Evaluation of community led total sanitation · ACKNOWLEDGEMENTS This is the report on evaluation carried out to access the approach of Community Led Total Sanitation (CLTS) implementation

Evaluation of community led total sanitation

Plan Nepal

2007

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TABLE OF CONTENTS

ABBREVIATION ACKNOWLEDGMENT EXECUTIVE SUMMARY

1. INTRODUCTION ................................................................................................................................................1

1.1 ABOUT THE CLTS PROGRAMME...............................................................................................................1 1.2 OBJECTIVES OF STUDY ............................................................................................................................1 1.3 EVALUATION ISSUES OF THE STUDY..........................................................................................................2

2. GENERAL APPROACH AND METHODOLOGY ...............................................................................................2

2.1 PREPARATORY WORKS ...........................................................................................................................2 2.1.1 Desk studies ....................................................................................................................................2 2.1.2 Development of field survey tools and instruments.........................................................................3

2.2 FIELD INVESTIGATION..............................................................................................................................3 2.2.1 Selection of sites for visits ...............................................................................................................3 2.2.2 Primary data collection tools...........................................................................................................3

3. ANALYSIS AND FINDINGS...............................................................................................................................4

3.1 BRIEF DESCRIPTION OF THE CLTS CLUSTERS ............................................................................................4 3.2 CLUSTER SELECTION ...............................................................................................................................6 3.3 PARTNERING WITH NGOS .......................................................................................................................6 3.4 KEY PROGRAMME INTERVENTION.............................................................................................................7

3.4.1 Introduction of ignition tools ...........................................................................................................7 3.4.2 Formation/Mobilization of Action Committee..................................................................................7 3.4.3 Formation/Mobilization of Child Clubs/BLOP groups:......................................................................7 3.4.4 Facilitation ......................................................................................................................................8 3.4.5 Monitoring Mechanism....................................................................................................................8 3.4.6 Reward/Incentives System ..............................................................................................................9

3.5 TIME REQUIRED TO DECLARE ODF COMMUNITY .........................................................................................9 3.6 TECHNOLOGY AND COSTING..................................................................................................................10

3.6.1 CLTS V/S temporary latrines .........................................................................................................10 3.6.2 Rebuilding/Upgrading of latrines ...................................................................................................11 3.6.3 Latrines for land less and less land HHs ........................................................................................11 3.6.4 Types of latrines ............................................................................................................................11 3.6.5 Costing ..........................................................................................................................................12

3.7 MOTIVATING FACTORS (FACTORS FOR SUCCESS)......................................................................................13 3.7.1 Ignition tools .................................................................................................................................13 3.7.2 Norms and regulations ..................................................................................................................14 3.7.3 Catalyst Role of Facilitators and Staff...........................................................................................15 3.7.4 Low Cost and Zero Investment Technology...................................................................................15 3.7.5 Social Factors ................................................................................................................................16 3.7.6 Cost for Latrine Vs Disease Treatment ..........................................................................................16 3.7.7 Natural Leaders/Opinion leaders...................................................................................................16 3.7.8 Favorable conditions .....................................................................................................................16 3.7.9 Others ...........................................................................................................................................17

3.8 BARRIERS (FACTORS FOR FAILURES OR LOW ACHIEVEMENT).....................................................................17 3.8.1 Lack of Technical Input..................................................................................................................17 3.8.2 Economic Factors. .........................................................................................................................18 3.8.3 Subsidy..........................................................................................................................................18 3.8.4 Social and Cultural Factors:...........................................................................................................18 3.8.5 Availability of Open Space ............................................................................................................18

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3.8.6 Political influence ..........................................................................................................................18 3.8.7 Other unfavorable conditions ........................................................................................................18

3.9 ENABLING ENVIRONMENT ......................................................................................................................19 3.9.1 Strengthened Local User/Action Groups .......................................................................................19 3.9.2 Resource Sharing...........................................................................................................................19 3.9.3 Availability of Skilled Human Resource and Materials...................................................................19 3.9.4 Availability of Credit Facilities .......................................................................................................20

3.10 INNOVATIONS AND BEST PRACTICES .......................................................................................................20 3.10.1 Approach:......................................................................................................................................20 3.10.2 Technology....................................................................................................................................21 3.10.3 Tools..............................................................................................................................................21

3.11 IMPACT ................................................................................................................................................21 3.11.1 Sanitation Aspects ........................................................................................................................21 3.11.2 Creation of strong local group to initiate other development activities..........................................21

3.12 CLTS VS CONVENTIONAL APPROACH AND SUBSIDY VS NO SUBSIDY .......................................................22 3.13 RELEVANCY .........................................................................................................................................23 3.14 PROGRAM EFFICIENCY...........................................................................................................................23 3.15 EFFECTIVENESS ....................................................................................................................................24 3.16 SUSTAINABILITY ...................................................................................................................................24 3.17 GENDER AND EQUITY ............................................................................................................................24 3.18 REPLICATION AND RIPPLE EFFECT ..........................................................................................................25 3.19. LIMITATIONS OF THE PROGRAMME .........................................................................................................25

4. KEY LESSONS LEARNT ..................................................................................................................................26

5. RECOMMENDATIONS ....................................................................................................................................27

Annex Annex 1: CLTS Implementation Guidelines Annex 2: District reports Annex 3: Check list for CLTS field survey

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ABBREVIATIONS

BLOP Better Life Option Programme

CPO Country Programme Outline

CBO Community Based Organisation

CLTS Community Led Total Sanitation

CODEF Community Development Forum

CSP Country Strategic Plan

DAG Disadvantaged Group

DDC District Development Committee

DC Development Coordinator

FGD Focus Group Discussion

HH Household

PU Programme Unit

PUM Programme Unit Manager

FGD Focus Group Discussion

NGO Non‐Government Organisation

ODF Open Defecation Free

SLTS School‐Led Total Sanitation

UC Users’ Committee

VDC Village Development Committee

WATSAN Water and Sanitation

WES Water and Environmental Sanitation

ACKNOWLEDGEMENTS

This is the report on evaluation carried out to access the approach of Community Led Total Sanitation (CLTS) implementation and its outcome and impact in Plan Nepal's programme districts. Plan Nepal extends its sincere appreciation and thanks to Plan Nepal's partners, members of the child clubs, members of water and sanitation user committees, children, their families and key informants who participated in the survey and discussions and provided excellent support. We are also very grateful to many other people, both within Plan Nepal and other organizations who provided valuable information during the study. We sincerely thank concerned line agencies personnel and communities of the Plan working districts for providing us valuable help in collecting information at the field level. Plan Nepal would like to thank study team, Mr. Guna Raj Shrestha (Team Leader), Ms. Babina Shrestha (Socio‐Economist) and Ms. Rashmi Singh Rana (Environmental Expert/ Gender Expert) of Community Development Forum (CODEF) who conducted the evaluation. Plan Nepal acknowledges key Plan staff; Nabin Pradhan, (Water and Environmental Sanitation Coordinator), Shusil Joshi (Corporate, Planning, Monitoring and Evaluation Coordinator), Shreeram KC (Development Communication Officer), who coordinated and contributed in the entire evaluation process. Special thanks to all the Programme Unit teams for extending cooperation and support during the course of evaluation. Plan Nepal

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EXECUTIVE SUMMARY

In its effort to increase sanitation coverage, Plan Nepal initiated, in partnerships with NGOs, three community led total sanitation (CLTS) programmes in 2004 and increased the number to 25 clusters by 2005. The programmes are found in all six of Plan’s working districts‐‐Morang, Sunsari, Bara, Rautahat, Makwanpur and Banke—and fall under all four of its PUs. The programme was started following a hands‐on training conducted by Dr. Kamal Kar, a CLTS expert from Bangladesh for the field staff of Plan Nepal and its partner organisations. In order to evaluate the CLTS approach, process, outcomes, and impact and to systematically document the implementation of CLTS programme, an assessment was carried out in June and July 2006 by a team of external consultants from Community Development Forum (CODEF), a NGO working in water and sanitation in Nepal. The field assessment, which was conducted in all clusters, addressed issues like project relevance, efficiency, effectiveness, impact, sustainability and equity.

Of the 25 clusters, 10 had been declared open defecation‐free (ODF) communities at the time of the field survey, and progress in two was nearly stagnant. In the remaining 13 clusters CLTS was ongoing and some were on the verge of being ODF. The size of the clusters varies from 20 to 236 households.

Once the clusters were selected for CLTS, ignition tools like social mapping showing who defecates where; faeces calculation of how many kg of faeces one person produces and eats in a year; transect walks to open defecation areas (walks of shame); stimulating words by facilitators; exposure visits to ODF clusters; flagging open defecation spots, a unique tool of “on‐site stool testing”; and demonstrations of the effects of faecal‐transmitted diseases were introduced to local people to incite them to take action against open defecation. Users’ committees (UCs) were then formed in each cluster in order to institutionalise action. These committees were to implement, coordinate, monitor and evaluate the CLTS programme.

Child clubs were often mobilised to support the activities of sanitation committees by pressuring people to stop defecating in the open and to build latrines. Some of the tools and activities used by the child clubs were i) flagging open defecation areas, ii) holding rallies and chanting against open defecation, iii) whistling at people caught defecating in the open, iv) drawing cartoons of people caught red‐handed, naming them and displaying the result on public notice boards, v) enacting street drama on sanitation and hygiene issues, vi) visiting individual homes to raise awareness about personal hygiene and household sanitation. Children were also involved in monitoring progress in latrine construction. In short, they acted both as agents of change and as vigilantes.

Facilitating and monitoring the activities of the CLTS action group is key to the implementation of a CLTS programme and to ensuring the participation of a community. Once sanitation action committees had formulated action plans to make their community free of open defection and to build household latrines, Plan and NGO staff made periodic visits to the clusters to make sure plans were converted into actions and to facilitate those actions.

ODF was usually declared at one of three times: i) immediately after latrines were completed, ii) a few weeks after their completion, and iii) after open defecation had stopped but before latrines had been completed. Once the ignition tools of CLTS were introduced, it took between 11 and 24 weeks for communities to declare themselves ODF. The major factors determining the time it took were the size of the cluster, the latrine technology employed, and the homogeneity of the community. The programme aimed to stop open defecation and to build latrines and in clusters selected. While the types of latrines found in each cluster varied, most were simple pits (both offset and direct) with

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temporary superstructures. That there is a misconception among CLTS implementers that CLTS involves only temporary latrines is evident from the fact that even households which could afford permanent latrines built temporary ones. The average cost of a temporary latrine was estimated to range from Rs. 1,000 to 2,000, including cash and kind. Upgrading temporary latrines had started in some clusters, like Gamargawan, Ekta Chowk and Prakriti Chowk, all of which had been declared ODF a year earlier. The ignition tools used were the main reason for the success of CLTS. The norms and rules set by sanitation action committees and child clubs and the active role of children in pressuring the community also. The realisation that latrines can be built cheaply using local materials also fostered the construction of latrines, as did the realisation among women that the cost of building a temporary latrine is about the equivalent of the money they spend every year treating diseases like diarrhea and dysentery. In addition, NGO and Plan Nepal facilitators were instrumental in their role as catalysts.

The frequent collapse of temporary latrines was a significant disincentive, especially among the poor, who could not afford to repair them or permanent latrines. They simply began to practice open defecation again. Poverty also contributed to failure or low achievement; some poor households could not spare time to build latrines or could not afford to invest even a few hundred rupees. Furthermore, the conventional practice of Plan Nepal and other agencies of providing a subsidy for latrine construction encouraged people to wait. Socio‐cultural beliefs like the prohibition against a daughter–in‐law defecating in the same place as a father‐in‐law, the conviction that only rhinos defecate in the same place all the time, and that a toilet should not be built near a kitchen or household worked against CLTS in some clusters. Other factors that led to failure or stagnancy included the unavailability of open space; the lack or insufficiency of land; illiteracy and alternative habits. To help sustain and scale up the CLTS programme in the future, the assessment makes recommendations in three areas: approach and strategies, technology, and human resource development (HRD). The major recommendations under approach and strategies are i) developing a guideline and disseminating it at all levels; ii) formulating a single, uniform policy on subsidies, iii) developing the capacity of action committees, child clubs and boys and girls so they can be mobilised to the optimum extent, iv) developing strategies required for post‐declaration efforts in order to ensure sustainability, replicability and scaling up, v) integrating CLTS with water supply schemes as far as possible, vi) networking and coordinating with various concerned organisations, particularly DDCs and VDCs, vii) establishing linkages to financial institutions and promoting income‐ generating activities in order to finance the upgrading of latrines and scaling up in villages, viii) carrying out the planning required at the VDC level, and ix) supporting sectoral line agencies in their efforts to develop and implement CLTS guidelines.

The technical recommendations include i) providing several technical options for latrines that are hygienic, durable, low‐cost, zero‐cost, and appropriate for the local situation rather than prescribing one version prescribe, ii) demonstrating how to construct low‐cost and hygienic latrines, iii) encouraging those who can afford permanent latrines to construct them. The HRD‐related recommendations include i) providing basic and refresher training to facilitators at the field level and orientation to management teams, ii) extending training and orientation to DDCs and VDCs so they can scale up CLTS, iii) providing national and international exposure to staff through exchange visits, seminar and workshops, and iv) training local people to construct low‐cost latrines.

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EVALUATION OF COMMUNITY LED TOTAL SANITATION (CLTS) PROGRAMME

1. INTRODUCTION

1.1 About the CLTS Programme

Water and environmental sanitation (WES) is one of Plan Nepal’s core programmes in its Country Programme Outline (CPO) 09. WES projects and activities include providing access to and ensuring the utilisation of sufficient safe drinking water and sanitary disposal facilities; proper waste management; school hygiene and sanitation; environmental sanitation; hygiene and sanitation education, awareness, and promotion; good hygiene practice, water quality monitoring; support for institutional latrines; capacity building of WES users, including children; and operation and maintenance of facilities. Plan implements such activities in 135 VDCs in its six working districts through water and sanitation user groups (WATSN UGs) and CBOs which get support from and are facilitated by Plan and its partner NGOs.

Sanitation coverage in Nepal is very low: only about 39% of the population has access to latrines. In Plan‐supported communities the situation is even worse: just 24% of families have access to household latrines. Open defecation is a common practice in rural and semi‐urban areas. The approach currently used by all agencies involved in implementing sanitation programmes is providing partial subsidies in cash and/or kind to users.

Plan Nepal piloted the CLTS approach in three communities in Bara District in mid‐2004 as an exercise during a hands‐on training for the field staff of various organisations involved in the sector which was jointly organised by Plan Nepal and Water Aid Nepal. The approach was based on experience in and learning about CLTS in Bangladesh and India. The CLTS approach was later extended to a few other villages in Rautahat, Bara, Makwanpur, Morang, Sunsari and Banke districts.

Plan Nepal currently implements CLTS in all six of its programme districts‐‐Morang, Sunsari, Bara, Rautahat, Makwanpur and Banke‐‐in partnership with local NGOs, namely, IDS Nepal in Banke, RADO Nepal in Makwanpur, ECARDS Nepal in Bara, RUWSAPS in Rautahat and NEWAH in Morang/Sunsari. CLTS has been introduced to 25 clusters; three in Banke, 3 clusters in Makwanpur, ten in Morang/Sunsari, one in Rautahat and eight in Bara.

1.2 Objectives of the Study

The overall objective of this study was to evaluate the implementation of CLTS approach, process, outcomes, and impact and systematically document the implementation of CLTS. The followings are the specific objectives:

• To assess and document the implementation approach and process of CLTS (for ongoing and ‘open defecation‐ free declared’ communities) vis‐à‐vis the conventional approach as adopted by Plan Nepal, in terms of the initial outcomes/impacts of the CLTS approach and the conventional approach including identification of key challenges, limitations, deficiencies, weaknesses and strengths.

• To assess and document a detailed outline of the innovations and technologies adopted in CLTS approach.

• To document the lessons learnt from this approach.

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• To assess and document the factors (social, cultural, geographical, economical, technical and others) behind the successes and failures of the approach.

• To come up with a set of recommendations for scaling up and replicating CLTS in other areas, for improving the CLTS approach and for improving policy making and action at the local, national and international levels.

• To prepare broad guidelines to CLTS implementation.

1.3 Criteria for Evaluation

The evaluation looked at the following issues in detail. Programme/project relevance: How well did CLTS address the key issues or problems that affected the Plan communities over the program period Programme/Project Efficiency: Measure the extent to which the program used the least possible resources to achieve the required quality of outputs/outcomes in line with CPO objectives. Programme/project Effectiveness: Assess the effectiveness analysis whether the program achieved what it is set out to achieve in its plans. Programme/project Impact: Conduct systematic analysis of the changes in people's lives (children, families and communities) brought about by the programme. Programme/project Sustainability: To what extent will the objectives of the programme continue to be met after phase‐out, without Plan’s support? Equity: How and to what extent has equity, especially for women and the socially excluded, been addressed by CLTS? 2. GENERAL APPROACH AND METHODOLOGY This study was based on the primary and secondary sources of information. Moreover, the method of the study was primarily quantitative and qualitatively in which the current status of the project implementation and the progress made by it would be quantified as far as possible.

The methodologies adopted included PRA and other tools applicable for assessing water, hygiene and sanitation. All tools were selected so that the output of the study would meet the expectations laid out in the TOR.

2.1 Preparatory Work

Immediately after the contract was signed and before field mobilisation, the study team carried out the preparatory works described below.

2.1.1 Desk Study

The following Plan Nepal documents were reviewed. Country Strategic Planning (CSP) Country Programme Outlines (CPOs), Plan Nepal Child Centered Community Development Handbook Plan Strategic Directions and Enablers Plan Principle Domain Guidelines Plan Nepal Annual Programme Communication (APC) (2001, 2002 and 2003) Guidance on Plan Programme Evaluation Plan Nepal monitoring reports, experience sharing and other reports pertinent to CLTS

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National and international literature, guidelines, etc available on CLTS and School Led Total Sanitation (SLTS) The study team also reviewed relevant documents from PUs.

2.1.2 Development of Field Survey Tools and Instruments

The team used the document review to develop a number of checklists, questionnaires and guidelines for use in the field. They are listed below.

Key informant’s interview (with Plan Nepal PU staff) : Checklist Key informant’s interview (with NGO partner staff)) : Checklist Key informant’s interview (with health post staff) : Checklist Focus group discussion (FGD) with WATSAN users’ committee members : Topic guide FGD with child club members : Topic guide FGD with women’s group : Topic guide FGD with DAG/ethnic/marginalised group : Topic guide Transect walk : Check list

After testing the checklists in Banke and revising them as needed, they were shared with the WES Coordinator before fieldwork in other PUs was carried out.

2.2 Field Investigation

Immediately after completing the preparatory work, the study team left for the field to collect primary information at selected sites. The field work was carried out from 24th May to 15th June, 2006. Details are given below.

2.2.1 Selection of Sites for Visits

The study team visited all 25 of the CLTS schemes, three in Banke, eight in Bara, one in Rautahat, three in Makwanpur, six in Sunsari and four in Morang. Three are in the hills; the rest, in the Tarai. By sampling one hundred percent of the schemes, the team was able to assess the situation comprehensively.

2.2.2 Primary Data Collection Tools

The following tools were used during the field investigation Key informant interview (KII):

At each scheme, the team conducted about five in‐depth interviews with some of the stakeholders listed below. A semi‐structured questionnaire was used to facilitate the interviews.

• Health post/sub‐health post staff • Facilitating NGO/CBO members/staff • Child club/BLOP members • Water and sanitation

users/action committee members

• Women’s group members • Plan Nepal staff at the field

and project levels

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• NGO partner staff

Focus Group Discussions: The FDG is a qualitative research technique which is very effective for gathering in‐depth information in a short period of time. FGDs were conducted with various functioning groups, including WATSAN UGs and users’ committees (UCs), child clubs, BLOP groups, the marginalised and disadvantaged, and women’s groups. Fig 1: Focus Group Discussion with Child Club

At least two FGDs were conducted in each scheme area. The groups were se so that there would be no duplication of the individuals with whom interviews were conducted. The team also ensured that the number of groups included in each district was in proportion to the total number of schemes present in that district. The table below provides more detail.

Table 1: Details of Focus Group Discussion

Type of group Sunsari/ Morang PU

Bara/ Rautahat PU

Makwanpur PU

Banke PU

WATSAN UCs/UGs 10 9 3 2 Child clubs/BLOP groups 8 4 0 1 Women’s groups and others 4 6 3 1 Transect Walk In each villages where CLTS was implemented, the study team made a transect walk with local people, including child club members, CLTS natural leaders, facilitators and NGO staff. The purpose of the walk was to observe the sanitation and hygiene situation, particularly the amount of open defection, the status of latrines, household and environmental sanitation, and personal hygiene. Interviews with Plan, NGO and CBO Staff

The team interviewed concerned Plan Nepal staff at the PU and CO levels as well as NGO and CBO staff to find out about lessons learned, trends in the issues CLTS addresses, and general observations of the programme. 3. ANALYSIS AND FINDINGS

3.1 Brief Description of CLTS Clusters

Ten of the 25 clusters are ODF communities, two are stagnant and the other thirteen are in the process of implementing CLTS or close to declaring ODF status. The size of the clusters varies from 20 to 236 households; other salient features are given below.

Table 2: Salient Features of CLTS Clusters

SN Name of

Cluster/VDC District HH

Coverage Ethnicity Latrine

Coverage (%)

Remarks

1 Shivpuri (Saigaon VDC)

Banke 144 Magar, Dalit Brahmin/Chettri, Awadhi

99 Declared ODF community

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2 Amritpur (Ganapur VDC)

Banke 13 Majority Chhettri 85 Subsidy provided

3 Parnipur (Samsergunj VDC)

Banke 38 Magar and Dalit 87 In progress

4 Gamagawan (Chatapipra VDC)

Bara 128 Dhanuk, Tharu, Kanu, Teli, Ahir, Kurmi, Lohar, Naounihar, Hajam


5 Nitanpur (Chhatapipra VDC)

Bara 125 Teli, kurmi, Dhanuk, Kalwar, Malah, Ahir, Pandit, Newar and Dalit

25‐30 In progress

6 Gothgaon (Chhatapipra VDC)

Bara 20 Muslim, Mahato

25 Almost a failure but reviving and in progress

7 Bharwalia (Barainiya VDC)

Bara 117 Shah, Baitha, Gond, Hajam, Lohar, Malhad and Dushad, Chamar


8 Bhalui (Bhalui Bharwaliya VDC)

Bara 116 Chamar, Das, Muslim, Shah

17 Stagnant but reviving

9 Ekwaniya (Bhalui Bharwaliya VDC)

Bara 78 Brahmin, Dhobi, Koiri, Tatma and Dushad

79 In progress

10 Fulbariya (Purainiya VDC)

Bara 174 Teli, Yadav, Dhanuk, Dhobi, Chamar, Dushad

10‐15 In progress

11 Nayabehara (Chhatpipra VDC)

Bara 125 Brahmin, Yadav, Shah, Kanu, Pashwan, Kayastha, Das, Bhuihar, Malhar, Giri

17 Stagnant

12 Chet Nagar (Dumariya VDC)

Rautahat 236 Dalits, Tharu, Teli, Kalwar, Yadav, Kami, Brahmin/Chhetri

40‐50 In progress

13 Sano Sukaule (Churiyamai VDC)

Makwanpur 63 Tamang 15‐20 In progress

14 Nayabasti (Churiyamai VDC)

Makwanpur 74 Chepang, Tamang, Magar, Brahmin

38 In progress

15 Pokhari (Bhaise VDC)

Makwanpur 28 Tamang 100 Declared ODF community

16 Pachira (Bhaluwa VDC)

Sunsari 61 Tharu 95 In progress

17 Khatabe Tole (Babiya VDC)

Sunsari 57 Khatbe/Dalit 100 Declared ODF community

18 Simarbona (Tanmuna VDC)

Sunsari 51 Tharu 92‐95 In progress

19 Chariya (Simariya VDC)

Sunsari 107 Mostly Urau 70‐80 In progress

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20 Jhungi Tole( Takuwa VDC)

Sunsari 58 Rishidev, Sharma, Rajbanshi, Godhi

2 Stagnant

21 Ekta Chowk (Urlabari VDC)

Morang 70 Brahmin/Chhetri, Rai, Uram, Dhimal


22 Prakriti Chowk (Urlabari VDC)

Morang 36 Rai, Dhimal , Dalits, Tharu, Chhettri, Dhami, Magar


23 Subidharjhoda (Urlabari VDC)

Morang 70 Rai. Limbu, Dalits, Rajbanshi, Dhimal, Newar, Chhettri, Magar


24 Paribartan Tole (Urlabari VDC)

Morang 60 Dalit, Janajati, Brahmin/Chhettri,


25 Paschhim (Bich tole) (Aurabani VDC)

Sunsari 30 Tharu 90‐100 Declared ODF community

3.2 Cluster Selection

Although the criteria for selecting clusters for CLTS varied from one district to another, all were within Plan Nepal’s working VDCs. Except for all schemes in Makwanpur and some in Bara, CLTS was Plan’s entry programme. In Makwanpur, clusters fell within area in which Plan was implementing water supply scheme areas. Selection was done jointly by Plan Nepal and its respective NGO partners. Most were selected because open defecation was widespread and latrine coverage very low. Participants in FGDs said that average coverage before Plan’s CLTS intervention did not exceed 10%. In some clusters, there was not a single latrine.

The boundaries of the clusters were determined in consultation with locals. Most were a consolidated settlement in a single ward or at most in two or three wards. In some clusters, however, small settlements within that cluster were left out because it was thought it would not participate. For example, the Shivpuri cluster in Banke did not include four or five households which migrate seasonally to India or elsewhere. In Rautahat, as Chetnagar is very large cluster, two or three tole (neighbourhoods) adjacent to Chetnagar was left out. Unfortunately, unless open defecation ceases here, CLTS in Chetnagar will not be effective.

The number of CLTS clusters in each PU varies. It was largely based on the capacity and commitment of Plan’s NGO partners.

3.3 Partnering NGOs

In all PUs CLTS was implemented in partnership with NGOs. Except in Rautahat/Bara PU where there are two partner NGOs, one in Bara and one in Rautahat, there is one partner NGO is each PU. All have worked with Plan Nepal on WES programmes for several years.

Except for NEWAH, the NGO partner in Sunsari/Morang, which had implemented CLTS in Dhading and Gorkha districts, all NGO partners were quite new to CLTS. Plan Nepal organised field‐level orientation to and training in CLTS to a few NGO staff members when Dr. Kamal Kar visited Nepal to initiate CLTS. In addition, Plan Nepal staff have been continuously supporting partner NGO staff by updating them and sharing learning about CLTS among PUs. NEWAH has also made use of learning from its previously implemented CLTS programmes while implementing the programme in new clusters under Plan Nepal.

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Table 3: NGO Partners of Plan Nepal for CLTS Implementation Districts Name of NGO Banke IDS Nepal Makwanpur RADO Nepal Bara ECARDS Nepal Rautahat RUWSAPS Sunsari/Morang NEWAH

3.4 Key Programme Interventions

3.4.1 Introduction of Ignition Tools

Once the clusters had been selected for CLTS, NGO staff trained in CLTS introduced some ignition tools to men, women and children in the community. The tools commonly used were as follows.

• Social mapping showing who defecates where; • Calculation of quantity of faeces (in kg) produced and eaten by one person in a year; • Transect walk (walk of shame) to open defecation areas; • Exposure visit to other ODF communities; • Faeces mobility map/route to show the transfer of faeces and the effects of faeces,

including faecal‐borne diseases ; • Stool tests.

All clusters used the first four tools, but only some used the last two. The on‐site stool testing carried out in Sunsari and Morang helped people to link defecation with diseases like worms, diarrhea and dysentery. In general, it was the use of multiple ignition tools and the skill in facilitation displayed by NGO staff which contributed to the success of CLTS, but in some clusters a specific tool worked best. 3.4.2 Formation and Mobilisation of Action Committees After ignition tools had been introduced and people had realized the disadvantages of open defecation and the importance of latrines, UCs were formed in each cluster to take action‐‐ implement, coordinate, monitor and evaluate the CLTS programme. UCs rarely had a gender balance. In Parnipur, Banke, all UC members were women, but elsewhere women formed only 20 to 30% of the total.

Under the guidance of partner NGO staff and, in some cases, Plan Nepal DCs UCs were then self‐mobilised to transform their cluster into a ODF community. The committees were the central and steering bodies to devise rules and norms and subsequently to mobilise child clubs and women’s groups to achieve total sanitation. 3.4.3 Formation and Mobilisation of Child Clubs and BLOP Groups Child clubs and BLOP groups were often mobilised to complement the actions of the sanitation committees. They were particularly useful in pressuring people to stop defecating in the open and to build latrines. They engaged in the following activities.

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• Flagging area of open defection • Conducting rallies and chanting against the open defecation • Whistling at people found defecating in the opening • Making cartoons of persons caught red‐handed and posting it and their names on public

notice boards. • Staging street dramas on sanitation and hygiene issues • Visiting homes to raise awareness about personal hygiene and household sanitation • Helping community members who do not have time to build latrines.

Since some of these activities, like watching the defecation area in the morning, whistling at people found defecating and chasing them, is only possible for children to do, their contribution to CLTS was invaluable.

The first three activities were pursued in almost all 25 clusters, whereas the remaining four were pursued only in some clusters. Drawing cartoons, for example, was popular in Sunsari and Morang, while staging street drama was common in Bara.

The efforts of children and youth put tremendous pressure on communities to stop open defection and to build latrines.

3.4.4 Facilitation Facilitation is key to implementing CLTS and to ensuring community participation. In fact, the success of the entire programme rested on facilitation at different levels.

Facilitation was done at the community level by community mobilisers/local facilitators together with NGO and Plan Nepal staff in order to build rapport, ignites the community, bring about self‐realisation, orient locals to different aspects of sanitation, and continuously follow up on programme progress. With the help of NGO and Plan staff, sanitation committee members guided the members of their own community and, occasionally, those of other clusters, in order to help them realise the need for CLTS.

Partner NGO staff also facilitated implementation by guiding community mobilisers/local facilitators in effectively executing facilitation at community level. They also visited clusters regularly to carry out follow‐up and monitoring. Planning, implementing, monitoring, reporting and documentation were some of the implementation‐level activities which ensured that the programme proceeded smoothly.

At the next tier, Plan Nepal provided support and guidance to partner NGOs and to community mobilisers/local facilitators so they could implement programme planning, monitoring, reporting and documentation. Plan Nepal staff, specifically the WES Programme Coordinator and DCs, were directly involved in facilitation at they community level; they participated during the processes of rapport building and ignition and also in follow‐up activities.

3.4.5 Monitoring Mechanism

Once a sanitation action committee had formulated an action plan to make the community ODF and to get households to build latrines, Plan and NGO staff made periodic monitoring visits to ensure the plans were converted into actions. The frequency and timing of visits were not fixed but staff nonetheless made visits quite often.

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The number of facilitators was not uniform either. NEWAH was the only NGO to assign a local facilitator to every scheme. In Banke, there was one facilitator for three CLTS schemes, while in Makwanpur; there were two facilitators for three CLTS schemes. In Rautahat/Bara and Sunsari/Morang coverage was even more scanty: three facilitators covered eight schemes and two facilitators covered ten schemes respectively. .

3.4.6 System of Rewards and Incentives CLTS tended to reward communities when they were able to declare themselves ODF. Incentives were direct or indirect and, except in Sunsari/Morang, did not include cash.

Communities felt that when they declared themselves ODF, Plan Nepal would support them in other development activities. Shivpuri, for example, expected help in gravelling village roads and other communities expected water supply facilities.

In Morang/Sunsari, between Rs 5,000 and 8,000 is awarded to a community when it declares itself ODF. Some communities have mobilised the amount awarded as a revolving fund to provide loan to community members to upgrade their latrines. Awards for the first family that stops open defecation, the first family that completes a latrine, and the family that uses its latrine most regularly and keeps it the cleanest are other incentives.

3.5 Time Required To Declare Oneself an ODF community

Before the field visit was conducted, eight clusters had already declared themselves ODF communities and another two declared themselves ODF during the visit. As there are no guidelines as to when a village can declare itself ODF, the time it took varied, but followed three general patterns:

• Immediately after the completion of latrines • A few weeks after the completion of latrines • After stopping open defecation but before completing latrines

The most common timing adopted in all PUs was immediately after latrines were completed. Some communities waited even longer, until no one defecated in the open and all used the completed latrines. In contrast, some clusters in Sunsari/Morang declared themselves ODF even before latrines were complete. It was assumed by the community that clusters will declare themselves ODF when latrine coverage is about 95% and about 90% of households no longer defecate in the open. It was believed that if a community declared itself ODF, those who procrastinated would feel the pressure to change their habits quickly. It appeared that, indeed, households which had not built their own latrines shared those of neighbours.

The time required to declare oneself ODF is affected by several factors. It is generally shorter the smaller and more homogeneous a cluster is. It is also profoundly affected by latrine technology. The period was considerably shorter in areas where simple pit latrines were adopted than in areas where latrines with offset pits lined with bamboo mesh were built. Constructing latrines with concrete rings of other more advanced technology took the most time. In Makwanpur, where CLTS was integrated with water supply schemes, people gave more priority to building water supply components than to constructing latrines, and, in consequence, it took a long time for communities to declare themselves ODF.

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It took between 11 and 24 weeks after ignition tools were introduced for communities to declare themselves ODF.

3.6 Technology and Costing

3.6.1 CLTS V/S Temporary Latrines Each cluster had a different type of latrine, but most were simple pit (both offset and direct) latrines with temporary structures. Bamboo mesh was to line most pits to prevent their collapse. The life of a pit is expected to be a maximum of two years even when plastic wrapping is used. Pans differed greatly. Most were built from locally available scrap material and included plastic jerricans, tin and other metal sheeting, plastic sheets, and HDPE pipes. The floor is usually mud if the pit is direct, but cemented if the pit is offset.

For more than 90% of the households in the CLTS clusters, it was their first time building a latrine. As a result, they were concerned about how fast the pit would fill and whether it would withstand the rainy season. They are worried about the dangers of rats’ making holes around the pits and causing it to collapse. In the Tarai area, flooding and rising ground water levels are other threats to pit latrines.

Fig 2: A Typical Pit Latrine

That there is a misconception among CLTS implementers that CLTS involves only temporary latrines is evident from the fact that even households which could have afforded to build permanent latrines did not. Because the amount of technical input from partner NGOs and Plan Nepal did not suffice in most clusters, many latrines were structurally weak and were not user‐friendly. In Parnipur, for example, the superstructures of more than 75% of latrines are so low that one can not stand up inside them. One latrine is so small that even a child of eight has to bend to get inside. Very often the pan holes of direct pit latrines were larger than is standard, thereby increasing the risk that a small child might fall in. It is clear from these shortcomings in the rudiments of latrine construction that Plan Nepal and its partner NGOs need more technical input. In Sunsari and Morang, where NEWAH was the partner NGO, however, the technical input was so advanced that options were provided. In some places, blueprints of low‐cost latrines were provided. As a result a single cluster had two or three varieties of latrine.

Most superstructures are also temporary; they are built of either bamboo or wood and plastered with mud and husks. Roofs are generally thatch but sometimes CGI sheets.

Fig 3: “Isn’t this latrine hole too big?”

Because they are temporary, latrines are built quite far away from and behind houses, thereby ensuring that there is at least the requisite minimum of10 m between them and the tube wells generally found nearby house yards.

In almost all clusters, the same type of technology, materials and superstructures were used by all. After the first few latrines were built, other households simply replicated those prototypes.

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Latrine builders rarely considered child friendliness. Many had holes which were too large or were built so far form the house that a child would not want to go at night in the dark. 3.6.2 Rebuilding and Upgrading Latrines

Some clusters, like Gamargawan, Ekta Chowk and Prakriti Chowk, have already started upgrading their temporary latrines. In these clusters, almost all the latrines are pit latrines with temporary superstructures.

In Gamargawan, one year after its ODF declaration, about 75% of households have built hygienic offset pits with permanent superstructures. Most of them have taken loan from a micro finance institution to upgrade their latrine. In addition, the sanitation committee has established a system to construct concrete rings at the cluster level for distribution to households in order to promote further upgrading. .

Not all household in Gamaragawan, Ekta Chowk and Prakriti Chowk clusters upgraded their latrines. Only those who could afford to had; the rest were looking for support. Some of the temporary latrines desperately need upgrading, but owners lack the finances to carry out improvements.

No other ODF clusters had upgraded their latrines as they were only a few months old and still functioned well.

3.6.3 Latrines for Landless Households and Those with Little Land A common problem is the lack of land or limited land for building latrines. Some communities were able to address this problem well, as is demonstrated below.

In Bharwalia (Bara), those who did not have other land built latrines attached to their houses. One household even built an offset pit latrine inside the house next to the kitchen. In Simarbona (Sunsari) cluster, a local person who had land just outside the cluster announced that he would give his land to the landless so they could build latrines. Three households took up his offer and built offset pit latrines with temporary superstructures. This same benefactor provided the poor with bamboo.

In Amritpur (Banke), a female neighbor offered a Dalit some of her land near his house to build a latrine.

In some clusters, two or three households shared a single latrine as they did not have sufficient land to build their own. In Pokhari (Makwanpur), three households built a shared latrine at a distance of about 200 m from their homes. All three had space to build latrines but they thought that pit latrines were too unhygienic to build in their yards. This latrine is not convenient at night, however, especially for children.

These examples demonstrate how the problem of the landless and limited landholders can be tackled if proper facilitation is done.

3.6.4 Types of latrines

The following types of latrines were observed: • Direct pit with bamboo/stone lining

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• Direct pit with concrete ring lining

• Single offset with bamboo/stone lining

• Single offset with concrete ring lining

• Twin offset with concrete ring lining

Fig 4: A Typical Well‐Built Latrine

3.6.5 Costing The average cost of a temporary latrine varied from about Rs 800 to 1,300, including cash and kind, while the cost of semi‐permanent latrines ranged from Rs 1,350 to 5,500. The costs of various latrines as quoted by local people are shown below.

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Table 4: Cost of Different Types of Latrines Found in CLTS Clusters

S.N Type Cost (Rs.)

Upto Pan Level 1 Simple direct pit latrine with stone bamboo lining 300‐500/‐ 2 Direct pit latrine with cement ring 850‐1100/‐ 3 Single offset with bamboo/stone lining 600‐1700/‐ 4 Single offset with cement ring 2300‐2500/‐ 5 Twin offset with cement ring 3200‐3500/‐ Superstructure 1. Temporary structure (thatch, bamboo, plastic, jute or plastic sacks) 500‐600/‐ 2. Semi‐permanent (bamboo or wooden plank, bamboo mat, tile or CGI

sheet roof, door of CGI sheet, plastered with mud or cement) 1500‐2000/‐

3.7 Motivating Factors (Factors for Success)

3.7.1 Ignition Tools Social map: Social mapping helped local people to think at least once about abolishing the open defecation and building latrines. When they made a map of who went where to defecate, they felt ashamed. Colouring the map yellow to show areas of defecation reinforced the idea that they were dirtying their own village.

Human faeces calculation: Community members were horrified when they realized that they ate between one and 2.5 kg of faeces every year.

Transect walk (walk of shame): Taking a transect walk with outsiders (NGO and Plan Nepal staff) was quite embarrassing for the community. They thought about how foolish they were to make the environment so dirty‐‐like pigs.

Stimulating words and phrases: Some of the slogans NGO facilitators used got people to turn against open defecation. “Shivpuri ta goo puri rahechha” (“Shivpuri is a faeces village”) and “We are like pigs, which eat faeces” were two that hit them. In Bara one facilitator used the slogan “We hide what we are supposed to expose (our faces), but we expose what we are supposed to hide (our buttocks)” This slogan touched those whose culture dictates that daughters‐in‐laws are supposed to cover their heads in front of their fathers‐in‐law.

On‐site stool test: On‐site stool tests were conducted on children, men and women in all the clusters in Sunsari and Morang. The majority found that they had worms. , When medical personnel explained that worms are a result of poor sanitation, the people immediately embraced the idea of building latrines to break the route of the faecal transmission.

Flagging: Marking open defecation spots with yellow flags made people realise how dirty their village was and led to an immediate cessation of open defecation on roads and trails.

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Exposure visit: Visiting ODF clusters played a major role in motivating communities to adopt CLTS. Most visitors were strongly affected and wanted to transform their own villages similarly.

Fig 5: Community members of Akwaniya VDC interacting with the Action Committee of Bharbaliya VDC during an exposure visit

3.7.2 Norms and Regulations

The norms developed by sanitation committees—in particular, that violators would be fined and children who spot them rewarded‐‐have worked well. The issue is not the size of the fine, but the fact that the violator has been shamed before the community.

Fig 7: Public notice that those who defecate openly will be punished

Fig 6: A board with norms and regulations

Other strict norms and rules adopted by action committees and child clubs like making regular home visits to pressure the community and dividing into groups to monitor and make households aware about sanitation were also effective

Cartoons: In Sunsari and Morang, child club members and other local artists made cartoons of people who did not build latrines or who defecated openly. These were quite an effective tool in getting those caricatured to change their behaviour.

Whistling/clapping: Child club members monitored open defecation places in the early morning. When they caught anyone red‐handed, they whistled, clapped or shined their torch lights, forcing the offender to run away in shame. Afraid of being detected and humiliated, people stopped defecating in the open.

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Notice board: By publishing the names of people who did and did not have latrines on public notice boards, sanitation committees appealed to their sense of pride and shame. Fearing their name would be displayed as not having followed through with their promise; people built latrines as quickly as they could.

Fig 8: Notice board listing people caught defecating in the open

A Story about How Strict Norms and Regulations brought a Change in the Sanitation Behavior of a Superstitious Saint

Sadhu Raj Banshi Das is more than eighty years old and lives in a temple in Barainiya‐2, Bharbaliya. He has three sons and used to live with his family, but now he lives as a saint. Here is his story: “After the CLTS programme was introduced in Bharbaliya, people started building latrines and tried to force me to build one at the temple, but I felt that a human being should not defecate in one place like an animal and refused. Ten or twelve community members used to come to me every day to convince me to build a latrine by saying that we were eating faeces because some people defecated in the open. I was firm in my decision not to build a latrine. Then they decided that I had to leave the village if I did not build latrine. After latrines were built by every household, I was forced to leave the village. I roamed around other villages for five days and finally returned because of the discomfort of roaming. I built a latrine and started living in the village again. At first I felt very uncomfortable about and even ashamed to use the latrine but I was afraid to defecate in the open because I would get whistled at and fined. Later, I got used to using the latrine and now I feel quite comfortable using it. Haivng a latrine has made my life easier as I am too old to go far to defecate. Now I do not have to go far and it is even easy during storms and on sunny days. When this temporary latrine becomes unusable, I will build a permanent one using my own resources.” The strict rules and active role of the action committee forced this superstitious saint to change his sanitation behavior

3.7.3 The Role of Facilitators and Staff as Catalysts

NGO facilitators and Plan Nepal staff continuously visited the clusters and followed up on the activities of sanitation committees, child clubs and women’s groups. Their devotion helped accelerate the pace of CLTS. Plan Nepal staff, particularly DCs, played a pivotal role in bringing about change. One sanitation committee member praised DCs highly and said that she thought that it was the duty of the committee to do whatever they said in order to make the programme a success.

3.7.4 Low‐Cost and Zero‐Investment Technology Some people who understood the importance of latrines could not build them because they did not have nay money and were under the wrong impression that it would cost Rs. 20,000 to 40,000.

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When CLTS was introduced, they were excited to find out a latrine could be built cheaply using local scrap materials like tins, pipes, and plastic. Many spent no more than Rs. 500 to build a pit latrine. 3.7.5 Social Factors Social factor also influenced the success of CLTS. It was found, for example, that migrants from the hills were easier to mobilise than local Tarai people. This fact helped spur the success of CLTS in the three clusters in Banke and four clusters in Morang where there are many migrants.

In some clusters women were organised through mothers’ groups and saving and credit groups. As these women were already in the habit of saving of money, they could afford to invest in latrine construction.

As CLTS is a community approach, every household felt pressure from other households to change its sanitation behaviour. In fact, it became a matter of prestige to build a latrine within a set time frame and some clusters even showed a competitive drive.

3.7.6 Cost of Building a Latrine vs. Cost of Treating Disease Most women realised for the first time that faecal contamination causes diarrhea, cholera and dysentery, disease which each household reported spending about Rs, 200 to 1,000 every year to treat. In comparison, building a latrine cost Rs. 500 to 1,000, just about their yearly expenditure on medical treatment. When women realized this, they were keen to build latrines.

“My 12-year-old granddaughter died three years ago from diarrhea. At that time, we were not aware about the importance of sanitation and hygiene. If we were aware and had followed good sanitation and hygiene practices, my granddaughter would not have died.”

One member of Nirdhan Women’s Group in Gamargawan, Bara District

3.7.7 Natural Leaders/Opinion Leaders In some clusters, a natural leader helped make CL TS a success. The active involvement of such people can motivate a community and help it organise into groups to bring changes.

Active Natural Leaders and the Success of CLTS Mr. Bhagirath Khatwe of Babiya, Sunsari District and the late Mr. Bir Bahadur Dhami of Prakriti Chowk, Sunsari are natural leaders. They took an active role in regularly motivating the community, leading it toward following good sanitation and hygiene practices and ending open defecation, and organising them into groups to bring changes. They are a major reason for the success of CLTS in Babiya and Prakriti Chowk, now ODF clusters.

3.7.8 Favorable Conditions The following conditions fostered the success of CLTS:

• Small size of the community • Homogeneity • Availability of local materials for building latrines

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• Absence of other sanitation programmes • Widespread open defecation • No or little experience with subsidies • Lack of areas for open defecation • Prevalence of diarrhoeal disease and high child mortality

3.7.9 Others The declaration that one cluster was free from open defection put psychological pressure on neighboring communities to do the same. A sort of competitive feeling was engendered.

In Sunsari and Morang, the practice of declaring a community ODF before it has complete latrine coverage also helped to accelerate the process of ending open defecation and raising coverage to 100%.

3.8 Barriers (Factors Leading to Failure or Low Achievement)

3.8.1 Lack of Technical Input Some people who had temporary latrines had to re‐building their latrines each year because flooding, high water tables and loose soil caused them to collapse. While proper technical input could readily have solved the problem, it was not provided. As a result, people felt demotivated and, unable to afford permanent latrines, resumed open defecation. This shortcoming contributed significantly to stagnation in Jhungi Tole of Sunsari, in Sano Sukaule of Makwanpur, in Amritpur of Banke and in some clusters of Bara.

The Lack of Simple Technical Input May Result into the Failure of the Entire CLTS Programme

Every household in Gamagawan, Bara District built a latrine and the community declared itself and ODF cluster. Then, during the monsoon, flooding washed away most latrines and some collapsed due to the rain. CLTS could very well have failed, but instead most households upgraded their latrines to semi‐permanent ones to curb that situation. It was only the unusual degree of motivation in the community that saved CLTS in Gamagawan. Not all clusters would be able to overcome such technological and environmental setbacks.

People generally had little faith in temporary latrines, which often collapse or whose pits fill up during the rainy season. The fact that pits attract flies or smell or that faeces are visible in the pit are other reasons people gave for not building direct pit latrine. Since few felt they had no other technological options or sufficient money to build permanent latrines, CLTS was held up.

The Story of a Small Girl Who Fell into a Poorly-Built Latrine Pit Shree Kumari Shah, the four-year-old daughter of Chandra Mila Devi Shah, a resident of Nitanpur in Bara District fell into the pit of the direct pit latrine in her household. She was not seriously injured as it was not deep, but she was covered in faeces when she was removed. Because they lacked technical know- how, her family had covered the too-large pit with a cracked CGI sheet, which gave way when the little girl was using the latrine.

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3.8.2 Economic Factors Poverty is another factor behind the failure or low achievement of CLTS. Some ultra poor households could not build latrines as they could neither spare the time from daily wage labour nor afford to invest even a few hundred rupees.

Women‐headed families also found it difficult to build latrines. They expect volunteers from the village to help them or for male household members to build latrines when they return from India or elsewhere. 3.8.3 Subsidy The conventional policy of Plan Nepal and other agencies to subsidise latrine construction has made some people put off construction to see if they will get a helping hand. The fact that neighbouring “old” Plan clusters get subsidies has sparked claims that Plan Nepal is unfair. 3.8.4 Social and Cultural Factors:

Socio‐cultural beliefs like the idea that a daughter‐in‐law cannot defecate in the same place as her father‐in‐law, that only rhinos defecate in the same place all the time, and that latrines should not be built near kitchens or households have played a major role in delaying the progress and success of CLTS. 3.8.5 Availability of Open Space If there are many open spaces, whether rivers, jungle, bush or open land, there is less hardship associated with open defecation and the incentive to adopt CLTS is low. In Amritpur, Banke District, for example, the fact that there is much open low land nearby the village may be one reason CLTS did not work there.

3.8.6 Political Influence When sanitation committee members were political figures, their rivals sometimes blocked CLTS in order to maintain their own status. In Bhalui, for example, the first chair was a politician whose rivals created hurdles to stop CLTS; when the committee was reformed another political figure was selected and the pace of change was similarly slowed. 3.8.7 Other Unfavorable Conditions Other minor factors delay the construction of latrines and abolishment of open defecation:

• Lack of unity • Illiteracy • Not having the habit of using a latrine • Availability of water in rivers, streams and canals

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• Unwillingness to waste money on temporary structures rather than invest in permanent ones

• Lack of own land/space • Unwillingness to invest in building a latrine on public land

3.9 Enabling Environment

3.9.1 Strong Local User/Action Groups Establishing strong local user/action groups and getting them to take an active role has helped create an enabling environment for CLTS success and progress especially in ODF‐declared clusters. Some of the features and actions of strong action groups follow.

• Strict norms and rules have been developed by the sanitation committee to ensure

that there is no open defecation and to achieve total sanitation. • Self‐monitoring of the ODF state and other components of sanitation is practiced by

child club members. • Groups support other community members by, for example, providing land to the

landless, bamboo to the poor, help digging pits, and supplying rings. 3.9.2 Resource Sharing Strong local action committees create an environment in which resource sharing is practiced. Such committees support other community members by, for example, providing land to the landless, bamboo to the poor, help digging pits, and supplying rings.

A Typical Example of Resource Sharing in the Community

Sixty-three-year-old Dhana Lal Majhi of Simarbona, Tanmuna-8 is a very kind-hearted person. He has provided land to some landless families to build houses and to build a police post in Simarbona to combat the deteriorating security situation. He built an attached latrine for his household six or seven years ago. When CLTS was introduced in Tanmuna, latrine construction was off to a rapid start. Some households, however, did not have the land to build a latrine. At a meeting of the sanitation action committee, of which Majhi is a member, he decided to offer his land to those households. Three households have done so already, with additional support from Majhi in the form of bamboo.

3.9.3 Availability of Skilled Human Resource and Materials In most clusters, ready access to markets, technology, skilled human resources and materials create an enabling environment for easy sanitation promotion. In Morang/Sunsari, for example, markets are found just 10‐20 minutes from most clusters.

In a few clusters in Bara and in Dumariya of Rautahat, Plan’s partner NGO has mobilised local organisations or skilled persons to make concrete rings. In addition, some action committees have been provided with a frame to make rings. Local engineers who can build and maintain latrine have also been identified.

Making materials and human resources available helps CLTS succeed.

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3.9.4 Availability of Credit Facilities In most clusters in Bara district, Nirdhan women’s groups have been formed to regularly mobilise saving and credit services. Sixty women of Gamagawan received loans from Nirdhan Utthan Bank, a microfinance institution, to construct latrines. Nirdhan was also active in Naya Behera of Bara District.

The sanitation action committee of Prakriti Chowk of Morang District has utilised the reward it received from NEWAH upon declaring itself a ODF cluster as a revolving fund for providing credit facilities to local people to construct latrines. They have been providing Rs. 1000/‐ credit to each applicant at subsidised interest rates.

Similarly, Janasewa Samudayik Sastha of Chetnagar, Rautahat, has been providing concrete rings to community as a loan. The recipient has to pay back the amount within three months at the rate of 24% interest.

The availability of such credit facilities at the local level creates an enabling environment for CLTS.

3.10 Innovations and Best Practices

Various innovative approaches, technologies and tools were witnessed in different CLTS programmes. The best practices are listed below. 3.10.1 Approach

• Self‐monitoring the state of sanitation in all households and the personal hygiene of

community members every month (Makwanpur) • Appointing a local facilitator from the cluster itself by the sanitation committee and

community people (Sunsari and Morang).

• Using local facilitators from ODF‐declared clusters in other clusters (Sunsari and Morang).

• Forming a network of sanitation committees of various ODF‐declared clusters in order

to scale up CLTS (Sunsari and Morang).

• Constructing concrete rings at the local level and providing them to local people with loans with 24% interest per annum. The rings are cheaper than they are in the market and people have three months to pay for them. (Janasewa Community Organisation of Chetnagar, Rautahat)

• Collecting money from individual households to construct concrete rings at the local

level in one place and distributing the rings in order to upgrade latrines. Encouraging women to use loans from the Nirdhan bank to construct latrines. (Sanitation committee of Gamargawan, Bara)

• Utilising reward money for being declared an ODF cluster to set up a revolving fund for

providing credit facilities at subsidized interest rates to community people to construct latrines. (Sanitation action committee of Prakriti Chowk, Morang)

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• Practicing resource sharing, like providing land on which to build latrines or bamboo

with which to build superstructures. (Simarbona, Sunsari)

3.10.2 Technology

• Using low‐cost technology‐‐bamboo lining of pits and vent pipe, use of scrap materials in place of PVC pipe

• Sharing a latrine • Promoting several different designs for pans • Building latrines within homes for the landless • Improving water supply facilities after CLTS

3.10.3 Tools

• Drawing cartoons of persons who defecate in the open and displaying them on public notice boards with their names.

• Staging street dramas to increase awareness • Conducting on‐site stool tests • Arranging exposure visits • Holding rallies and chanting the name of people who defecate in the open

3.11 Impact

3.11.1 Sanitation Aspects While it is too earlier to assess the impact of CLTS on health and hygiene trends and other socio‐economic parameters, environmental and household sanitation were found to have improved. According to local, foot trails used to be covered with the faeces of children, but now roads and trails are clean. People manage wastewater well by diverting it to agricultural fields and kitchen gardens. Knowledge about environmental cleanliness, household sanitation and personal hygiene has increased even in communities where CLTS failed, but sanitation practice is highest in ODF clusters. Knowledge in ODF communities was found to range between 95 and 100%, while practice ranged between 75 and 90%.

Even members of CLTS‐failed communities know they should wash their hands with soap or ash after defecating and working and before eating. Though knowledge has increased, practice is comparatively low due to lack of motivation.

The impact of CLTS on the incidence of diarrhoeal diseases is still to be seen but community members of ODF clusters say it has decreased significantly. According to one resident of Bharwaliya, three doctors used to visit the community regularly, but this year they have rarely had to be summoned. 3.11.2 Creation of Strong Local Group to Initiate Other Development Activities Continuous community mobilisation has resulted in the establishment of strong local groups like sanitation committees and child clubs in some ODF‐declared clusters. These groups have initiated other developmental activities like tree plantation and village road widening and gravelling.

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Women’s groups which were formed to share the activities and functions of UCs have also initiated some social reforms; in Ekta Chowk and Paribartan Tole of Morang District, for example, women have banned alcohol consumption. Some action committee has installed bamboo and cement waste bins around the villages of Gamargawan and Bharbaliya of Bara District.

Child clubs in Babiya of Sunsari District and Ekta Chowk of Morang District have initiated activities like tutoring younger children, saving and credit mobilisation, and raising awareness among parents about sending their children to school

Networks of both child clubs as well as sanitation committees have been formed between four clusters of Urlabari VDC, Morang, to initiate developmental activities within that VDC.

3.12 CLTS vs. the Conventional Approach and Subsidy vs. No Subsidy

The subsidies currently provided in the conventional approach range from Rs 2,500 to 4,000 depending on the wellbeing ranking of the recipients. The subsidy is provided in terms of both materials and the cost of skilled labor. The poor have to contribute Rs. 200 in cash; the rich, Rs. 800. Plan Nepal has gradually decreased its subsidy over the years: it was Rs. 4,500 in 2002, Rs. 4,000 in 2003 and Rs. 3,000 in 2004. The conventional approach offers two options, usually according to a household’s economic status: the double pit for the affluent and the single pit for the poor. The programme period normally last one year: six months for social preparedness and six months for latrine construction. This approach sets a fixed target for the number of households to build latrines in a year and 100% coverage is envisaged only after three to five years, depending on the size of the community. Plan Nepal offers both stand‐alone sanitation and integrated water and sanitation programmes in equal proportion. Training, campaigning and latrine building are the major components of the conventional sanitation programme. Its impact is slow and steady, and since Plan Nepal and NGO partners are quite familiar with the approach and the technology employed, human resource development is not a .

Unlike the convectional sanitation programme, the primary focus of CLTS is on creating awareness and self‐realisation through motivation, awareness and training by the application of ignition tools. The major shift of the CLTS is to zero subsidy and total sanitation through the abolition of open defecation rather than just the building latrines. The role of the implementing organisation is greater than in the conventional approach; CLTS, in contrast, focuses on creating a sense of ownership among community members.

That subsidy is not the motivating factor for sanitation promotion was clearly seen in Maheshpur of Bara District. Plan Nepal has provided nearly Rs. 2,900 to each household to build a latrine and required that each household contribute some cash. Most latrines are now complete, but the doors that the households themselves had to supply have not been made. Since most people were reluctant to build the door themselves, the nearly finished latrines remained unused. One was used to store straw and fodder. When the evaluation team asked the owner why she did not use the latrine, she said it was because she has no door because Plan Nepal had not provided one. In another household, the latrine was incomplete and there were children’s faeces all over the kitchen garden and on the slab of the latrine pit. The community clearly had not realized the importance of sanitation; they had built their latrines simply to please Plan Nepal. In contrast, in Bharwaliya, Bara, where CLTS was implemented, all households built latrines at their own expense. In fact, even the poorest of poor households and households with minimal land built latrines. The people of Bharwaliya are well aware of the importance of all aspects of sanitation. They feel they are the owners of CLTS and have realized themselves that sanitation is important.

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Though these two examples do not apply widely or universally to all sanitation programmes implemented by Plan Nepal, self‐realisation and ownership are two major ways that CLTS differs radically from the conventional approach. Indeed, even in clusters with failed and stagnant CLTS programmes remember how many kg. of faeces they eat each year and the basic elements of sanitation.

Despite the high subsidies, the conventional approach has not been able to solve the problem of open defecation. Despite the fact that millions have been spent on sanitation, the achievement is only 39% coverage across Nepal and only 24% in Plan areas.

3.13 Relevance

Almost all the clusters chosen for CLTS implementation had very poor sanitation coverage, personal hygiene and household and environmental sanitation. Through CLTS, the improvement, even in failed and stagnant clusters, is significant. People who once knew little about sanitation because they had little exposure to the outside environment have now realised how important good sanitation is. The low level of practice could be easily enhanced through continuous follow‐up and mobilisation. Though latrine coverage and control of open defecation may have failed, in terms of knowledge and realisation CLTS has succeeded. Low achievement in terms of latrine coverage can be attributed to various factors which need to be addressed. CLTS definitely was relevant to the clusters into which it was introduced.

Some clusters did not build latrines even though they recognized their importance because they thought they would be more costly than they could afford. CLTS has demonstrated that low‐cost models can be built. In the case of people who lacked the land and materials to build latrines, CLTS created an environment for resource sharing. In ODF clusters at least, CLTS has been able to address and overcome several barriers to sanitation promotion.

Nepal is committed to the millennium development goal of halving the proportion of its people without access to sanitation by the year 2015 and to achieving 100% sanitation coverage by the year 20171. The implication of these targets for Nepal as a whole is that approximately 14000 latrines need to be constructed each month for the next ten years. Nepal has $74 million from different sources available to meet this target, but the amount it requires is $163 million. There is a resource gap of $6 million per year2. In this context, the CLTS approach, which provides no subsidies, is extremely relevant.

Although millions of dollars has been spent on subsidies to promote latrine construction and sanitation has been promoted for many years, coverage is still only 39%. Even where latrines have been built, they are often not used because people have not realised their importance, and open defecation is still widely practiced. CLTS promises to change this situation. In just two years, ten of 25 clusters have declared themselves ODF and community ownership, one of the most important factors for the success of any programme, is very high. Except in a few clusters, self‐realisation has motivated communities to adopt good sanitation practices.

3.14 Program Efficiency

1 Water Supply and Sanitation National Policy, 2004. 2 The Water and Sanitation Millennium Development Targets in Nepal, Water Aid Nepal, Sept. 2004.

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In the conventional approach, both hardware and software activities are subsidized, but in the CLTS approach, only software activities are subsidized. Staff input is more or less same in both. Considering that hardware subsidies account for about 30% of the total cost of sanitation and hygiene in a cluster, the cost input for the CLTS approach is 30% less than that for the conventional approach but still yields 100% sanitation coverage. The conventional approach takes two to three years to achieve 100% coverage, while CLTS works in just two to six months.

3.15 Effectiveness

Although it is still too early to assess the impact or CLTS, the behavioural changes observed—using latrines and stopping open defecation—are remarkable. The level of awareness about sanitation and hygiene among men, women and children is overwhelming. The mobilisation and participation of children in the programme has proved to be the most effective strategy, but the ignition tools and the facilitation skills of Plan and NGO staff are also key. CLTS results in faster behavioural change than the conventional approach does, in part because of the low cost of its components. Together, these fundamental features render CLTS effective.

3.16 Sustainability

CLTS has helped all the communities it was introduced into, the ODF‐declared ones as well as the failed or stagnant ones, to address with sanitation issues. Knowledge about personal hygiene and household and environment sanitation has increased significantly even in stagnant and failed clusters though practice levels are lower than they are in ODF clusters. These results suggest that achievement in terms of improving the overall sanitation situation can be sustained. Because changes in sanitation behavior are due to self‐realisation, not force, achievement should be long‐term. The various ignition tools the CLTS approach uses makes a strong impact on people’s mindset so they are unlikely to revert to earlier behaviours.

In terms of latrine hardware, and its correlation with open defecation, sustainability is more in doubt. Most latrines constructed are temporary; require gradual upgrading to permanent ones for sustainability. If people get tired of rebuilding temporary latrines every year or two because they lack the resources and funds to upgrade them, they may revert to open degradation. Upgrading has been seen in clusters which declared themselves ODF some time ago, but mostly among more affluent households. The ultra poor were unable to upgrade without resources from outside. In the interest of sustainability, CLTS must be integrated with either micro‐finance programmes so that credit facilities can be availed for upgrading or with livelihood or income‐generating programmes to eradicate poverty.

Establishing strong local groups could also bring sustainability, as could steps like providing local engineers to build latrines making material like concrete rings locally available. Creating an enabling environment ensures the sustainability of the programme. If behavioural changes are made sustainable, people may continue to build temporary latrines until they can upgrade them.

3.17 Gender and Equity

There are fewer women than men members in most action committees and in some Tarai clusters there are no women at all. In the hills, women are members, but they do not participate actively. Instead, women participate in CLTS through women’s groups; indeed, the active mobilisation of such groups has been a major factor in the success of CLTS in some clusters. Training and orientation just for women and women’s group has helped ensure their participation.

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The participation of children is high; in fact, they play a major role in pressuring people to stop defecating in the open. Children are mobilised through child clubs and BLOP groups.

Some clusters, like Babiya of Sunsari District, are comprised only of so‐called low‐caste groups, and most clusters, barring a few homogeneous ethnic clusters, have some Dalit and socially excluded households. Such groups are represented in most sanitation committees and do get special preference though the programme itself has no separate provisions for them. Because of strong facilitation by Plan and NGO staff, the local sanitation committees of some clusters have made provisions for sharing resources with poor and socially excluded groups.

In most clusters, women and socially excluded groups are not as active in decision‐making by sanitation committees. However, women were more active in decision‐making at the household level and were able to bring about behavioral changes with regard to sanitation. Except in a few clusters, women have not assumed leadership for CLTS. Socially excluded groups, because they are so poor, lack the access to land and resources they require to adopt good sanitation. Behavioral change was easier to establish among women and children than among man.

3.18 Replication and Ripple Effects

If CLTS succeeds in one cluster, it creates a ripple effect and other clusters begin demanding CLTS for themselves, Success in Ekta Chowk and Prakriti Chowk, for example, created a demand in Subhidhajhoda and Pariwartan tole. Elsewhere, success in Pariwartan tole generated demand in Sirudhar and Baghdada. Similarly, the communities of Bhalui and Naya Behara of Bara District and Chetnagar of Rautahat District are keen to transform their villages into something like the ODF villages of Bharbaliya and Gamaragawan of Bara District. In addition, the communities of Simarbona, Tanamuna VDC, Sunsari District have also expressed a desire to emulate Ekta Chowk, Urlabari VDC, Morang District as soon as possible.

3.19. Limitations of the Programme

The inadequate attention to the gradual upgrading of latrines from temporary to permanent types has rendered CLTS less sustainable because people get tired of reconstructing their temporary latrines every year.

• Not enough thought has been given to the role of Plan Nepal and partner NGOs in ODF

communities.

• There are no clear‐cut guidelines for partner NGOs to implement CLTS. Some Plan Nepal and NGO staff had not participated in the hands‐on training by Kamal Kar and were confused about how to approach CLTS implementation. Their relative inexperience has worked against the uniformity and effectiveness of implementation and thereby against the success of CLTS in general.

• In some clusters, CLTS focused less on sanitation and hygiene behavioral change and

more on latrine construction. Some poor families did not even know about oral rehydration treatment and in general little attention was given to innovations like waste bins and kitchen drying racks. Total sanitation is shortchanged in the name of ending open defecation and constructing latrines.

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• Those clusters with integrated programmes placed more emphasis on and accorded more priority to water supply than sanitation because of inadequate mobilisation regarding sanitation.

• Not enough attention was accorded to strengthening sanitation action committees and

helping them emerge as self‐reliant and independent institutions which could continue to promote sanitation activities. Stagnation and failure in some clusters can be attributed to the weak role committees played. In ODF clusters, while strong sanitation committees do exist, their sustainability is not ensured due to the lack of sufficient financing, skills and knowledge. Their shortcomings may limit the sustainability of CLTS.

• In most cases, too little emphasis were placed on the quality of latrines, particularly

their durability, hygiene, and child‐ and gender‐friendliness. • The involvement and participation of women’s group and child clubs is too low in some

clusters and not accorded sufficient priority. The fact that the representation of women on sanitation committees is low or absent is another problem, one which has limited the success or progress of CLTS in some clusters.

• Facilitators wrongly believe that they should promote only direct pit latrines and

therefore do not present any options. They mistakenly assume that because there is no subsidy households will not invest financially and that no other variety will be affordable.

• Not enough technical advice on how to make latrines durable and hygienic even with

zero investment is provided.

• Because there is no subsidy, CLTS is not well‐accepted. They would rather work themselves because they think that Plan Nepal has nothing to offer them.

• Not enough consideration has been given to addressing the needs of the ultra poor. • Social leaders are not active enough participants.

4. KEY LESSONS LEARNT

• Off‐set latrine pits are more durable than direct pits. • A weak or inactive sanitation action committee is a major contributing factor in the

failure of CLTS.

• Providing simple technical input will help make latrines more durable and CLTS more sustainable.

• Latrines built using locally available materials are easy to replicate.

• Replication of technology is very high, so if the first few latrines are built with due

consideration to important technical aspects as well as to cost and durability, the quality of the latrines built later will be better and the sustainability of the entire programme, greater.

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• It is easier to implement CLTS in clusters where demand has been created through the

success of CLTS in a neighboring cluster.

• Options for latrine types should be provided.

• Even latrines built with zero investment can be durable and user‐friendly if the factors listed below are considered:

‐ To prevent the superstructure from blowing away in a windy hill area, the height of the latrine should be reduced. ‐ If a direct pit is used, the base should be slanted slightly so the faeces are not

seen. ‐ Using a cover prevents the gathering of flies.

‐ A latrine should be used continuously to avoid damage by rodents. ‐ Throwing ashes and water in the pit prevents bad smells and keeps away flies.

• Continuous follow‐up and intensive interaction is a requisite for the success of CLTS.

• The declaration of an ODF community is only part of CLTS; the achievement of actual total sanitation requires a sufficiently long time period.

• Activities to promote awareness about mortality and morbidity should be linked to

existing social activities.

• When small clusters are included, the output of CLTS is low in comparison to the effort made.

• The active mobilisation of child club is major factor contributing to the success of CLTS.

• Clusters inhabited by migrants from the hills implement CLTS faster than clusters with

only indigenous Tarai residents. 5. RECOMMENDATIONS Based on the lessons it learned from its analysis of the clusters studied, the study team makes the following recommendations for effectively planning, implementing, and monitoring CLTS as well as for scaling up, replicating, upgrading and making it sustainable in the future.

Approach/Strategy:

• Developing guidelines for CLTS implementation including post‐ODF declaration activities and disseminating them to the Plan Nepal and partner NGO staff of all PUs. The guidelines should include strategies for latrine‐upgrading, replication and scaling up at the cluster‐ and the VDC‐level;

• Formulating and enforcing a single uniform policy on subsides within a couple of years. • Developing the capacity of sanitation action committees, child clubs, and youths

through training, orientation, exposure and feedback in order to maximise their participation;

• Integrating CLTS with water supply projects as far as possible;

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• Establishing linkages to financial institutions and income‐generating activities so that latrines can be upgraded and scaled up;

• Instituting planning and programming at the VDC level for greater impact. • Encouraging the networking of the action committees of ODF clusters by involving

active members in the facilitation of new CLTS programmes; • Supporting sectoral line agencies in developing and implementing CLTS guidelines • Promoting networking and coordination with other line agencies especially local

government bodies, including DDCs and VDCs, in order to avoid duplication and develop a sense of ownership.

• Special packages for the ultra poor should be included following these steps:

i. Identifying the ultra poor through poverty ranking at the initiation of the

action committee ii. Setting them up with alternative income‐generating activities suitable for

local conditions and markets by helping them access a grant from the livelihood programme of Plan Nepal or some other line agency.

iii. Facilitating the establishment of a revolving fund to build latrines. Loans will be paid off within a specific time period through earnings from income‐generating activities.

iv. Also encouraging the sanitation action committee to mobilise land holders, bamboo owners, and community forestry groups to support the landless and the ultra poor with land and construction materials;

v. Encouraging action committee to mobilise child clubs and youth groups to volunteer to build latrines for those who depend on daily wages for their livelihood and can not build latrines due to the lack of time.

Technology • Provide several technical options and inputs that are hygienic, durable, low‐cost, zero‐

cost, and appropriate for the local situation rather than prescribing one type; • Encourage a few families, especially those with members in the CLTS action

committees or child clubs, to build latrines, preferably with offset pits, first to serve as demonstration latrines that will familiarise others with the options for hygienic, low‐cost and durable latrines;

• Sensitise Plan Nepal and NGO staff and child club and action committee members to

design and build latrines that are child‐ and women‐friendly;

• Maintain a safe horizontal distance (10 m) between latrines and tube wells; • Encourage those who can afford to build permanent latrines at the outset;

Human Resource • Plan and organise basic CLTS training for new facilitators and periodic refresher training

for experienced staff to strengthen their capacity to effectively plan, implement and monitor the programme.

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• Organise orientations to CLTS strategies, processes and activities for the Plan management team so that it will allocate sufficient budget and other support;

• Organise periodic national and international exchange visits, seminars and conferences

for Plan Nepal and NGO staff to widen their experience in and learning about CLTS;

• Make available sufficient local human resources to construct latrine using local materials by conducting trainings for local masons;

• Organise capacity‐building programmes for VDCs/DDCs to scale up and/or upgrade

CLTS in their respective areas.

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Documents

Evaluation of community led total sanitation · ACKNOWLEDGEMENTS This is the report on evaluation carried out to access the approach of Community Led Total Sanitation (CLTS) implementation