Moving beyond ODF to safely managed sanitation

Bronwyn Powell on 16/06/2017 15:42 EST

eDiscussion: CSOs roles in moving beyond ODF to safely managed sanitation for all 

What is required of organisations, particularly CSOs, in thinking beyond Open Defecation Free (ODF) to safely managed sanitation for all?

The Civil Society WASH Fund hosted an e-discussion to explore the role that CSOs play in assisting households, communities and governments to move up the sanitation ladder to ensure the safe and sustainable sanitation for all. This e-discussion facilitated by Mark Ellery formed part of the lead-up to the Fund’s South Asia Regional Learning Event on “Thinking beyond Open Defecation Free (ODF) towards the SDGs and safely managed sanitation for all”.

The eDiscussion ran from 12 September - 7 October 2016. 

Background: Open defecation is a major cause of malnutrition, disease and death in children. Open defecation practice also disproportionately places the welfare of women and girls at risk. Although South Asia is home to the majority of the open defecators in the world, the practice of open defecation is falling at a faster rate in South Asia than in any other region. This has been due to the effectiveness of behaviour change programs such as CLTS (that was invented and developed in South Asia) that are changing the socially accepted behaviour of open defecation (UNICEF, 2016). Building on this momentum, the challenge increasingly in South Asia is to move beyond the eradication of open defecation towards the safe and sustainable management of sanitation for all at scale.

Context: Civil Society Organisations (CSOs) have played an important role in developing community based approaches (such as CLTS) to change individual and community perceptions towards open defecation. The changing of individual behaviour towards open defecation is however not of itself sufficient to ensure the hygienic use of improved latrines, nor the management of waste or wastewater, nor the contribution to improved environmental health outcomes. Addressing these challenges at scale requires changes in the behaviours of the institutions that demand and supply, regulate and arbitrate on the delivery of sanitation services. This requires CSOs to continuously assess the extent to which their activities are assisting the institutions of service delivery to address the most pressing challenges within their jurisdiction and beyond.

Objective: This objective of this e-discussion was for CSOs and other practitioners to share their experiences of working with households and communities, private and public sectors to not only eradicate open defecation but to ensure the safe management of sanitation for all. This e-discussion seeks to understand the role that CSOs and others are currently playing in assisting communities to move from the eradication of open defecation (i.e. triggering the behaviour change of individuals within communities to achieve collective ODF status), to improved sanitation for all (i.e. including the proximate, sufficient, affordable and hygienic sanitation facilities for all … including children, the poor & disabled), to total sanitation (i.e. including the management of fecal sludge, drainage and solid waste services), to ensuring improved health outcomes (i.e. including the regulation and enforcement of environmental health compliance of sanitary facilities). It is intended that this e-discussion will be followed by a webinar in October, 2016 that will explore the role that CSOs in South Asia are playing to support the institutions of service delivery to move beyond the elimination of open defecation to address the universality and sustainability of sanitation services.

Facilitation: This e-discussion was facilitated by Mr. Mark Ellery. Having spent the last decade working with the World Bank in South Asia, Mark is now an independent water, sanitation and local governance consultant based in Western Australia. With more than 20 years of experience in the water sector, Mark has a good understanding of the application of policies, projects and behaviour change in developed and developing countries, within emergency response, reconstruction and development programmes.

Please make responses to the questions succinct (suggest a maximum of 300 words) 



Anonymous's picture
I am a WASH practitioner from Pakistan and I am very much interested in attending this forthcoming webinar for knowledge enhancement and knowing about the new processes in sanitation.
Anonymous's picture
I encourage active participation in this eDiscussion and the following Webinar as preparation for the learning event in Kandy. We are all busy but I believe that your contributions here will help deliver a more targeted learning event. Good luck for a successful preparation!
Mark_Ellery's picture
Thanks Iftikhar for your interest & Gerard for your clarification.

Over the next four weeks we wish to explore the experiences of different organisations in applying different approaches to address the different challenges of (1) eradicating open defecation, (2) the use of improved sanitation by all, (3) total sanitation and (4) environmental health as part of the lead-up to the South Asia Regional Learning Event.

We will be kicking off this e-discussion today.
Warmly, Mark
Mark_Ellery's picture
In contexts where open defecation is the major sanitation challenge, how does your organisation support households, communities and governments to eradicate open defecation?

We are interested to learn more about how your organisation is responding to the challenge of open defecation. For example, please describe the approach your organisation has adopted, such as CLTS, SLTS or behaviour change communication, and why you have chosen this approach. How are the poor and most vulnerable included? Who is responsible for the verification of ODF and how is this undertaken? You could mention particular innovations or best practices that your organisation has adopted to eliminate open defecation in your target area. Is there potential for these innovations be taken to scale? Please include any experiences your organisation has in addressing sanitation beyond the household, for example in schools, healthcare facilities, marketplaces, etc. as part of a community or local government achieving ODF status.
Anonymous's picture
Short Profile-NoPReF:
Nomadic Pastoral & Relief Foundation (NoPReF) is a civil society organization based at the hard to reach areas of the Somali regional state of Ethiopia. NoPReF leads an emergency community-based holistic intervention to address drought-affected areas and to save lives in communities at risk in the Ethiopian Somali regional state.
About NoPReF:
• We don’t advise the community society what to make, they let us know
• NoPReF is a Civil Society Organization committed to operate in partnership with communities in Somali regional state of Ethiopia to bring about sustainable, impactful transformation that recovers the lives and livelihoods of the poor vulnerable.
• Growth development is not what we perform for the population; it is moderately we perform with them. We consider that the populations who value their needs paramount are the population of the community itself….
• We create variety by engaging with communities, governments, the private sector, and other stakeholders as partner for better-quality—bringing together harmonizing strengths and shared responsibilities to work toward common goals.
What makes out our work?
• The power of what we perform lies in our capacity to develop relationships that put the population of the community at the front line of their own progress development. Enhanced by the capacity to build confidence and accepting, it is our genuine focal point on community to partner with them and partnership that makes out our work.

Answer to your Question:
The Water, Sanitation & Hygiene interventions is based on NoPReF community development approach, in which communities are initially mobilized around immediate, urgent needs, such as increased access to drinking water and sanitation. NoPReF adopts a Training of the Trainer (TOT) approach to build the capacity of the Community Agents (CAs) who will in turn train the Water Management Committees (WMCs). The interventions effort will be fully facilitated by our Program coordinator team and our Field Sanitation & Hygiene Officers, which has been successful in implementing programs in the Somali region demonstrating an ability to operate within the local cultural context. NoPReF is based in the Somali Region Ethiopia and particularly hard to reach communities with a field office in programs areas and is experienced in relief activities with many time of advocacy to enhance the livelihoods of the pastoralists and agro-pastoralists. NoPReF has been improving beneficiaries’ socio-economic situation through water interventions focusing on natural resource development, environmental protection, and gender equity. We are an instrumental in helping the Community Agents in the target communities to play key roles in design, implementation, and taking complete responsibility for the long term viability of sanitation and hygiene development in the program. The NoPReF team works with clan leaders and elders to revive or organize the Community Agents & WMCs, which will recognize traditional organizational structures and serve as the primary implementing unit of all program interventions. Through participation in our programs, each Community Agents & WMC, and therefore the community itself, will improve its capacity to cope with the current situations.
NoPReF’s Participatory Action for Community Enhancement (PACE) Approach: NoPReF’s emergency team will apply a community participation approach as a problem solving method. The PACE approach encourages local participation in defining problems and solutions related to Sanitation, and disease control. The community itself analyses its own beliefs and practices and then decides what needs to be changed. Outside experts, such as local health personnel and professional water and sanitation (WatSan) engineers will also participate and share information with the community. NoPReF’s PACE methodology draws on our last year of experience implementing successful emergency community-based interventions in the hard to reach communities in Shebelle zone of Somali region. PACE recognizes that sanitation and hygiene education will be effective if integrated in community practices and adopted by the whole group as a way of living. When people understand why improved sanitation is to their advantage, they will act appropriately to halt using Open Defecation Field and hence stop the fecal–oral route of disease transmission.

The NoPReF Sanitation & Hygiene program is designed to achieve the greatest impact possible - when improved hygiene behavior and sanitation, increased water quantity, and improved infrastructure for water quality are implemented as a package. NoPReF will be sensitive to the community’s cultural and social preferences. The Sanitation & Hygiene program will target mothers of young children, and include other family members as well in order to build behavior change. Sanitation practices for infants, as well as those of pre–school age children, the elderly, the sick and the disabled, generally do more to contaminate water supplies and spread disease than those of healthy adults.
Through our Participatory Approach, Including Choice of Technology:- The NoPReF program’s holistic design will actively engage the community in all stages of the project including planning and development of management systems, establishment of user fees if possible, construction, operation and maintenance. This will lead to appropriate design, enhance adoption of new behaviors, and help generate the levels of community commitment and support needed for proper maintenance. An essential part of the process is to give families and communities a selection of generally appropriate technology and design options. NoPReF will offer technology alternatives that can be operated and maintained locally at the village level; ensuring local capacity to maintain them is readily available. NoPReF will encourage community cost sharing (e.g., contributions of cement, labor, and sand); when households share the cost of building Sanitary latrines, overall costs drop, and the sense of ownership and responsibility increases, usage is greater, and maintenance improves. Pit Latrine Construction: The Program Wat/San engineering team will build private and communal pit latrines applying best practices for sanitation in emergency settings to ensure a successful intervention: 1) identify and address social barriers to using latrines; 2) use a ventilated improved pit latrine design that traps insect vectors; and 3) evaluate the depth of the water table, including seasonal fluctuations and groundwater hydrology. Pit latrines will not be installed where the water table is shallow or where the composition of the overlying deposits makes groundwater or an aquifer vulnerable to contamination. The SWISS team will work closely with clan leaders and the WMCs to site and design latrines that are culturally acceptable, and to ensure there is a reliable system for safely cleaning and maintaining the latrines.

The Second approach NoPReF used in implementing the Sanitation & Hygiene programs includes Community Led Total Sanitation (CLTS). Under this approach is critically emphasizing more on ODF project in community level. During our implementation of one of CLTS project in Shebelle zone, indeed there are some challenges we faced at the initial time of our CLTS program.
Most Vulnerable Groups
NoPReF’s field assessment to the hard to reach communities in the region indicate that the most vulnerable members of the target communities are the elderly, women and children, especially female-headed households and mothers of children under five years old who are at a greater risk from dehydration and malnutrition, and those families whose main income earner is disabled or over 60 years of age. Typically, these groups are left behind in drought-affected areas, which leave them prone to disease outbreaks as well as a lack of water and food, where the men on the other hand migrate with livestock to seek grazing land and water. Rural women from the target area are expected to perform productive, reproductive, and social roles in the community. Typically women are expected to produce, prepare, and process all household food requirements, as well as be responsible for the health of their children. According to the dominant local culture, women cannot inherit assets, as it is the sole prerogative of male descendants. SWISS will provide immediate assistance to this vulnerable population by providing training in the SWS or PuR process to ease the time and intensity involved in food processing and water preparation, and training in diarrhea care and the use of Oral Rehydration Salts (ORS).

In the case of ODF verification's the responsibility lies to the whole community in generally, but NoPReF CLTS implementation has grouped the ODF verification's responsibility in the following ways;
We have divided the community in to groups, sex, age, for instance our CLTS program has set that the whole village children’s as one group and let us know that are of ODF in the village, who are members has defecate d here properly they try to mention even the name of the person who has defecate here and there etc… The other group been School children to get the responsibility to identify the ODF in the school compound and the village at a large same like the children group they specify the person who has defecate d there and here. Where some time the specified person name is present in the team, we have observed that many people mentioned their names during the verification of the ODF in the CLTS program areas…. Likewise Older age group were grouped together to verify the ODF just like the prior group has done, but at this old age group it was different from the two groups as to their verification of ODF was interesting that even it has brought members to defecate at ODF, Therefore one other interesting was that at the older group No one can mention where women has defecated even if one knows it. Because of the culture norm, When we try to engage the groups to identify where women uses for ODF in the village every one shouted out that “STOP” what we are talking and mind we repeat by asking on women in the ODF issues then that could led us end of our existence in that area……

At the end of Groups verification of the ODF, we then tried to consult with all the community through CLTS mapping as second verification of the ODF sectors in the Village level. Then we tried to consult with individually and then everyone to mention or to map where he/she is located in this map, and also village administration was asked to map the schools, health centers, the market place, main roads mosque and the water points etc… In the Mapping identification hard papers colored (different colors) were used where the ODF identification was used the hard paper colored with Red cards…..
Then finally, the whole map of the village appeared to be the RED hard paper cards. The at one we found that the whole village members busted with laughter, the when we asked that what is the matter that made you all bust in laughter at once, the village administration answered that we laughed that the ODF Red cards identification is more than the village population residents!! He then added that the whole village is surrounded with feces/stools… Then at the backbenches of the community some shouted Oh! We are dead people- and how come that we are unable to know that we suffering all the way decades in our village.

The second session started by out sanitation & hygiene officers to integrate the issue of village and the Health sectors. Thus many of members of the village came to know that why their water points is contaminated us due to the ODF practices in their village. The whole sickness they were suffering since the existence of their village was due to the ODF he added…
Finlay the CLTS committees were identified in the village and together with NoPReF the a solution was a brought that every household must have his/her own Latrine at the home yard level and that is the way to minimize the high cost of the medical bill they were inventing and soon the following days the village members have started their action on self implementing their own latrines as privately……

In deed NoPReF has only supported with communities with CLTS training and improvement of the rehabilitation of their water points in the village level. Therefore the best eliminating ODF is the CLTS approach and we recommend all stakeholders and donors to boost Sanitation & hygiene promotion through CLTS approach if community ownerships and sustainability is required in community level.

In scaling up: - We recommend some of the people in the in the villages be supported with transport facilities like donkey cart transportation which makes easier to bring the local construction materials to a simple latrine in rural areas and hence with that provision of the transport facilities it make access and availability of material to the local market and hence with cheap price thus it will scale up all those members of the villages and they will be attracted to the availability of the local material in the market hence ownership to build up once own toilet at his/her household yard will be in high possibility as we have observed through our experience in promoting one of our CLTS programs in Shebelle zone, Ethiopian Somali region state. NoPReF has already demonstration, at scale, to be viable and essential features of its work.

Our Experience in Sanitation and Hygiene includes both the two approaches we have mentioned above. Therefore we have implemented both the Sanitation programs through these approaches of Participatory Action for Community Enhancement (PACE) and Community Led Total Sanitation (CLTS).
Anonymous's picture
Dear Abdullahi Mohamed,

I'm Nguyen Quy Hoa (short name - Mr. Hoa), WASH manager, Plan International in Vietnam (PIV).
I like your two approaches, In fact we are also following this tract, both CLTS and Sanitation Marketing with community participation.
To encourage people to improve their basic toilets (which are usually not hygienic), it's important to introduce them with new options which are suitable and costly. But how? the way we are trying to do to achieve is to get household to contribute labour cost for digging hole, local materials (like bamboo, grass, wood,...) for making the upper part of the toilet, participating in the transportation of materials (sand, gravel,...), making the toilets component on site to reduce the transportation cost (like concrete ring, slab), using simple and light mold.
By this way, people will not have to pay much from their own pockets while taking the advantage of using what they have in hands and increasing the ownership spirit.
One weak point in the implementation of this participation approach is that the linking between the masons groups and the customers (the users). Usually the masons are weak in getting people understand about participation approach, as well as they don't have much contacts with users in order to do this work.
On the other hand, people are poor and they don't have adequate information on making the low cost toilets and information about the suitable services, so they didn't decide or take action.
to create an effective link is still a question in practice to scaling up the hygienic sanitation coverage in the rural mountainous area.

All the best!

Anonymous's picture
CANDO is pleased to learn about good practices and share ideas on how to enable sanitation and clean water for all.
Anonymous's picture
I am a career local government officer and am looking after the WASH sector through local government since 2009, including the all important discussion of up-scaling the ODF and what the Government and the local governments should do in this regard in the context of Khyber Pakhtunkhwa province of Pakistan and what can be the ideal team work of Government, local governments, CSO's donors and the all important communities in this cause. I think this will be very interesting and relevant for me and my organization to learn from this experience.
Mark_Ellery's picture
Dear Cando & Said,
Thank you for joining this discussion. We trust that we will all learn from this exchange.

Dear Abdullahi,
Thanks for getting the ball rolling with this wonderfully detailed response to the initial questions posed.

To summarize, I understand that NoPreF:
- works with nomadic pastoralist Hard to Reach communities where open defecation rates are still high
- adopts a CLTS (i.e. triggering for eradicating open defecation) plus PACE (i.e. community led appropriate technology design) for facilities for communities and/or the poor with a special emphasis on the most vulnerable (i.e. female headed households, fecal exposure of children).
- Identification of open defecation is undertaken by the community divided into separate groups and validated through a community mapping process because it is not possible to ask females where they defecate.
- Community ignition of the need for households to install latrines is based on the realization of the health implications of the mal-practice of open defecation.

We are interested to hear from other organizations how they are working to achieve, validate & sustain open defecation free status in their jurisdiction (including Hard to Reach areas).
Anonymous's picture
I am a school WASH officer in Vanuatu. Live and Learn Vanuatu through its DFAT WASH project has also engaged on this battle against Open Defecation.
2 Community Based Sanitation Enterprises have been set up to look into the improvement of sanitation in peri urban communities.
The business model used is the Cooperative where targeted community households are invited to pay for a membership in order to have access to special toilet services through instalments, hire purchase.
Prior to the setting up of the enterprises rapid and in-depth household surveys were carried out to map out areas of needs, ability and willingness to pay for the services. The data were then presented to the communities. In between times trainings were conducted to communities, to enable members to chose the right toilet types (VIP, Button Flush, Pour Flush and Compost toilets) that suit their geographical and geological particularities as well as their budgets.
The CBSE members went through all sorts of trainings to prepare them to take up the challenges of helping community member to move up on the ladder of sanitation.
Most of the toilets visited during the surveys appeared to be (walled open defecation... where there is an unlined pit, a wall but no roof)...
The idea from the CBSE's is now to help the people who do not have the right budget yet improve what they have now to a safer sanitation. household owners can buy toilet parts, products, from the CBSE's or make their own with their improved knowledge and support from the CBSE's.
As for the schools, the same types of toilets as described above could be seen in the rural areas. But a national Education Stakeholders workshop has resulted in sanitation to be target through the policies that have been drafted and administered by the Ministry of Education.
Bronwyn Powell's picture
Hi David. Thank you for your contributions, it's always good to hear from the Pacific experience. It sounds like in Vanuatu people have the behaviour of using a toilet, but it is unimproved sanitation and, since the waste is not separated from the environment it still poses a health risk. 'Open defecation' is a term usually used when people have no option but to defecate in the fields, mangroves, etc. It sounds like you are lucky not to have that problem in Vanuatu, and instead are grappling with hope to move from unimproved to improved sanitation (the JMP has some useful information It will be really interesting to hear how you and the CBSEs are encouraging and/or incentivising households to move to improved sanitation - and which of the toilet types are popular and why. Bronwyn
Anonymous's picture
Thank you Bronwyn for your comment, just to add on to what David had already mentioned our CBSE is in the peri urban area in Port Vila so the challenge for us is to encourage households to improve their sanitation when they have more pressing issues like land tenure which is the main reason why most household in peri urban areas don't have a "proper"toilet or build a super structure toilet. This is why we using the chiefs, area council etc to be part of the WASH Committee and raise the awareness of what can happen if they practice poor sanitation and lack of hygiene behaviour. Also the use of the "F Diagrame" the transmission route, this is a very powerful tool that we use during our trainings as this clearly shows how diseases are easily spread if there is poor sanitation and no handwashing
Anonymous's picture
Greetings from SNV and Bhutan, great to see the discussion underway.

SNV is responding to the challenge of open defecation by working with national and sub-national governments, as the duty bearers, to strengthen capacity to lead and accelerate progress towards district-wide sanitation coverage and hygiene practices.

Using the example of our Sustainable Sanitation and Hygiene for All Programme (SSH4A) we use an approach in 15 countries across Asia and Africa that integrates sanitation demand creation (for example CLTS in Nepal and Community Development for Health in Bhutan), strengthening of sanitation supply chains, hygiene behavioural change communication (BCC), governance, and gender and social inclusion. The choice of sanitation demand creation approach is based on many factors including the context, the coverage, the relevant mandated approach by the governments as well as being informed by the triggers for households. In Nepal, there are clear processes in place led by the national level for verification of ODF and post ODF and total sanitation. In Bhutan, basic sanitation coverage is already high and as such the focus is on 100% access to improved sanitation including WASH in institutions (eg schools and monsasteries) and small towns.

Some of the thinking behind it are,
• The need to develop capacities and approaches that can be scalable through a government-led district-wide approach, as opposed to an exclusive community focus.
• The need to reach all requires explicit strategies for inclusion.
• The need to innovate in hygiene promotion practice, linking this to the sanitation drive, but also embedding this practice in long-term health promotion.
• The need to have a long-term strategy to sustain sanitation and hygiene behaviour change, as opposed to one-off triggering and ODF-focused programmes.
• The need to measure small steps of progress including access to and the use and maintenance of toilets, changes in hygiene behaviours and practices as well as increased capacity of local stakeholders.

Look forward to the ongoing discussions and meeting many of you at the upcoming learning event in Sri Lanka.
Gabrielle, SSH4A Programme Coordinator (Asia)

Biplob Kanti Mondal's picture
Bangladesh Red Crescent Society in collaboration with IFRC has been implementing the CDI2WASH Program at 4 communities in Rangpur and Gopalganj of Bangladesh since 2014 to improve the water and sanitation condition of 24,000 community people and school children. While working with the community to improve the sanitation condition, we revealed that many households did not have latrines. As such, one of the problems was open defecation which was seen while we walked around the community. In order to solve this issues, the project introduced Participatory Hygiene and Sanitation Transformation (PHAST) and Child Hygiene and Sanitation Transformation (CHAST) approach for behaviour change as those approaches were applied in BDRCS earlier projects in Bangladesh. Also, Red Cross and Red Crescent Movement works since long on implementing the aforementioned approaches. For implementing those approach, ToT was given to community volunteers, school teacher and students. They then took sessions at the community and school level to aware the community people and school children. Besides, posters and leaflets on good sanitation and hygiene behaviour were distributed among community people and students. In addition, the activities of Sanitation Marketing were implement by iDE at the community so that the people can get the sanitation products from Community Service Providers (CSPSs), who has been trained on producing good quality sanitation/latrine products i.e. ring, slab, superstructures etc. They also has been trained on latrine construction addressing the flood prone areas. These CSPs were constructing the improved latrines at the community. As part of the program, subsidised improved latrines have been provided to hard core poor people of the community. PWDs and socially excluded groups have been given priority while distributing the latrines. Also, some community people constructed their latrine materials with their own cost buying the latrine products from CSPs. On the other hand, already some School Toilet Blocks separate for boys and girls were constructed including the hand wash facilities for improving the sanitation condition the school and surrounding community. This School toilet blocks also addressed the disable friendly features and menstrual hygiene management issues. All those activities have been monitored by project staff, community volunteers and change agents who have been trained on participatory monitoring and evaluation. The project staff and change agents reported that the people are using the constructed improved latrines and they are washing their hands with soap after defecation. Open defecation has been reduced significantly and are seen very minimal now. The communities the will get the ODF status soon.
Anonymous's picture
Hi everyone; its feels nice to see former colleagues at this forum; SABAWON is a national NGO in Pakistan. SABAWON has recently accomplished 2 projects (on on rural sanitation and one on urban sanitation in District Bannu, Khyber Pakhtunkhwa Province in North West part of Pakistan with UNICEF.
These projects were inspired by recently introduced Pakistan Approach towards Total Sanitation (PATS) Ideology.
PATS Project was initiated for achieving and sustaining an open defecation free environment with clear emphasis towards behavior change and social mobilization enhancing the demand side of sanitation. Under the Project, SABAWON arranged 5 days training of Social Organizers on facilitation of PATS in the rural communities of District and FR Bannu. Demand for sanitation was created through Behavior Change Communication Campaigns. During the campaign, the audience was chosen from schools, communities, religious places and inside houses to inform people on the need and importance of safe drinking water, safe sanitation measures and hygiene education.
Village Sanitation Committee (VSC) is the representative group of community formed under PATS project for promoting sanitation. The members of VSC s provide assistance to the project staff in successful implementation of the UNICEF’s PATS project in Pakistan.
VSCs members organized monthly meetings for identifying sanitation issues and finding their solutions within the catchment areas with the idea to keep proper record keeping. The VSC members facilitate the social organizers in identifying Community Resource Person (CRP) for their respective cluster and ensure that CRP performs their responsibilities as per agreed Terms of Responsibilities (TOR). VSC members also support CRPs in CLTS triggering activities.
SABAWON also launched Mass Media BCC campaigns and community events for instance street theaters, puppet shows, radio talk shows and special events for example global hand washing day and world water day.
Government officials and Political Leaders are among the key persons, whose presence is utmost important to ensure ownership of PATS to communities for up-Scaling rural sanitation, increasing understanding on sanitation importance, to reduce diarrheal diseases and also to mobilize the community door to door for eradication of polio. To provide support in this project SABAWON’s team arranged one day training to the new elected representatives and also Government officials of the target area. The main purpose of the training was to train/orient the Government officials and Political Leaders of the target communities (District Bannu) for ownership of PATS and provide support in Up-Scaling rural sanitation.
Polio is categorized an endemic infection across Pakistan, in an effort to curb Polio, UNICEF with SABAWON currently implements Sanitation Program at Scale Project in Urban Settlements of District and FR Bannu. The WASH Project is extensively focused on Polio eradication to translate the goal of sanitation promotion in Khyber Pakhtunkhwa in Pakistan.
In this model project, the sanitation component is divided into two components namely internal component with the responsibility resting with community for constructing sanitary latrine, household connection, and lane sewer, and the external component, with the responsibility resting with the external agency (Government, NGO, etc.) for constructing main sewers and treatment/disposal works. Rather than sharing the costs of the total system, the responsibility for components of service provision is clearly allocated between the involved stakeholders. This component model sharing ensures the model for the other people to see and act.

Anonymous's picture
Dear Mark ,
Good point...a good issue I must say. Regard to my country Bangladesh I strongly feel for a research regarding the retention of the ODF community. As a result of the motivation and peer pressure many households here stop the open defecation but soon they go back to ODF. The reason mainly is the low -cost/ no cost latrine. I feel that a technological boost is needed. I am sure you know that the most of the latrines are pit latrine here...a very shallow in deep which get filled up quickly and people can not manage emptying it. Those who knows somehow, doesn't know the total issue of FSM. To me, the involvement of private sector with technological innovation is just a need of the time. Lacking of FSM is evident everywhere ... from big cities to the rural communities, no where Fecal Sludge is managed scientifically . I assume that it is affecting the quality of the ground water. In brief I would like you to inform that involvement of the private sectors, regulation from the public ( government ) sector is needed.
Mark_Ellery's picture
Thanks for your kind contributions.

Dear Gabrielle,
Thanks for sharing the SSH4A. We are interested to learn more about how SNV is making choices between the methods deployed for demand creation, strengthening supply chains, ensuring inclusion and sustaining progress. I hope that we will hear more on this from SNV during the webinar scheduled for the 19th of October.

Dear Biplob,
It is interesting to learn that the Bangladesh Red Crescent has adapted its previous experience in Participatory Hygiene and Sanitation Transformation (PHAST) and Child Hygiene and Sanitation Transformation (CHAST) to eradicate open defecation in communities. It will be interesting to learn more about the effectiveness of this approach versus approaches like CLTS.

Dear Iftikhar,
It is lovely to hear from SABAWON and your work on PATS in Khyber Pakhtunkhwa. I see that your identification of ‘natural leaders’ occurs after the triggering process. I am interested to know, do other organisations wait for natural leaders to evolve from the triggering process or do they train natural leaders in advance?
Thanks also for introducing the Component Sharing model (more information is available at and the link to eradication of the risk of the transmission of polio.

Dear Firoj,
Thanks for sharing the Bangladesh experience of communities and households backsliding into ‘open defecation’ because of the low quality of low cost latrines. Next week we will pick-up on your suggestion of a larger role for the private sector ... but or now I would like to pick up on the question of the certification, validation & sustaining of ODF status!

Can other organisations share their experience of how they prevent ODF communities from returning to open defecation?
Iftikhar_Hussain's picture
Dear Mark,

Many thanks for your response. As a matter of fact, mostly natural leaders emerge during Participatory Rural Appraisal (PRA) activity or triggering process within the focused project communities. Community Resource Persons (CRPs) are our natural leaders. Time factor is also important in this context as most projects run for limited duration and usually we are constrained to strictly follow the set schedule and procedures for timely completion of the project.
Anonymous's picture
We believe the challenge is 2-fold: access to appropriate, affordable on-site sanitation technologies and human capacity to implement and that equal focus on each is required. For that reason, CAWST does not work directly with communities, but instead builds the capacity of local organizations to implement sustainable latrines projects. We have a suite of services on various decentralized sanitation topics including Latrine Design and Construction, Environmental Sanitation, Community WASH Promotion and Fecal Sludge Management. We are currently developing a Sanitation Implementation workshop to help stakeholders in the sanitation sector become aware of and choose between the various implementation approaches.

We also believe that for effective implementation of on-site sanitation technologies the following 5 aspects must be in place: creating demand for toilets, supply of products and services, capacity building, financing, and monitoring for improvement. We create materials (see, conduct training and provide ongoing support to latrine project implementers to support them to do each of these 5 things better.

Civil Society has been focused on making their communities ODF, with a big push from the MDGs and SDGs and therefore governments. However, latrines (or toilets) often simply store fecal sludge. Latrines are a necessary component of the sanitation system, but without proper fecal sludge management (FSM), toilets are a ticking public health bomb. We look forward to continuing this discussion beyond ODF!
Anonymous's picture
Sharing SNV’s experiences in Bhutan.

Public Health Engineering Division (PHED), Health Ministry is the lead agency for Rural Sanitation and Hygiene programme (RSAHP). SNV supported PHED in developing RSAHP approach based on SNV’s SSH4A subsidy-free programme model.

Engaged local capacity builder during approach development and implementation phase. They are involved in strengthening capacity of key district stakeholders. SMEs/Masons are encouraged, trained and capacities built to engage/invest in sanitation business to cater to household demands. They provide technical advice and services in toilet construction.

Community Development for Health (CDH) workshop, an adapted version of CLTS and PHAST is the main tool used for community mobilization, sanitation demand creation and behaviour change. It’s emphasise is on appreciating strengths rather than shaming which has a stronger cultural fit. Workshop is conducted in all community clusters. At least one household member participates and plans their own toilet construction. Main motivating factors are: self-realisation on affordability, convenience for elderly and all household members, health & economic benefits and dignity.

Health Ministry endorsed the approach and prioritized sanitation and hygiene programme as key result area in its 2013-18 National Plan with target to increase improved sanitation from 54% to over 80%. RSAHP is now being implemented in six districts. Sanitation and hygiene in school and monastic institutions is also integrated in programme.

During 2015 WTD, Health Ministry recognised two more sub-districts as having achieved 100% access, while Kurtoe was verified as having maintained its coverage since 2011. During 2015 review, two districts reported improved access of 98% up from 27% and 57%. District health sector took ownership of review process. Districts incorporated sanitation targets in their Annual Performance Agreements and progress regularly monitored.

During this year’s WTD, Ministry is expected to declare not only ODF but also access to improved sanitation in many sub-districts.
Mark_Ellery's picture
Thanks to everyone this week for your contributions on the different approaches for eradicating open defecation. It seems to me that irrespective of the different approach adopted (i.e. CLTS or SLTS, PHAST or CHAST, PRA or BCC) the key seems to be to the generation of a collective understanding that individual choice to defecate in the open is no longer acceptable irrespective of the motivation (i.e. shame, health, safety, status), Sustaining this ODF status (as highlighted by Ugyen) also requires some form of regulation by government.

What also seems to be evident from the discussion over the last week, is that most organizations have realized that the eradication of open defecation is not sufficient (nicely captured by Sterenn above).

Over the course of the next week we are going to be seeking your experiences on approaches for moving households up the sanitation ladder.
Mark_Ellery's picture
In contexts where unimproved sanitation is the major sanitation challenge, how does your organisation facilitate household and community access to improved sanitation?

We are interested to learn more about the challenge of moving households and communities from unimproved latrines to improved latrines, and unhygienic to hygienic practices.
- With respect to moving from unimproved to improved sanitation, describe the approaches your organisation has adopted such as sanitation marketing and training masons, accessing sanitation credit or subsidies. You could include why this approach has been chosen and whether it is effective in reaching poor and vulnerable groups, particularly women and girls, people living with disabilities and those in remote or otherwise marginalised communities.
- With respect to moving from unhygienic to hygienic practices, what innovation has your organisation introduced and what is the potential for these to be taken to scale? Examples might relate to handwashing, infant faeces and menstrual hygiene management and might include innovations in technologies, behaviour, supply chains, finance etc.
Anonymous's picture
I guess I came one week earlier on this topic.
Anonymous's picture
After working in the industry for over 15-years I have found that the so called "experts", are not!!!

I have debated with these "experts" and have found that their solutions not solutions, and will inevitably contribute to and exacerbate the problems that they say they are solving.

In the end I believe that many of the "experts" are in the industry to collect a consultancy fee.

Give me a budget and I will tell you what can be done!!! Because the problems that are witnessed in many sub-Saharan countries should have been solved years ago.
Anonymous's picture
I am associated with Rajputana Society of Natural History (RSNH) based in Rajasthan (India) working on the aspects of conservation and environment protection through community participation. WASH is our one of the primarily focused concern. We are facing the challenges in terms of perception of the common mass (urban poor and rural) towards ODF. It is really a great challenge for any organization (GOs/ NGOs/ CSOs etc) to deal with the mental setup of the people.

There are several reasons which we observed among the people defecating in open:
1. Non-availability of the space (toilet) is first one. Although in nations like India, governments at national as well as state levels had supported the commoners to construct low cost toilets so this is now not considered as the prime cause.
2. Unacceptability or No-use of constructed toilets, is another important aspect which need immediate attention. We found that mental setup of many of the people (especially experienced with rural community) is not accepting or mending up their mind to use the constructed Toilets. This is tedious responsibility which everyone has to work out collectively. Though this social responsibility was tackled by our team through various means but still a grand success is a need of time.
3. Toilets with unhygienic conditions is another issue need to be taken care off. We had given space and supported the steps to construct the toilets but the cleanliness or regular services are lacking. The reasons might be several but in the regions with scarcity of water the conditions are worst.

RSNH team successfully worked out on the options through social-models to overcome the above concern. With due respect to the customary actions and indigenous approach RSNH team motivated the target communities from the rural and tribal areas to work out on the issues raised. Fortunately, result was as per expectations, and team is working on the same with the urban communities where the conditions are different....

Alex Grumbley's picture
WaterAid has been working with change agents to implement CLTS and adapted forms of CLTS in Timor-Leste since 2007. More recently we have been engaged in and supported a 3-district ODF sustainability study with the Ministry of Health, BESIK, UNICEF and Plan. Initial results from the first district study show that 78% of HH continued to practice ODF, however only 20% of communities managed to maintain full ODF status. An interesting trend emerging is that the majority of HH’s that revert to OD have built simple pit latrines and report becoming frustrated after a year or more with the durability and in particular the smell (as users are often pouring water in the pits). However, of the the HH maintaining ODF status 60% used pour flush toilets while ~40% continued to use simple pit latrines. Full report available soon with comprehensive drivers, barriers etc.. analysis. It was hard to find evidence of HH’s making incremental upgrades/ ‘climbing the ladder’.

On sustaining ODF WaterAid works through our change agents ( local NGOs, CBOs and local government staff and volunteers) to follow-up beyond ODF achievement and have been utilizing sanitation BCC videos and discussion guides developed by MoH with BESIK that have been helpful with sustaining community momentum on ODF. Now we are working with the local government administration to take this further and lead on achieving and sustaining an ODF district with the support of sector partners.

WaterAid is also trialing light-weight plastic SaTo flapper toilet pans, as transport is a major cost and barrier, as an incremental upgrade to a pit, as well as for new toilet construction, linking with existing local weekly market network and businesses that sell into these. We are also working to trial a consumer-rebate with voucher methodology for rural Timor, incorporating learning from many fund colleagues in SE Asia and would be intersted to hear more information about some of the work in South Asia such as the Stunting Free Village initiative in Bangladesh.
Mark_Ellery's picture
David, Joseph, Satya, Alex,
Nice to hear from you all.

Dear David,
Your comments from last week are a great starting point for this discussion where you highlighted the key importance of ‘product knowledge’ in enabling households to choose the right toilet types (i.e. VIP, Button Flush, Pour Flush and Compost toilets) that suit their geographical and geological particularities as well as their budgets. You also highlighted that the business approach supported by Live & Learn is a Cooperative model which offers its members knowledge, access to toilet parts and installation (or guidance to install their own) and access to credit (i.e. hire purchase options). A beautiful package … product knowledge + product choice + product finance 

Dear Joseph,
The idea of this knowledge exchange is that everyone is simultaneously a learner and a teacher. The goal is to create an environment where we can reduce the perceived hierarchies of knowledge between ‘experts’ and the rest of us. Please stay tuned to see how we go!

Dr Satya & Alex,
Thanks for the voice of experience (Dr Satya) & analysis (Alex) highlighting that the unsanitary nature of latrines is a major factor behind the return to open defecation. To reinforce this point, I would like to make the point pf the need to separate the anaerobic (i.e. water based) from aerobic (i.e. dry) sanitation technologies. The failure to do so, can result in the wrong choice of latrine for the particular mode of anal cleansing of users with disastrous results.

Dear Alex (and others),
We are particularly interested to learn more about the effectiveness of this shift you have cited from collective behavior based approaches (via NGOs, CBOs & local governments) to market based approaches (via entrepreneurs, MFIs & cooperatives) in assisting households to move up the sanitation ladder.

Grateful to hear from your experiences & in the meantime I will request those in Bangladesh associated with Output Based Aid (i.e. rebates) and Stunting Free Villages to ‘chime in’ over the coming weeks.
Anonymous's picture
I am a Lecturer/Training Officer at Papua New Guinea University of Technology. My background is Educational Leadership and English Language Literature and Communication for Development.
My Community Service activity is to provide consultation services to Malikum Plumbing and Construction, 100% nationally own company in Lae- PNG that has more than 15 years partnership experience with AusAid and EU on Water supply, sewerage and sanitation.
I am therefore here to share our experience in that area but it may not be related to your interest.
Obviously we agree that open defecation is unsustainable. As educators and engineers we need to be placed on the same page by way of establishing networks, mobilizing our village water and sanitation committees in order to communicate our research knowledge to the grassroots level of understanding what health and hygiene mean and practically show them how to construct sustainable means of latrines for instance.
Our network of engineer and consultant, plus other members of our company go out of our way to draft Expressions of interest, project proposals, feasibility studies and soon and submit to responsible authorities of different levels of government. We educate the communities using our mobile network as well as deciding on the service level and we plan. After our expression of interest are approved, we move to draft proposals for feasibility studies and construction.
We then proceed to present to responsible governmental levels such as District Development Authorities and Provincial governments for funds.
We are proactive and We do not sit back and ask our government to pay before we do the ground work. We do it using our own resources and then when our proposals are approved, we get paid under operational cost.
Most of our smaller water projects get completed in less than two months and around four-five months for bigger projects as we mostly use local rural labour simultaneously because we make sure they take ownership of the projects . We do two to three projects in different sites concurrently too.
The engineer and consultant takes periodic site inspection visit as well as to give further education and training to check on the quality of work and for purposes of monitoring and evaluation reports to be presented to the sponsoring authorities.
Our approach model is social Web.
However, we still do have Challenges in areas of sustainable and durable latrines for those rural areas that we have constructed Water supply projects.
we are hoping that some donors who care about Water, sewerage and sanitation causes will come to our aid and look at latrines as the second development phase for all rural water supply projects that we have completed so far.

Anonymous's picture
The solutions are here ...... "knowledge exchange" is not required ...... if you do not have the knowledge, why are you in the industry of providing solutions.

Nothing needs to be invented.

You keep stuffing it up.

You keep wasting time.

You keep wasting money.

You keep collecting your fee and collecting your wages.

People keep getting sick.

It is not that hard.
Anonymous's picture
Yes I do agree with you here that it is important to utilize local knowledge and interpersonal communication networking is a very important tool for any form of civil society development. One did not have to be an engineer to understand all the Basics needs of a developing country like ours (PNG).
This is because we are the living experience.
One of the most important factor contributing to effective community management of these Water and Sanitation associated development projects is strong and decisive leadership.
From our Melanesian perspective, we must first establish early contacts with the communities through their community leadership network. This is because these community leaders are highly respected and they are the guardians of local environmental knowledge which they believe must be guarded at all cost. Their local knowledge is copyright orally and so development partners must respect that as leadership in communities are important ingredients.
When this community communication network is established, these leaders efficiently mobilize communities to take ownership of the projects. These charismatic leaders have effectively helped us implement those projects ranging from gravity fed, hydraulic rams, hand pump schemes, boreholes and rain water harvesting by providing unskilled and semi skilled labor for sustainable construction as rugged terrain makes it very difficult for earth moving machine/technology to be brought into some of the worst rugged terrain and mountainous rural areas.
Education is for life- Feed the man a fish and he will eat for a day. Give the man a fish and he will fish for a lifetime!
Mark_Ellery's picture
Dear Jimela,
Lovely to hear from you. The experience of Malikum Plumbing is very relevant to this discussion on market based solutions (not least personally as I spent the first few years of my life in Lae-PNG). In particular, it is great to hear from consulting firms are conducting ‘feasibility studies’ before undertaking scheme design and seeking to integrate technical solutions with local knowledge.
In particular to this discussion, we would be interested to hear some more from you (& others) about the feasibility of the revenue models for sanitation solutions. That is, the financial viability of households paying for networked or non-networked sanitation solutions via either network user fees, local taxes or by paying local plumbers to install improved sanitation facilities.

Dear all,
Alex has indicated that WaterAid is exploring the market viability of the SaTo pan. Are there other experiences in South Asia on the market viability of the production, transport, sale & installation of the SaTo pan?
Anonymous's picture
With respect to moving from unhygienic to hygienic practices, what innovation has your organisation introduced and what is the potential for these to be taken to scale? Examples might relate to handwashing, infant faeces and menstrual hygiene management and might include innovations in technologies, behaviour, supply chains, finance etc.

Behaviour Change communication in Rural Sanitation and Hygiene Programme (RSAHP) focuses mainly on rural households and institutions in the rural communities (monastic institutions/nunneries and schools). BCC was poorly understood and was never seen as a separate component/activity but was always perceived as just hygiene promotion with health and knowledge based messages. Over the years this has changed, the approaches for BCC and the way it is being delivered has developed. The RSAHP is now upscaled to five districts and the activities which are mentioned below are all key interventions of the BCC component. SNV and the Public Health Engineering Division (PHED, lead of the RSAHP) also works with the Ministry of Education, Dratsang Lhentshog (Religion and Health) and Bhutan Nun’s Foundation (BNF) with an intention to have an increased access to improved and hygienic sanitation practices not only for rural households but also for schools and monastic institutions.

In order to move from unhygienic to hygienic practices, some of the interventions that are in place are:

The sanitation and hygiene coverage in rural areas is 58.4% and the target is to increase to more than 80% in 2018, through a nationwide scaling-up of the RSAHP. The programme has carried out formative studies on sanitation and hand washing with soap behaviours which is a key element of the evidence-based programming and overall strategic planning for the PHED. The findings from these studies have also supported in developing communication messages and also district BCC strategies that guide the district health officials in carrying out BCC activities. At the district level, from the initial phase of the programme BCC is introduced and action plans are drawn. The action plans include; Target 1- 100% Access to improved Sanitation and Hygiene by all Households and Target 2- 100% Access to Improved sustainable sanitation and hygiene usage for all Households including institutions (Schools, monastic institution/nunneries) and Public places. These action plans benefit in follow up, district level reviews and of all separate activities for behavior change. The action plans are further supported by the hand washing session in the CDH workshops and global day celebrations especially the Global hand washing day, World toilet day and menstrual hygiene day.

With regard to schools and monastic institutions, it’s a new intervention that the programme has designed. Study findings indicated that the main draw back in the schools are infrastructures and the way handwashing with soap and sanitation is given less priority. It came out strongly that knowledge was not the barrier. Keeping that in mind, the designed intervention targeted the management at school and the monastic institutions. A day programme was developed to encourage the management in prioritizing handwashing with soap and hygienic usage of toilet, and to influence decision in allocating a separate budget for the two behaviours. In addition, the intervention also included a session on menstrual hygiene management (MHM) as MHM is least talked about in schools and nunneries. MHM is a new programme under the RSAHP. Thus the intervention focuses to break the silence, initiate discussion and help encourage more health talks on MHM as opposed to the current practice of a yearly or no MHM talk.

Communication materials: We have developed communication materials in the past years but most of the materials are either knowledge based or health based messages. This year in 2016, in collaboration with the London School of Hygiene and Tropical Medicine, we are in the process of developing an innovative behavior change communications which uses the universal emotional drivers of nurture, disgust and affiliation. The development of this intervention is expected to be completed by this November.
With respect to moving from unimproved to improved sanitation, describe the approaches your organisation has adopted such as sanitation marketing and training masons, accessing sanitation credit or subsidies. You could include why this approach has been chosen and whether it is effective in reaching poor and vulnerable groups, particularly women and girls, people living with disabilities and those in remote or otherwise marginalised communities.

Sanitation Supply chain in Bhutan, was first introduced in 2010 during the district wide expansion phase of the SSH4A/RSAHP in eastern Bhutan (Lhuntse). However, it faced challenges as there were no structured/suitable models that existed to fit the Bhutan’s context. All the sanitary hardware materials were imported from India and no manufacturing company existed in the country. Keeping in mind the challenges, a district supply chain study was carried out in 2011 and the findings facilitated in the development of strategic principles, product and marketing options and generated business models that was then tested in Pemagatshel District (programme area 2012-2014).
The results from the district-wide pilot in Pemagatshel indicated an increase in improved sanitation from 31% to 88% of households in 12 months. Over 90% of all the new toilets installed were pour-flush toilets, of which most sanitation materials were supplied by the programme engaged SMEs, generating an additional gross sales revenue of 2,095,000 BTN (39,500 USD). The pilot result also gained government partner’s (Public Health Engineering Division (PHED), Ministry of Health) confidence and trust to identify a dedicated supply chain focal person within the office.

The households (consumer) are the key target intervention areas under the supply chain component and SMEs/Masons as the suppliers of products and services.

At consumer (Households) level, the programme intervention facilitated in providing the platform to SMEs for product and service marketing including sharing of cost. This helped greater price awareness and information about where and how to purchase toilet products to the consumer thus simplifying the procedure for ordering, paying and delivery of sanitary products. Sanitation fair were organised at local festivals to link SMEs with their consumers, promote affordable toilets and further improve access to sanitary products and services.

SMEs were identified, encouraged, trained and their capacities built by the programme to engage and invest in sanitation business to cater to the demand of the consumers (households). SMES were also facilitated in offering flexible financing options to help ease the purchase burden particularly for the lowest wealth quintiles.
In addition, Masons were trained in different programme districts including female mason to make toilet construction skills on different toilet options readily available to the households. Female participants were encouraged not only to gain skills but to offer equal economic and training opportunities as men. The trained masons with technical knowledge and skills offer services in their community to build improved toilets (toilet options as per their affordability), with consideration for women and girls, with alternative pit options to overcome pit emptying issues and making toilet easier to use by differently abled person and elderly which is an important session of the training.

RSAHP is currently being up scaled in the 5 district of Bhutan and the programme provides a market facilitation role, engaging, encouraging, training and linking private enterprises to consumers including the vulnerable groups.

Tashi Dorji and Thinley Dem
WASH Advisor
SNV Bhutan
Anonymous's picture
Hi Mark!
I am Kazi Rashed Hyder. I have been working on WASH for the last 12 years and now working as consultant.
I have keen to share my experiences in assisting households to move up the sanitation ladder in Bangladesh Context. After arresting feces in household level different organizations are implementing their activities in two ways, are hardware and software activities . Under hardware activities, households are motivated to install twin pit/offset pit latrine instead of direct pit latrine and local government with sanitary entrepreneurs are taking responsibilities to assist to upgrade these latrines. Local sanitary masons and entrepreneurs are receiving training on latrine materials and designs. Households are also motivated by demonstrated latrine which constructed near to their house/community. But we face another one challenge on ODF- It is observed that ODF declared communities at climate/disaster vulnerable areas become OD community due to struck natural disaster like flood, cyclone and other hazards. So strong coordination and close monitoring is essential among GO, NGOs, LGIs and communities. Beyond ODF, now School latrine and latrine at public places are also considered to repair/ renovate to achieve total sanitation. In household level, 5 star approaches are followed by few organizations under healthy home concept. These stars are water hygiene, sanitation hygiene, food hygiene, environmental hygiene and personal hygiene. Now soap and available water also ensure near to household’s latrine. Beyond ODF, a big challenge is facing, fecal sludge management (FSM). At household level, it is very difficult and unhygienic to emptying the pit. Local level sweepers are disposing sludge in here and there. Now few organizations like Practical Action Bangladesh and WaterAid Bangladesh have initiated piloting of FSM and co-posting systems. But these are very small level and required high cost with close O&M. As per my thinking, a comprehensive planning with strong coordination is required to upscale and disseminate the learning of these initiatives.
Mark_Ellery's picture
In moving beyond open defecation free status (in contexts where unimproved sanitation is the major sanitation challenge) it appears that there is a need to shift from the more community-based mobilization models (seeking to influence critical behaviors) to the more market-based models (associated with consumer preferences).

Over the last week, contributors have highlighted:
- The importance of ‘product knowledge’ in enabling households to choose the right toilet types (David) against the risk of backsliding from ODF status with the wrong choice of latrine design (Dr Satya & Alex) or the risk of natural disasters (Rashed).
- The need for building on traditional knowledge and understanding consumer preferences at the feasibility stage of the design of systems or programmes (Jimela).
- The importance of differential targeting of learning institutions (schools & monasteries). For instance, in the case of Bhutan, hygiene awareness was high but hygiene practice was low due to the failure to allocate an operational budget for sanitation & hygiene (Thinley & Tashi).
- Cooperative sanitation service delivery models providing local access to product knowledge, product finance and guidance on installation (David)
- Building small & medium enterprises to link supply chains with consumer preferences by facilitating access to finance, promotion through fairs & markets. Of particular note is the gender sensitive promotion, design and installation by female masons (Thinley & Tashi)
- The opportunities offered by new technology options such as the lightweight & no/low water use SaTo pan and options to offer consumer rebates or conditional cash transfers (Alex).
- The significance of going the ‘last mile’ to ensure that there are sanitation technology options that are appropriate for the elderly and the disabled (Thinley & Tashi).

The critical importance of improving fecal sludge management (FSM) was also highlighted (Rashed, Thinley & Tashi). Over the next week, we are going to be seeking further inputs on how different organizations in different countries are moving beyond ODF & beyond improved sanitation for all ... to achieve 100% sanitation (i.e. including fecal sludge & solid waste management).
Mark_Ellery's picture
In contexts where faecal sludge & solid waste management are major sanitation challenges, how does your organisation support faecal sludge management (FSM) and solid waste management (SWM) to achieve total sanitation?

We are interested to learn more about how your organisation is responding to the public service challenges of managing faecal sludge, effluent and solid waste? What approach has your organisation chosen and why? Who owns, operates and maintains these public services? Who oversees the quality of these operations? How do you deal with the most vulnerable who are often most exposed to the poor management of faecal waste, drainage and solid waste? What are the innovations or best practices that you have adopted to ensure total sanitation for all in your target area? How can these innovations be taken to scale?
Anonymous's picture
A very open ended question ......

In regard to faecal sludge and solid waste management you have to consider the climate and operating conditions.

How does any organisation is responding to the public service challenges of managing faecal sludge, effluent and solid waste?
How is it paid for??

What approach has your organisation chosen and why?
State which environment we are working in.

Who owns, operates and maintains these public services?
Who pays to operate and maintain these public services?

Who oversees the quality of these operations?
How much money do you have to manage the quality of these operations? Is the public system corrupt??

How do you deal with the most vulnerable who are often most exposed to the poor management of faecal waste, drainage and solid waste?
In regard to faecal sludge management we are all the "most vulnerable", Bacteria and parasites do not have prejudices. Have you forgotten 'Typhoid Mary'

What are the innovations or best practices that you have adopted to ensure total sanitation for all in your target area?
Again, what environment??

How can these innovations be taken to scale?
Nearly every system can be scaled up

Anonymous's picture
I am Madhab Raj Neupane from Nepal and working in an organization called KIRDARC. we have been engaged in WASH sector since 10 years contributing to the most remote region of the country i.e. mountain region of mid-west Nepal.

Efforts of WASH sector in Nepal accelerated only after sector harmonization through National Sanitation and Hygiene Master Plan in 2010. However, these efforts are limited to declaration of ODF villages/districts as a final destination of Sanitation movement. Recently, Depart of Water Supply and Sewerage has drafted Total Sanitation Guideline but it is not yet finalized. Based on my experience, below are the crucial factors to be considered to move beyond ODF:
- Wider Integration of Sanitation Issue with Health and Education: talking sanitation issue with few campaigns, triggering and in isolation will not result the long-term change in overall sanitation and hygiene rather they can achieve ODF in very short run. Communities may not think beyond ODF through these campaigns. Hence, the sanitation intervention must integrate school WASH intervention, hygiene education through children and FCHVs. This education will serve as foundation for future adoption of sustainable practices.
- Integrating Sanitation with Livelihoods and Economy: Until now, the sanitation has been considered as an additional expenses to be covered. It has not been considered as an investment for health. In addition, by introducing the private sector actors it can be converted into local sanitation enterprises such as solid waste management, repairs and maintenance, marketing of local technical solutions for sanitation options etc. In addition, this can be linked with use of urine and sludge as a fertilizer for local economic growth.
- Behaviour Change Communication Tools (BCC): Although there has been increased use of BCC tools, these are blanket tools not contributing to behaviour change rather serving as a IEC tools. Hence, a revised methodology and tools is needed to tackle the identified barriers of bahviour change. KIRDARC has been trying to introduce Barrier Based Behavior Change Communication tools and methodology.
- Inclusive Facilities and Reaching to Unreached (person with disability, children, elderly and women): the current sanitation facilities and models are demonstrated as one for all. These models do not consider the requirement of certain users like children, women and girls (menstruation facilities), and person with disabilities. Without reaching to all and creating models for facilitating use by all.
- Resilient WASH services: with lessons from earthquake, flood and landslides, it is most urgent to integrate disaster resilience in current sanitation movement. Not only the technical designs but also the preparedness among communities to fight against potential epidemic outbreaks.
- Continued effort and steering of government: as already highlighted, decleration of ODF has been considered as ultimate goal and celebrated with all available resources to organize expensive ceremonies. Local government authorities including VDCs consider that WASH intervention is completed as we achieve ODF status and divert the WASH budget into other sectors. The most important component hygiene promotion ignored. KIRDARC has considered this issue very consciously to devise local WASH plans at VDCs and Schools with due focus on post-ODF interventions. It has been providing IDOS (institutional development and organizational strengthening) support to V-WASH-CC for continuous monitoring of such plans developed.
- Supply of Water: moving beyond ODF needs substantial amount of water for sanitation and hygiene practices. With recent conditions of limited availability of water, the post-ODF interventions can not be successful unless we devise innovative and low-cost technology that use less water. In addition, there must be constant focus on expanding coverage of water services.
- Innovation and Knowledge Management; there are different innovative practices promoted/invented by local people and organization in limited area and scale. There is need of proper documentation of those initiatives for others to learn, adapt and replicate.

I think, if we fail to consider above aspects in future sanitation, we cannot move beyond ODF.
Anonymous's picture
Hi Madhab,

Quite a challenging environment that you are working in.

May I ask, within your communities, what is the most common technology used to manage sewage in small villages
Anonymous's picture
Thanks for your Query,

Actually in small mountain village there is no practice of sewage treatment (wastewater). Some of them use in kitchen gardening and most of them drain up to nearest stream.
Anonymous's picture
Well that is exceptionally disappointing.

I do hope that you get the infrastructure you need soon.
Anonymous's picture
Dear colleagues hi
waste management is a challenge for different countries within urban and rural areas in the Democaratic Republic of Congo. Based to my field experiences it requires government implication by defining country policies and make a strong monitoring system, Goverment have to decide about Waste management budget , We are trying involving CSO and Women local associations in Goma city but our efforts need to be supported , In this process private sectors more important . if you need to learn more about us please visit www,biferdong,
Thank you
Anonymous's picture
My name is Geoffrey Weyinda and I am working for Save the Children International .We are implementing a CS WASH project funded by DFAT in Kani Township, Sagaing Region in Central Myanmar.
We are implementing our sanitation program based on a mixture of two approaches, the Sanitation Marketing (SanMark) and Output Based Aid (OBA) approaches that are underpinned by availing partial grants to Village Health Committees (VHC) to support individual households to construct latrines .We mobilize the VHCs to form a sanitation fund where each member without a latrine or with a need to improve their latrine contributes shares towards construction/upgrading of their latrine. The VHC then begins construction for a few first members in accordance with the available shares contributed and the grant given. To accelerate the starting up of the fund, and to motivate the villagers to contribute towards the sanitation fund, the project decides to support each VHC that shows proof of collecting a certain threshold of shares a little grant varying from us $ 500 to US $ 1000 depending on the number of household without latrines in the v illage .The grant is used in purchasing moulds (of various designs) and to kick start the construction of a few latrines as the VHC fund builds up. Deciding the order of construction for the members is done by balloting for those who have started contributing their shares. The communities are given a couple of different technologies to choose from and they construct the latrines to these specifications. They are expected to refund the loans to VHCs plus a small interest that will be used in managing the loan system by the VHC. The management of the loan system is done by the Village Health Committees (VHC), who we have trained in financial management and are already managing other local funds collected from the piped water supply schemes that we have supported them to construct. The project supports the VHCs by providing them with training on how to keep records of payments and re-payments, promoting this approach to merchants and training merchants in book keeping .The project pays some supervision fee to the VHC for every latrine constructed properly. This motivates the VHC to promote this approach.
Mark_Ellery's picture
Thanks everyone,
Great to have such a detailed description of the sanitation movement in Nepal. The drafting of total sanitation guidelines by the Department of Water Supply & Sewerage sounds like a logical next step (BTW – We will come back to the priority role of government institutions next week).
The main point made thus far in moving beyond ODF to 100% sanitation is the need for a multi-sectoral focus that includes education (i.e. promoting hygiene behavior change), health (responding to hygiene failures), livlihoods (i.e. solid waste & fecal sludge markets), the economy (i.e. recycling waste for fertilizer), the unreached (i.e. the disabled & areas of social taboo), disaster resilience (including responding to epidemics) & supply of water (for handwashing, anal cleansing & flushing).
We have also heard more about the collective efforts to link sanitation marketing efforts (on the supply side) with the introduction of output based aid (OBA) making finance available to households that construct latrines (demand side) through VHCs. Is there any experience of these VHCs going-on to address the supply & demand side challenges of fecal sludge or solid waste management?
It would be interesting to hear more experiences in FSM and SWM to achieve 100% sanitation or even experiences in enforcing accountability on providers of FSM and SWM services?
Anonymous's picture
The first step in planning for FSM is to create awareness and a common understanding of the whole sanitation system and the importance of FSM among ALL stakeholders. FSM is not a one-person job. It requires diverse skills and the collaboration of many stakeholders. To plan, implement and operate/maintain a whole sanitation system, stakeholders need to work together, speak a common language and utilize each other’s strengths.

To create this common understanding, CAWST and EAWAG collaborated to develop an introductory training on FSM. This 2- to 3-day active learning training provides sanitation stakeholders (governments, CSOs, engineers, planners, etc.) with an overview of the different components of FSM (technologies, finances, regulation, incremental improvement, etc.). We work with local organizations to adapt the workshop to the local context to better suit the needs of the participants. The workshop materials are open source and can be found here:

After creating a common understanding of FSM, and defining stakeholder roles and responsibilities – stakeholders need to take action. However, there is a clear knowledge and skills gap in FSM. How can you build the capacity of all stakeholders in a city to undertake their role effectively and reach city-wide sanitation? To fill these capacity gaps in India, CAWST is supporting the National Institute of Urban Affairs (NIUA), to design a Sanitation Capacity Building Platform (SCBP). The objective of the SCBP is to build the capacity of sanitation stakeholders, including municipalities, CSOs and consultants. To do so, NIUA assesses the needs of the various stakeholders, develops a capacity building program for each city and coordinates capacity building activities between stakeholders and SCBP partners (expert organizations in various fields). Created in March 2016, the SCBP has enormous potential to catalyze solutions to India’s sanitation challenges.
Rokeya__Ahmed_'s picture
Community based models are very effective in changing collective opinion to influence individual behavior away from the practice of open defecation, market based models are more effective in supporting individuals to move from basic to improved sanitation models. Given a legacy of community based approaches within the sanitation sector but a vibrant domestic private sector and micro-finance markets outside of the sector, the World Bank did a pilot project from 2011 to 2015 to support the development, testing and roll-out of market based sanitation service delivery models in rural Bangladesh by bringing together the domestic private sector, financial institutions, local government and household demand, this pilot extended support for the bottom-up sanitation mobility of rural households from unimproved (unhygienic) to improved (hygienic) sanitation. Strengthening of the local private sector has assisted the government to scale up safe and hygienic sanitation through a sanitation marketing approach designed to cater to the bottom of the pyramid. For years, only one latrine model was available in rural Bangladesh. This pilot program introduced a series of new latrine models that are both hygienic and desirable. The capacity of local private sector developed to produce and marketing. No doubt these latrines are comparatively much expensive. The Water and Sanitation Program (WSP) addressed this challenge by developing linkages between MFIs (micro finance institutes), sanitation entrepreneurs and households. In Bangladesh, WSP partners with a MFI name ASA, WSP trained for the capacity building for sanitation entrepreneurs, and ASA offer loans with flexible terms and low interest rates to these entrepreneurs to expand their business and also gave loan to households to purchase the toilets.

Partnership with MFIs can have dramatic positive impacts for both rural households and small-scale sanitation entrepreneurs. Increasing the availability of microfinance for sanitation simultaneously allows poor households to invest in improved sanitation products and allows sanitation entrepreneurs to increase their profit margins and sustainability, in turn expanding offerings and services for rural customers.

Considering the success of the pilot program a program has been started for a sanitation marketing initiative that will combine social and commercial marketing approaches to stimulate supply and demand for hygienic sanitation facilities by poor consumers. The commercial side of the program will involve lending by a wholesale MFI (WMFI) to a select number of retail MFI’s for on-lending to two kinds of borrowers: (i) rural consumers, for the purchase of materials and the construction of completed hygienic latrines, and (ii) small scale local sanitation entrepreneurs (LEs) who will provide products and construction services. The resources for whole-sale lending by the MFI will be provided from their existing project resources. In addition the World Bank administered the Global Program for Output Based Aid (GPOBA) has committed additional resources for the targeting of output based subsidies for the hard core poor. The social side of the partnership will involve advisory support and capacity building for the staff of the WMFI and participating MFIs, training for small-scale entrepreneurs and community group leaders, as well as project monitoring and evaluation.

Beyond Bangladesh, WSP has also seen the value of engaging MFIs to improve access to sanitation products in Cambodia.
Anonymous's picture
Hello everyone from lovely mountainous village Jumla-Nepal
The E-discussion matter is interesting and quite appropriate for us to review and search the contribution of CSOs toward sustainable sanitation for all. I am glad to have different experience from your respective county through this E-Discussion. In terms of Nepal, We have some different role and experience of CBOs, regarding on sanitation movement. Recently about 260 INGOs and more than 3500 NGOs are working in different sector of development and social transmission. One very common characteristic of CBOs is that every CBOs are contributing fully or partially in WASH movement to achieve national goal of ODF till 2017. (Recently 39 districts has declared ODF out of 75). In those ODF declared District, some movement of total sanitation are already beginning with initiation of CBOs, even government of Nepal has defined the fix dedicator for total sanitation in national sanitation master plan. These are as following
1. Hygienic use of toile.
2. Hand washing with shop
3. Safe drinking water.
4. Safe and Hygienic food.
5. Householder level sanitation (cleaning0
6. Environmental sanitation.
In this six above indicator different, another 21-sub indicator has also mentation in master plan. As per the guideline all CBOs are mobilizing in community level with support of civil society forum (Ward level, VDC level and district level forum) Insuring all this six indicators, local government has legal authority to declare total sanitized village. In recent date more than 150 community (small village with 35-50 householders) has declared total sanitize community in Nepal.
Beyond the ODF campaigns, the CSOs has great opportunity to influence the people and motive them toward hygienic behavior through many social mobilization tools. And I am closely observing this movement in my region. Recently in Nepal, People are taking sanitation as fundamental element for foundation of development. For evidence every livelihood, Agriculture, Health, and structural development project has allocated little bit fund for sanitation and hygiene promotion activities. In Karnali region of Nepal one NGO (KIRDARC) is working in the sector of drinking water supply schema but main aim of the project is improve the hygiene and sanitation status of community people. For that it has built community bath center with solar heater for hot water (because of cold usually people do not prefer to bath)
As part of sustainable sanitation, to improve environmental sanitation, few district of Nepal has started “Green and Clean district .... Campaign”. One of the mountainous district of Nepal is Dolpa, which is located at Midwestern region of Nepal, and it has tropical and rock geography. With support and initiation of local community based organization, Dolpa has started GREEN and CLEEN Dolpa campaign. Where they are working for soil conservation and plantation. Similarly, another one district (Rukum) of same region has been starting GREEN and Clean Village campaign. Where the local government is awarding to people for using green color in their house (Per householders NRS-1000 rupee)
As sum of my observation in Nepal, CSOs are contributing on sustainable sanitation through separate or integrate program, formal and informal campaign (movement) using volunteer or paid staff,

Mark_Ellery's picture
Dear Rokeya,
Thanks for the response to the earlier query by Alex on the use of rebates to assist households move-up the sanitation ladder. I think that this cleverly demonstrates how Government can deploy Output Based Aid for sanitation to draw MFIs into the sanitation sub-sector while also strengthening the supply chains for local entrepreneurs that offer consumers a range of improved sanitation options.

Dear Sterenn,
Thanks for highlighting the complexity of faecal sludge management requiring all elements of the service chain (i.e. containment-collection-transportation-treatment- disposal/reuse) to be hygienically managed. The assignment of roles & approaches to each step of the chain needs to be contextualized.

Dear Tika,
I am routinely impressed by the sanitation movement in Nepal which seems to continuously re-invent itself. What struck me from what you shared is the manner in which the central drive to move beyond ODF to 100% sanitation is actually surpassed by inspired local initiatives:
- To allocate local Health, Agriculture, Livelihood budgets to sanitation
- To seek to declare local jurisdictions as environmentally ‘Green & Clean’
- To provide public water sources of hot water (to improve hygiene behavior)

From next week we will be soliciting your experiences in the strengthening of government systems to improve sanitary compliance.
Mark_Ellery's picture
Dear all,
In contexts where grappling with ‘safely managed’ sanitation is the major challenge, how does your organisation support relevant government agencies, and possibly the private sector, with regulation, standards and environmental health compliance?

The framework of the new SDGs will require that countries progressively work towards not only improved, but ‘safely managed’ sanitation, and that access is equitable and explicitly address hygiene, the needs of women and girls and those in vulnerable situations (JMP Green Paper 2015).

In responding to this question, please share how your organisation is responding to the challenge of ensuring that sanitation is ‘safely managed’. What approach has your organisation chosen to either demonstrate, educate, promote, standardize, license, police or regulate the safety of sanitation facilities and practices? How is your organisation working to support relevant duty bearers and the institutional arrangements required to ensure safe sanitation systems for all?
Anonymous's picture
I simply do not understand what the issue is .......

I can fit 35 x 3000L polymer Septic Tanks in a 40' container. From Australia I have shipped these across the South Pacific, even to South America. They have been installed in the highlands of PNG to some of the remotest islands you will find. These are manufactured to International Standards.

It is not hard!!! It is not hard!!! It is not hard!!!!

Unfortunately it is becoming evident that some people in this industry does not want to fix the problem but perpetuate it. How else will they keep up their international travel to go to these meeting and seminars that result in so little.
Bronwyn Powell's picture
Joseph - This e-discussion is a platform for constructive contributions and debate. You clearly have some strong opinions on these issues. If you would like to continue add to the discussion please do so in a constructive manner. For the benefit of others identify your role, organisation and experience (as others have done). Regards, Bronwyn


Discussion *REQUIRED

Please note that you are now in the PUBLIC e-discussion section