Figure 23 is largely attributable to the fact that a higher

percentage of female-headed households had access to a toilet than male-headed households.

38.9 42.5

55.2

37.2

10.0

3.0 2.5

2.0

1.8

57.1 52.6

41.0

56.9

70.0

0.1 0.1 1.0 2.4 1.7

4.1

20.0

0.0

25.0

50.0

75.0

100.0






No toilet or toilet is not used as atoilet



For both female-headed and male-headed households, the largest proportion of households that were using

a toilet were had a functional toilet (level 2) but hardly any had a clean toilet (level 3 and above) (Figure

24).

Figure 24. Use of a hygienic toilet (% of households) as per QIS scale,


30.5

50.8

69.5

49.2

0.0

25.0

50.0

75.0

100.0

Female Male


Below benchmark

28.3

48.4 2.2

2.4

65.5

47.4

0.2 3.8 1.8

0.0

25.0

50.0

75.0

100.0

Female Male






3.5 Households with Access to a Hand Washing Facility in or near the Toilet

(Impact Indicator 3.1)

This indicator assesses the existence and quality of hand washing facilities in or near a toilet as a proxy

indicator for the behaviour of safe practice of hand washing with soap after defecation, the logic being that if

a handwashing facility is easily accessible in close proximity to a toilet, then there is a greater likelihood of

people washing their hands after they have used the toilet.

Table 18. QIS scale for impact indicator 3 and benchmark level


0 No hand washing station in or near

the toilet There is no hand washing station within 10m of the toilet.

1 Hand washing (HW) station

There is a hand washing station

(i) within 10m distance of the behaviour (but no soap)

2

BENCHMARK

Hand washing station, with soap

(HWWS)


(i) within 10m distance of the behaviour

(ii) there is soap or soap alternative available (e.g. ash) (but

water can be contaminated by hands)

3 Hand washing station, with soap,

without contamination


(i) within 10m distance of the behaviour, and

(ii) the is soap or soap alternative available (e.g. ash), and

(iii) station prevents contamination of the water by hands

4

Hand washing station, with soap,

without contamination, with running

water


(i) within 10m distance of the behaviour, and

(ii) the is soap or soap alternative available (e.g. ash), and

(iii)station prevents contamination of the water by hands, and

(iv)station has running water

The QIS scale for the indicator reflects both the existence of a facility as well as the level of health safety

provided from the washing practice. The lowest level is no hand washing facility available within 10m of the

toilet. If a household does not have access to a toilet, then they automatically fall into level 0 as people are

defecating in the open and therefore have no established facility nearby. The scale moves up with a hand

washing facility being accessible but with no soap or soap substitute being present, to soap (or substitute)

being available at the point of hand washing but with possible contamination of the water being used by

hands, to a facility which prevents any contamination by hands, to a facility which also has running water.

Table 18 shows the description of the scales for indicator 3.1 and defines the benchmark (level 2) as being a

hand washing facility that has soap or a soap substitute available.

3.5.1 Overall Access to a Hand Washing Facility in or near the Toilet

The survey revealed that based on the proxy indicator of having access to a handwashing facility in or near

the toilet, only 8.1 percent of the households were at or above the benchmark for the indicator and had a

handwashing facility which had soap available in or near the toilet (Figure 25).

Figure 25. Access to a handwashing facility in or near the toilet (%)

as per benchmark level of QIS scale.

Looking at the distribution on the QIS scale, 84.5 percent were at level 0 and had no hand washing facility in

or near the toilet and included those households who had no access to a toilet. A further 7.5 percent had a

hand washing place but without soap, 2.3 percent had soap available but with possible contamination of

water by hands, 0.7 percent had a facility where water contamination did not occur, and 5 percent had

running water available at the hand washing facility (Table 19).

91.9

8.1

0.0

25.0

50.0

75.0

100.0

Household


Below benchmark

Table 19. Access to a hand washing facility in or near the toilet

as per QIS scale (with benchmark, level 2)

Level Hand Wash Frequency Percent

0 No hand washing station 2517 84.5

1 Hand washing station 222 7.5

2 Hand washing station, with soap 70 2.3

3 Hand washing station, with soap, without contamination 20 0.7

4 Hand washing station, with soap, without contamination,

with running water 150 5.0

Total 2979 100.0

3.5.2 Access to a Hand Washing Facility in or near the Toilet by Ecological Zone

Differences along ecological zones showed that the terai had the poorest status with 98.8 percent of the

households below benchmark. Mountain and hill ecological zones were similar in status with 90.8 percent

of mountain and 87.6 percent of hill districts below benchmark (Figure 26).


benchmark level of QIS scale, by ecological zone

90.8

87.6

98.8

9.2

12.4

1.2

75.0

100.0

Mountain Hill Terai


Below benchmark

The QIS scale shows that the majority of households for all eco-zones below benchmark were at level 0

having no access to a handwashing facility at or near a toilet. In the mountain and hill districts, almost 10

percent of the households had a handwashing facility but no soap available. Notably however, for those

households that were at or above benchmark, most had reached the highest level of the QIS scale with 6.6

percent of households in the mountains and 7.0 percent of households in the hills having access to a hand

washing facility with soap, no contamination and running water (Figure 27).


scale by ecological zone

3.5.3 Access to a Hand Washing Facility in or near the Toilet by Project District

From the eight project districts Salyan district had the highest proportion of households (24.4%) that were

at or above benchmark followed by Dolpa, Jumla, Rolpa and Rukum (16.2%, 10.5%, 9.2%, and 6.3%

respectively). Kalikot along with the two terai districts had more than 98 percent of households that were

below benchmark.

80.9 77.9

96.7

9.9 9.7

2.2

1.8 4.6

0.9

0.8 0.9

0.1 6.6 7.0

0.1

0.0

25.0

50.0

75.0

100.0

Mountain Hill Terai

HWWS station, with running water

HWWS station, no contamination

HWWS station

HW station

No HW station


benchmark level of QIS scale, by district

The majority of households in all project districts were not practicing hand washing after defecation and the

proportion of households falling in level 0 was especially higher in Sarlahi, Mahottari, Rukum, Jumla,

Kalikot, and Dolpa districts. In Rolpa and Kalikot, event if a hand washing facility was present, it did not

have any soap (level 1). Dolpa, Jumla, Salyan and Rolpa had the highest proportion of households (almost

10 percent) that had achieved level 4 of the indicator (hand washing with soap from running water) (Figure

29).

98.6 89.5

83.8 90.8 93.7

75.6

98.5 99.2

1.4 10.5

16.2 9.2 6.3

24.4

1.5 0.8

0.0

25.0

50.0

75.0

100.0


Below benchmark


scale by district

3.5.4 Access to a Hand Washing Facility in or near the Toilet by Wealth Quintile

Findings for the indicator across the wealth quintiles showed that there was an upward trend in the

proportion of households being at or above benchmark for the indicator moving from the lowest wealth

quintile to the highest wealth quintile with 3.8 percent, 5.6 percent, 8.3 percent, 31.2 percent, and 70.0

percent for the poorest, poor, medium, rich and richest categories respectively (Figure 30).

81.1 81.5 80.0 74.9

87.5

69.7

95.4 97.9

17.5 8.0

3.8 15.9

6.3

5.9

3.0 1.3 0.5

5.3 0.2

0.8

15.0

1.3 0.5

1.3 1.2 1.0 0.5

1.3

0.3 0.8

9.3 9.7 7.9 5.0 8.1

0.3

0.0

25.0

50.0

75.0

100.0

HWWS station, withrunning water

HWWS station, nocontamination

HWWS station

HW station

No HW station


benchmark level of QIS scale, by wealth quintile

More than 80 percent of households from poorest, poor and medium, and 58.7 percent of households from

rich quintiles did not have hand washing facilities. In case of the richest households, only 20% of them did

not have a hand washing station at an accessible distance. A higher percentage of hand washing facility

with running water (40.0%) was found among richest households, followed by decreasing values for the rich

(12.4%), medium (6.0%), poor (4.2%), and poorest (2.0%) (Figure 31).

96.2 94.4 91.7

68.8

30.0

3.8 5.6 8.3

31.2

70.0

0.0

25.0

50.0

75.0

100.0



Below benchmark


scale by wealth quintile

3.5.5 Access to a Hand Washing Facility in or near the Toilet by Gender of Household

Head

A slightly higher percentage of households headed by males were below benchmark for the indicator

(93.1%) than households headed by females (87.0) (Figure 32).


benchmark level of QIS scale, by gender of household head

88.6 87.2 84.6

58.7

20.0

7.6 7.2 7.1

10.1

10.0

1.4 0.9 1.6

16.1

30.0

0.7

2.8

2.0 4.2 6.0 12.4

40.0

0.0

25.0

50.0

75.0

100.0


HWWS with runningwater

HWWS wothoutcontamination

HWWS with potentialcontamination

Hand washing withoutsoap

No hand washing

87.0 93.1

13.0 6.9

0.0

25.0

50.0

75.0

100.0

Female Male


Below benchmark

There was not much difference for the different levels of the QIS scale for households headed by women as

compared with households headed by men for the indicator. The proportion of households with a

handwashing facility without soap was similar across the two categories. For female-headed households,

6.0 percent had reached the highest level (level 4) and for male-headed households 4.8 percent had

reached the highest level on the QIS scale.


Scale by gender of household head

3.6 Households with Use of Toilet by All at All Times at Home (Impact Indicator 4)

This indicator measures whether households use their toilet consistently when they are in or around the

house and whether all members of the household use the toilet. The aspect of “all” members includes

whether the toilet is convenient for the elderly and those living with a disability and whether it provides a

secure environment for women, adolescent girls and children. Additionally it addresses the aspect of proper

management of children’s feces. Therefore the indicator assesses issues of accessibility, convenience and

privacy, and disposal of children’s faeces as a proxy indicator for the use of toilet by all at all times when

members are in and around the house.

The QIS scale for this indicator reflects these aspects. Level 0 is for the scenario where a toilet does not

exist or it exists but is not in use as a toilet. This is the same as for level 0 for indicator 2.1 about hygienic

use of a toilet. Level 1 shows the toilet to be visibly in use. Level 2 is when the toilet is physically

accessible by all members of the family at all times including any members with difficulty such as the elderly

and those living with a disability. Level 3 ensures that the toilet provides convenience and privacy for all

79.8 85.6

7.2

7.5 6.7 1.4

6.0 4.8

0.0

25.0

50.0

75.0

100.0

Female Male

HWWS with running water

HWWS wothout contamination

HWWS with potentialcontamination

Hand washing without soap

No hand washing

members. This includes whether the superstructure and its location provide privacy and a secure

environment for women and children. Level 4 looks at evident for children’s stools. Exposure to children’s

faeces, especially faeces from children under the age of three, is a critical factor, because young children are

more likely to contaminate the household environment since they are less likely to use a latrine. It is

therefore essential that the faeces of infants and small children that are not able to go to the toilet

independently are collected and safely disposed in the toilet by a caretaker (Table 20).

Table 20. QIS scale for impact indicator 4 and benchmark level.

Level Criteria Description/Scenario

0 No toilet or toilet is not used as a

toilet

There is no toilet, or

a toilet exists but is not in use as a toilet by any of the

household members

1 Toilet is in use as a toilet


(i) is used for defecating

2

BENCHMARK

Toilet is used and accessible for all



(ii) is physically accessible for all at all times when at

home including the elderly and disabled, and

3

Toilet is used, is accessible, and

provides convenience and privacy for

all




home including the elderly and disabled; and

(iii) provides convenience and privacy for all at all times

4

Toilet is used, is accessible, provides

convenience and privacy for all, and

no children’s stools are visible




home including the elderly and disabled;

(iii) provides convenience and privacy for all at all

times; and

(iv) there is no visible evidence of children’s stools in or

around the house and surrounding yard

(faeces of infants and children who are not able to

independently go to the toilet are collected and safely

disposed)

3.6.1 Overall Use of Toilet by All at All Times at Home

Assessment of the status of use of a toilet by all at all times when at home shows that slightly under half of

the households were at or above benchmark (44.6%) and slightly more than half were below benchmark

(55.4%) for the indicator (Figure 34).

Considering only the households that had access to a toilet, however, the majority of the households were at

or above benchmark for the indicator, with 78.1 percent of households being at the minimum desired level

of having a toilet that is being used and is physically accessible for all at all times, including the elderly and

people with disabilities.

Figure 34. Use of toilet by all at all times at home (%) as per benchmark level of QIS scale

As was reported for indicator 2.1 on hygienic use of toilets, 44.6 percent of households were at level 0 and

had either no toilet or were not using it as a toilet (Table 21). Also as reported earlier, most of the

households at level 0 were infact those that did not have access to a toilet as only 3.2% of households that

had a toilet were not using the facility as a toilet.

Looking at the rest of the categories in the QIS scale (Table 21), 10.7 percent of households had a toilet

which was in use but was not physically accessible to all members of the household, including the elderly

and people with disabilities. This was a significant number because 13.8 percent of households had a

member living with a disability and 2.6 percent of the population were living with a disability, which included

any member had difficulty in seeing, walking or climbing steps, or self-care such as washing or dressing

(Table 22). Table 21 further shows that 1.6 percent of households had a toilet which was at the least

physically accessible by all members including the elderly and people with a disability, 27.7 percent had

additionally a toilet that was convenient and provided privacy for all members including women and children,

and a further 15.3 percent of households were additionally disposing off children’s faeces safely.

55.4

44.6

0.0

25.0

50.0

75.0

100.0

Households


Below benchmark

Table 21. Use of toilet by all at all times at home as per QIS scale (with benchmark, level 2)

Level Hand washing Frequency Percent



2 Toilet is used and accessible for all 47 1.6

3 Toilet is used, accessible, and provides

convenience and privacy for all 826 27.7

4 Toilet is used, is accessible, provides convenience

and privacy for all, no children’s stools are visible 457 15.3

Total 1704 100.0

Table 22. Total number and percent of households and people (household members) living with a

disability in the project area

Disability (People with special needs) n %

Total number of people with physical disability 512 2.6

Total number of households having person(s) with disability 410 13.8

3.6.2 Use of Toilet by All at All Times at Home by Ecological Zone

Figure 35 shows that there was a distinct different across the ecological zones for the indicator. The hill

districts had the highest proportion of households that were at or above benchmark (69.9%), followed by

the mountain districts (50.3%), and then the terai districts (98.7%) who were largely defecating in the

open.

Taking into account only the households that had access to a toilet, the trend was similar- the hill districts

had 85.7 percent, mountain districts had 70.6 percent and terai districts had 38.5% of households at or

above the benchmark for the indicator.


QIS scale, by ecological zone

Distribution on the QIS scale shows that for the mountain and hill districts most of the households fell in the

top two levels. In the mountain districts 31.3.0 percent were at level 3 and 17.0 percent had achieved the

highest level which indicated proper disposal of children’s stools in addition to having a toilet that was in

use, physically accessible and convenient for all at all times. In the hill districts, 43.2% had reached level 3

and a further 24.4 percent had reached level 4 (Figure 36).

Figure 36. Use of toilet by all at all times at home (% of households) as per QIS scale

by ecological zone

49.7

30.1

98.7

50.3

69.9

1.3

0.0

25.0

50.0

75.0

100.0

Mountain Hill Terai


Below benchmark

31.4 21.0

96.7

18.4

9.1

2.1

2.0

2.3

31.3

43.2

1.0

17.0 24.4

0.3

0.0

25.0

50.0

75.0

100.0

Mountain Hill Terai

Toilet is used, accessible,convenience and privacy for all,no children's stools visible

Toilet is used, accessible, withconvenience and privacy for all

Toilet is used and accessible forall



3.6.3 Use of Toilet by All at All Times at Home by Project District

The district-wise results showed that the two terai districts were similar with 98.2 percent and 99.2 percent

falling below benchmark for Mahottari and Sarlahi respectively. For the remaining districts, Rukum and

Rolpa were performing the best with 79.1 percent and 69.0 percent at or above benchmark respectively.

This was followed by Kalikot and Salyan which both had around sixty percent at or above benchmark. Dolpa

and Jumla were next lowest with 51.5 percent and 40.5 percent at or above benchmark respectively (Figure

37).


QIS scale, by district

A further breakdown of the QIS scale revealed that for households below the benchmark, in all districts

there was a notable proportion that were at level 1, i.e. the toilet was being used but was not physically

accessible to all members of the household, especially the elderly and people with disabilities. This ranged

from 8 to 33 percent of households in the three mountain districts and from 6 to 11 percent in the three hill

districts (Figure 38).

In all districts, from the households that were at or above benchmark, hardly any were at benchmark level

itself (level 2); rather almost all had either reached level 3 or 4 and thus the toilets were accessible,

convenient and offered privacy for all household members. Rukum had the highest proportion of households

that had reached level 4 where children’s faeces are also disposed of safely (33.9%) (Figure 38).

40.2

59.5 48.5

31.0 20.9

40.4

98.2 99.2

59.8

40.5 51.5

69.0 79.1

59.6

1.8 0.8

0.0

25.0

50.0

75.0

100.0


Below benchmark

Figure 38. Use of toilet by all at all times at home (% of households) as per QIS Scale by district

3.6.4 Use of Toilet by All at All Times by Wealth Quintile

Figure 39 shows that for wealth disaggregated analysis, the percentage of households below benchmark

were in ascending order as follows: richest (40.0%), rich (45.9%), poor (50.7%), poorest (55.2%), and

medium (61.6%).

Interestingly, wealth disaggregated analysis only for the households that had access to a toilet showed that

the richest wealth quintile had the highest proportion of households that were below benchmark (33.3%).

This was followed by the poor (24.9%), poorest (21.8%), medium (16.8%) and the rich (15.7%).

7.7

45.3 40.6

20.3

10.7

34.5

95.4 97.9

32.5

14.3

7.9

10.7

10.2

5.9

2.8 1.3

4.9

0.8

0.7

3.9

2.3

37.4

18.3 40.0

47.9

41.3

39.4

1.5 0.5

17.5 21.5

11.2 20.3

33.9

17.9

0.3 0.3

0.0

25.0

50.0

75.0

100.0

Toilet is used, accessible,convenience and privacy forall, no children's stools visible


Toilet is used and accessible forall


No toilet or toilet is not used asa toilet


QIS scale, by wealth quintile

Figure 40 further confirms that the richest quintile had the largest proportion (30%) of total households that

were at level 1 where the toilet was being used but was not physically accessible to all household members

and notably none of the richest households had reached level 4. For the other four wealth quintiles,

between 6 to 13 percent of households were at level 1, almost none at level 2, and a similar distribution of

households had reached levels 3 and 4 across the wealth quintiles.

50.7 55.2 61.6

45.9 40.0

49.3 44.8 38.4

54.1 60.0

0.0

25.0

50.0

75.0

100.0



Below benchmark

Figure 40. Use of toilet by all at all times at home (% of households) as per QIS Scale

by wealth quintile

3.6.5 Use of Toilet by All at All Times by Gender of Household Head

The survey revealed that a higher proportion of male-headed households (59.2%) were below the

benchmark for indicator 4 whereas only 38.6 percent of female-headed households were below the

benchmark for the indicator (Figure 41).


QIS scale, by gender of household head

38.9 42.5

55.2

37.2

10.0

11.8 12.7

6.4

8.7

30.0

2.2 1.9

0.8

0.5

29.7 27.7

24.0

34.9

60.0

17.4 15.2 13.5 18.8

0.0

25.0

50.0

75.0

100.0


Toilet is used, accessible,convenience and privacy forall, no children's stools visible

Toilet is used, accessible,with convenience and privacyfor all

Toilet is used and accessiblefor all


No toilet or toilet is not usedas a toilet

38.6

59.2

61.4

40.8

0.0

25.0

50.0

75.0

100.0

Female Male


Below benchmark

Distribution across the five levels of the QIS scale shows that a slightly higher percentage of female-headed

households (26.4%) than male-headed households (20.1%) had reached the highest level for the indicator

and thus were disposing children’s stool safely in addition to having an accessible and convenient toilet

(Figure 42).

Figure 42. Use of toilet by all at all times at home (% of households) as per QIS Scale


28.3

48.4

10.3

10.8

2.9

1.3 32.1

19.4

26.4 20.1

0.0

25.0

50.0

75.0

100.0

Female Male

Toilet is used, accessible,convenience and privacy for all, nochildren's stools visible


Toilet is used and accessible for all



3.7 Discussion of Results of the Household Survey

The household survey carried out in the target VDCs of the eight project districts provided information on

the socio-demographic characteristics of the households as well as the baseline status of the four impact

indicators measured under the SSH4A programme.

Socio-demographic data

The socio-demographic data provides the context of the project area and an insight into potential factors

that may influence the sanitation and hygiene situation. The findings confirmed that Nepal is a patriarchal

society and 81% of the households were headed by men whereas only 19% were headed by women. The

project area had an average household size of 6.7. Notably, 21% of the households had more than 8

members in their household. Having a large household size can make it more challenging to maintain toilets

in a hygienic condition and also prevent people from using a toilet at all times if there are many people

waiting to use the toilet.

Other demographic data showed that 31% of the households had children below 2 years of age for whom

disposing children’s faeces safely would be critical. 44% of the households had children under the age of

five for whom safe disposal of children’s faeces and/or having a toilet that can be conveniently used by

children would be necessary.

The survey revealed that 14% of the households had at least one member living with a disability, which was

any member who had difficulty in seeing, walking or climbing steps, or self-care such as washing or

dressing. Furthermore, 59% of households had people who were older than 50 years of age. Therefore,

there was a significant population for whom physical accessibility may be an important criterion for using a

toilet.

The sampled households were distributed into one of five wealth quintiles relative to national wealth

ranking: poorest, poor, medium, rich, or richest. The findings showed that the respondents belonged mostly

to the poor wealth category followed by medium and poorest categories. Differentiation according to the

ecological zones showed a clear distinction between the three zones with the mountain districts being the

poorest, followed by the hills, and then the terai. Notably, households having a member with a disability

were more prevalent in the poorest and poor quintiles. Whereas the two quintiles accounted for 17% and

50% of the households respectively, 22% of the poorest households and 59% of the poor households had a

member living with disabilities. Therefore, there may be a greater challenge for these households to cater

to the specific sanitation and hygiene needs of people with disabilities.

Indicator 1.1

Indicator 1 for the programme measured access of households to a sanitary toilet according to the following

progressive scale: no toilet (level 0); a basic toilet structure exists but human excreta is exposed to the

environment or there is access to a shared toilet (level 1); an improved toilet exists that contains the faeces

and prevents contact by humans and animals but may still be accessible to flies (level 2-benchmark); an

improved toilet exists that contains excreta and does not allow access to flies; and an improved toilet exists

which is environmentally safe and does not allow contamination of surface or ground water sources.

The findings showed that 43% of the project area was defecating in the open. Notably, the terai, which was

comparatively wealthier than the other ecological zones, had the highest proportion of households

defecating in the open, 97%, as compared with the hills where 19% had no access to a toilet and the

mountains where 29% had no access to a toilet. Therefore, affordability was not a key determinant for

enhancing access to sanitation. Rather, the difference in figures reflects the results of the sanitation

movement which has been adopted by the local leadership in the mountain and hill districts since a few

years. In contrast, in the terai the sanitation movement is at an early stage and people are still highly

influenced by a subsidy mindset, a message which is reinforced by the subsidies being provided to their

Indian neighbours.

Looking at the distribution on the QIS scale, the findings showed that in general, households were found to

be either defecating in the open (43%) or to be high up on the ladder at levels 3 and 4 (43% combined for

the two levels), which meant that they had at least an improved toilet which had no access to flies. Kalikot,

Rukum, Rolpa, and Salyan districts had between 41% to 62% of households that had an environmentally

safe toilet that was not polluting surface or groundwater sources. This can be attributed to the high

prevalence of water-seal flush toilets and therefore excreta are contained and there is no access to flies.

Also, the hill and mountain areas have permeable soils and in many locations the ground and surface water

sources are far away; therefore, pits do not fill up or overflow easily and the chances of contaminating

groundwater are very low. In the terai, on the other hand, environmental contamination is high risk due to

the flat land, high population densities, high groundwater table in many areas, and regular flooding events.

Therefore, although currently sanitation coverage is low, achieving level 4 with an environmentally safe

toilet is a considerable challenge.

Although there was a significant volume of households that had reached levels 3 and 4 of the QIS scale with

respect to access to a sanitary toilet, district-wise analysis showed that there was still scope for

improvement in the three mountain districts to move up the ladder from a basic toilet to the benchmark of

an improved toilet. Kalikot, Jumla, and Dolpa all had approximately 20% or slightly higher proportion of

households that had only a basic latrine. For the three hill districts- Rolpa, Rukum, and Salyan- between 9

to 15 percent of households had the scope of upgrading from a basic latrine and improved one.

At the time of the baseline, from the eight project districts, Kalikot district had already attained Open-

Defecation-Free (ODF) status; it had been declared ODF in 2013. However the survey showed that 4% of

households in Kalikot district were defecating in the open, which points to the difficulties of sustaining the

ODF status. One factor that makes it challenging is the growth of family sizes and splitting up of households

requiring new toilets. Another factor is the climatic condition with the natural landscape where annually

infrastructure is damaged due to landslides and people have to rebuild assets.

The findings also showed that there was a difference in achieving access to sanitation based on the gender

of the household head. On the one hand, a smaller proportion of female-headed households were

defecating in the open, and on the other hand, a higher proportion of female-headed households had

attained the highest level of having an environmentally safe toilet, as compared with male-headed

households.

Indicator 2.1

Indicator 2 of the programme assessed whether or not households used a hygienic toilet according to the

following progressive scale: a toilet is not being used either because it does not exist or it exists but nobody

in the household uses it as a toilet (level 0); the toilet is visibly in use for defecation (level 1); the toilet is

being used and is functional (level 2- benchmark); the toilet is in use, functional and clean (level 3); the

toilet is in use, functional, clean and provides privacy (level 4).

Comparing level zero of indicator 1 and indicator 2 showed that 42.8% of households did not have access to

a toilet (indicator 1) and 44.6% of households were not using a toilet either because they did not have

access to a toilet or because a toilet existed but it was not in use as a toilet (indicator 2). The small

difference in the two percentages highlights that in fact most of the households that were at level zero for

indicator 2 were not using a toilet because they did not have access to a toilet. Figures show that from the

households that had a toilet, 97% were using the facility as a toilet. This high usage rate can perhaps be

attributed to the no-subsidy approach adopted by the Government of Nepal where households that were

investing in making a toilet were also using that facility.

Results for indicator 2 showed that the overwhelming bottleneck in use of a hygienic toilet was cleanliness.

The majority of households that were at or above benchmark for the indicator were at level 2 indicating that

the toilet was maintained in a functional condition. As most of the households constructed flush toilets this

meant having a functioning water seal. However, only 2.2% of the households were using a toilet that was

clean. Notably, this trend was seen across ecological zones, individual districts, wealth quintiles, as well as

gender of household head.

Interestingly, indicator 2 and indicator 4 both include elements of privacy. In indicator 2, the criterion of

whether or not the toilet provides privacy is considered as the highest level (level 4) and comes after the

criterion of whether a toilet is clean or not (level 3). Results for indicator 2 showed that where toilets are

fulfilling the criterion of cleanliness (level 3), they are also fulfilling the criterion of privacy (level 4);

however, as few toilets are being kept clean, households are not able to move up the ladder to reach level 4

in the assessment of indicator 2. In indicator 4 however, privacy is addressed with respect to use of toilet

by all at all times and it is seen that 43% of the total households have a toilet which provides privacy to all.

In conclusion, the issue faced in indicator 2 was not the use of a toilet rather the issue was the hygienic

aspect of keeping the toilet in a clean condition.

Indicator 3.1

Indicator 3 for the programme assessed access of households to a hand washing facility in or near the toilet

as a proxy indicator for the behaviour of the safe practice of handwashing with soap after defecation. The

following progressive QIS scale was used to measure the indicator: no hand washing facility is available

within 10m of the toilet (level 0); a hand washing facility is accessible but no soap or soap substitute is

present (level 1); a hand washing facility is available with soap (or substitute) within 10m of the toilet but

with possible contamination of the water by hands (level 2- benchmark); a hand washing facility is available

with soap and prevents contamination by hands (level 3); a handwashing facility is available with soap and

running water. Households that do not have a toilet fall under level 0 as it is assumed that if an established

hand washing facility is not available close enough to the behaviour of defecation, there is less likelihood

that people will wash their hands after defecating and open defecation is usually done away from the

housing compound.

The results showed that 85% of households had no hand washing facility within 10m of a toilet and

therefore were not washing their hands after defecation. Moreover, in indicator 3 there was little difference

between the three ecological zones. So, even though in the terai, most of the households had yet to

construct a toilet and therefore would by default have no hand washing facility near a toilet (97%),

remarkably even for the other two eco-zones, a high proportion of households had no hand washing facility

(81% for mountains and 78% for hills).

The results for the indicator further revealed that for the most part even if households had a hand washing

facility close to the toilet, having no soap or soap substitute was a problem. Only Jumla, Dolpa and Salyan

districts had a greater proportion of households that had soap available at the hand washing station than

households that did not have soap available at the hand washing station. Kalikot district in the mountains

and Rolpa district in the hills were found to have the highest proportion of hand washing facilities without

soap.

In the mountain and hill districts, where households are at or above benchmark, i.e. they had a hand

washing facility with soap, they tended to have reached level 4 with the service of running water (with the

exception of Salyan district). This is owing to the spring-fed gravity flow water supply systems that are

prevalent in the mountain and hill districts.

There was a clear trend across wealth quintiles for the indicator with the highest proportion of households

from the poorest quintiles being below benchmark for the indicator followed by the poor, medium, rich and

richest wealth quintiles. The richest also had the highest percentage of households that had a hand washing

facility with soap and running water. Therefore it appears that people have a higher tendency to establish a

hand washing facility if they have a better economic status.

There was no notable difference in access to a hand washing facility or a facility with soap according to

gender of household head.

In conclusion, findings for indicator 3 showed that hand washing is a significant issue in the project districts

and is prevalent in all districts. Furthermore, hand washing with soap was also a critical issue in many

districts.

Indicator 4

Indicator 4 for the programme measured whether or not households demonstrated use of a toilet at all

times by all when at home according to the following progressive scale: a toilet does not exist or it exists

but is not in use as a toilet (level 0); the toilet is visibly in use (level 1); the toilet is visibly in use and

physically accessible by all members of the family at all times including any members with difficulty such as

the elderly and those living with a disability (level 2- benchmark); the toilet is visibly in use, is accessible,

and provides convenience and privacy for all members (level 3); the toilet is visibly in use, is accessible,

provides convenience and privacy, children’s stools are safely disposed (level 4).

Level 0 for indicator 4 was the same as level 0 for indicator 2. Therefore, 44.6% of households had no toilet

or did not use the facility as a toilet, out which the majority fell in the former category.

The indicator showed that 11% of households had a toilet which was in use but it was not physically

accessible to all members of the household, including the elderly and disabled. Considering that 14% of

households in the project area had a member living with a disability (i.e. they have difficulty in seeing,

walking or climbing steps, or self-care such as washing or dressing), it means that a lot of the households

who have a member with disabilities do not have a toilet which is accessible for the people with special

needs. Furthermore, even though a higher percentage of households in the poorest and poor categories

were found to have people living with disabilities (socio-demographic characteristics), notably, the richest

class had the highest proportion of households (30%) that had toilets being used which were not accessible

to all members. Therefore, it appears that ensuring toilets are physically accessible to all is more a matter

of awareness rather than of resource availability.

For households that were at or above benchmark, almost all were at level 3 or 4 and therefore were using

toilets that were accessible and providing convenience and privacy to all household members. Hence, the

toilets provide a secure environment for women and children to be able to use the toilet. However, analysis

of level 4 of the indicator showed that only 15% of households had reached the highest level where in

addition to a toilet being used by all, children’s faeces were also being disposed safely. This may perhaps be

due to the thinking that children’s faeces are considered as less dangerous, whereas in reality the opposite

is true.

In conclusion, indicator 4 showed that there were issues in ensuring physical access to toilets for people

living with a disability. However, where a toilet was physically accessible, it tended to provide convenience

and privacy to the users. Disposing children’s stool safely was a topic that needed to be addressed.

SECTION IV. Findings of School Survey

This section describes the quantitative results of the study based on school impact survey. School survey

measured the level of first three impact indicators (Access to toilet, Hygienic use of toilet, and HWWS after

defecation) as well as menstrual hygiene management practice in schools.

4.1 General (demographic) Findings

School survey was carried out in 95 schools from eight study districts. Table 24 depicts district wise

distribution of number of sample schools.

Table 19. Distribution of Sample Schools by District

District Frequency Percent

Salyan 11 11.6

Rukum 10 10.5

Rolpa 16 16.8

Kalikot 10 10.5

Dolpa 10 10.5

Jumla 10 10.5

Mahottari 16 16.8

Sarlahi 12 12.6

Total 95 100.0

The higher proportion of surveyed schools were primary level (41.1%) whereas the rest were lower

secondary level (16.8%), secondary level (23.2%) and higher secondary level (18.9%).

Figure 43. Type of School

Table 20. Distribution of Students by Type of School

Primary Lower

secondary level

Secondary

level

Higher

secondary level Total

Number of schools surveyed 39 16 22 18 95

Total number of students 6104 4642 11117 14570 36433

Mean number of students 157 290 505 809 384

Total number of boy students 3039 2443 5442 7199 18123

Total number of girl student 3080 2205 5675 7316 18276

Total number of teacher 185 147 307 302 941

Mean number of teacher 5 9 14 17 10

Number of female teacher 72 48 60 66 246

Number of male teacher 113 99 247 236 695

There were altogether 36433 students (approximately equal number of boys and girls) in the sampled

schools. The mean number of students in each school was 384. Among the total 941 teachers, male

teachers outnumbered (695) the female teachers (246). The mean number of teacher in each school was

10. The number of students as well as the number of teachers seemed higher with the increase in level of

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Primary level Lower secondary level Secondary level Higher secondary level

school. There were higher number of students and teachers in higher secondary, followed by secondary,

lower secondary and primary school.

Around 1.3 percent of students and 2.6 percent of teachers were disabled (with special needs). (Table 26)

Table 21. Number of Students and Teachers

Total Disabled

Students

Boys 18123 232

Girls 18276 253

Total 36433 485

Percentage of disabled student

1.3

Teachers

Female teachers 246 8

Male teachers 695 16

Total number of teachers 941 24

Percentage of disabled teacher

2.6

4.2 Defecation Practice in School

The survey questioned where the students and teachers defecated and urinated during school time.

Students and teachers used school toilets in most of the schools (see table 27); however, students (both

boys and girls) in more than 20 percent and teachers in 9.5 percent of the schools were practicing open

defecation.

Table 22. Defecation and Urination Practices (multiple response)

Where do the students and teachers urinate and or

defecate during the school hours?

Girls Boys Teachers

n % n % n %

School toilets 84 88.4 81 85.3 86 90.5

School urinals 27 28.4 26 27.4 14 14.7

Toilets belonging to neighbouring families 5 5.3 1 1.1 4 4.2

Public toilets 5 5.3 3 3.2 2 2.1

Home 7 7.4 4 4.2 4 4.2

Do not use any toilet (open defecation) 20 21.1 22 23.2 9 9.5

Type of Toilet in School

Table 28 shows different types of toilets (including urinals) prevalent in the sample schools. There were a

total of 166 urinals and 282 toilets in 95 sampled schools. On average, there were 3 toilets (excluding

urinals) per school. The table below also shows the average number of sanitation facilities at schools

available for girls, boys, shared and teachers.

Table 23. Access to Sanitation Facilities at Schools (number of toilet)

Type of toilet Girls only Boys only Shared Teachers Total

n average n average n average n average n average

Urinals (one cabin counts for

one) 64 0.67 72 0.76 13 0.14 17 0.18 166 1.75

Pit latrine (direct drop pit with

squatting slab) 8 0.08 6 0.06 4 0.04 7 0.07 25 0.26

VIP latrine 6 0.06 5 0.05 6 0.06 2 0.02 19 0.20

Pour-flush latrine with pan and

water seal and direct drop pit

or tank

31 0.33 26 0.27 23 0.24 32 0.34 112 1.18

Pour-flush latrine with pan

water seal and with offset pit 32 0.34 35 0.37 17 0.18 27 0.28 111 1.17

Flush toilet (with automatic

flushing mechanism) 4 0.04 4 0.04 2 0.02 5 0.05 15 0.16

Total (Including urinals) 145 1.53 148 1.56 65 0.68 90 0.95 448 4.72

Total excluding urinals 81 0.9 76 0.8 52 0.6 73 0.8 282 3

Number of users per toilet6 137 142 13 132

The ratio of toilet users and number of toilet in table 28 shows that there were 137 girls, 142 boys and 13

teachers per toilet. On average, 132 pupils (students and teachers) were using a toilet.

6 Shared toilet is counted in both girls and boys toilet.

*Shared toilet has been counted for both girls and boys.

Figure 44. Number of Students/Teachers per Toilet (excluding urinals)

Table 29 shows that more than 97 percent of the students were using toilet; however, the proportion of

students using improved toilet were only 76.7 percent.

Table 24. Access of Students to Sanitation Facilities+

Male Female Total

n % n % n %

Number of students not using toilet (Open Defecation) 389 2.1 452 2.5 841 2.3

Number of students using toilet 17728 97.9 17824 97.5 35592 97.7

Number of students using improved toilet 13742 75.9 14206 77.7 27948 76.7

Total number of students 18117

18276

36433

+This figure may give wrong conclusion, as the number of student to toilet ratio is very high and we are

changing the unit of analysis from school to individual (student).

137 142

174

151 154

191

0

20

40

60

80

100

120

140

160

180

200

Girls Boys Total

Number of students pertoilet

Number of students perimproved toilet

4.3 Schools with Access to Sanitary Toilets (Impact Indicator 1.2)

Impact indicator 1.2 of the programme accesses the progress in access to sanitary toilets in schools. This

indicator looks at the existence of latrines as well as the design quality of latrine structure using QIS scale.

The measurement of impact indicators for school were same as for household (refer to table 13 for QIS

level). The QIS score ranged from 0 to 4. A school might have more than one toilet falling in different level

of the QIS score. However, all toilets present in a school were converted into single score. The criterion for

scoring was as follows:

Score 0 if there was no toilet in school.

If there is/are toilet(s) in school, the score was calculated as:

(# level 1*1 + # level 2*2 + # level 3*3 + # level 4*4) /Total number of toilets in school

Table 30 shows that almost half (49.5%) of the schools had toilet with enclosed and covered pit (at level 2),

whereas 6.3 percent of the schools had no toilet. More than one-fifth (23.2%) of the schools had toilet

where excreta was exposed to environment and only 4.2 percent of the schools had water seal or squatting

hole covered toilet which was at least 10 meters away from water source (level 4).

The below table illustrates that 71.5% of School latrines were on and above the bench mark (level 2).

Table 25. Number of Schools with Access to Sanitary Toilets

Score/ Level Description Frequency Percent

0 No toilet 6 6.3

1 Has toilet or shared toilet 22 23.2

2 Improved toilet (access to flies) 47 49.5

3 Improved toilet (no access to flies) 16 16.8

4 Environmentally safe toilet 4 4.2

Total 95 100.0

Figure 45. Schools with Access to Toilet (Indicator 1.2)

The distribution of impact indicator 1.2 across ecological zone has been depicted in figure 45. The hill

districts had 10.8 percent of schools who scored level 4, while none of the schools in the mountains and the

terai were at level 4. The majority of schools in all ecological region were at level 2.

Figure 46. Indicator 1.2 by Ecological Region

6.3

23.2

49.5

16.8

4.2

0

10

20

30

40

50

60

70

80

90

100 Water seal or squatting holecovered and at least 10 m awayfrom water source

Water seal or squatting holecovered

Toilet with enclosed andcovered pit

Toilet, where excreta exposedto environment

No toilet

6.7% 5.4% 7.1%

26.7%

8.1%

39.3%

50.0%

51.4%

46.4%

16.7%

24.3%

7.1% 0 10.8% 0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mountain Hill Terai

Level 4

Level 3

Level 2

Level 1

Level 0

Table 31 shows the impact indicator 1.2 by districts. Higher proportion of schools had access to toilets with

enclosed and covered pit in all districts whereas only Rolpa (18.8%) and Salyan (9.1%) had toilets with

water seal or squatting hole covered and at least 10 meter away from water source.

Table 26. Schools Access to Sanitary Facilities by District

Districts

Level 0 Level 1 Level 2 Level 3 Level 4

% % % % %

Salyan 9.1 0.0 72.7 9.1 9.1

Rukum 0.0 20.0 30.0 50.0 0.0

Rolpa 6.3 6.3 50.0 18.8 18.8

Kalikot 0.0 30.0 40.0 30.0 0.0

Dolpa 10.0 20.0 70.0 0.0 0.0

Jumla 10.0 30.0 40.0 20.0 0.0

Mahottari 12.5 31.3 50.0 6.3 0.0

Sarlahi 0.0 50.0 41.7 8.3 0.0

Total 6.3 23.2 49.5 16.8 4.2

Figure 47. Impact Indicator 1.2 by Districts

4.4 Hygienic Use of Toilets in Schools (Impact Indicator 2.2)

Impact indicator 2.2 of SSH4A programme assesses the progress in hygienic use of toilet by schools. This

indicator is concerned with the operation and maintenance of sanitation facilities (latrines). The indicator

was measured in 4 levels using QIS score (See table 16 for scoring criteria).

The criteria for scoring was as follows:

Score 0 if no toilet in school.

If there is/are toilet(s) in the school, the score was calculated as:

(# level 1*1 + # level 2*2 +# level 3*3 + # level 4*4) /Total number of toilets in school

4.4.1 Hygienic Use of Toilet in School

More than half of the schools (55.8%) schools had toilet with water sealed or lid covering squatting hole

while 6.3 percent toilet were not used as toilet. Likewise more than one fifth (22.1%) schools had used toilet

9.1

0.0 6.3

0.0

10.0 10.0 12.5

0.0

0.0 20.0 6.3

30.0

20.0

30.0 31.3

50.0

72.7

30.0 50.0

40.0

70.0

40.0

50.0 41.7

9.1

50.0 18.8

30.0

0.0

20.0

6.3 8.3 9.1

0.0

18.8

0.0 0.0 0.0 0.0 0.0

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0Water seal or squatting holecovered and at least 10 maway from water source

Water seal or squatting holecovered

Toilet with enclosed andcovered pit

Toilet, where excretaexposed to environment

No toilet

for defecation and 15.8 percent schools had no visible excreta on pan and walls. Thus, 28.4% of School

latrines are below the bench mark (level 2) identified in the base line survey.

Table 27. Schools that use hygienic toilet

Score/ Level Description Frequency Percent



2 Toilet is used and functional 53 55.8

3 Toilet is used, functional, and clean 15 15.8

4 Toilet is used, functional, clean, with privacy 0 0.0

Total 95 100.0

Figure 48. Hygienic use of toilet in school

None of the schools in all ecological region could achieve score 4. In all region, higher proportion of schools

belonged to level 2 of the indicator 2.1 (Water seal or lid covering squatting hole).

6.3

22.1

55.8

15.8

0.0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1

Level 4 No cleansing materialsare exposed

Level 3 No visible excreta on panand walls

Level 2 Water seal or lid coveringsquatting hole

Level 1 Toilet used for defecation

Level 0 Toilet is not use as toilet

4.4.2 Hygienic Use of Toilet in School by District

Table 28. Schools that use hygiene toilets by districts

Districts

Level 0 Level 1 Level 2 Level 3 Level 4

% % % % %

Salyan 9.1 27.3 54.5 9.1 0.0

Rukum 0.0 40.0 50.0 10.0 0.0

Rolpa 6.3 18.8 50.0 25.0 0.0

Kalikot 0.0 0.0 50.0 50.0 0.0

Dolpa 10.0 10.0 70.0 10.0 0.0

Jumla 10.0 60.0 30.0 0.0 0.0

Mahottari 12.5 25.0 50.0 12.5 0.0

Sarlahi 0.0 0.0 91.7 8.3 0.0

Total 6.3 22.1 55.8 15.8 0.0

The proportion of schools where toilet is no toilet or toilet not as toilet (level 0) were high in Mahottari,

Dolpa, Jumla and Salyan, as compared to the other districts. Half of the schools in Kalikot got score 3, while

none of the schools in Rukum, Kalikot and Sarlahi got score 0.

Figure 49. Impact indicator 2.2 by district

4.5 Access to Hand Washing Facilities at School

This section presents the findings related to hand washing facilities in school. At first, general information

about hand washing facilities at school are described, which is followed by the QIS score of impact indicator

3.2.

4.5.1 Hand Washing Facilities at School

Two-third of the schools (66.3%) had hand washing facilities at school. Among them, higher proportion of

schools (65.1%) had hand washing place with running water, while 39.7 percent had tube well, followed by

closed water container with tap (19.0%), open water container with tap (9.5%), open and water container

with dipper (4.8% each) and others (1.6%).

9.1

0.0 6.3

0.0

10.0 10.0 12.5

0.0

27.3 40.0

18.8

0.0

10.0

60.0

25.0

0.0

54.5 50.0

50.0

50.0

70.0

30.0

50.0

91.7

9.1 10.0

25.0

50.0

10.0

0.0

12.5 8.3

0.0 0.0 0.0 0.0 0.0

0.0 0.0 0.0

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Salyan Rukum Rolpa Kalikot Dolpa Jumla Mahottari Sarlahi

Level 4

Level 3

Level 2

Level 1

Lebel 0

Table 29. Hand washing facilities at schools

Characteristics Frequency Percent

Hand washing facility at school

Yes 63 66.3

No 32 33.7

Number of hand washing facility

0 32 33.7

1 37 38.9

2 19 20.0

3 2 2.1

4 4 4.2

10 1 1.1

Water for Hand washing

Running water 41 65.1

Closed water container/tank with tap 12 19.0

Closed water container with dipper 3 4.8

Open water container with tap 6 9.5

Open water container with dipper 3 4.8

Tube well 25 39.7

Other 1 1.6

There were altogether 107 hand washing facilities in the sample schools. Among the schools which had

toilet, there were approximately 2 toilets on average. The number of toilet ranged from 1 to 4, except one

school in Dolpa, where 10 hand washing facilities were recorded. Out of total hand washing facilities, more

than 50 percent were located near toilet, while nearly 20 percent of the facilities were located near office

room. (Table 35)

Table 30. Number of Hand washing facilities

Hand washing facilities Frequency Percent

HW facilities near toilet 57 53.3

HW facilities near classroom 9 8.4

HW facilities near office room 21 19.6

HW facilities others place 20 18.7

Total 107 100

The ration of hand washing facility to students/teachers is 1:349.

4.5.2 Schools with Access to Hand Washing Facilities in or near the Toilets (Impact

Indicator 3.2)

Indicator 3.2 assessed the existence and quality of hand washing facilities in or near the toilet in school as a

proxy indicator for the behaviour of safe practice of hand washing with soap at after defecation. QIS ladder

of impact indicator 3.2 is same as impact indicator 3.1 (refer to table 18 for QIS score).

A school might have more than one hand washing facilities falling in different level of the QIS score.

However, all the HW facilities present in a school were converted into single score. The criterion for scoring

was as follows:

Score 0 if there was no hand washing facility within 10 paces of toilet.

If there is/are hand washing facilities within 10 paces of toilet in the school, the score was calculated as:

(# level 1*1 + # level 2*2 + # level 3*3 + # level 4*4) /Total number of HW facilities within 10 paces of

toilet

Half of the schools (50.5%) had no hand washing facilities within 10 paces of toilet (level 0); while one-third

(34.7%) had hand washing facilities with water within 10 paces of toilet (level 1). The proportion of schools

who were at level 4 (hand washing facility with running water and soap) was only 5.3 percent. Altogether,

85% of Schools were below the bench mark (level 2)

Table 31. Schools with Access to Hand Washing Facilities In or Near Toilets

Level Indicator 3.2 Frequency Percent

0 No hand washing station 48 50.5

1 Hand washing station 33 34.7

2 Hand washing station, with soap 7 7.4

3 Hand washing station, with soap, without contamination 2 2.1

4 Hand washing station, with soap, without contamination, with running

water 5 5.3

Total 95 100.0

Figure 50. Schools with Access to Hand Washing Facilities In or Near Toilets

50.5

34.7

7.4 2.1

5.3

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%HW facility with running (piped)water

HH facility that preventscontamination

HH facility witth water and soap

HW facility with water within 10paces of toilet

No HW facility within 10 paces oftoilet

4.5.3 Hand Washing Facilities at School by Ecological Region

Figure 51. Hand Washing Facilities In or Near Toilets across Ecological Region

Higher proportion of schools in all three ecological regions did not have hand washing facility within 10 paces

of toilet (level 0); the proportion was highest in the mountains (56.7%) followed by the terai (50.0%) and

the hills (45.9%). More than 13 percent of schools in the hills had hand washing facility within 10 paces of

toilet, equipped with soap and running water (level 4); however, none of the schools in the mountains and

the terai were at level 4.

4.5.4 Hand Washing Facilities at School by District

Around half of the schools had no hand washing facilities in or near toilets in all districts. The hill districts

(Rukum - 20%, Rolpa - 12.5% and Salyan - 9.1%) had hand washing facilities within 10 paces of toilet with

running water and soap (level 4).

56.7% 45.9% 50.0%

30.0%

29.7%

46.4%

10.0%

8.1%

3.6% 3.3%

2.7%

13.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mountain Hill Terai

Level 4

Level 3

Level 2

Level 1

Level 0

Figure 52. Hand Washing Facilities In or Near Toilets by District

4.5.5 Findings Related to Menstrual Hygiene Management at School

School survey asked different questions related to menstrual hygiene management at school which included

availability of sanitary pad in school, facilities for menstrual hygiene, disposal practice of used sanitary pad

and absenteeism of girl students due to menstruation, if any. Menstrual hygiene related questions were filled

in lower secondary, secondary and higher secondary schools (but not in primary schools). Out of 95 schools

sampled, 56 schools were above primary level.

Only 1 out of 56 schools (1.8%) had availability of sanitary pad to girls when needed at school with the

facility to use them during menstruation.

54.5 50.0

37.5

60.0 50.0

60.0 50.0 50.0

18.2 30.0

37.5

20.0 40.0 30.0 50.0

41.7

9.1 12.5

10.0

10.0 10.0 8.3

9.1

10.0 9.1 20.0

12.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0HW facility withrunning (piped)water

HH facility thatpreventscontamination

HH facility witthwater and soap

HW facility withwater within 10paces of toilet

No HW facility within10 paces of toilet

Table 32. Availability of Sanitary Pad to Girls When Needed

The questionnaire also included questions related to availability of container for storage/disposal of used

sanitary pad, availability of water in the facility including place for washing reusable napkins and cleaning

body. However, these questions were automatically skipped during data collection since only one school

reported availability of sanitary pads in school. The school had a container for storage of used napkins and

disposed the used napkins/pads by burying in school compound; however, no water was available during

observation and there was no facility for washing reusable napkins and cleaning body.

Respondents were asked whether absenteeism of girl students could be linked to menstruation. More than

one-third (37.5%) of the respondents agreed that absenteeism could be due to menstruation. When asked

about the reason for such absenteeism during menstruation, the respondents mentioned lack of adequate

facility for menstrual hygiene management at school (lack of water, bathroom, and no pads/clothes

available) as the major reason. In addition, some of the respondents mentioned traditional culture (e.g. girls

should not touch other during periods), uneasy feeling at school, shyness, etc. as some of the reasons for

absenteeism.

During the school survey, attendance register of recent months of a class was checked and noted if girl

students had been absent regularly for more than 3 days. If absenteeism was seen, the attendance register

of previous two months were checked to follow the absenteeism. If the same girl was absent in each of the

three months in an interval of 25 to 30 days, it was noted as absenteeism due to menstruation. Such

absenteeism was recorded in 22 out of 56 schools (39.3%). However, girls’ absenteeism could be due to

some other reasons.

Characteristics Frequency Percent

Availability of sanitary pad to girls when needed

Yes 1 1.8

No 55 98.2

Availability of facility to use sanitary pads during menstruation

Yes 1 1.8

No 55 98.2

4.6 Discussion of Results of Schools Survey

Impact Indicators

Regarding an access to sanitation facilities in school, around half of the schools had toilets with enclosed and

covered pits and only few schools in Rolpa and Salyan had toilets with water seal or squatting hole covered

and at least 10 meter away from water source. The majority of schools in the mountain and hill region had

access to toilets compared to schools in the terai region. This may be due to low awareness level of school

management committee/implementing body, unavailability of space or because it was not thought of as a

major issue.

Regarding the hygienic use of toilets in schools, higher proportion of schools had toilets with water seal or lid

covering squatting hole whereas no schools had reached level 4 (no cleansing materials were visible).

However, very few schools had no visible excreta on pan and walls of a toilet; it could be a result of low

level of awareness on hygiene and sanitation and unavailability of water in toilets.

Half of the schools had no hand washing facilities in or near toilets and only five percent of the schools had

hand washing facilities with running water. It showed that many schools were far behind in providing hand

washing facilities which directly impacts the health of students and teachers. Higher proportion of schools in

the terai had hand washing facilities in or near toilets compared to regions. This may be due to easy access

of water in the terai.

Menstrual Hygiene Management at School

The practice of menstrual hygiene management was quite poor in the schools. None of the schools had

sanitary pads/napkins in school for the time of menstruation at school or had facility for changing/using

pads. The baseline survey did not interact with girl students; however, the teachers mentioned that some of

the students brought pads/napkins from home for use in case of emergency. They used girls’ toilet for

changing pads. Inadequate facility for menstrual hygiene management at school (lack of water, bathroom,

and pads/clothes available) has been cited as the major reason for school absenteeism among girl students.

Section V. Findings of outcome indicators

A survey was carried out to measure outcome indicators for the SSH4A programme. The outcome indicators

measure are shown in Table 38.

Table 33. Outcome Indicators of SSH4A Consumer Preference Programme

Indicator Explanation

Outcome

Indicator 6

Sanitation service and business

development

The progress in sanitation services and business

development

Outcome

Indicator 7 Capacity to steer BCC at scale

Progress with regards to increased capacity of line

agency to steer behaviour change communication

at scale and with quality

Outcome

Indicator 8

Capacity of local line agencies to

steer and monitor rural sanitation

and hygiene

The progress in capacity of local line agencies to

steer and monitor performance in rural sanitation

and hygiene

Outcome

Indicator 9

Improved enabling environment

in terms of sectorial alignment

The progress in rural sanitation and hygiene sector

alignment

Outcome

Indicator 10 Pro-poor support mechanisms The progress in pro-poor support mechanisms

Outcome

Indicator 11 Influence of women in WASH

The progress in degree of influence of women

during planning and implementation of sanitation

and hygiene programmes

Outcome

Indicator 12

Influence of poor households in

sanitation and hygiene programs

The progress in degree of influence of people from

poor households during planning and


programmes

Outcome

Indicator 13

Influence of socially excluded

groups in sanitation and hygiene

programmes

The progress in degree of influence of people from

socially excluded groups during planning and


programmes

The outcome indicators were measured to assess baseline status of organisational and individual capacity to

implement sanitation and hygiene related activities. The SSH4A performance monitoring framework has 10

outcome indicators (indicator 5 to 14) linking to the objectives of different components.

The outcome indicators are related to government’s policy environment, strengthened capacity of local

government, private sector, and their participation for improved sector alignment. The baseline survey

assessed the capacity of local responsible actor (WSSDO/DWASHCC) on demand creation in sanitation and

hygiene, and local sector alignment in seven project districts through focus group discussions and

interactions with the key sector stakeholders at the districts. Findings of the studies are discussed below in

the subsequent sections.

5.1 Outcome Indicator 6. Progress in Sanitation Services and Business

Development

5.1.1 Data Collection Methods

Outcome indicator 6 is related to the involvement of private sector in sanitation hardware and services and

is measured at district level through interaction with private sector actors using self-assessment scorecards.

FGD with the chief of WSSDO and/or representatives, members of DWASHCC and representatives from

hardware suppliers were also conducted. The issues discussed during FGDs included general sanitation

situation of the district, actors involved in sanitation supply chain, sanitation products and services offered,

marketing, promotion and business management of sanitation products, distribution of products to rural

communities, etc. During the discussions, private sector engagement scorecard were also filled based on

what had emerged from the discussions. The score was then confirmed with the participants.

5.1.2 Findings

Main Players Involved in Latrine Construction and Their Roles in Supply Chain

Wholesalers/retailers and cement ring producers supplied toilet construction hardware products such as pan,

pipe, cement, bricks, ring, iron rods, etc. Masons and labourers were directly involved to construct latrines

in communities. In addition, transportation agents and individuals who carried sanitary hardware up to the

construction sites are also involved in supply chain.

In the mountain and hill districts, there were virtually no hardware producers; whereas, in the terai there

were a number of cement concrete ring producers involved. Table 39 depicts private sector actors’

engagement in sanitation business in the study districts. All actors in the supply chain in the project area

were male.

Table 34. Private Sector Actors Engaged in Sanitation Businesses or Related Supply Chains in the

District

Type of private sector

actors engaged in

sanitation businesses or

related supply chains in the

district

Mountain

districts Hilly districts Terai districts

Dolpa Jumla Kalikot Salyan Rukum Rolpa Sarlahi Mahottari

1. Sanitation hardware

producers (#) 0 0 0 0 0 0 25 30

2. Wholesalers / retailers (#) 10 7 8 20 40 25 30 25

3. Cement sales agents* (#) 3 3 3 5 11 8 10 10

4. Masons / carpenters (#) 20 130 145 90 150 145 200 175

5. Pit emptying service

providers (#) 0 0 0 0 0 1 10 8

6. Others, specify (#)

Total number of private

sector actors (#) 33 140 156 115 201 179 275 248

* Cement sales agents are also included in wholesalers/retailers.

Concentration of private sector actors’ were high in the terai districts as compared to the hill and mountain

districts. They mostly ran their business in district head quarter; however, some of them had installed

outreach in business centre nearby highway. Wholesalers/retailers had established their business linkages

with community level grocery shops and provided goods/materials to the community level shopkeepers to

sale their products.

Concentration of masons and carpenters were high in the hill and terai districts as compared to the

mountains.

Furthermore, a remarkable number of sanitation hardware producers were observed in the terai districts as

compared to zero sanitation hardware producers in other project districts (Table 39).

Existing businesses in the terai districts were concentrated at district head quarter, sub-district level, nearby

highway and community level in ‘General Shops’. Whereas in the hills and mountains, the hardware

businesses were concentrated at district headquarters with limited business centres at sub-district level due

to difficulties of transportation. Even in the mountain districts, the hardware businesses were managed by

limited business owners whom transported the goods and materials by aircraft and mule.

Sanitation Product and Services Offered

The most common type of latrine in community were pour flush offset pit and simple pit. The community

people used stone, wood, mud, sand, gravel, etc. as local materials and cement, pan sheet, pipe, iron rod

and GI sheet as imported materials. Hardware goods such as ceramic pan and fittings material were

imported from India, while cement, concrete rings, iron rods and PVC pipes were produced in Nepal.

People in the terai mostly used bricks for latrine construction

while those in the hills and mountains used stones. For the

construction of sub-structure (structure below ground surface),

households in the terai mostly used concrete rings, bricks,

cement, sand and a few stones while the people in the hills and

mountains mostly used stones, sand, cement and a few bricks.

Even though, masons and carpenters at local level provided

construction services, most households were quite active on

providing unskilled or semi-skilled construction labour.

The items sold by the wholesalers/retailers were mostly pans,

pipes, cement, bricks, gravel and sand. However, some of them

also kept cleansing materials, cements, iron rods, pipe fittings

and marble stone (for flooring material). In most cases,

sanitation hardware related sales were only a fraction of sales

of their other products. The proportion of income from selling

latrine related items ranged from 10 to 25 percent of the total income.

The most popular and highly demanded items were pans, pipes, cement and tiles. Pans were popular

because of hygiene concern among people whereas tiles were popular due to ongoing new constructions.

Similarly, the highest sold items were cement, iron rods and tiles. The more profitable items were tiles and

marbles. The months with highest sales were from June to October. Dry season was the most favourable

season for selling goods. The number of pans sold ranged from 15 to 300 per month depending on the size

and location of the business. Most of the wholesalers and retailers confirmed, the sales of items related to

latrines were increasing in recent years (increased on an average of 20-30 percent from last year). The

major reasons cited for the increase in sales of latrine related items were ongoing construction of new

buildings in neighbouring areas, government policy of ODF and changing consumer behaviour regarding

sanitation and hygiene through awareness campaign.

In the terai, the cost of ceramic ordinary pan ranged from NPR 550 to 650 per piece whereas the cost of

cement ranged from NPR 600 to 700 per bag (50 Kg). However, the cost of cement per bag (50 Kg) goes up

to NPR 6500 to 7500 in the mountain districts like Dolpa and NPR 800 to 900 in the hills. The cost of

construction materials were high in the hills and mountains due to high cost of transportation. Wholesalers

in central terai districts directly purchased construction hardware (cement, iron rod, pipes) from

manufacturers in Birgunj, Siraha, Hetauda, and Biratnagar. Similarly, wholesalers in the hill and mountain

districts, Mid-Western Region, purchased construction hardware from Nepalgunj, Bhairahawa and Dang.

Wholesalers in Rukum, Rolpa and Salyan districts purchased hardware goods and materials from Dang,

Butwal and Nepalgunj.

Some of the wholesalers in the terai district had their outreach at sub-district level market hubs. Most of the

time, individual consumers bought products on retail. In some cases, the wholesalers/retailers of the district

head quarter and business centre provided goods and materials to community retailers and grocery shops

who were their regular customers and bought their products in bulk regularly. They provided discount in

price to the consumers who purchased goods in large amount ranging from 5 to 25 percent depending upon

the type of goods.

The majority of wholesalers/retailers said that the price of sanitary items were increasing and the reported

increase in price was 5 to 20% from that of previous year. The prices had mostly increased for pipes, fittings

materials, sand/aggregate, and iron rods. The sharp increase (over 30%) in prices for sand and aggregates

were due to GoN’s policy to band excavation of sand and aggregate considering a fragile ecosystem of the

Churiya Hills and refine work in many places in the terai. Some of the wholesalers/retailers provided

suggestions and advices to their customers on quality, durability, prices of the products and types of toilets

as well.

In the mountain and hill districts, toilet construction work was primarily carried out by local masons. Most of

them worked on daily wages. Majority of them had not received formal training in construction and learnt

masonry skill through experience. The consumer preference study showed that it is difficult to find masons

with appropriate skills in the mountains and hills.

In general, people preferred water sealed pour-flush latrine compared to the traditional pit. Pit with dry

stone wall latrine in the hills and mountains and cement rings inside pits in the terai were widely prevalent.

In the mountains, people preferred plastic pans because of ease to transport; however, complained about

difficulty in cleaning them.

Marketing and Promotion

Businessmen got most of their customers from personal contact. Only a few customers found out about

these shops from sign board and FM radio advertisements. Similarly, some of the customers found out

through masons’ and others’ recommendations. Majority of the wholesalers/retailers did not advertise to

promote their goods; however, a few had done so in local FM stations and a very few had used some agents

to promote their goods. Businessmen selling sanitary goods and materials competed with each other by

establishing good relationship with their customers and by selling quality goods and products. When asked

about how the latrine construction items could be made accessible to the poor families, they said that it

could be done through the formulation of sound government policy on such matters followed by subsidy

from the government and important NGOs along with the support from business enterprises. None of the

wholesalers/retailers had been filed any complaint by any customers. Only 8-20 shops (per

wholesaler/retailer) competed in their market and none of them had collaborated with their competitors on

issues such as price regulation. However, the producers of cement ring, slab, brick and tile in the terai

displayed their products at their main entrance to grab costumer’s attention. Furthermore, the businessmen

in the terai who sold sophisticated sanitary materials such super flush, pan, tap items, sink basin and tiles

had showrooms and demonstrated their materials and goods to provide material choice to the costumers.

Most of the wholesalers/retailers in the terai had developed business cards; however, none had participated

in trade fair or developed and disseminated flyers.

Business Management

Most of the hardware suppliers (wholesalers/retailers and cement ring producers) had taken loan to expand

their business from financial institutions (bank and cooperatives). The loan interest rate varied in

commercial, development bank and cooperatives. Commercial banks charged 9 to 11 percent interest per

annum whereas, development banks charged slightly higher interest rate (up to 12 percent) and

cooperatives charged the highest (up to 18 percent). Commercial banks also charged for costumer services

during the loan sanction process which varied from 0.25 to 1 percent depending on the volume of loan

taken. The borrowers were required to renew their loan agreement each year from their respective banks.

The larger wholesalers/retailers preferred to take loan from commercial banks who charged lower interest

rate than development banks and cooperatives. The accessibility of banks prevailed at district head quarter

in the hill and mountain districts whereas they were available even at business centre or at sub-district level

marketing hub in case of the terai. Micro-finance institutions and cooperatives existed and provided loan in

inner parts of the terai to their customers to promote their business.

Most of the businessmen had plans to expand or extend their existing business. Some of them mentioned

that challenges for expansion of sanitation hardware business were a lack of awareness and motivation

among the customers. Furthermore, they said that such challenges could be overcome by raising awareness

campaigns, creating supportive and sound government policies, technical assistance from government and

I/NGOs along with socio-economic empowerment of people. Sanitation campaigns should not only focus on

demand creation but also give equal importance to supply side. All of them supported the idea that it was

necessary to further expand sanitation services nearby village and rural areas. Most of the cement ring

producers showed interest to expand their business by producing variety of products to address the

consumers’ needs. Few of them had schemed to upscale their business by increasing ring and tile casting

moulds. However, due to collateral problem they had limited access to borrow loan from financial

institutions.

Distribution/Transportation of Latrine Products to Rural Households

Transportation of products was primarily the responsibility of customer themselves, except when the

supplier managed the transportation in case of bulk

purchase. The supplier however did not take any

responsibility of damage occurred during

transportation.

Transportation of sanitary materials was difficult in

the hills and mountains as compared to the terai.

The materials were mostly transported by

individuals, mules, horses and donkeys in the hills

and mountains whereas tri-cycles, manual pulling

carts (for short distance) and bullock carts and

tractors (for long distance 5 to 10 Km away from

the purchased site) were used for material transportation in the terai. The middle to rich people used mules,

horses and donkeys for materials transportation. People in the hills and mountains said it was quite difficult

to carry the materials needed to construct latrines.

In case of the mountain district Dolpa, wholesalers/retailers brought construction materials from Nepalgunj

and Surkhet and sold them from Dunai and Jufal. The customers had to buy products from Dunai and Jufal

and transported it using man labourer and mule/donkey. The costumers had to walk one to three days and

the walking distance ranged from 20-40 Km away from district head quarter. In some case of the mountain

districts, however, seasonal roads were available by which retailers could transport the materials from

Surkhet and Nepalgunj.

In some part of the hill districts seasonal roads were

available for transportation of construction materials.

Most of the materials were procured from district

headquarters or market centre of adjoining districts in

the mountains because of unavailability of such

product in local market. Aircrafts were commonly used

to transport construction materials from regional

market Nepalgunj to Jumla.

In the terai, trucks were used for transportation of

materials from manufacturer to wholesalers/retailers.

Similarly, bullock carts and tractors were commonly

used to transport materials from wholesaler/retailer and concrete ring producers to costumers.

In case of the terai districts, a high number of private entrepreneurs were involved in sanitation business

and were scattered throughout the district, while in case of the hills and mountains, they were largely

concentrated at district head quarter and a few at sub-district level market hubs.

5.1.3 Scoring of Outcome Indicator 6

Table 40 shows the scores and criteria for each of the scores of outcome indicator 6.

Table 35. Ladder Level and Criteria for Outcome Indicator 6

Score Description

0 No private sector actors involved in sanitation related businesses or supply chains within reach of

the customers

1

Private sector actor,

(i) is involved in sanitation related businesses or supply chains that are within reach of the

customers.

2



customers, and

(ii) experienced increase in sales during the past year.

3



customers,

(ii) experienced increase in sales during the past year, and

(iii) markets sanitation through a form of outreach.

4



customers,

(ii) experienced increase in sales during the past year,

(iii) markets sanitation through a form of outreach, and

(iv) reaches the poorest wealth quintile.

Based on discussion with stakeholders, the level of private sector involvement has been scored.

Table 41 and radar diagram (figure 54) below shows the score obtained by each districts.

0

1

2

3

4Jumla

Dolpa

Salyan

Rukum

Rolpa

Kalikot

Sarlahi

Mahottari

Table 36. District Score of Outcome Indicator 6

District Score

Jumla 2

Dolpa 1

Salyan 2

Rukum 2

Rolpa 2

Kalikot 2

Sarlahi 3

Mahottari 3

Rolpa District

Major market centres: Liwang, Sulichaur, Ghartigaon, Holeri, Thawang and Iriwang

District head quarter Liwang was the main market place of sanitary hardware and other construction

materials in Rolpa district. Sulichaur, Ghartigaon, Holeri, Thawang and Iriwang were community market

hubs and sold daily consumable goods along with small scale construction materials. There were 5-7

hardware and sanitary materials suppliers in Libang whom purchased hardware materials from Nepalgunj,

Figure 53. Private Sector Engagement in Sanitation (district wise score)

Gorahi and Lamhi. Furthermore, they supplied a small volume of construction materials to rural market area

and also sold construction materials from grocery shop which were meant for selling daily consumable

goods. The sale of sanitary products had increased 20-30 percent in recent years. Based on that evidence,

score 2 was given for the engagement of private sector in sanitation and hygiene.

The overall excerpts from all stakeholders’ interaction showed that the private sector is directly involved in

sanitation hardware and/or services, marketing sanitation and had outreach to communities. 17 hardware

private sellers were now registered in district chamber of commerce and industry.

Rukum District

Major market centres: Musikot, Chaurjahari, Rukumkot, Aathbichkot, Gotamkot, Solabang, Simrutu and

Kankri

District head quarter Musikot was the main market place of sanitary hardware and other construction

materials in Rukum followed by Chaurjahari located in western Rukum near Jajarkot. Other market business

centres at sub-district level wee Rukumkot, Aathbichkot, Gotamkot, Solbang, Simrutu and Kankri in Rukum

district. Those sub-district level and community level business hubs sold daily consumable goods and

hardware materials. There were 7-10 hardware and sanitary material vendors in Musikot and Chaurjhari

whom brought hardware materials from Nepalgunj, Tulshipur, Gorahi and Lamhi business centre of Dang

district. They also supplied a small volume of construction materials to rural market area through grocery

shop where they sold daily consumable goods. At present Rarijyula in north is connected via seasonal road

network from Khalanga Jajarkot and Musikot district head quarter is developing a market hub and also an

entrance of Dolpa which is supplying the daily consumable goods and hard ware to Dunai, district head

quarter of Dolpa district. All sanitary hardware suppliers inquired during the study mentioned increased sale

of latrine construction materials in recent years as compared to previous years. Based on that evidence,

score 2 was given for the engagement of private sector in sanitation and hygiene.

Salyan District

Major market centres: Khalanga, Shreenagar and Kapurkot

In the district, private sectors were involved in sanitation related business and as a result, supply of

sanitation related materials had increased in comparison to previous year. However, not a single

entrepreneur was marketing nor had any outlets outside the district headquarter.

Private sectors involved in supplying sanitation materials in the district were often based in the head quarter

and a few in rural VDCs where they supplied a small quantity of materials. Retailers in those VDCs worked

as sales agent of the wholesalers in the head quarter. District head quarter Khalanga located at the centre is

a main market hub of the district. Kapurkot and Shreenagar located in southern east were connected via

Tulshipur-Rukum Musikot highway and sold daily consumable goods along with construction materials and

sanitary goods. In addition, Salle Bazaar, the entrance of Jajarkot which was connected from Chhinchhu and

junction of Salyan, Chaurjhari of Rukum and Jajarkot district head quarter is the business hub of Salyan

district in western part of Salyan district and sold sanitary hardware and daily consumable goods. Overall,

there were 7-10 hardware suppliers mainly located in the district head quarter Khalanga and Kapurkot and

Salle bazaar. Khalanga based wholesalers/retailers had local connection and linkages to sell goods to their

regular shop keepers in the rural area. Based on the business people experiences they have been increasing

their business as capitalise their experiences and expansion their business and given 2 score.

Dolpa District

Major market centres: Dunai Bazaar, Jufal and Tripurasundari

8-10 wholesalers/retailers were supplying sanitary hardware in the district. Majority of them were found in

the district head quarter Dunai and a few at sub-district level Junai. Few grocery shops found in

Tripurasundari sold a small amount of sanitary products along with consumable goods. There were no

outreach to supply latrine construction materials from their own outreach. Based on those experiences,

wholesalers/retailers had expanded their production to meet the demand. Overall, demand for latrine

construction had increased 25-30 % in Dolpa. (Score 1)

Mahottari District

Major market centres: Bardibas, Jaleswar, Gausala, Aaurahi, Ramgopalpur, Sarpallo, Samsi, and

Raghunathpur

In Mahottari district, 25-30 cement ring producers and around 20-30 wholesalers/retailers of hardware

sales entrepreneurs were working to supply sanitary hard-ware from district head quarter and sub-district

level business centre nearby East West highway. Few of them had outreach centre and linkages to sale their

products through market linkages. Based on that evidence, score 3 was given for the engagement of

private sector in sanitation and hygiene.

Sarlahi District

Major market centres: Malangawa, Lalbandi, Haruyaun, Nawalpur, Naya Bazzar, Karmaiya, Barthawa,

Haripur, Gadaita and Maismara barrage

In Sarlahi, 20-25 cement ring producers and around 25-30 wholesalers/retailers of hardware sales

entrepreneurs were working to supply sanitary hardware from district head quarter and sub district level

business centre. Few of them had outreach centre and linkages to sale their products through market

linkages. Based on that evidence, score 3 was given for the engagement of private sector in sanitation and

hygiene.

5.1.4 Discussion on Outcome Indicator 6

Outcome indicator 6 is related to the engagement of private sector in sales of sanitation hardware and

services. In terai districts, with better road connectivity and high population density, more number of supply

chain actors were engaged in supply chain than in the hills and mountains. In terai districts, private sectors

also engaged to manufacture a large volume of cement. Concrete ring producers, high number of

wholesalers/retailers of sanitary and hardware materials from district head quarter and sub-district level

business centres sold their products through their own outreach and/or supplied materials to community

level retailers and grocery shops. Cement ring producers were also found at community level and supplied

their products in 5 to 7 VDCs. Due to better transportation access, cost of latrine construction is found to be

50% cheaper compared to the hills and the terai. Masons were found in all VDCs and they were not only

constructing buildings and latrines but also acted as advisors. They had improved their technical skills from

experiences. In the terai districts, relatively higher number of financial institutions were active and provided

loan to hardware wholesalers/retailers and ring producers. The potential for latrine construction was found

very high in the terai. Wholesalers/retailers were also interested in scaling up their business.

WSSDO, who concentrated highly in demand side in the past, had now realised the importance of supply

side as well. WSSDO, Dolpa and NGO working in WASH sector provided sanitary hardware materials to the

consumers to increase access to sanitation facilities. WSSDO, Sarlahi in coordination with IDE provided

marketing and sales promotion training with product promotion to cement ring producers focusing in rural

area.

In the hill and mountain districts, there were a few number of private sectors engaged in supply chain. They

mostly engaged in district head quarter and very few business centres were developed in the rural area. Few

mason/artisans were active in latrine and building construction works. Furthermore, some masons in Dolpa

were from Ramechhap and Jajarkot district. People in Dolpa preferred masons from Ramechhap district

followed by masons from Jajarkot district as they provided quality work. Nonetheless, across all ecological

zones, wholesalers/retailers did not have strong outreach in rural area. Even the large scale

wholesalers/retailers had not aggressively promoted their business, despite an increase in demand for

sanitation hardware. Mason/artisans were not trained and mostly acquired their skills through experience.

Most of the masons were technically weak to fit slab, pan or pipe properly. Also, the capacity building

institutions WSSDO and I/NGOs were more focused in demand creation than supply chain promotion.

Customers had very limited or zero technical options available for building a latrine; the terai located at 75

MSL and Dolpa at more than 2500 MSL used same technology which is not workable. Thus, improvement of

technology along with maximum use of local materials in the mountain district is another option to meet

sanitation national goal.

The existing method of supply chain needs to be improved to increase an access to sanitary materials in

remote area. A VDC could collect demand for toilet construction and put forward the demand to

wholesalers/retailers and in turn the wholesalers/retailers could manage transportation of sanitary materials

in bulk which would reduce transportation costs and increase access to sanitary materials at the community

level. In the terai, WSSDO and VWASHCC needs to encourage cement ring producers to establish their

business in rural community to increase community peoples’ access to latrine construction materials.

5.2 Outcome Indicator 7. Progress with Regards to Increased Capacity of Line

Agency to Steer Behaviour Change Communication at Scale and with Quality

Outcome indicator 7 measures the progress in increased capacity of district line agency (WSSDO) to steer

behaviour change communication activities at scale with quality. Outcome indicator 7 was used with WSSDO

which is the lead agency responsible for implementing BCC interventions.

Table 37. Statements and Score Criteria for Outcome Indicator 7

Organisational elements

and statements 0 1 2 3 4

1. Has led the development

of a district BCC strategy

that includes sanitation and

hygiene focus behaviours

and target groups in line

with national guidance

and/or plans.

There is no

physical

evidence of

a district

BCC

strategy.

i) A hard copy

of BCC

strategy is

available in

the office.

i) A hard copy

of BCC

strategy is

available in

the office;

and

ii) It provides

all details

about the

intended

results and

required

resources.

i) A hard copy of

OP is available in

the office;

ii) It provides all

details about the

intended results

and required

resources; and

iii) It is time

bound, realistic

and therefore

doable.

i) A hard copy of OP is

available in the office;

ii) It provides all details

about intended results

and required

resources;

iii) It is time bound,

realistic and therefore

doable; and

iv) It is shared with,

understood and used

by all BCC

stakeholders.

2. Ensures that a clear

division of roles and

responsibilities to implement

the strategy is defined

between the stakeholder

organisations in BCC

There is no

physical

evidence of

a clear

division of

roles and

responsibilit

ies.

i) The

organisational

/ stakeholder

roles and

responsibilitie

s are clearly

defined.

i) The

organisational

roles and

responsibilitie

s are clearly

defined; and

ii) Field

implementati

on,

supervisory

and quality

control roles

or functions

are clearly

separated.

i) Within the

organisation,

roles and

responsibilities

are clearly

defined;

ii) Field

implementation,

supervisory and

quality control

roles or functions

are clearly

separated; and

iii) This is well

documented.

i) Within the

organisation, roles and

responsibilities are

clearly defined;

ii) Field

implementation,

supervisory and quality

control roles or

functions are clearly

separated;

iii) This is well

documented;

v) It is available,

understood and used

by all stakeholder

organisations.

3. Is mobilising adequate

human and financial

resources to implement BCC

activities in line with district

strategy

No

resources

are being

mobilised

for

implementa

tion of

district

strategy.

i) Resources

have been

mobilised but

are not being

used to

implement

BCC activities

in line with

strategy.

i) Resources

have been

mobilised;

and

ii)

Implementers

are being

guided to

develop

activities/tool

s as per

district

strategy.

(i) plus

(ii) Plus (iii)

Resources have

been mobilised

and are being

used to

implement

prioritized BCC

activities in line

with the district

strategy.

i) plus

ii) plus

iii) plus

iv) The activities

implemented are being

shared with all BCC

stakeholders.

4. Leads BCC strategy

development based on

formative research or

evidence of motivators

There is no

physical

evidence

that

formative

research

has been

undertaken

in project

area.

i) Hard copies

exist of a

report with

outcomes of

formative

research.

i) Hard copies

exist of a

report with

outcomes of

formative

research; and

ii) The report

provides an

insight to

barriers and

motivating

factors of the

main

population

segments.

i) Hard copies

exist of a report

with outcomes of

formative

research;

ii) The report

provides an

insight to barriers

and motivating

factors of the

main population

segments; and

iii) The main

outcomes of the

formative

research are

shared with and

understood by all

relevant

organisations

responsible for

BCC activities.

i) Hard copies exist of

a report with outcomes

of formative research;

ii) The report provides

an insight to existing

KAP of the main

population segments;

plus (iii) plus

iv) The main outcomes

of the formative

research are used for

developing a localised

BCC strategy together

with stakeholder

organisations

responsible for BCC

activities.

5. Ensures that effectiveness

of messages and materials

are tested with target

audience

Messages

and

materials

are not field

tested.

i) Messages

and materials

are tested but

not

specifically

with target

audience.

i) Evidence

that

messages and

materials are

tested before

use with an

applicable

target group

in terms of

understandin

g of key

messages and

appropriatene

ss.

i) Evidence that

messages and

materials are

tested before use

with an applicable

target group in

terms of

understanding of

communication

objectives, key

messages and

appropriateness.

ii) Materials have

been adjusted

based on

outcomes of

testing, if

required.

i) Evidence that

messages and

materials are tested

before use with an

applicable target group

in terms of

understanding of key

messages and

appropriateness; and

ii) Adjusted materials

have been shared with

all stakeholder

organisations.

6. Ensures that training to

facilitators or other

implementers in BCC

approaches is being

provided to an adequate

standard

There is no

training

being

provided for

facilitators

in BCC

approaches

and tools.

i) Training

has been

provided but

was not

assessed.

i) Training

has been

provided and

assessed; and

ii) Hard

copies exist of

the necessary

tools and

training

reports.

i) Training has

been provided

and assessed with

facilitators

achieving an

adequate

standard; plus

(ii) plus (iii)

Based on training

report and

assessment,

WSSDO provided

feedback to

training

organisation to

ensure adequate

standard.

i) Training has been

provided and assessed

with facilitators

achieving an adequate

standard; plus (ii) plus

(iii)

iv) Training

organisation

incorporated any feed

back into training

curriculum.

7. Ensures that regular

assessment of the

performance of facilitators of

BCC interventions is being

done by implementing

organisation

There is no

assessment

of

facilitators

in BCC

approaches

and tools

taking

place.

i) Follow-up

assessments

are being

done on an

ad-hoc basis.

i) Follow-up

assessments

are being

done in a

planned

manner.

i) Follow-up

assessments are

being done in a

planned manner;

and

ii) Documented.

i) plus

(ii) plus

iii) Feedback is being

provided to facilitators

based on assessment

and document.

8. Facilitates review on

effectiveness of BCC

interventions based on

monitoring or lessons

learned

Effectivenes

s of BCC

intervention

s has not

been

reviewed.

i) Monitoring

or lessons

learnt

exercise has

been done on

effectiveness

of BCC

interventions.

i) Plus

ii) Review

exercise has

been done

and BCC

approaches/t

ools/activities

are adjusted.

i) Adjusted BCC

approaches/tools/

activities are

shared with all

BCC stakeholder

organisations.

i) Adjusted BCC

approaches/tools/activi

ties are shared with all

BCC stakeholder

organisations and are

being applied.

Table 38. Outcome Indicator 7, District Wise Score

Organisational statements Rolpa Rukum Salyan Jumla Kalikot Dolpa Sarlahi Mahottari Average

1. Has led the development of a

district BCC strategy that includes

sanitation and hygiene focus

behaviours and target groups in line

with national guidance and/or plans

0 0 0 2 2 2 0 1

2. Ensures that a clear division of

roles and responsibilities to

implement the strategy is defined

between the stakeholder

organisations in BCC

0 0 0 0 0 0 0 0

3. Is mobilising adequate human

and financial resources to

implement BCC activities in line

with district strategy

0 0 0 1 0 0 0 0

4. Leads BCC strategy development

based on formative research or

evidence of motivators

0 0 0 0 0 0 0 0

5. Ensures that effectiveness of

messages and materials are tested

with target audience

0 0 0 0 0 0 0 0

6. Ensures that training to

facilitators or other implementers in

BCC approaches is being provided

to an adequate standard

1 1 0 1 1 0 0 0

7. Ensures that regular assessment

of the performance of facilitators of

BCC interventions is being done by

implementing organisation

0 0 0 0 0 0 0 0

8. Facilitates review on

effectiveness of BCC interventions

based on monitoring or lessons

learned

0 0 0 0 0 0 0 0

Jumla, Kalikot and Dolpa developed a BCC strategy

that included sanitation and hygiene focused

behaviour change interventions. In these districts,

there was a district BCC work plan prepared. The

plan provided details on expected outcomes of BCC

activities. In Mahottari district, there was no

separate BBC plan; however, some BCC activities

were incorporated in the district WASH strategic

plan. The districts which had sanitation strategic

plan incorporated BCC as a component but did not

allocate separate budget or include resource detail.

The hill (Rolpa and Rukum), and mountain (Jumla

and Kalikot) districts were providing training to

local facilitators in BCC approaches. However, no

specific standards on training were made and hard copies of training reports and tools used were found.

Awareness programmes related to sanitation and hygiene were launched through different media such as

radio/FM, posters, pamphlets, wall painting, etc. Different organisations (e.g. UNICEF and UMN in Rukum,

Red Cross in Salyan, SNV and INF in Jumla, Oxfam and IDE in Siraha, Oxfam and UNHABITAT in Mahottari)

were supporting such awareness raising activities.

None of the studied districts had carried out formative research nor had evidence of motivators’ engaged in

developing BCC materials. However, project districts displayed most of BCC materials which were adopted

and prepared by other supporting organisations with NGOs initiation except for local Radio/FM aerial and

wall painting. There was no prepared schedule nor tools developed for monitoring effectiveness of BCC

materials in the project districts. Sometimes follow up of local Radio/FM disseminated message was done on

an ad hoc basis during the WSSDO and or DWASHCC official field visit. Even in the terai district, some of the

BCC materials were installed in strategic place (Market day place-HAT BAZAAR, in front of DDC, WSSDO,

main market area of district business centre etc.) by WSSDO, but those materials were not retained for long

time and lost within a few days. It showed that they had not developed a local level committee to display

and take ownership of BCC materials to educate rural people or target audiences. None of the studied

districts had institutionalized documentation and knowledge sharing mechanism.

BCC activities were not well guided by developed strategy. BCC materials should be developed considering

ecological aspect as well, where language, culture, and dress materials are not similar. If the local

communities have an option to observe their own language, dress materials and culture, they would have

ownership on BCC materials and could easily communicate message in their practices. DWSSDO was yet to

take lead role in developing BCC strategy in most of the districts. Despite the increasing sanitation coverage

in recent years, the implementation of concrete strategic steps on BCC is a most desired area of intervention

for accelerating sanitation and hygiene behaviour promotion in rural communities.

5.3 Outcome Indicator 8. Progress in Capacity of Local Line Agencies to Steer

and Monitor Performance in Rural Sanitation and Hygiene

Outcome indicator 8 assessed the capacity of district-level leading government agencies (which include

WSSDO/SDOs) to steer and monitor performance in rural sanitation and hygiene. Measuring baseline status

for this indicator was based on ten organisational statements (dimensions) related to capacity of a district

line agency (WSSDO/SDOs), and each of the statements were scored in a continuum from 0 to 4 (0=non-

existent; 4=fully present). Table 44 shows the organisational statements and criteria for scoring.

Table 39. Statements and Capacity Score Criteria for Outcome Indicator 8

Rolpa District

In Rolpa district, out of ten statements, statements 1 (setting priority and target in line with national

policies), 2(has plan for implementation) obtained the highest score of 3 compared to other statements.

Statements 3 (ensure human and financial resources), statement 5 (give active follow up), statemen6 (has

monitoring system) and statement 10 (adjust based on monitoring) were found to have improved at most

with score of 2. The district had developed sanitation and hygiene strategic plan for entire district in

collaboration with various stakeholders who were working in WASH sector; however, the stakeholders and

their staff were yet to fully develop a common understanding among them since the work division and the

responsibility was not clearer. At the time of assessment, stakeholders were gradually adopting sanitation

and hygiene strategic plan to implement their sanitation related projects in the districts.

However, the district needs to improve in the following areas (statements): (a) Has a clear division of role

and responsibility (b) in monitoring social inclusion, and (c) Review village status for sustainability and

coverage. The scores obtained for each of the ten organisational statements by Rolpa district has been

graphically presented in figure 54 below.

Figure 54. Outcome Indicator 8, Rolpa District

The detail score is graphically presented in the Figure 54 above.

0

1

2

3

4

Set priority and target in linewith national policies

Has a plan for implementation

Enusre human and financialresources

Has a clear division of role andresponsibility

Give active follow up

Has monitoring system

Ensure sharing of information

Monitor social inclusion

Review village status forsustainability and coverage

Adjust based on monitoring

Rukum District

In Rukum district, out of ten statements, the strongest were statement 1 (setting priority and target in line

with national policies) and statement 2(has plan for implementation); they had the highest score (4). Four

other statements (give active follow up, has monitoring system, ensure sharing of information and adjust

plan and actions after monitoring) obtained the second highest score (3). However, the district needs to

improve on two areas; monitoring on social inclusion and dividing role and responsibility for each.

Figure 55. Outcome Indicator 8, Rukum District

Salyan District

Out of ten statements assessed in Salyan district, the statement 1 and 2 (setting priority and targets in line

with the national policy and has a plan for implementation) obtained a score of 2. Statement 4 (has a clear

division of role and responsibility) and statement 8 (monitor social inclusion) had the lowest score (0). Rest

of other statements were also found very weak (score1).

0

1

2

3

4

Set priority and target inline with national policies

Has a plan forimplementation

Enusre human andfinancial resources

Has a clear division ofrole and responsibility



Ensure sharing ofinformation


Adjust based onmonitoring

Figure 56. Outcome Indicator 8, Salyan District


Jumla District

In Jumla district, statements 1 (setting priority and target in line with national policies), statement 2(has

plan for implementation) and statement 7 (ensure sharing of information) obtained the highest score of 3

compared to other statements.

The district had developed sanitation and hygiene strategic plan for the entire district in collaboration with

various stakeholders who were working in WASH sector; however, stakeholders and their staff were yet to

fully develop a common understanding among them and needs to have a clear division of role and

responsibility of each.

Five out of 10 statements (Ensure human and financial resources, has a clear division of role and

responsibility, give active follow up, has monitoring system and adjust based on monitoring) obtained a

score of 2.

0

1

2

3

4




Has a clear division of roleand responsibility






Figure 57. Outcome Indicator 8, Jumla District

The detail score is graphically presented in the figure 57 above.

Kalikot District

In Kalikot district, statements 1 (setting priority and target in line with national policies), and statement

2(has plan for implementation) obtained the highest score of 3 compared to other statements. Three out of

10 statements (Ensure human and financial resources, has monitoring system and review village status for

sustainability and coverage) obtained a score of 2.

The district had developed sanitation and hygiene strategic plan for entire district in collaboration with

various stakeholders who were working in WASH sector; however, stakeholders and their staff were yet to

fully develop a common understanding among them and dividing roles and responsibility for each was still

lacking. Monitoring on social inclusion, follow up in regular and adjust the program activities based on

monitoring needs a lot of attention as they were sored very low ( 1 and below).

0

1

2

3

4










Figure 58. Outcome Indicator 8, Kalikot District


Dolpa District

In Dolpa district, statements 1 (setting priority and target in line with national policies), and statement

2(has plan for implementation) obtained the highest score of 3 compared to other statements. The district

was found weak in other areas since only other 3 statements (ensuring resources, clearly dividing roles and

responsibility and review village sanitation and hygiene status for the sustainability) out of 10 had obtained

score 1 and have a nil score in other 5 statements that includes setting up monitoring mechanism, providing

regular follow up, sharing of information monitoring social inclusion and adjusting the program activities

based on the monitoring.

The scores obtained by each of the 10 organisational statements in Dolpa district are graphically presented

in Figure 59 below.

0

1

2

3

4




Has a clear division ofrole and responsibility





Review village status forsustainability and

coverage


Figure 59. Outcome Indicator 8, Dolpa District

Sarlahi District

In Sarlahi district, a generic plan incorporating demand creation component was available; however,

implementation part needed to be further improved and strengthened compared to the scores of other

statements since no clear targets and objectives were set focusing the national policy.

Five out of ten statements were considered absent (0 level) (Fig. 7). The main areas for improvement were

found on statements (1) develop the strategic plan with clear objectives and targets, (2) ensure

implementation plan is available with clear monitoring mechanism and process and monitoring mechanism

and follow up for the social inclusion parts. The discussion indicated that even though Sarlahi had a plan for

sanitation, with information about barriers and an action plan, there were inadequate pro-active actions

taken to ensure required resources. District strategy vaguely talked about monitoring and evaluation system

to measure progress on demand creation activities in the district under the leadership of DWASHCC.

0

1

2

3

4









Review village status forsustainability and

coverage


Figure 60. Outcome Indicator 8, Sarlahi District

Mahotari District

None of the statements in Mahotari district had crossed the score 1 and two of them (clearly divided role

and responsibility and monitoring social inclusion) had nil (0) score.

The district had developed a sanitation and hygiene strategic plan for entire district in collaboration with

various stakeholders who were working in WASH sector; however, the strategy did not well align with the

national policies and did not have clearly set targets and objectives nor did have clearly defined strategic

action points and implementation plan.

0

1

2

3

4

Set priority and target in line withnational policies










Figure 61. Outcome Indicator 8, Mahottari District

0

1

2

3

4

Set priority and target in line withnational policies










Outcome Indicator 8, Average Score by District and Individual Statement

Table 40. Indicator 8, District Wise Score

Indicators and

statements Rolpa Rukum Salyan Jumla Kalikot Dolpa Sarlahi Mahottari

1 Set priority and target in

line with national policies 3 4 2 3 3 3 0 1

2 Has a plan for

implementation

3

4 2 3 3 3 0 1

3 Ensure human and

financial resources

2

2 1 2 2 1 1 1

4 Has a clear division of role

and responsibility 1 1 0 2 1 1 0 0

5 Give active follow up 2 3 1 2 1 0 1 1

6 Has monitoring system 2 3 1 2 2 0 1 1

7 Ensure sharing of

information 2 3 1 3 1 0 1 1

8 Monitor social inclusion 0 0 0 0 0 0 0 0

9

Review village status for

sustainability and

coverage

1 2 1 1 2 1 0 1

10 Adjust based on

monitoring 2 3 1 2 1 0 1 1

Average 1.8 2.5 1 2 1.6 0.9 0.5 0.8

Table 45 and figure 62 show that Rukum and Jumla districts were in a better position in terms of indicator 8.

Two terai districts were found in the lowest level as they lacked the proper strategy, plan and resources to

implement the sanitation program. Rolpa and Kalikot were near about the average score of 2 but needs high

attention on program follow up and monitoring system. None of the districts had any mechanism on

monitoring social inclusion issues and except Kalikot and Rukum all other districts had scored below 2 on

reviewing village status for sustainability and coverage.

Figure 62. District Wise Average Score of Outcome Indicator 8

5.4 Outcome Indicator 9. Progress with regards to Improved Rural Saniation and

Hygiene Sector Alignment

Outcome indicator 9 assessed the status of sector alignment at district level. The indicator consists of ten

organisational statements related to sector alignment at district level, and each of the statements were

scored in a continuum from 0 to 4 (0 indicating non-existent and 4 indicating fully present). Table 46 shows

the organisational statements and criteria for scoring.

0

1

2

3

4











Table 41. Statements and Scoring Criteria for Outcome Indicator 97

Statements

Scores

0 1 2 3 4

1. A multi-stakeholder

dialogue has started

(on rural sanitation)

none minimal

dialogue &

not

structured;

structured but

not all inclusive;

structured and

all-inclusive but

not held on

regular basis;

Structured and all-

inclusive and held on

a regular basis.

2. All relevant (local)

government sector

stakeholders are

involved in the

dialogue

never rarely occasionally frequently always

3. All relevant (local)

donor (or funding)

agencies are involved

in the dialogue


4. Relevant civil society

and private sector

stakeholders are

involved in the

dialogue


5. Information and data

(evidence base) are

shared in the group

evidence is

not

available

and not

shared

evidence

exists inside

organisation

s but is only

shared

sometimes

and on

request

there are

moments in

which

organisations

share their

information/evid

ence in the

stakeholder

group, but it is

not regular

regular sharing

of information

and evidence

takes place in

the stakeholder

group

Stakeholder

information and

evidence is readily

available and shared

in a common system

(paper based system

or electronic, such as

website, mailing list

etc.).

6. Sector priorities (for

rural sanitation) are

set jointly by

stakeholders


7. Sector targets (for

rural sanitation) are

set jointly by

stakeholders

never Rarely occasionally frequently always

7 This measurement is hierarchical, i.e. 2 is better than 1, 3 better than 2 etc. It is NOT QIS scale (which is

based on all previous scenarios being fulfilled).

Statements

Scores

0 1 2 3 4

8. Plans (for rural

sanitation) are made

jointly.

never Rarely occasionally frequently always

9. Approaches (to rural

sanitation) are aligned

not at all some

elements

all elements by a

few stakeholders

all elements by

most

stakeholders

all elements by all

stakeholders

10. Standards and norms

(related to rural

sanitation) are aligned

not at all not fully in full by a few

stakeholders

in full by most

stakeholders

in full by all

stakeholders

Water Supply and Sanitation Divisional Offices/Sub Divisional Offices (WSSDO/SDOs) were assessed in

coordination with District Development Committees (DDCs) for the status in relation to sustainability

indicator 6. WSSDO is a responsible government authority for sector alignment and acts as a member

secretary of DWASHCC established at district level for coordination and harmonisation of all actors and their

WASH related programme activities. DDC on the other hand is a local government institution and chairs the

DWASHCC. DWASHCC was formulated in a district as a multi-stakeholder forum as envisaged by National

Sanitation and Hygiene Master Plan (NSHMP-2011) and is held responsible for planning, monitoring,

coordinating and harmonising sector actors working in the district to acknowledge district’s sanitation and

hygiene strategic plan and related projects in the district. This indicator was measured by conducting focus

group discussions and interactions with the representatives from WSSDO/SDO which is the responsible

authority to take a lead for priority setting, sector planning and target setting in sanitation & hygiene sector

at district level.

The scores obtained for each of the ten organisational statements by each district has been visualised in a

radar diagram and a brief summary of findings of each of the aspects is described in the following sections.

Sector Alignment in Rolpa district

Figure 63. Outcome Indicator 9, Rolpa District

Rolpa district had established DWASHCC, a multi-stakeholder forum in the WASH sector at district level

following NSHMP 2011. The members of DWASHCC met once a month; however, they lacked active

participation in dialogue process which needs to be strengthened. The involvement of government

stakeholders in WASH sector observed satisfactory. Sectorial priorities and plans for rural sanitation and

hygiene were set jointly following local bodies’ participatory process. Involvement of donor agencies, civil

society and private sector stakeholders in WASH sector requires further improvement in Rolpa district.

Similarly, of the ten set criteria under sector alignment, criteria 9, setting standard norms was found the

poorest and needs effort for further improvement.

0

1

2

3

4

1. A multi-stakeholderdialogue has started

2. Governmentstakeholders are involved

3. Donor (or funding)agencies are involved

4. Civil society andprivate sector

stakeholders involved

5. Information and datashared

6. Sector priorities setjointly

7. Sector targets setjointly

8. Plans made jointly

9. Approaches arealigned

10. Standards and normsare aligned

Outcome indicator 9, Rolpa district

Sector Alignment in Rukum District

Figure 64. Outcome Indicator 9, Rukum District

The multi-stakeholder dialogue had started in Rukum district with formulation and operation of DWASHCC in

the district. Similarly, sectorial priorities were set and plan had been formulated jointly with WASH sector

stakeholders. Involvement of donor agencies, civil society and private sector in WASH sector were areas

that require further improvement. The approaches followed, standards and norms need better alignment

between WASH sector stakeholders to further develop and improve. There was no uniformity in WASH sector

activities implementation approaches and norms developed and executed by the DWASHCC.

0

1

2

3

4


2. Governmentstakeholders are

involved




5. Information anddata shared





10. Standards andnorms are aligned

Outcome indicator 9, Rukum district

Sector Alignment in Salyan District

Figure 65. Outcome Indicator 9, Salyan District

The strongest points observed in Salyan district were on formation and operation of multi-stakeholder

dialogue and sectorial priorities set jointly. Similarly, the involvement of donor agencies and formation of

plans jointly for rural sanitation and hygiene were other criteria found above average. Seventy percent of

the criteria under sector alignment in Salyan district need improvement to achieve the goal and objectives of

sanitation and hygiene. The district was poor at alignment of standards and norms and needs further

development and execution with the support of WASH sector stakeholders.

Sector Alignment in Jumla District

Compared to other districts, Jumla district was at a relatively better position in most of the criteria. It was

particularly strong in formulation and operation of multi-stakeholder dialogues and joint setting of sectorial

priorities. The mobilisation and engagement of donors’ agencies, information and data sharing, sector target

setting were other criteria where Jumla district performed better than the other districts. However, civil

society and private sector stakeholders’ involvement and alignment of approaches need further

improvement. The standards and norms aligned criteria was the poorest among all criteria in Jumla district.

DWASHCC Jumla was relatively active and mobilised WASH sector stakeholders and practiced participatory

planning process which gave positive results in WASH sector in Jumla district.

0

1

2

3

4



involved










Outcome indicator 9, Salyan district

Figure 66. Outcome Indicator 9, Jumla District

Sector Alignment in Kalikot District

The multi-stakeholder dialogue had been carried out in Kalikot district before and during ODF declaration.

The other criteria such as sectorial priorities set jointly, sector target set jointly had observed a better

position followed by the participatory planning process of DDC. Likewise, VWASHCCs were formed at VDC

level and actively worked to formulate a plan. The members of DWASHCC met once a month; however, they

participated less in the recent meetings. It was apparent that the members attended the meetings less

frequently after Kalikot was declared ODF.

The government institutions’ representation is similar to that of other district DWASHCC. DDC, WSSDO,

DHO, DEO, DFO, and DWDO were present and participated in dialogues; however, the dialogue process

seemed to slack after their ODF declaration.

Limited funding agencies were present in Kalikot compared to other districts and there were very limited

CSOs functioning in sanitation and hygiene.

At times, NGOs shared some of their activities about their projects/activities/approaches with DWASHCC;

however, they lacked a systematic way of sharing information and data in the DWASHCC. District Council

with represents from political parties, government line agencies and CBOs jointly discussed and set sector

priorities. Sector priorities were set jointly by all sector stakeholders and endorsed in DWASHCC.

0

1

2

3

4



involved










Outcome indicator 9, Jumla district

Figure 67. Outcome Indicator 9, Kalikot District

Systematic efforts were made to jointly set sector targets. The targets were fixed through participation by

all WASH related stakeholders. However, their involvement in dialogue had diminished post-ODF. All sector

stakeholders related to WASH were involved most of the times in setting sector priorities which were further

endorsed by DWASHCC. Also, sub-groups were present where approval was sought. Post ODF, the Water

Supply and Sanitation Service improvement strategic plan and school sanitation strategic plans were

developed jointly by involving different stakeholders. However, no synergistic efforts were made to

implement the plan at the time of assessment.

Plans from individual organisations were also presented in DWASHCC forum and approved; however, there

was inadequate discussion about the plans presented in DWASHCC. Approach alignment to rural sanitation

was largely unsatisfactory. The approaches were prepared individually and sometimes presented in the

DWASHCC forum as formalities. Furthermore, no specific standards and norms related to rural sanitation

existed in the district. When organisations (I/NGOs) had WASH projects, they would set standards

individually on project basis, but not from DWASHCC.

Sector Alignment in Dolpa District

Following the National Sanitation and Hygiene Master Plan 2011, a multi-stakeholder dialogue had started in

Dolpa district. The DWASHCC meetings were organised every month; however, the minutes revealed low

participation of stakeholders. The government stakeholders involved in dialogue were DDC, WSSDO, DHO,

DTO, DEO, DFO, and DWDO similar to other districts. DDC, WSSDO and DHO were more active and

participated regularly compared to other government institutions in multi-stakeholder dialogues. There were

limited funding agencies present in Dolpa; however, WSSDO, DDC, CARE, SNV and UNICEF were prominent.

0

1

2

3

4




4. Civil society and privatesector stakeholders

involved





9. Approaches are aligned


Outcome indicator 9, Kalikot district

There was a lack of coordination among funding agencies and WSSDO had failed to take leadership, identify

and mobilise the funding agencies properly in WASH sector. Thus, the involvement of government, civil

society and private sector was an area which required further improvement.

DWASHCC meetings were conducted when needed and lacked systematic sharing of information and

evidence base data. The criteria on sector priority setting obtained a good score but most of the criteria

under sector alignment to rural sanitation are largely unsatisfactory. Approaches were prepared individually

and sometimes presented in the DWASHCC forum. Also, no specific standards and norms related to rural

sanitation existed in the district to execute the sanitation and hygiene promotion plan in Dolpa.

Figure 68. Outcome Indicator 9, Dolpa District

Sector Alignment in Sarlahi District

Out of ten criteria under sector alignment, three criteria namely multi-stakeholder dialogues initiated,

sectorial priorities setting and donor (funding agencies) engagement were at a better position than the

others. The weaker criteria in Sarlahi district were information and data sharing, sector target set jointly

and approaches are aligned, which were areas for further improvement. The alignment of standards and

norms was observed the poorest among all. The plan for rural sanitation was made jointly.

The WASH sector stakeholders in Sarlahi followed DDC participatory planning process. They present their

plans in sectorial meetings organised by the DDC. District Council with representation from political parties,

00.5

11.5

22.5

33.5

4










Outcome indicator 9, Dolpa district

government line agencies and CBOs jointly discuss and set sector priorities. All sector stakeholders

contributed to prioritisation of sectors and endorsed in DWASHCC. Individual organisations had their own

approach and followed their own approach to implement WASH activities. The practices were not aligned in a

group and no one had initiated to develop common approaches considering the socio-cultural setup of rural

area. Individual organisations had their own norms, but there was no common standards and norms for all

stakeholder involved in WASH sector.

Figure 69. Outcome Indicator 9, Sarlahi District

Sector Alignment in Mahottari District

DWASHCC is a multi-stakeholder platform constituted as per the National Sanitation and Hygiene Master

Plan (2011) and had started a multi-stakeholders dialogue. Also, it had developed district level strategic

plan. Government stakeholders involved at district level dialogue were CDO, WSSDO, DDC, DHO, DEO,

DWDO and Municipality.

0

1

2

3

4


2. Government stakeholdersare involved


4. Civil society and privatesector stakeholders involved


6. Sector priorities set jointly

7. Sector targets set jointly



10. Standards and norms arealigned

Outcome indicator 9, Sarlahi district

Figure 70. Outcome Indicator 9, Mahottari District

The relevant local funding/donor agencies in WASH sector in Mahottari were WSSDO, DDC, GSF/UN-Habitat,

SNV Nepal and Oxfam GB. Donor agencies were not regular in attending the DWASHCC meeting. Mostly

their presence depended on agendas they wanted to discuss and intended to decide for their own

comfortable presence in WASH sector.

Stakeholders working in WASH sector shared their information with the WSSDO on bilateral basis. The

stakeholders who had received fund from donors would produce activities and trimester reports and submit

to WSSDO; however, there was no system established to share information in DWASHCC itself. The

individual organisations working in WASH sector prepared their priority based on available resources and

shared in DDC sectorial committee and then it was forwarded to district council.

However, most of the time, individual organisations prepared their project targets and shared in DDC jointly

in WASH sector stakeholder meeting. In Mahottari, individual organisations prepared their annual plan and

shared in DWASHCC in a joint forum however detailed productive discussions were not done in DWASHCC.

Individual organisations had their own approach and followed their own approach to implement WASH

activities. The practices were not aligned in a group and no one had initiated to develop common approaches

considering the socio-cultural setup of the district populace till date. Approaches of an individual stakeholder

0

1

2

3

4



involved




5. Information anddata shared






Outcome indicator 9, Mahottari district

working in WASH sector was guided or predominated by a funding institution. Individual organisations had

their own norms, but there were no standard norms for WASH sector in the district. DWASHCC had not

developed any standards or norms to execute sanitation and hygiene promotional activities in Mahottari

district.

Outcome Indicator 9, Average Score per District and Statement

Table 47 shows summary of district wise scores of outcome indicator 9 in each of the statements.

Table 42. Outcome Indicator 9, District Wise Score

Rolpa Rukum Salyan Jumla Kalikot Dolpa Sarlahi Mahottari Average

1. A multi-stakeholder dialogue has

started 4 4 4 4 4 4 4 4 4.0

2. Government stakeholders are

involved 3 3 2 3 2 2 3 3 2.6

3. Donor (or funding) agencies are

involved 2 2 1 2 1 1 2 2 1.6

4. Civil society and private sector

stakeholders involved 2 2 1 2 2 1 2 2 1.8

5. Information and data shared 2 3 1 3 2 1 1 1 1.8

6. Sector priorities set jointly 4 4 4 4 4 4 4 4 4.0

7. Sector targets set jointly 2 3 1 3 3 1 1 2 2.0

8. Plans (for rural sanitation) made

jointly 3 3 2 3 3 2 2 2 2.5

9. Approaches (to rural sanitation)

are aligned 2 1 1 2 1 1 1 1 1.3

10. Standards and norms are

aligned 1 1 0 1 1 0 1 1 0.8

Mean 2.5 2.6 1.7 2.7 2.3 1.7 2.1 2.2 2.2

Figure 71. Outcome Indicator 9, All Districts

Figure 71 shows that sector alignment was strongest in statement 1 (multi stakeholder dialogue started)

and statement 6 (sector priorities set jointly). In all study districts, a multi-stakeholder dialogue had started

by establishing DWASHCC and DWASHCC meetings were held at least once a month. Statement 6 (sector

priorities, which is a bit confusing), received a score of 4 because all districts had a practice of district

council meeting every year, in which all sector stakeholders participated and discussed sector priorities

based on the resource available.

The districts, on average, could not meet the benchmark score in five out of ten statements which include

statements 3 (donor involvement), 4 (civil society and private sector involvement), 5 (sharing of

information), 9 (approach alignment) and 10 (alignment of standards and norms). Alignment of standards

and norms (statement 9) got the least score on average, followed by approach alignment (statement 8).

Figure 72 below shows the average score of outcome indicator 9 obtained by each district. Overall, Jumla,

Rukum and Rolpa obtained higher scores (2.7, 2.6 and 2.5 respectively), while Salyan and Dolpa lagged

behind (score 1.7 of each).

0

1

2

3

4


2. Government stakeholdersare involved


4. Civil society and privatesector stakeholders involved


6. Sector priorities set jointly

7. Sector targets set jointly

8. Plans (for rural sanitation)made jointly

9. Approaches (to ruralsanitation) are aligned

10. Standards and norms arealigned

Outcome indicator 9, all districts average

Figure 72. Mean Score of Outcome Indicator 9 of All Districts

5.5 Outcome Indicator 10. Progress in Development of Pro-poor Support

Mechanisms

More than three fourth (66.8%) of sample households belonged to either poor or poorest wealth quintiles.

36.0% and 40.4% of poorest and poor households did not have access to sanitation facilities (level 0 in

impact indicator 1). Among those who had latrine available, majority of the poor households had flush

latrine. In the past, many of the poor households were provided a pan, pipe and cement with free of cost.

Those households had constructed latrine with materials they were provided for latrine construction, but

they did not take care of sanitation pit. This might also be a reason why the poor segments also had more

flush latrines. Many pour flush latrines were not used and maintained properly and as a result were tagged

to QIS level 1 in impact indicator 1 and 2.

Regarding access to hand washing facilities, more than 85% of households from both poor and poorest

wealth quintiles lacked hand washing facilities within 10 paces of toilet.

None of the studied districts had pro-poor policy to enhance access of poor and excluded groups of society

to sanitation facilities. The district sanitation strategy did not clearly tell about any type of pro-poor support

mechanism. Thus have almost no access to finance for the lowest or lower tier people. Nor any financial

institutes had supported them through Corporate social mechanism neither there was any discussion or

agreement with the different cooperatives , micro credit groups and fringe financial institutions to engage in

sanitation movement while providing soft loans and supports to lowest quintiles people.

0

1

2

3

4Rolpa

Rukum

Salyan

Jumla

Kalikot

Dolpa

Sarlahi

Mahottari

Outcome indicator 9, mean score by district

In some districts (e.g. Jumla, Dolpa and Mahottari), there was a provision of providing some kind of support

(material: e.g. pan, pipe, cement, etc.) to the ultra-poor households. These ultra-poor households were

identified and approved by VDC and VWASHCC. However, there was no systematic way to collect and

analyse inclusion data.

None of the district was able to provide different affordable sanitation items to the poorest and poor

consumer segments neither they were informed or involved on designing toilet options. The district or VDC

usually provides data on latrine coverage however; there was no practice of including disaggregated data in

monitoring and no practice of identifying excluded groups and their specific needs.

People from these two wealth groups either did not took part in the meetings, even taken parts they could

not influence the decision. It is worth mentionable, even about the discussion and decision on poor their

voice and choice is usually ignored.

Regarding access to hand washing facilities, more than 85% of households from both poor and poorest

wealth quintiles lacked hand washing facilities within 10 paces of toilet.

None of the studied districts had pro-poor policy to enhance access of poor and excluded groups of society

to sanitation facilities. The district sanitation strategy did not clearly tell about any type of pro-poor support

mechanism. There was no practice of including disaggregated data in monitoring and no practice of

identifying excluded groups and their specific needs. In some districts (e.g. Jumla, Dolpa and Mahottari),

there was a provision of providing some kind of support (material: e.g. pan, pipe, cement, etc.) to the ultra-

poor households. These ultra-poor households were identified and approved by VDC and VWASHCC.

However, there was no systematic way to collect and analyse inclusion data.

5.6 Outcome Indicator 11. Influence of Women during Planning and

Implementation of Sanitation and Hygiene Programmes

This outcome indicator was measured during focus group discussions in sample VDCs of project districts. In

each of the districts, 3 to 5 FGDs were carried out with women participants. Each of the FGDs consisted of 8

to 14 members. In each FGD, QIS scorecard representing the degree of influence of women in sanitation

and hygiene programmes was filled as an evidence of more inclusive decision making. The average score of

FGDs per district has been presented in this report. Table 48 shows the QIS scorecard for outcome indicator

11.

Table 43. QIS Scorecard for Outcome Indicator 11

Level Descriptions / mini scenarios Score

0 No participation of women in meetings and events.

1 Women,

(i) attend meetings (but do not speak).

2

Women,

(i) attend meetings, and

(ii) speak (but do not influence decisions).

3

Women,

(i) attend meetings,

(ii) speak, and

(iii) influence decisions.

4

Women,


(ii) speak,

(iii) influence decisions, and

(iv) the decisions made also reflect and respect women’s needs and perspectives.

District Score

Rolpa 2

Rukum 3

Salyan 1

Jumla 3

Kalikot 3

Dolpa 1

Sarlahi 0

Mahottari 0

Figure 73 shows the QIS score obtained in outcome indicator 11 by the study districts. Compared to the

other districts, Rukum, Jumla and Kalikot districts were at a better position in this indicator. Women

0

1

2

3

4Rolpa

Rukum

Salyan

Jumla

Kalikot

Dolpa

Sarlahi

Mahottari

Outcome indicator 11, influence of women by district

Figure 73. Outcome Indicator 11 by District

participated in FGDs mentioned that they participated in meetings, spoke and influenced decisions especially

they were vocal on village level activities (triggering and campaign with the involvement of FCHV and

females). Some of the participants in the FGDs mentioned that they had participated in VWASHCC meetings

where they were involved in planning process. It seemed there was good participation of women in

development work group and they were involved in ward citizen forums, women groups, saving and credit

groups, and mother groups. Rolpa district scored 2 in QIS score indicating that they attended meetings and

spoke; however, they had no influence in decision making. Some of the women who actively participated in

FGDs mentioned that their husbands were abroad and women themselves had to go forefront to tackle day

to day problems. When invitation was sent out for meeting in the community, women had to attend in the

absence of adult male members in the household.

On the other hand, Dolpa and Salyan districts obtained score 1. Women from these districts mentioned that

they were invited to meetings and participated in meetings, but hardly spoke or influenced the decision. This

was perhaps due to the reluctance to hear from women or due to the shy and hesitation from women

creating barriers on engagement on decision making. This should be further assessed through barrier

analysis or Formative research.

It was found that most of the women were invited for their signature in minute. During discussion it was

found that women from the poor and minority households were hardly invited to meetings. During FGD

women from these districts spoke without hesitation.

“Most of the time we do not know about the meeting. Sometime we are asked for participation, but in the

meeting women do not speak and even if they speak, nobody cares about their voice. The meetings and

events do not consider agenda and daily activities and responsibilities of women and backward society.”

- A women in FGD in Salyan

Overall, the terai districts Mahottari and Sarlahi were found the weakest in comparison to other districts with

total average score of 0 in outcome indicator 11. The women participated in FGDs had not participated in

sanitation and hygiene related meetings. Some of the women mentioned different programmes conducted

on sanitation and hygiene in their VDC, but they had not participated in planning process.

5.7 Outcome Indicator 13. Influence of Socially Excluded Groups during

Planning and Implementation of Sanitation and Hygiene Programmes

Outcome indicators 13 measures the influence of socially excluded groups respectively in sanitation and

hygiene programmes as evidence of more inclusive decision making. People from socially excluded groups

(e.g. Dalit the lower caste, ethnic and religious minorities, and indigenous groups) belonged to poor

category. Hence, FGDs were conducted with socially excluded groups only (as decided in baseline

preparatory workshop). In each district, 3 to 5 FGDs were conducted with members from socially excluded

groups and QIS scorecard representing the degree of influence of women in sanitation and hygiene

programmes as evidence of more inclusive decision making was filled. The average score of FGDs per

district has been presented in this report. Table 49 shows the QIS scorecard for outcome indicator 13.

Table 44. QIS Scorecard for Outcome Indicator 13

Level Descriptions / mini scenarios Score

0 No participation by people from socially excluded groups in meetings and

events.

1

People from socially excluded groups,

(i) attend meetings (but do not speak).

2


(i) attend meetings, and

(ii) speak (but do not influence decisions).

3



(ii) speak, and

(iii) influence decisions.

4



(ii) speak,

(iii) influence decisions, and

(iv) the decisions made reflect and respect socially excluded groups’ needs and

perspectives.

.

As shown in figure 74, the study districts were in a deprived position in indicator 13 indicating low influence

of socially excluded groups in sanitation and hygiene programmes. None of the district could achieve score 3

or above. Compared to other districts, Rolpa and Kalikot were at a better position. In these districts,

households from socially excluded groups were invited to attend the meetings. They attended and expressed

their views but their views were not considered while decision making.

In other districts, the participants believed that they belonged to poor and uneducated group and others

would not listen to them. Sometimes, they attended meetings but did not talk. Though, households from the

poor and minority group were sometimes allowed to attend relevant programme related activities, meetings

and events, they did not engage actively in the event by speaking and participating in discussions.

In case of the terai districts, many of the participants in FGD were illiterate and felt shy and nervous in

expressing their views. Mahottari, Sarlahi and Dolpa districts were found weakest among all with a total

average score of 0 in outcome indicator 13. Socially excluded groups were not invited to any sanitation and

hygiene related meetings. According to them, no one listened to them because they were from a

disadvantaged group. They were unknown to meeting points, when it took place and who should attend.

Socially and culturally, they were depressed and neglected.

“I used to attend the meetings in VDC office in the past, but the richer people do not want to listen and

cooperate with me, as I am from Dalit caste. So I did not see any advantage of attending the

meeting…………………………………… people from poor households also do not participant because they do not

have time for such events as they have to work for food for themselves and their children”

- A participant in FGD in Sarlahi

District Score

Rolpa 2

Rukum 1

Salyan 1

Jumla 1

Kalikot 2

Dolpa 0

Sarlahi 0

Mahottari 0

0

1

2

3

4Rolpa

Rukum

Salyan

Jumla

Kalikot

Dolpa

Sarlahi

Mahottari

Outcome indicator 13, influence of socially excluded groups by district

Figure 74. Outcome Indicator 13 by District

5.8 Discussion of Results of Outcome Indicators

The eight districts, except Sarlahi had developed a district level sanitation and hygiene strategic plan in local

context with the spirit of National Sanitation and Hygiene Master Plan (NSHMP), 2011. However, the

implementation of strategic plan by developing a common understanding among the district WASH sector

stakeholders and mobilisation of their respective resources (such as staff, and fund etc.) were not

sufficiently stimulated in all the districts. None of the districts had a system to generate or had not yet

maintained disaggregated data that provides information on the groups of beneficiaries and people that

include socially excluded groups and people living with disability and special needs. None of the studied

districts had pro-poor policy to enhance the access of poor and excluded groups of the society to sanitation

facilities. Promoting standards and follow-up mechanism of sanitation and hygiene statement was another

area for improvement.

Despite a better involvement of private sector actors in sanitation and improved road access in the terai

districts, they lagged behind the hill and mountain districts. The DWASHCCs in the terai districts were newly

formed and their respective meetings were not held regularly. Similarly, the commitments and functioning of

the WSSDOs and DWASHCC members in sanitation promotion were not found strong enough. Instead of

institutional strengthening of WSSDO/SDOs and other WASHCC structures to promote sanitation and

hygiene intervention, the pre-determined concept of subsidy among sector actors and end target groups

played a vital role in affecting adversely the capacity of districts in promoting sanitation demand creation. In

fact multi-stakeholder platform (DWASHCCs) in the terai districts was yet to be institutionalised. The terai

districts need to be emphasised for improving their institutional capacity for better performance in this

particular indicator which is very essential for enhancing sanitation access and coverage of the district at the

end by stimulating sanitation demand creation in the beginning.

Evidence based data with disaggregation in terms of gender, social inclusion and other factors like

disabilities and wealth perspective were required to be institutionalised in all districts while improving the

district’s monitoring and data management system in all project districts.

Overall, on the basis of local context, WSSDO needs to develop consensus among stakeholders through

DWASHCC to adapt appropriate approaches uniformly while implementing the project activities in relation to

WASH in the districts.

WSSDOs were found weak in practice of sharing information and evidence based data among sector

stakeholders. The WSSDOs need to create a mechanism to learn and share information and data that eases

knowledge sharing and upscale learning. This part was found weak in almost all the districts. In most of the

cases, available information and data were shared through DWASHCC but not on a regular basis, in fact on

ad-hoc basis. Though information and data were there, there was no practice of sharing widely with other

stakeholders. Even if there was a practice of sharing information, they were done verbally among the

stakeholders in DWASHCC meetings and there was no systematic way of sharing organisations’ progress

review. Proper documentation of shared data and information were yet to be practiced effectively.

WSSDO/SDOs were not able to set common standards and norms for districts to adhere and follow by all

district stakeholders for promoting rural sanitation. There is a scope for WSSDO/SDOs to bring all actors

together and jointly formulate/review existing norms and standards for the districts and then endorse it by

DWASHCC to be rolled out for implementing the districts’ plans for WASH in general and rural sanitation in

particular building synergy and harmony to achieve the districts’ target and thus contribute to achieve

national target by 2017.

All studied districts, except Sarlahi, had developed a district level sanitation and hygiene strategic plan

under the leadership of WSSDO. In most of the districts, sanitation strategy also covered annual plans for

initial years of the strategy. All studied districts need to improve in promoting standard and regularly

assessing the performance of organisations engaged in demand creation. Besides that, the districts should

ensure that the monitoring data avails with disaggregated information to cater excluded groups of society

such as people with disabilities and special needs.

The improved sector alignment in sanitation and hygiene at local level seems to be at a better position than

the capacity of local government or line agencies to steer sanitation demand creation. WSSDO/SDOs were

not able to set common standards and norms for the districts to adhere and follow by all district

stakeholders to promote rural sanitation. Most of the stakeholders, in reality, were adopting their project

based norms and policies formulated based on their organisational norms and requirements. These were

again found different with different organisations in the districts. Hence, there is a scope for WSSDO/SDOs

to bring all actors together and formulate/review existing norms and standards jointly for the districts and

then endorse it by DWASHCC to be rolled out by the district stakeholders to implement districts’ plan for

WASH in general and rural sanitation in particular with synergy and harmony to achieve the districts’ target

and thus contribute to achieve national target by 2017.

The terai districts need to be taken care of for improving their institutional capacity and for their better

performance to enhance sanitation access and coverage of the district by the end. The improvement of

current situation in mobilising local resources, local leadership and local government bodies taking lead of

the entire process is required to progress in these statements of the indicators. Along with this, evidence

based data with a system of disaggregated information in terms of gender, social inclusion and other factors

like disabilities and wealth perspective are required to be institutionalised while improving district’s

monitoring and data management system. Though the institutionalisation of multi-stakeholder platform

(DWASHCCs) is a gradual and continuous process, it is yet to be done for functioning to their full capacity.

Section VI. Conclusions and Recommendations

6.1 Conclusion

On the whole, out of 8 districts, Kalikot, Rukum and Rolpa (mountain and hill districts) were comparatively

better off, and Salyan, Dolpa and Jumla (the hill and mountain Districts) were in a moderate position,

whereas the two terai districts (Sarlahi and Mahottari) lagged behind and needs to make much efforts to

further improve their sanitation status. The terai districts had more than 95 percent of households practicing

open defecation. The districts which had higher scores in outcome indicators (especially outcome indicators

8, 9 and 11) were. Rukum, Kalikot, Rolpa. WSSDOs of these districts were leading WASH promotion

activities with a clear strategic plan, better sectorial alignment and by ensuring resources for implementing

the plan. Women at community level showed better involvement in sanitation and hygiene related

programmes. This ultimately resulted to higher sanitation coverage, better use and maintenance of

sanitation facilities, and hand-washing practice. The findings showed increased capacity of district line

agencies, especially DWSSDO, which is a pre-requisite for improved sanitation and hygiene. In addition to

intuitional strengthening of WSSDOs and other WASHCC structures, a pre-determined concept of subsidy

among sector actors as well as communities had played a vital role in lagging districts with capacity for

promoting sanitation demand creation. The study team had realised that the leadership of WSSDO/SDOs

and DDC made a considerable difference in districts’ status in these statements. Besides, the frequent

changes of government officials also affect the functioning of districts.

6.2 Recommendations

Based on the findings and discussions, the following recommendations are made:

All districts except Sarlahi had prepared district sanitation and hygiene strategy plan targeting ODF

by 2017. Sarlahi was developing their strategic plan at the time of assessment. However, the plans

lacked time bound action plan, did not ensure human and financial resources to achieve the target

and did not fully incorporate dalits, poor, marginalised and people with disability. Thus, the

prepared strategic plans require review followed by amendments. It is crucial to orientate all WASH

sector stakeholders to develop a common understanding on their strategic plan. Also, Kalikot district

needs amendments considering their post ODF situation.

There was a lack of system and tools to promote standards and regularly assess the performance of

sanitation facilitators on demand creation in all project districts. Thus, a simple standard guidelines

and tools should be developed to assess the performance of organisations and facilitators on a

periodic basis and the inputs should be fed for their institutional and programme improvement.

The districts should ensure that the monitoring data avails with disaggregated information to cater

excluded groups of society such as people with disabilities and special needs.

A capacity building training should be organised to orient respective stakeholders for data

generation, packaging and dissemination of learning to feed in next planning cycle for the

improvement of plan and activities.

All project districts had established a multi-stakeholders dialogue forum, DWASHCC, as envisaged

by the National Sanitation and Hygiene Master Plan (2011). The participation of stakeholders in

dialogue process was not meaningful and thus, extra efforts are required to make discussions

worthwhile and meaningful in the future.

All project districts were weak in engagement of stakeholder in multi-stakeholder forum, thus the

WSSDO should prepare a stakeholder map and inventory of active WASH sector stakeholders and

generate synergy in collaborative efforts.

The WSSDO needs to develop a consensus among stakeholders through DWASHCC to adapt an

appropriate approach uniformly while implementing project activities in relation to WASH in the

districts.

The WASH sector stakeholders had started a good practice of following DDC participatory planning

to share data, set sector priorities, target and jointly formulate plan, and endorse the outcome from

district council. These practices strengthen the decentralisation process and makes the service

provider accountable towards the service receivers. Hence, WSSDO, a member secretary of WASH

sector should encourage all WASH sector stakeholders to follow the participatory process in the

future.

There was a lack of approaches, standards and norms in WASH sector; and thus, they are areas for

further improvement. DWASHCC should coordinate with stakeholders and develop approaches

considering local, socio-political and cultural aspects mainstreaming gender and social inclusion in

WASH, and endorse those approaches and norms followed by all stakeholder working in WASH

sector in the district.

The districts should develop a mechanism to support hard-to-reach groups in line with the

provisions made in NSHMP-2011 but also in line with district context. Also, the districts should have

clear and disaggregated data to identify the poor, disabled, etc. Accordingly, differentiated approach

of the districts should be reviewed and mainstreamed in the districts for all actors to adapt.

The districts should prepare comprehensive BCC strategy based on formative research to change

hygiene behaviour in a sustainable manner. BCC activities needs to be promoted with priority using

different means & tools with special focus on hand washing with soap and hygienic use of latrines.

Pour flush latrine is generally considered to be environmentally safe; however attention should be

given to construct a flush latrine such that it prevents soil and ground water contamination and

provides adequate privacy and environmental safety.

Proper use and maintenance of latrine facilities and hand-washing practices are closely associated

with water availability. Inadequate water may be a risk factor in trying to achieve behaviour

change for hand washing with soap and keeping toilets clean.

In the districts where sanitation coverage was high, it is necessary to consider post ODF preparation

starting from sensitization and working out post ODF strategy development.

Strengthening sanitation supply chain in terai region with informed choice materials will enable the

upcoming demand for sanitation to be met.

Annex I. Household questionnaire

Question Response

HH: Household information

1. HH1: Cluster number / क्लस्टर नम्बर _________________________ 2. Select the Donor supporting the

programme / डोनर नाम DFID / DFID______

DFAT / DFAT______

Only answer if you responded DFID to Q2

3. Region Name / रीजोन (क्षेत्र) नाम

Eastern Development Region (EDR) / पुर्ाान्चल वर्कास क्षेत्र

______

Mid-Western Development Region (MWDR) / मध्ये

पश्चचमान्चल वर्कास क्षेत्र ______

Only answer if you responded DFAT to Q2

4. Region Name / रीजोन (क्षेत्र) नाम

Central Development Region (CDR) / मध्यमाांचल वर्कास क्षेत्र

______

Mid-Western Development Region (MWDR) / मध्ये

पश्चचमान्चल वर्कास क्षेत्र ______

Only answer if you responded Eastern Development Region (EDR) to Q3

5. Name of the district / श्जल्ला

Siraha / ससरहा______

Saptami / सप्तरी ______

Only answer if you responded Mid-Western Development Region (MWDR) to Q3


Banke / बााँके ______

Surkhet / सुरे्खत ______

Dailekh / डलेैर्ख ______

Humla / हुम्ला ______

Mugu / मुगू______

Only answer if you responded Central Development Region (CDR) to Q4


Sarlahi / सलाही ______

Mahottari / महोत्तरी ______

Only answer if you responded Mid-Western Development Region (MWDR) to Q4


Salyan / सल्यान ______

Rukum / रुकुम______

Rolpa / रोल्पा ______

Dolpa / डोल्पा ______

jumla / जुम्ला ______

Kalikot / कासलकोट ______

Only answer if you responded Siraha to Q5

9. Name of the VDC in Siraha / ससरहाअ

व्ड्क क नाम

Khirauna / खर्खरौना______

Lagadigoth / लगदिगोथ ______

Laxminiya / लक्ष्मीननय ______

Madar / मिर ______

Mahadewa Portaha / महिेर् पोताहा ______

Malhaniya Gamharia / मल्हननय गम्हररअ ______

Sakhuwanankarkatti / सरु्खर्नन्कका त्त ______

Sonmati Majhaura / सोन्मती मझौर ______

Sukhachina / सुर्खचचना ______

Gadha / गधा ______

Itarhawa / इतहाार्ा ______

Hanumannagar / हनुमन्नगर ______

Laksmipur Pra.Ma / लश्क्स्मपुर प्र ।म ______

Bishnupur Pra.Ra / बबष्णुपुर प्र ।र ______

Only answer if you responded Saptari to Q5

10. Name of the VDC in Saptari / सप्तरी

Belhi______

Dhanagadi______

Haripur______

Malhanama______

Malhaniya______

Mauwaha______

Paterwa______

Rautahat______

Ramnagar______

Saraswor______

Siswa Beihi______

Tikuliya______

Banarjhula______

Only answer if you responded Banke to Q6 11. Name of the VDC in Banke

Sonapur______

Jaisapur______

Belahari______

Piparawa______

Saigau______

Gangapur______

Matehiya______

Kalaphata______

Laxman pur______

Katkuiya______

Narayanpur______

Raunyapur______

Fattepur______

Only answer if you responded Surkhet to Q6 12. Name of the VDC in Surkhet

Ghoreta______

Dandakhali______

Kafalkot______

Chhapre______

Lagam______

Chhinchu______

Betan______

Matela______

Dharapani______

Lekhparajul______

Pamka______

Taranga______

Bajedichaur______

Only answer if you responded Dailekh to Q6 13. Name of the VDC in Dailekh

Dullu______

Baluwatar______

Kanshikandh______

chhiudi pushakot______

Malika______

Chamunda______

Chauratha______

Kharigaira______

Raniban______

Padukasthan______

Layati Bindrasaini______

Tilepata______

Sigaudi______

Jambukandh______

Bansi______

Toli______

Danda parajul______

Piladi______

Rawatkot______

Nagarpalika______

Only answer if you responded Humla to Q6 14. Name of the VDC in Humla

Barai______

Syada______

Dandaphaya______

Limi______

Srinagar______

Chhipra______

Thehe______

Raya______

Simikot______

Sarkideu______

Only answer if you responded Mugu to Q6 15. Name of the VDC in Mugu

Dhainakot______

Dolphu______

Gamtha______

Hyanglu______

Jima______

Kotdanda______

Mugu______

Natharpu______

Photu______

Seri______

shreekot______

Shreenagar______

Sukadhik______

Only answer if you responded Sarlahi to Q7 16. Name of the VDC in Sarlahi

Achalgadh______

Arnaha______

Balara______

Chhataul______

Chhatona______

Dumariya______

Gadahiyabairi______

Khirwa______

Madhubani______

Mirjapur______

Ramban______

Ramnagar Bahuarwa______

Rohuwa______

Sisout______

Sudama______

Sekhauna______

Mainathpur______

Only answer if you responded Mahottari to Q7 17. Name of the VDC in Mahottari

Shreepur______

Sundarpur______

Khairbanni______

Raghunathpur______

Sonama______

Basabitti______

Parsa Dewadh______

Shamsi______

Gaidha Bhetpur______

Khopi______

Pokharibhinda Samgrampur______

Ramgopalpur______

Sahasaula______

Only answer if you responded Salyan to Q8 18. Name of the VDC in Salyan

Khalanga______

Laxmipur______

Kubindedaha______

Dhanwang______

Banjhkanda______

Bafukhola______

Majhkanda______

Syanikhal______

Dhajaripipal______

Chandekarenji______

Nigalchula______

Bhalchaur______

Marmaparikanda______

Tharmare______

Hiulcha______

Kaprechaur______

Swirath______

Kalimati Kalche______

Malimati Rampur______

Devsthal______

Only answer if you responded Rukum to Q8 19. Name of the VDC in Rukum

Khalanga______

Kakri______

Ranmamaikot______

Hukam______

Sisne______

Gotamkot______

Taksera______

Rangsi______

Only answer if you responded Rolpa to Q8 20. Name of the VDC in Rolpa

Gajul______

Jedwang______

Dhawang______

Gairigaon______

Talabang______

Masina______

Jelbang______

Rank______

Ot______

Seram______

Tebang______

Budhagaon______

Pachhabang______

Pakhapani______

Dubidanda______

Uba______

Jhenam______

Libang______

Mijhing______

Pang______

Jaimakasala______

Sirpa______

Only answer if you responded Dolpa to Q8 21. Name of the VDC in Dolpa

Dunai______

Juphal______

Laha______

Narku______

Kalika______

Rimi______

Kaigau______

Phoksundo______

Saldang______

Tinje______

Dho______

Only answer if you responded jumla to Q8 22. Name of the VDC in Jumla

Patarashi______

Chhuchaur______

Dillichaur______

Guthichaur______

Kudari______

Tamti______

Badki______

Dhapa______

Pandafgufa______

Narakot______

Sanigaon______

Malikathanta______

Tatopani______

Only answer if you responded Kalikot to Q8 23. Name of the VDC in Kalikot

Manma______

Phomahadev______

Rachuli______

Chapre______

Chilkhya______

Odanaku______

Mehelmudi______

Mumra______

Raku______

Jubitha______

Kumalgau______

Malkot______ 24. HH8A: Groundwater table in this

village (metres) / यो गाउाँमा जसमन मुननको पनन को सतह कती छ ? (समटर) _________________________ 25. HH9: What is the dominant soil-type

in this village? / यो गाउाँमा मुख्यतया कस्तो प्रकर को माटो छ ?

Clay / silt / पााँगो माटो ______

Sand / बलौटे माटो ______

Gravel / रोडा माटो ______

26. HH11. Name of respondent / उतिााता को नाम _________________________

27. HH12: Gender of respondent / सलांग Male / पुरुष______

Female / मदहला ______

28. Can I take your Picture / के म तपाइको फोटो सलन सक्छु ?

Yes / हुन्छ ______

No / हुिैन ______

29. Photo / फोटो _________________________

HM: Household members

30. HM1: Name of head of household / घरमुलीको नाम _________________________

31. HM1A: Gender of the Household head / घरमुलीको सलङग

Male / पुरुष______

Female / मदहला ______

32. HM2: Number of women aged 50 years and older /

५० बषाा भन्ि माचथका मदहलाको सांख्या _________________________

33. HM3: Number of men aged 50 years and older / ५०

बषाा भन्ि माचथका पुरुषको सांख्या _________________________

34. HM4: Number of women aged 15 - 49 years / १५

िेर्खी ४९ बषा का मदहलहरु को सांख्या _________________________

35. HM5: Number of men aged 15 - 49 years / १५ िेर्खी ४९ बषाा क पुरु को सांख्या _________________________

36. HM6: Number of girls aged 6 -14 years / ६ िेर्खी १४

बषाासम्मा का मदहलहरु को सांख्या _________________________

37. HM7: Number of boys aged 6 – 14 years / ६ िेर्खी १४

बषाासम्मा का पुरुषको सांख्या _________________________

38. HM8: Number of girls aged 3 – 5 years / ३ िेर्खी ५

बषाा सम्मका मदहलहरु को सांख्या _________________________

39. HM9: Number of boys aged 3 – 5 years / ३ िेर्खी ५

बषाा सम्मका पुरुषह्हरु को सांख्या _________________________

40. HM10: Number of girls aged 0 – 2 years / ० िेर्खी २

बषाा का मदहलहरु को सांख्या _________________________

41. HM11: Number of boys aged 0 – 2 years / ० िेर्खी २

बषाा का पुरुषह्हरु को सांख्या _________________________

42. HM12: Total number of household members / जम्मा घरका सिस्यहरुको सांख्या _________________________ 43. HM13-1. Because of a health problem or old age, does anybody in your household have difficulty seeing?

(No difficulty) / तपाईकोघरमा कसैलाई हेना (आर्खा निेख्ने)

समस्या छ ? (कनत पानी समस्या नभएका हरु को सांख्या लेख्ने) _________________________ 44. HM13-2. Because of a health problem or old age, does anybody in your household have difficulty seeing?

(Some Difficulty ) / तपाईकोघरमा कसैलाई हेना (आर्खा निेख्ने)

समस्या छ ? ('केदह समस्या समस्या भएका हरु को सांख्या लेख्ने) _________________________ 45. HM13-3. Because of a health problem or old age, does anybody in your household have difficulty seeing?

(A lot of difficulty) / तपाईकोघरमा कसैलाई हेना (आर्खा निेख्ने)

समस्या छ ? ('धेरै समस्या समस्या भएका हरु को सांख्या लेख्ने) _________________________ 46. HM13-4. Because of a health problem or old age, does anybody in your household have difficulty seeing?

(Unable to do it) / तपाईकोघरमा कसैलाई हेना (आर्खा निेख्ने)

समस्या छ ? ('पुरै निेखर्खने समस्या भएका हरु को सांख्या लेख्ने) _________________________ 47. HM14- 1. Because of a health problem or old age, does anybody in your household have difficulty walking

or climbing steps? (No difficulty) / तपाईकोघरमा कसैलाई

दहा्ं न र्ा ससांढी च्न समस्या छ ? (कनत पनन समस्या नभएका हरु को सांख्या लेख्ने ) _________________________ 48. HM14-2. Because of a health problem or old age, does anybody in your household have difficulty walking

or climbing steps? (Some difficulty) / तपाईकोघरमा कसैलाई दहा्ं न र्ा ससांढी च्न समस्या छ ? (केदह समस्या समस्या भएका हरु को सांख्या लेख्ने) _________________________ 49. HM14- 3. Because of a health problem or old age, does anybody in your household have difficulty walking

or climbing steps? A lot of difficulty) / तपाईकोघरमा कसैलाई दहा्ं न र्ा ससांढी च्न समस्या छ ? (धेरै समस्या भएका हरु को सांख्या लेख्ने) _________________________ 50. HM14- 4.Because of a health problem or old age, does anybody in your household have difficulty walking

or climbing steps? (Unable to do it) / तपाईकोघरमा कसैलाई दहा्ं न र्ा ससांढी च्न समस्या छ ? (दहा्ं डुल गना नसक्ने/पुरै समस्या भएका हरु को सांख्या लेख्ने) _________________________

51. HM15-1. Because of a health problem or old age, does anybody in your household have difficulty with self-care such as washing or dressing? (No dificulty) /

तपाईको घरमा कसैलाई आफैले आफ्नो हेचााह गना र्ा कपडा लगाउन र्ा धुन समस्या छ ? ( समस्या नभएका हरु को सांख्या लेख्ने ) _________________________ 52. HM15-2. Because of a health problem or old age, does anybody in your household have difficulty with self-care such as washing or dressing? (Some

difficulty) / तपाईको घरमा कसैलाई आफैले आफ्नो हेचााह गना र्ा कपडा लगाउन र्ा धुन समस्या छ ? (केदह समस्या भएका हरु को सांख्या लेख्ने) _________________________ 53. HM15-3. Because of a health problem or old age, does anybody in your household have difficulty with self-care such as washing or dressing? (A lot of

difficulty) / तपाईको घरमा कसैलाई आफैले आफ्नो हेचााह गना र्ा कपडा लगाउन र्ा धुन समस्या छ ? (धेरै समस्या भएका हरु को सांख्या लेख्ने _________________________ 54. HM15-4. Because of a health problem or old age, does anybody in your household have difficulty with self-care such as washing or dressing? (unable to do it)

/ तपाईको घरमा कसैलाई आफैले आफ्नो हेचााह गना र्ा कपडा लगाउन र्ा धुन समस्या छ ? (केदह गना नसक्ने/ पुरै समस्या भएका हरु को सांख्या लेख्ने) _________________________ 55. Total number of people in this household with

special needs / जम्मा घरका समस्या भएका सिस्यहारुको सांख्या (धेरै र केदह पनन गना नसक्ने-पुरै समस्या भएका हरु) _________________________

W: Household characteristics / wealth index 56. URB/RUR: OBSERVATION

Question / अर्लोकन Urban / शहर ______

Rural / ग्रासमन______

57. W01. What is the main source of drinking water for members of your

household? / तपाइको घरका सिस्य हरु को लागी र्खानेपानीको मुख्य श्रोत के हो ?

Piped water / पाइप धारा ______

Tube well or borehole / ह्यान्ड पम्प (ट्युब र्ेल)् ______

Dug well / इनार ______

Water from spring / मुलको पानी ______

Rainwater / बषाात को पानी सन्कलन ______

Tanker truck / ट्याांकर र्ा ट्रक बाट ल्याइएको पानी ______

Surface water (river/dam/lake/pond/stream/canal) / सतहको पानी (नदि, र्खोला, ताल,् पोर्खरर, कुलो) ______

Stone tap / Dhara / धुङे धारा ______

Bottled water / बोतलको पानी ______

Only answer if you responded Piped water to Q57

58. Piped water / पाइप धारा

piped into dwelling / घरसभत्रै पाइप धारा ______

piped to yard/plot / आगनमा पाइप धारा ______

public tap/standpipe / सार्ाजननक धारा ______

Only answer if you responded Dug well to Q57

59. Dug well / इनार

Protected well / छोवपएको (सुधाररएको) इनार ______

Unprotected well / नछोवपएको इनार ______

Only answer if you responded Water from spring to Q57

60. Water from spring / मुलको पानी

Protected spring / छोवपएको (सुधाररएको) मुल______

Unprotected spring / नछोवपएको मुल______

61. W02. What kind of toilet facility do members of your household usually

use? / तपाइको घरका सिस्यहरुले प्राए प्रयोग

गने चारपी कस्तो प्रकारको छ ?

flush toilet / फल्स चपी ______

traditional pit toilet / पारम्पररक र्खाल्डे चपी ______

ventilated improved pit toilet / भी आइ वप चपी ______

no facility/bush/field / चपी नभएको______

62. W03. Do you share the toilet facility

with other households? / के तपाइको घपाररर्ारले प्रयोग गने चारपी यस पररर्ारका सिस्य बाहेक अरुले पनन प्रयोग गछान ?

Yes / गछान ______

No / गिैनन ______

63. W04. Does your household have? /

के तपाइको घपाररर्ार साँग ननम्न उल्लेखर्खत

चचझरु छन

Electricity / बबधुत ______

A radio / रेडडयो ______

A television / दट भी ______

A mobile telephone / मोबाइल टेसलफोन ______

A non-mobile telephone / अचल तसेलफोन (लेन लाइन)______

A refrigerator / फ्रिज ______

Table / टेबल ______

Chair / मेच ______

Bed / र्खाट______

Sofa / सोफा ______

Cupboard / िराज______

Computer / कम्प्युटर ______

Clock / सभत्ते घडी ______

Fan / पन्र्खा ______

DHIKI/JANTO / चधकी जातो ______

64. W19. What type of fuel does your

household mainly use for cooking? / के

तपाइको घरमा र्खाना बनाउन प्राय जसो कस्तो Electricity / बबधुत ______

lpg/ natural gas / सससलन्डर ग्यास ______

फ्रकससमको इन्धनको प्रयोग हुन्छ ? Biogas / बायो ग्यास______

Kerosene / मदितले ______

Coal, lignite______

Charcoal / कोइला ______

Wood / िाउरा ______

Straw/Shrub/grass / पराल, नल, घााँस पात ______

Agricultural crop / र्खेती बाट बााँकी रहेको ............... जस्तै मकै को ढोड ______

Animal dung / गोबर ______

no food cooked in house / घरमा र्खाना नबनाउने ______

65. W20. What is the main material of

the floor in your household? / घरको भुई के

ले बनेको छ ?

Natural floor (Earth/sand) / प्राकृनतक भुई (माटो)______

Rudimentary floor / मौसलक भुई ______

Finished floor (Parquet or polished) / सुसश्जजत भुई ______

Only answer if you responded Rudimentary floor to Q65

66. Rudimentary floor / मौसलक भुई

Wood planks / काठको फल्याक ______

Palm/bamboo / बााँस ______

Only answer if you responded Finished floor (Parquet or polished) to Q65 67. Finished floor (Parquet or polished) /

सुसश्जजत भुई

Wood / काठ ______

Vinyl or asphalt strips / सभनानयल ______

Ceramic tiles / ससरेसमक टाइल______

Cement / ससमेन्ट ______

Carpet / कापेट ______

68. W21. ASk and OBSERVE / अर्लोकन

गरेर लेख्ने Natural roofing / प्राकृनतक छत ______

Rudimentary roofing / मौसलक छत ______

Finished roofing / सुसश्जजत छत ______

Only answer if you responded Natural roofing to Q68

69. Natural roofing / प्राकृनतक छत

No roof / छत नभएको ______

Thatch/palm leaf / पराल, पात, स्याउला ______

Only answer if you responded Rudimentary roofing to Q68

70. Rudimentary roofing / सुसश्जजत छत

Rustic mat / चटाई______

Palm/bamboo / बााँस ______

Wood planks / काठको फल्याक ______

Cardboard / गत्ता______

Only answer if you responded Finished roofing to Q68

71. Finished roofing / सुसश्जजत छत

Galvanised sheet / जस्ता पाता______

Wood / काठ ______

Calamine/cement fiber / कलामाइन/ससमेन्ट फाईबर______

Cement / ससमेन्ट ______

Roofing shingles / काठको चचपाट ______

72. W22. ASk and OBSERVE / अर्लोकन

गरेर लेख्ने Natural walls / प्राकृनतक सभत्ता ______

Rudimentary walls / मौसलक सभत्ता ______

Finished walls / सुसश्जजत सभत्ता ______

Only answer if you responded Natural walls to Q72

73. Natural walls / प्राकृनतक सभत्ता _________________________

Only answer if you responded Rudimentary walls to Q72

74. Rudimentary walls / मौसलक सभत्ता

Bamboo with mud / बााँस र माटो ______

Stone with mud / ढुांगा र माटो ______

Plywood / पलाई र्ुड ______

Cardboard / गत्ता______

Reused wood / काठ/फल्याक ______

Only answer if you responded Finished walls to Q72

75. Finished walls / सुसश्जजत सभत्ता

Cement / ससमेन्ट______

Stone with lime/cement / ससमेन्ट ढुांगा ______

Bricks / इिा ______

Cement blocks / ससमेन्ट ब्लक______

Wood planks/shingles / काठको फल्याक/ चचपाट ______

76. W23. How many rooms in your household are used for sleeping? /

तपाइको घरमा कनत ओटा कोठाहरु सुत्न को लाचग प्रयोग गररएको छ ? _________________________ 77. W24. Does any member of your

household own? / तपाइको पररर्ारको कुनै

सिस्यसांग यी सामानहरु छन ्?

Watch / हात ेघडी ______

Bicycle / साइकल ______

Motorcycle or motor scooter / मटर साइकल / स्कुटर ______

Three wheel tempo / नतन पाांगे्र टेम्पो ______

Animal-drawn cart / जनार्रले तान्ने गाडा ______

Car, truck / कार/ट्रक/गाडी ______

78. W30. Does any member of your household own any agricultural land? / Yes / छ ______

तपाइको पररर्ारको कुनै सिस्यसांग आफ्नै नाम

मा जग्गा जसमन छ ? No / छैन ______

79. W31. How many hectares of your agricultural land do members of this

household own? / कनत जग्गा छ? _________________________ 80. W32. Does your household own any livestock, herds, other farm animals or

poultry? / तपाइको घर मा कुनै

जनार्र/बस्तुभाउ/कुरु्खरा आदि छ?

Yes / छ ______

No / छैन ______

81. W33. How many Buffalo does your

household own? / तपाइको पररर्ारको कनतओटा भैसी/रााँगा हरु छन?् _________________________ 82. W34. How many milk cow or bulls

does your household own? / तपाइको पररर्ारको कनतओटा गाइ / गोरु हरु छन?् _________________________ 83. W35. How many Horses, Donkey, or mules does your household own? /

तपाइको पररर्ारको कनतओटा घोडा/र्खच्चड/गधा हरु छन?् _________________________ 84. W36. How many Goats does your

household own? / तपाइको पररर्ारको कनतओटा बाख्रा हरु छन?् _________________________ 85. W37. How many Sheep does your

household own? / तपाइको पररर्ारको कनतओटा भेडा हरु छन?् _________________________ 86. W38. How many Chicken does your

household own? / तपाइको घरमा कनतओटा कुरु्खराहरु छन?् _________________________ 87. W39. How many Ducks does your

household own? / तपाइको घरमा कनतओटा हााँसहरु छन?् _________________________ 88. W40. How many Pigs does your

household own? / तपाइको घरमा कनतओटा सुाँगुर/बांगुर हरु छन?् _________________________ 89. W41. How many Yaks does your

household own? / तपाइको घरमा कनतओटा चौरी गाई छन?् _________________________ 90. W42. Does any member of your household have a Bank account/cooperative/ or other savings

account? / तपाइको पररर्ास को कुनै सिस्य

को बैंक र्ा सहकारी म र्खाता छ ?

Yes / छ ______

NO / छैन ______

91. W43. How many people live in your

household / तपाइको घर म कनत जना _________________________

सिस्यहरु छन ्?

92. W43. Do you own your house or any other house either alone or jointly with

someone else? / तपाई र्ा तपाइको पररर्ार को कुनै सिस्यको नाममा यो घर र्ा अरु कुनै घर छ?

Yes / छ ______

No / छैन ______

Sanitation

Only answer if you responded DFAT to Q2 93. Do the members of your household

have a toilet? / के तपाई को घरमा चवपा छ ?

No toilet, Practice OD / चवपा छैन, रु्खला स्थान जस्तै मैिान, झाडी मा दिसा गछौं______

Use Toilet / चवपा छ र प्रयोग गछौं______

Share – use others toilet / अरुको चवपा मा दिसा गछौं______

94. SAN1. Do the members of your

household use a toilet? / के तपाइको घरका सिस्यहााँरुले चपीको प्रयोग गिाछन ?

No toilet, Practice OD / गिैनन ______

Use Toilet / गछान ______

Only answer if you responded Use Toilet to Q94 95. SAN2. ASK and OBSERVE Question

/ यदि गछान भने कस्तो प्रकारको चपी हो ?

कृपया मलाई िेर्खाउन सक्नु हुन्छ ?

Flush/pour flush toilet / फल्स चपी______

Ventilated improved pit toilet (VIP) / सुधाररएको र्खाल्िे चपी (भी आइ वप) ______

Pit toilet with slab / स्लाब सदहतको र्खालडे चपी______

Pit toilet without slab / स्लाब बबनाको र्खालडे चपी______

Composting toilet / कमपोश्स्टङ चपी______

Urine diversion toilet / वपसाब सांकलन गना समल्ने चपी (दिसा र वपसाब छुत्युना समल्ने)______

Bucket / बाश्ल्टन चपी______

Hanging toilet or hanging toilet / झुश्न्डएको चपी र्ा तैररने

फ्रकससमको चपी______

Only answer if you responded Use Toilet to Q94 96. SAN2A. Ask and OBSERVE

Question / दिसा गररसकेपछी त्यो दिसा कहााँ जान्छ ?

The street, field or open pit / सडक, मैिान तथा रु्खला र्खाल्डो ______

A pond / पोर्खरी मा ______

The river or storm water drain / निी र्ा घर छेउको नालामा ______

A direct pit / ससधै र्खाल्डे चपी मा ______

An off-set pit / चपी भन्िा असल टाढा रहेको र्खाल्डो मा ______

A double (alternating) off-set pit / चारपी भन्िा ताधा रहेको िइुओटा र्खाडल मध्य एउटा र्खाडल मा ______

Alternating compartments (ecosan) / बैकलवपक कमपरतमेन्टमा (ECOSAN)______

Two sequential pits / िइु समानानतर र्खाल्डोमा ______

A water tight pit / पानी ननछने र्खाल्डोमा (water tight) ______

A water tight double chamber septic tank / िइुओटा कोठा भएको पानी ननछने र्खाल्डोमा (Septic Tank)______

Piped sewer / पाइप बाट ढलमा ______

97. Can I take a picture of your toilet?

(OUTSIDE FRONT) / के म तपाइको चपी को फोटो सलन सक्छु? _________________________ 98. Can I take a picture of your toilet?

(OUTSIDE BACK) / के म तपाइको चपी को फोटो सलन सक्छु? (बादहर पछाडडबाट ) _________________________ 99. Can I take a picture of your toilet?

(INSIDE) / के म तपाइको चपी को फोटो सलन

सक्छु? (सभत्र) _________________________

Only answer if you responded Use Toilet to Q94 100. SAN3. Can rats reach the faeces in

any way? / के दिसामा मुसाहरुको पहुच कुनै

फ्रकससमबाट पुग्छ ?

Yes / पुग्छ ______

No / पुग्िैन ______

Only answer if you responded Use Toilet to Q94 101. SAN4. How many households use

the toilet? / यो चपी को प्रयोग कती पररर्ारक

ब्यश्क्तहरुले गछान ?

One (only own household) / एक (एक मात्र पररर्ारले) ______

More than one / एक भन्िा बढी घर पररर्ारले ______

Only answer if you responded Use Toilet to Q94 102. SAN5 .OBSERVE- Does the toilet pan or slab allow flies to go in and out of

the pit? / के चपी को प्यान र्ा स्लाब बाट

खझङा र्खाडल सभत्र जाने र बादहर आउने गना सक्छन ?

Yes / सक्छन_्_____

No / सक्िैनन ______

Only answer if you responded Use Toilet to Q94 103. SAN5A. Is the toilet slab washable

and/or cleanable? / के तपाइन्को स्लाब

पर्खाल्न तथा सफा गना सफ्रकने र्खालको छ ?

No / छैन______

Yes, cleanable, but not washable / छ, सफा गना सफ्रकने र्खाल्को छ

तर पर्खाल्न सफ्रकने र्खाल्को छैन______

Yes, cleanable, and washable / छ, सफा गना सफ्रकन ेतथा पर्खाल्न

सफ्रकने र्खाल्को छ______

Only answer if you responded Use Toilet to Q94 104. SAN6 Is the tank/pit above the

ground? / के तपाइको चारवपको र्खाडल

जसमनको सतह भन्िा माथी छ ?

Yes / छ______

No / छैन______

Partly / थाहा छैन ______

105. SAN7. How deep is the pit below

the surface? (meters) / चपीको र्खाडल

जसमनको सतह भन्ि कती समटर गदहरो छ ? _________________________

Only answer if you responded No|Partly to Q104 106. SAN8. Can (ground) water get in or

out of the pit? (‘water tight’) / के जसमन

मुननको पानी चपीको र्खाडलसभत्र जाने र बादहर ननश्स्कन सक्ने अर्स्थामा छ ?

Yes / छ______

No / छैन______

Don't know / थाहा छैन ______

Only answer if you responded No|Partly to Q104 107. SAN9. When the pit was dug, was any

ground water seeping in? / चपीको र्खाडल र्खन्िा जसमनमा पानी बगेको/ननस्केको चथयो ?

Yes / चथयो ______

No / चथएन ______


Only answer if you responded No|Partly to Q104 108. SAN10. Does the pit or toilet leak waste water at any time of the year? (CONSIDER

RAINY SEASON TOO) / बषाा को कुनै पनन

समयमा, चपी तथा चपीको र्खाडल बाट फोहोरा पानी चुदहने र्ा बग्ने गरेको छ ?

Yes / छ______

No / छैन______


109. SAN11. What is the distance to the

nearest water source? / चपीको र्खाडल बाट

नश्जकको पानीको कुनै श्रोत सम्मको तसेो िरुी कती छ

? (समटरमा)

Less than 10 metres / १० समटर भन्िा कम______

Between 10 and 100 metres / १० िेर्खी १०० समटर सम्म______

Between 100 and 500 metres / १०० िेर्खी ५०० समटर सम्म______

More than 500 metres / ५०० समटरभन्िा माथी ______

Only answer if you responded No|Partly to Q104 110. SAN12. ASK and OBSERVE Question /

नश्जकैको पानीको मुहान चवपाबता माचथल्लो भागमा पछा फ्रक तल्लो भागमा पछा ?

DownHill / तल्लो भागम पिाछ ______

UpHill / माचथल्लो भागम पिाछ______

At the same level / समानान्तर सतहमा पिाछ______

111. SAN13. Has the pit ever been emptied?

/ चारवपको र्खािला कदहल्यै सफा/र्खाली गरेको छ ? Yes / छ ______

No / छैन ______

Only answer if you responded Yes to Q111 112. SAN14. When was it emptied into? /

कदहले र्खाली गरेको हो?

Less than 12 months ago / गत १२ मदहना सभत्र ______

Between 1-3 years ago / १ िेखर्ख ३ बषामा ______

Between 4-5 years ago / ४-५ बषामा ______

More than 5 years ago / ५ बषा भन्िा बढी ______

Don’t know / थाहा छैन ______

Only answer if you responded Yes to Q111 113. SAN15. Who actually empties the

pit? / चपी को र्खाडल कसले र्खाली /सफा गरेको हो?

The house owner/ tenants / घरमुली/घर को सिस्य______

A sweeper/ service provider / पोंडे, सफा गने मान्छे ______


Only answer if you responded Yes to Q111 114. SAN16. To empty the pit, did someone

need to enter the pit. / चपी को र्खाडल सफा गना कोदह र्खाडल सभत्र पस्नु परेको चथयो?

Yes, with full protection (gloves +mask+boots) / चथयो, सुरक्षक्षत तर्रले (बूट, ग्लोव्डस, मास्क लगाएर)______

Yes, without full protection / चथयो, कुनै सुरक्ष्या बबना ______

No / चथएन ______


Only answer if you responded Yes to Q111 115. SAN17. What was it emptied into? /

चपीको र्खाडल सफा गिाा ननस्केको फोहोर के मा फासलयो ?

Directly into drain/water body / field / ससधै ढलमा, पानीको श्रोत तथा जसमनमा ______

Into a pit on the compound that is then covered /

धाफ्रकएको/छोवपएको र्खाल्डोमा______

Into a pit on the compound that is left open / रु्खल्ला (नधाफ्रकएको) र्खाल्डोमा______

Directly into drum/open container and taken away / ससधै

द्रम सभत्र अथर्ाअ रु्खल्ला (नधाफ्रकएको) ट्याांक मारार्खी लाचगएको ______ Directly into closed container/tanker and taken away /

ससधै मेसशन तथा ट्याांकरमा रार्खी लाचगएको ______

Use of Sanitation 116. USAN1. Is the toilet in use, as a

toilet? / के चपीको प्रयोग चपीकै रुपमा भएको छ ?

Yes / छ______

No / छैन ______

Only answer if you responded Yes to Q116 117. USAN2. Is the toilet functioning as intended?

/ के चारवपको प्रयोग राम्रो रुपमा भैरहेको छ ?

Yes / छ______

No / छैन ______


Only answer if you responded Yes to Q116 118. USAN3. Are the walls and the door of the

toilet in place? / चपीमा धोका र पर्खाालहरु छन फ्रक छैनन

?

Yes / छ______

No / छैन ______

Only answer if you responded Yes to Q116 119. USAN4. Is the toilet free from faecal smears

on pan, wall and floor? / चपीको भुइमा, पर्खाालमा तथा प्यानमा दिसा िेखर्खएको छ फ्रक छैन ?

Yes / छ______

No / छैन ______

Only answer if you responded Yes to Q116 120. USAN5. Is the toilet pan free from used

cleansing materials (paper, stones, sticks)? / के

चपीको प्यान/दिसा पुछ्न प्रयोग गररएका समागहृरु (जस्तै पेपर,् ढुङ्गा, काठ आदि) िेखर्खएको छ के छैन ?

Yes / छ______

No / छैन ______

Only answer if you responded Yes to Q116 121. USAN6. What do you use for anal cleansing? /

दिसा गररसकेपछी चाक धुन अथर्ा सफा गना तपाइ के प्रयोग

गनुा हुन्छ ?

Nothing / केदह प्रयोग गदिान ______

Paper / पेपर/कागज ______

Water / पानी ______

Ash / र्खरानी ______

Soil / mud / माटो ______

Sticks / लकडी ______

Grass / झार/पात/घााँस ______

Stones / ढुांगा ______

Only answer if you responded Yes to Q116

122. USAN7. Do you flush the toilet? / के तपाइ

चपीमा फ्लश गनुा हुन्छ ?

No flush – pit toilet or other / फ्लश छैन - र्खाल्िे चारपी अथर्ाअ अन्य______

Yes, pour flush / छ, पोर फ्लश ्( ______

Yes, full/ handle flush / छ, पूना ह्यान्डल फ्लश ______

Only answer if you responded Yes, pour flush|Yes, full/ handle flush to Q122 123. USAN8. Is water available in the toilet? (for

anal cleaning and flushing) / के चपीमा दिसा गरेपछी चाक धुन (सफा गना) तथा फ्लश गना पानी उपलब्ध छ ?

Yes / छ______

No / छैन ______

Only answer if you responded Yes to Q116 124. USAN9. How do you dispose off the stools of

children under the age of 3 years old? / घरम ३ बषाा भन्िा कम उमेरका बाल्बछाहरुको दिसा कसरी ब्यर्स्थापना गनुा हुन्छ ?

Pick up and deposit in the toilet / दिसा उथाउने र चारवपमा तहा लगाउने______

Pick up and deposit in the garbage / दिसा उथाउने र फोहोरा फाल्ने थाउमा फाल्ने______

Leave where it drops / जहााँअ दिसा गछा त्यही थाउमा त्यनतकै राख्ने ______

Only answer if you responded Yes to Q116 125. USAN10. Does the toilet provide

privacy? / चारवपमा गोपननयता कायम छ ?

Yes / छा______

No / छैन ______

Only answer if you responded Yes to Q116 126. USAN11. Is everyone in the household presently able to use the toilet

easily and conveniently, unassisted? / के

घरको सब ैजनाले अदहले कसैको सहयोग बबना सश्जलै तथा आरामसांग चपीको प्रयोग गना सक्छन ?

Yes / सक्छन ______

No / सक्िैनन______

Only answer if you responded No to Q126

127. If no, why / यदि छैन भने, फ्रकन ?

Illness / बबरासम भएर ______

Old age / बधृबधृाहरु/बुढा-बुढी भएर ______

Injury / घाइते भएर ______

Disability / अपाङ भएर ______

Pregnancy / गभार्नत भएर ______

Menstruating women / मदहनार्ारी भएका मदहला______

Small children / ससाना बाल्बासलकाहरु ______

Only answer if you responded Yes to Q116 128. USAN11A. How many people in your household are unable to use the

toilet because of special needs? / बबशेश

कारणले, तपाइको घरमा कती जनाले चारवपको प्रयोग गना सक्नु हुन्न ?

0 / 0______

Specify how many people / कनत जना हो लेख्नुहोस?______

129. Specify how many people / कनत

जना हो लेख्नुहोस? _________________________ 130. USAN11B. In this household, are people with this special needs assisted in any way, to make use of the toilet /

तपाइको घरमा बबषेश आर्स्यकता भएका (अपाङ्ग, बुढा-बुढी, बबरामी, घाइत)े सिस्यहरु ल ै

चपी प्रयोग गना सहयोग गनुा पिाछ ?

No / छैन ______

Yes, with a walking aid / छ, दह्न सहयोग गनुापने ______

Yes, with a pedestal / छ, अग्लो बनाउनु पने ______

Yes, they use a bed-pan / छ, कोपरो प्रयोग गने ______

131. If yes, Specify / यदि छ भने कनत जना? _________________________ 132. USAN12. Does anybody in the household have any problems using

your toilet? / तपाइको घमाा कसैलाई चपीको प्रयोग गनामा समस्या रहेको छ ?

No problems / समस्या छैन______

Not clean / सफा छैन______

Smelly / गन्हाउछ______

No water inside / सभत्र पानी छैन______

Not easy to reach toilet / चारपी सम्मा पुग्न असश्जलो छ______

Not easy to squat / चारवपमा दिसा गिा बस्न असश्जलो छ______

Afraid of falling or slipping / ल्ने र्ा चचश्प्लने डर छ______

Not easy to wash yourself / दिसा गररसकेपछी सफा गना सश्जलो छैन______

Not easy to flush / फ्लश गना सश्जलो छैन______

Too small / धेरै सानो छ______

Too dark / धेरै अन्ध्यारो छ______

No privacy / गोपननएता कायम छैन______

Insects and animals inside / फ्रकरा तथ जनार्रहरु सभत्र आर्त जार्त

गनासक्छ______

133. USAN13. Do you have any problems cleaning and maintaining your

toilet? / तपाइलाई चपी सफा तथा ममात गना केदह समस्या छ ?

No problems / समस्या छैन______

Toilet blocks often / चपी प्राय जाम हुने गछा______

Water not available to clean / सफा गना पानी उपलब्धा छैन______

Cleaning materials not available / सफा गने सामग्रीहरु उपलब्ध

छैन______

Don’t know how to clean / सफा कसरी गने थाहा छैन______

Too many users / प्रायोगकतााहरु धेरै छन_्_____

Other users don’t know how to use / अन्य प्रयोग गनेहरुलाई चपी कसरी प्रयोग गने थाहा छैन ______

Other users don’t take their turn to clean / अन्य प्रयोग गनेहरुले

सफा गने पालो नै सलन्िैन______

Design is difficult to clean / चपीको बनोटले गिाा सफा गना गहो छ______

Fills up too quickly / चाडै भररन्छ ______

134. USAN14. What is the main problem

with the design? / तपाइको को प्राबबचधक

पक्ष्य तथा बनोटमा प्रमुर्ख के समस्या छ ?

Too small / धेरै सानो छ______

Too dark / धेरै अन्ध्यारो छ______

Wrong construction materials / गलत ननमाान सामागहृरुको प्रयोग

भएको______

Wrong internal layout / चपीको सभबत्र बनार्ोट गलत छ ______

Handwashing 135. HW1. Please mention all the occasions when it is important to wash

your hands? / तपाईं कुन कुन अर्स्थामा साबुन पानीले हात धुनु हुन्छ ? र्ा साबुन पानीले

हात धुनुपने मह्त्र्पूणा अर्स्थाहरु कुन कुन हुन

?

Before eating / र्खाना र्खानु अनघ______

Before breast feeding or feeding a child / बच्चालाई आमाको िधु

रु्खर्ाउनु तथा र्खाना रु्खर्ाउनु अघी ______

Before cooking or preparing food / र्खाना पकाउन अनघ______

After defecation / दिसा गररसकेपनछ______

After cleaning a child that has defecated/ changing child's

nappy / बच्चाको दिसा धोएपछी र्ा दिसा ससाफाइ गरेपनछ______

After cleaning toilet or potty / चपी र्ा बच्चाको दिसा गने भाडा सफा गररसकेपनछ______


136. HW2. Is there a place for hand washing within 10 meters from the toilet?

/ के साबुन पानील हात्धुने ननश्स्चत स्थान र्ा सुबबधा चारपी बात १० समटर सभत्र पछा र्ा पिैन

?

Yes / छ______

No / छैन ______

137. Can you show it to me please?

(Picture Question) / कृपया तपाइले मलाई

िेर्खाउन सक्नु हुन्छ ? (फोतो प्रचन) _________________________

Only answer if you responded Yes to Q136 138. HW3. Is there water available at the specific place for hand washing, now? /

हात धुने स्थानमा पानीको सुबबधा उप्लब्ध छ ?

Water is available / पानी उपलब्ध छ______

Water is not available / पानी उपलब्ध छैन ______

Only answer if you responded Yes to Q136 139. WH4. ASK and OBSERVE

Question / हात धुने स्थानमा साबुन र्ा साबुनको सिा प्रयोग गना सफ्रकने सामाग्री उप्लब्ध छ ?

No / छैन ______

Soap / साबुन ______

Ash / mud / sand / र्खरानन माटो बालुर्ा______



उक्त स्थान िेर्खाउन सक्नु हुन्छ ? (फोतो प्रचन) _________________________

Only answer if you responded Yes to Q136 141. HW5. Does the hand washing station prevent contamination of the

water by hands? / के पानी को हात धुने

स्थान/पानी हात बाट हुनेप्रिषुणबात मुक्त छ ?

Yes / छ______

No / छैन ______

Only answer if you responded Water is available to Q138 142. HW6. Is there running water from a

tap? / के तपाइको धाराबाटबाट ननयसमत रुपमा पानी आउछ? (पाइप बाट आउने धारा अथर्ा पानीको श्रोत बाट आउने धारा को पानी आदि)

Yes / छ______

No / छैन ______

143. HW7. Is there a place for hand washing within 10 steps from where food

is prepared? / के हात धुने ननश्स्चत स्थान र्ा सुबबधा भान्सा कोठा बाट १० मेतरे सभत्र पछा र्ा पिैन ?

Yes / पछा______

No / पिैन ______



उक्त स्थान िेर्खाउन सक्नु हुन्छ ? (फोटो प्रचन) _________________________

Only answer if you responded Yes to Q143 145. HW8. Is there water available at the specific place for hand washing, now? /

के उक्त ठाउमा साबुन पानीले हात धुन को लाचग

अदहले पानी को उपलब्धता छ ?

Water is available / पानी उपलब्ध छ______

Water is not available / पानी उपलब्ध छैन ______

Only answer if you responded Water is available to Q145 146. HW9. Is there soap or a soap substitute available at the specific place

for hand washing, now? / के ननश्स्चत

थाउन्मा हात्धुन को लाचग अदहले साबुन र्ा हात

धुने स्थानमा साबुन र्ा साबुनको सिा प्रयोग गना सफ्रकने सामाग्री उप्लब्ध छ ?

No / छैन ______

Soap / साबुन_्_____

Ash / mud / sand / र्खरानन माटो बालुर्ा______



उक्त स्थान िेर्खाउन सक्नु हुन्छ ? (फोटो प्रचन) _________________________

Only answer if you responded Water is available to Q145 148. HW10. Does the hand washing station prevent contamination of the

water by hands? / के तपानी को हात धुने

स्थान हात बात हुने प्रिशुन बात मुक्त छ ?

Yes / छ______

No / छैन ______

Only answer if you responded Water is available to Q138

149. HW11. Is there running water from a tap? / के

तपाइको धारा बाट ननएसमता रुपमा पानी औच? ? (पाइप बाट

आउने धारा अथर्ा पानीको श्रोत बाट आउने धारा को पानी आदि)

Yes / छ______

No / छैन ______

150. HW12. Have you seen / heard any promotion on good hand washing practice in the last 12

months? Through which source or media? / बबगत

एक बषा (१२ मदहना) यता तपाइले साबुन पानीले हात धुने

सम्बश्न्ध कुनै असभयान भएको िेख्नु भएको र्ा सुन्नु भएको छ ? एिी छ भने कुन श्रोत बाट र्ा कुन सन्चार माध्यम बाट

सुन्नु भयो ? र्ा िेख्नु भयो ? र्ा थाहा पाउनु भयो ?

No / छैन ______

Yes, in a workshop / छ, गोस्टी र तासलम आदि बाट

______

Yes, on the radio / छ, रेडडयो बाट ______

Yes, on TV / छ, दट भी बाट ______

Yes, in the newspaper / छ, पत्रपत्रीका बाट ______

Yes from a health visitor / community worker / छ,

स्र्ास््य स्र्एम सेबबकाहरु र्ा सामुिायका सहजकतााहरुबाट______

Yes, through a brochure / छ, पोस्टअर तथा पम्फ्लेटरुबात ______

Only answer if you responded Yes, in a workshop|Yes, on the radio|Yes, on TV|Yes, in the newspaper|Yes from a health visitor / community worker|Yes, through a brochure to Q150

151. HW13. Which organisation

organised it? / यदि िेख्नु भयो र्ा सुन्नु भयो र्ा थाहा पाउनु भयो भने त्यो असभयान कस्ले र्ा कुन सन्स्था बाट आयोजना गररएको चथयो ?

Don’t know / थाह छैन______

SNV (or one of our partners in this programme) / एस एन सभ

(र्ा एस सन्स्था को साझिेर सन्स्था बाट)______

Local government / स्थानइय ननकाय बाट ______

Country-specific questions

152. Do you have a bath shelter / तपाइको घरमा नुहाउने ठाउाँ छ?

Yes / छ ______

No / छैन ______

Only answer if you responded DFAT to Q2 153. Does the size, walls, door and access way (steps) of the toilet allow

access to all? / के चवपाको साइज, पर्खााल,

ढोका अनी आउने जाने बाटो (रु्खट्फ्रकला) सब ै

जना ले सश्जलै प्रयोग गना सक्न ेर्खालको छन?्

Yes / सक्ने र्खालको छन_्_____

No / सक्ने र्खालको छैनन_्_____

Only answer if you responded DFAT to Q2 154. Does the size and shape of the toilet pan and or squatting hole allow use

by all? / के चवपाको प्यान अथर्ा दिसा बग्ने

प्र्ाल सबै जना ले सश्जलै प्रयोग गना सक्न े

र्खालको छ?

Yes / सक्ने र्खालको छ______

No / सक्ने र्खालको छैन______

Only answer if you responded DFAT to Q2 155. Is the toilet's location, considering distance, slope, time of day, etc., easily

accessible for all? / चवपा रहेको स्थान, घर बाट चपी को िरुी, जााँिा आउाँिा को उकाली, ओराली, जाने आउने समय आदि को आधारमा के चवपा सबैजनाले सश्जलै प्रयोग गना सक्छन?

Yes / सक्छन______

No / सक्िैनन_्_____

Observations 156. Interviewer’s Observations /

अन्तरबाताा कार को अर्लोकन _________________________ 157. Field Editor’s Observations _________________________ 158. Supervisor’s Observations /

सुपरभाईजर को अर्लोकन _________________________

Location

159. GPS location / जी वप यस _________________________

Annex II. Outcome indicator tools/Focus Group Discussion Forms

Outcome indicator 6. Progress in sanitation services and business development

Outcome Indicator 7. Progress with regards to increased capacity of line agency to steer

behaviour change communication at scale and with quality

Organisational elements and statements

0 1 2 3 4

1. Has led the development of a district BCC strategy that includes sanitation and hygiene focus behaviours and target groups in line with national guidance and/or plans.

There is no physical evidence of a district BCC strategy.

i) A hard copy of the BCC strategy is available in the office

i) A hard copy of the BCC strategy is available in the office; and ii) It provides all the details about the intended results and required resources

i) A hard copy of the OP is available in the office; ii) It provides all the details about intended results and required resources; and iii) It is time bound, realistic and therefore doable

i) A hard copy of the OP is available in the office; ii) It provides all the details about intended results and required resources; iii) It is time bound, realistic and therefore doable; and iv) It is shared with, understood and used by all BCC stakeholders.

2. Ensures that a clear division of roles and responsibilities to implement the strategy is defined between the stakeholder organisations in BCC

There is no physical evidence of a clear division of roles and responsibilities

i) The organisational/ stakeholder roles and responsibilities are clearly defined

i) The organisational roles and responsibilities are clearly defined; and ii) Field implementation, supervisory and quality control roles or functions are clearly separated

i) Within the organisation roles and responsibilities are clearly defined; ii) Field implementation, supervisory and quality control roles or functions are clearly separated; and iii) This is well documented

i) Within the organisation roles and responsibilities are clearly defined; ii) Field implementation, supervisory and quality control roles or functions are clearly separated; iii) This is well documented; v) It is available, understood and used by all stakeholder organisations

3. Is mobilising adequate human and financial resources to implement BCC activities in line with the district strategy

No resources are being mobilised for implementation of district strategy.

i) Resources have been mobilised but are not being used to implement BCC activities in line with strategy

i) Resources have been mobilised and ii) Implementers are being guided to develop activities/tools as per district strategy

(i) plus (ii) plus (iii)Resources have been mobilised and are being used to implement prioritized BCC activities in line with the district strategy

i) plus ii) plus iii) plus iv) The activities implemented are being shared with all BCC stakeholders

4. Leads BCC strategy development based on formative research or evidence of motivators

There is no physical evidence that formative research has been undertaken in the programme area

i) Hard copies exist of a report with the outcomes of formative research

i) Hard copies exist of a report with the outcomes of formative research; and ii) The report provides insight to barriers and motivating factors of the main population segments

i) Hard copies exist of a report with the outcomes of formative research; ii) The report provides insight to barriers and motivating factors of the main population segments and iii) The main outcomes of the formative research are shared with and understood by all relevant organisations

i) Hard copies exist of a report with the outcomes of formative research; ii) The report provides insight in existing KAP of the main population segments; plus (iii) plus iv) The main outcomes of the formative research are used for developing a localised BCC strategy together with stakeholder organisations responsible for BCC activities.

responsible for BCC activities

5. Ensures thateffectiveness of messages and materials is tested with the target audience

Messages and materials are not field tested.

i) Messages and materials are tested but not specifically with target audience

i) Evidence that messages and materials have been tested before use with an applicable target group in terms of understanding of key messages and appropriateness.

i) Evidence that messages and materials have been tested before use with an applicable target group in terms of understanding of communication objectives, key messages and appropriateness. ii) Materials have been adjusted based on outcomes of testing if required.

i) Evidence that messages and materials have been tested before use with an applicable target group in terms of understanding of key messages and appropriateness; and ii) Adjusted materials have been shared with all stakeholder organisations.

6. Ensures that training to facilitators or other implementers in BCC approaches is being provided to an adequate standard

There is no training being provided for facilitators in BCC approaches and tools

i) Training has been provided but was not assessed

i) Training has been provided and was assessed; and ii) Hard copies exist of the necessary tools and training reports

i) Training has been provided and was assessed with facilitators achieving an adequate standard; plus (ii) plusiii) Based on training report and assessment, WSSDO provided feed back to training organisation to ensure adequate standard

i) Training has been provided and was assessed with facilitators achieving an adequate standard; plus (ii) plus (iii) iv) Training organisation incorporated any feed back into training curriculum.

7. Ensures that regular assessment of the performance of facilitators of BCC interventions is being done by implementing organisation.

There is no assessment of facilitators in BCC approaches and tools taking place.

i) Follow-up assessments are being done on an ad-hoc basis

i) Follow-up assessments are being done in a planned manner

i) Follow-up assessments are being done in a planned manner; and ii) Documented.

i) plus (ii) plus iii) Feedback is being provided to facilitators based on assessment and document.

8. Facilitates review on effectiveness of BCC interventions based on monitoring or lessons learned

Effectiveness of BCC interventions has not been reviewed.

i) Monitoring or lessons learnt exercise has been done on effectiveness of BCC interventions

i) Plus ii) Review exercise done and BCC approaches/tools/activities are adjusted

Adjusted BCC approaches/tools/ activities are shared with all BCC stakeholder organisations

Adjusted BCC approaches/tools/activities are shared with all BCC stakeholder organisations and are being applied.

Outcome indicator 8. Capacity of local governments or line agencies to steer sanitation

demand creation at scale in their area

Organisational statements Scores

0 1 2 3 4

Are you implementing any sanitation demand creation activities in the Sub county? Do the activities cover the whole sub county?

Do you have a county action plan for demand creation? How was the plan developed and who was involved? Are there minutes of meetings held?

0= no plan for demand creation; 1= plan for demand creation but not covering entire district/ county 2=plan for demand creation covering entire district/county –even if in phases; 3=plan for demand creation covering entire district/ country, and well documented (results activities, resources); 4=plan for demand creation as in (3) and shared with all staff in the organisation.

1. Has plan for implementing demand creation activities covering the entire district (even if in phases)

Have you assigned specific staff to implement your plan? If yes, have you been able to mobilise the activity budgets according to what was planned?

0= No resources allocated or mobilised for demand creation; 1= only ad-hoc allocation and mobilisation, not according to plan; 2= human & financial mobilised in line with plan but inadequate to implement the plan completely; 3= adequate resources have been mobilised for all activities and/or strategies within the plan have been adjusted to resource limitations; 4= adequate resources have been mobilised for all activities

2. Ensures that there are human and financial resources to implement demand creation activities in line with its plans (in-house or other)

Are there different partners implementing CLTS in the county/District? What role does the county team play in these activities? Are partners encouraged to implement in a specific way? Do they share their reports regularly? Does the county give feedback on these reports?

0=no standards; 1=Standards exist but are not shared or no discussion about its application; 2= demand creation standards are shared; 3= standards are shared and discussed with partners but not at regular basis; 4=demand creation standards are shared, discussed at regular basis and partners assess their performance

3. Promotes standard and regularly assesses the performance of organisations engaged in demand creation

Is there any monitoring of demand creation activities? Who plays this role? How do they do it? What system do they use for progress tracking and reporting?


0 1 2 3 4

0=no system; 1=system not well defined; 2=system defined but not used; 3=2+used irregularly; 4=system well defined and used regularly

4. Has a monitoring system that measures progress on demand creation targets and results at village and sub-district level

How do you practice follow-up on the demand creation plan as above? What determines the time and frequency? When are decisions on this made?

0=no follow-up; 1= follow-up is ad hoc; 2= there is a plan for follow-up; 3=regular follow-up at most appropriate times; 4= as 3+ well reported

5. Ensures that follow-up happens at the most appropriate times of the year

Who is responsible for progress reporting? Who are the reports shared with? Is feedback provided? If yes, how is it done?

0=not shared/ line agency does not have access to information from stakeholders working on demand creation; 1= line agency has access to information but it is not shared with others; 2=1+discussed but not analysed; 3=2+analysed but measures are taken; 4=3+agreement on improvements with relevant stakeholders

6. Ensures that information on progress is shared, analysed and discussed with relevant sub-district and district level stakeholders

What key indicators are monitored on a regular basis by the stakeholders in your area? How were these determined? What measures have been put in place to ensure equity and inclusion of all groups?

0=no inclusion; 1=partial inclusion in data; 2=inclusion in data but no assessment; 3=2+with assessment but irregular monitoring; 4=3 with regular monitoring

7. Ensures that monitoring includes data that assesses inclusion of all groups within the villages, including people with a disability

How is the monitoring data on sanitation demand creation/ ODF progress used after it has been analysed? Can you give some examples of what you have mentioned?

0=not used; 1=used rarely; 2=used partially; 3= largely used; 4=always used

8. Uses the data from monitoring and experiences to adjust or improve implementation of sanitation demand creation when relevant


0 1 2 3 4

How do stakeholders in your district handle hard to reach villages and those lagging behind? How do you ensure that? Is this defined in your plan? Cite examples where this has been done.

0=no identification of villages lagging behind/ hard to reach; 1= Identification of hard to reach villages but no adjustment in approach; 2= as 1+ possible adjustments are discussed; 3= as 2+ differentia approaches are used; 4=as 3+ local government ensures that all organisations adjust their approach to include hard to reach villages and those lagging behind.

9. Uses a differentiated approach for hard to reach villages and those lagging behind

Do you, and how do you convince others in local government such as political leadership, your bosses, your staff, other divisions, lower levels of government about the need to work on sanitation.

0= Not: “We do not speak to other people in local government about sanitation because it’s not their responsibility”; 1=Irregular: “Now and then we try to convince other people in local government”; 2= regular: “We try to convince them at all possible moments”; 3= regular + focused “We speak to them regularly about specific topics”; 4= 3+with clear targets & views “We speak regularly to specific people about specific topics suggesting key messages they could disseminate ”.

10. Mobilises local government and other local leadership around sanitation

Other general comments/ Narrative:

Outcome Indicator 9: Improved sector alignment at local level


0 1 2 3 4

Is there a forum through which stakeholders discuss sanitation issues? Who are the stakeholders involved?

0=none; 1=minimal dialogue & not structured; 2=structured but not all inclusive; 3=Structured and all inclusive but not held on regular basis; 4= Structured and all inclusive and held on a regular basis

1. A multi-stakeholder dialogue has started (on rural sanitation)

0=never; 1=rarely; 2=occasionally; 3= frequently; 4=always

2. All relevant (local) government sector stakeholders are involved in the dialogue.


3. All relevant (local) donor (or funding) agencies are involved in the dialogue.


4. Relevant civil society and private sector stakeholders are involved in the dialogue.

0=evidence is not available and not shared; 1=evidence exists inside organisations but is only shared sometimes and on request; 2=there are moments in which organisations share their information/evidence in the stakeholder group, but it is not regular; 3= regular sharing of information and evidence takes place in the stakeholder group; 4=stakeholder information and evidence is readily available and shared in a common system (paper based system or electronic, such as website, mailing list etc).

5. Information and data (evidence base) are shared in the group.

Are sector priorities set jointly by the stakeholders?


6. Sector priorities (for rural sanitation) are set jointly by stakeholders.



0 1 2 3 4

7. Sector targets (for rural sanitation) are set jointly by stakeholders.


8. Plans (for rural sanitation) are made jointly.

Are the stakeholder approaches aligned with the principles as defined in country plan or strategy for sanitation?

0=not at all; 1=some elements; 2=all elements by a few stakeholders; 3=2+most stakeholders; 4=3+ all stakeholders

9. Approaches (to rural sanitation) are aligned.

0=not at all; 1=not fully; 2=in full by a few stakeholders; 3=in full by most stakeholders; 4=in full by all stakeholders

10. Standards and norms (related to rural sanitation) are aligned.

Other general comments/ Narrative:

Annex III. Training schedule to the enumerators

RECID-NEPAL COLLABORATION WITH SNV-NEPAL

2 Days’ Enumerator Training on

“DATA COLLECTION THROUGH MOBILE APPLICATION”

District: ……………………. Date: ……………………….

DAY I

Time Topics Facilitators

10:00-10:30 Climate setting-Introduction of participants, facilitators and objective of the training

10:30-11:00 A brief objectives of Baseline Survey and SSH4A

11:00-11:45 A brief description of different types of latrines used in Nepal

11:45-13.00 Use of mobile apps (Time setting, GPS, Wi-Fi, launching of Akvo apps, review status)

13.00-14.00 Khana Break

14.00-16.00 Exercise on questionnaire filling, review/discussion on each questions

16.00-17.00 Q and A, Revision of today’s sessions

DAY II

07:00 – 7:30 Breakfast

7:30 – 12:00 Field survey testing

12:00- 14:00 Back to hotel and lunch

14:00- 15:00 Feedback and Q and A from the field exercise; and dash monitoring

15:00-15:30 Break

15:30- 17:00 Sampling of VDCs, Wards and Households survey and field plan

Contact Information

SNV Netherlands Development Organisation

Nepal Office

Address: Jawalakhel, Lalitpur

P.O. Box 1966

Kathmandu, Nepal

Tel. +977 (0) 1 5523444

Fax. +977 (0) 1 5523155

Email. [email protected]

Contact person: Nadira Khawaja, SL ([email protected])

SNV is dedicated to a society where all people enjoy the freedom to pursue their own sustainable

development. We contribute to this by strengthening the capacity of local organisations.

mailto:[email protected]

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