Community-Led Total Sanitation

As a Working Approach: Plan Ethiopia’s Experiences

By Matebu Tadesse

Nov 19-21, 2007 Moshi, Tanzania

Plan Ethiopia Operates in

Outline•Background: Sanitation and hygiene status

•Coverage + Usage•CLTS introduction •What is CLTS?•Rationales for CLTS•Principles of CLTS•Shifts in CLTS•Methods in CLTS•Triggering elements in CLTS•Steps/processes in CLTS

Outline…• Plan Ethiopia’s experiences• Emerging benefit• Scaling up with quality: Jimma,

Lalibela…• Challenges • Lessons• Conclusion

Background: Sanitation and hygiene status

Coverage + Usage• Access to safe water and sanitation

facilities (at national level)oWater 52% (MoWR, Nov 07)oSanitation 31% (rural =21% urban=80%) (CSA,

2006. Rigorous efforts being made to improve• However, safe hygiene behavior not

adequately created to a level communities internalize it.

• Demographic Health Statistics indicate 46% of childhood deaths are accounted for by diarrhea and 80% of the diarrhea is attributed to lack of safe water supply, and poor sanitation and hygiene practices.

Background…Inadequate Change? Why?

• Limitations with previous approaches to sanitation and hygiene development

oThey were top-down interventions or based on superficially participatory models.

oEmphasis was on sanitation coverage than on improving hygiene behaviour.

oThey were donor/supply-driven rather than demand-driven.

oLargely externally funded, designed and implemented

• led people to develop expectant attitude. • communities had weak sense of ownership

Background…on the other hand• Issue of sanitation and hygiene development is

gaining attention from the government and its partners/stakeholders

• Personal Hygiene and Environmental Sanitation identified as one of the priority health issues in the country.– Improved Water Supply, Improved Hygienic Practicesand Improved Sanitation

• Different actors rushing to improve sanitation and water supply services.

• More funds and efforts in place to meet– The MDG targets for Water and Sanitation– Universal Access Plan (Ethiopian Govt Plan)– IYS 08

• WHAT WOULD ENABLEACHIEVE THESE ON SUSTAINABLE BASES?

Background…to a solution• Rigorous and persistent efforts needed

to improve not only sanitation coverage but also HYGIENE BEHAVIOR.

The need for shift in approach is evident.

So What?• Plan Ethiopia and Plan RESA looked

for an effective approach that would enable dramatic improvements in both SOFTWARE + HARDWARE.

• Community-led Total Sanitation (CLTS) approach, pioneered by Dr Kamal Kar, was introduced in Shebedino District, Southern Nations Nationalities and Peoples Region (SNNPR) in Feb 07.

• Rationales?

Rationales• “First thigs first!”: Start with creating Need + positive

attitude• Induce pride of self-respect instead of subsidy• Trigger self initiative to plan and act• Need-based & community-led solutions• Real involvement not mere participation

• Strong community ownership• Changes in sanitation and hygiene behavior

“Real devt is people’s devt”.

What is CLTS?• CLTS is a community-empowerment

approach which starts from charging the minds with the trigger to change.– Behavioral/attitudinal change + action on

hardware• CLTS is led by communities and it is

about TOTAL sanitation THROUGH LADDERS.

• CLTS is an approach with immense potentials to allow rapid developments in any other sector.

Principles of

CLTS• Experts consult with and learn from communities not dictate,

• Experts facilitate, communities lead the process,

• Let people design toilets not rely on blue print designs by “engineers”,

• Push less money for software but no subsidies for hardware;

• Encourage children, women, men to get involved

• Encourage people to call a spade a spade.

Shifts in CLTSPrevious approaches

CLTS

Teaching communities Learning from communities

“We must subsidize the poor”

“Communities should do it”

“We pursue and motivate”

“It’s up to you, you decide”

Top-down standardization

Bottom up diversity (they design)

Bigger budget Lower budgetsSpending on hardware Spending on empowering

(mental and psychological)Achievement measured by coverage figures

Achievement measured by number of ODF communities: Behavior/attitude change

Methods in CLTS• Ignition PRA/PLA•Community Empowerment

Model

Triggering Elements of CLTS

•Element of shame

•Element of disgust

•Element of fear

Steps/processes1. Introduction & rapport building2. Participatory analyses

• Village mapping• Shitting area mapping• Water sources mapping• Shit calculation

3. Ignition moment • Shit flow diagram• Where that shit ends in• Bottle/bread exercises…

Steps/processes (Cont’d)4. Action planning

by community5. Implementation

by community6. Follow up and

technical support by experts

Plan Ethiopia’s Experiences•Arranged Regional CLTS

training (February 07) Participants: WATSAN Advisors

of Plan RESA Countries, Plan Eth staff, staff members from Health Bureaus and offices of SNNPR, Oromiya & Amhara Regions, staff member from Hawasa University, partner NGOs.

Experiences from Plan Eth…• Exercised CLTS with communities in 8

villages: Midre Genet, Leku town, Remeda, Taremessa, Fura and Morocho kebeles.

Fura kebele people triggered by CLTS revelations Mr Francis igniting!

Experiences from Plan Eth…

• Communities selected natural leaders, including children.

• Conducted a half day national workshop

• Drew action plans to exercise CLTS in Plan Ethiopia program implementation areas.

A school child presenting children’s action plan

Post-training progresses • Feb 2007 – District CLTS Taskforce established

• District Administrator - Chairperson• District Health Officer – Secretary • GOs and NGOs including Plan Eth-members

• March 2007– District level stakeholder analysis & training to frontline staff – Field exercises and community planning

• Children• Community• Natural leaders

• As of March 2007: Communities started actions

• CLTS Taskforce makes continuous follow up.

Post training progresses…

•Promising progresses in Shebedino CLTS introduced to at least 160 villages in 14 kebeles.Children, women and men very involved.

“We want to live in a clean environment! End open defecation!”, Leku Town children

People’s attention drawn

Post training progresses…

Fura Kebele, which has 1265 HHs, achieved ODF; it built 465 HH pit latrines and 8 communal latrines for passers by.

Community members, natural leaders, the Health Extension Worker, District Health Office, Plan are promoting also use and usage.

Children shouting at those who practice OD.Communities penalize offenders

differently: making them scoop it with their hands!

Post training progresses…• Children insisted families to construct

toilets.– Peaceful demonstration

• Different committees established: Chilo Eradication Committee

• Communities started to be the vanguard of sanitation

• ODF Celebrated

Post training progresses…

• The story of Weizero (Ms.) Belayinesh Worku’s bravery brave acts: “After the CLTS approach was introduced, each household in our village dug a latrine of its own. For passers-by, we constructed seven communal latrines along the main road to the market place. After all these efforts, I found four men at different times defecating in open fields in our village. I ordered them to shovel it with their hands and take it into the nearby toilet. As I caught them with their trousers down, they didn’t resist; they only begged me to allow them to handle their shit with leaves. I allowed them and they shovelled it with leaves into the toilet.”

Belayinesh Work expressing how she

penalized them

Post training progresses… More heroes?

“You can visit our kebele anytime and you will find no shit out of toilets”

Kebele Health Extension Worker Assefash Kifle

One of the pit latrines for passers-by

Post training progresses… More heroes?

Atnafe Beyene (right) appreciating Belayinesh (middle) and Jemal (left) for keeping their environment open-defecation free

I mad

e fo

ur m

en

shov

el it

!

I sho

uted

and

chas

ed m

any

men

who

trie

d to

defe

cate

ope

n

Bravo vanguards!

We join hands!

Post training progresses… More heroes?

“What may come, my family and I have now owned the practice and value of using latrines”.

Post training progresses… More heroes?

“We are planning to improve our pit latrines to better ones”, Seyoum Hamesso Chairperson of Natural Leaders

Post training progresses…What is special at Fura?

At Fura, there is strong collaboration from government offices, communities,

Real commitment and involvement of the people

Yet tempted by passers-by who live with the habit of open defecation.

However, even the kebele militia and the Kebele Chairperson actively guard against open defecators.

Kebele not contaminated by subsidy. They achieved and celebrated open

defecation free environment (Sept 02, 2007).

Post training progresses…, Fura celbrated ODF

Environment• Communities organized ODF celebration

The dignifying signpost Plan awarded to the community reads,“The ODF Kebele Fura”

Post training progresses…, Fura celbrated ODF

Environment• Invited Regional Health and Water bureau Officials, staff members, communities, chairpersons of neighboring kebeles, Plan Ethiopia, and many others

• About 500 people at the event. Positive competition created in other kebeles

“I will make Midre Genet the

second kebele

to celebrate ODF environment.” Hagerso

“I will make it before

Midre Genet. We don’t

want to be third. I want

my kebele people to

walk high as do the

Fura people.”

Michael

Post training progresses…, Fura celbrated ODF

Environment• Congratulatory messages and encouragements from officials and Plan Eth PSM.

• “How Fura achieved this target should be studied and replicated”, Key message from Plan Eth PSM.

• Drama and short plays by community

Community members act out how they penalize

open defecators

• Fura Communities promised to improve latrine standards, to promote safe hygiene and to share their experiences to other communities.

Post training progresses…, Fura celbrated ODF

Environment

SNNPR Health Bureau Deputy Head handing over certificate Plan Ethiopia staff members with awardees

•Prominent actors awarded certificates

What about in other kebeles?

• Progresses in other kebeles of Shebedino are encouraging.

• Taremessa, Midregenet, and some more kebeles at good track. – Number of latrines constructed after CLTS was

introduced totaled 2648 (Fura included)• Costs are so negligible! It is less the 1$ per

pit latrine and that is for facilitation!

Scaled up to Plan Eth Jimma Program Unit• Also introduced to:

– 6 villages in Merewa kebele of Kersa District; 3 villages ODF.

•ToT was given to 36 facilitators in Serbo and Tiro Afeta Districs to introduce CLTS (Oct 30-Nov 02, 07)•Zone Water Resource Office, District Administration, Development Agents from Agriculture and Rural Devt Office, District Health Offices, District Water Resource Offices, and Community Development Facilitators of Plan Jimma Program Unit from both districts. • Practical actions in progress•Monitoring format developed

Scaled up…• The ToT trained gave training to Garee

(one of 25) CLTS facilitators • The trainees included

– Tiro Afeta – Tiyo – 25 CHW– Buusa- 18 CHW – 43CHW

– Kerasa – Tikur Balto – 24 CHW- Merewa – 23 CHW – 47CHW

– Kerasa & Tiro Afeta – 4 Kebele chairpersons • Established Garee (one of 25) CLTS

facilitators at community level– Garee leaders – Community Health Workers– Natural Leaders

Scaled up…• How to plan?• Establish Wereda CLTS Team

– Administration– Health– Education– Plan– Agriculture & rural devt – ETC

• Establish Kebele CLTS Team – Kebele Chairperson– DAs– Teacher– Health extension worker– Udan Eradication committee– Plan – Etc

Scaled up to Lalibela program Unit

•In Sept 2007, a 1 day Advocacy Workshop given to District officials.

•Another 1 day sensitization workshop given to kebele chair persons.

•Decided to introduce CLTS in 28 villages (50 to 60 people in a village) until Dec 07.

•Primary school principals, teachers, and students to be involved.

•Review meeting results revealed that HEWs found the approach helpful.

Overall challengesThe subsidy motive appears to have diluted

morals of people in subsidized areas. In some areas like Lalibela, termite

incidence is considered a challenge.Differences in efficiency and commitment

among natural leaders Differences in commitment among

stakeholdersDifferences in understanding CLTS approach Improper facilitation CLTS procedures• Given the small number of staff, it requires

continuous follow up and monitoring; otherwise may be destined to fail!

Overall lessons• CLTS is a key to empower and involve

communities in their own development• In fact gaining increasing welcomes by the

World Bank, UNICEF, Shebedino Health Office, etc.

• Building facilitation skills is vital• Continuous follow up and monitoring are

key to success. When otherwise, retreats have been noted, even in Fura.

• Joint venture tremendously helps, Fura case• Approach bears huge potential for

application in other development sectors.

Overall lessons• Previous subsidy-recipient

communities less triggered: Experience in line with the principle that CLTS works best in never subsidized communities.

CONCLUSION People cannot be developed; they can only develop themselves. For while it is possible for an outsider to build a man's home, an outsider cannot give the man pride and self-confidence in himself as a human being. Those things a man has to create in himself by his own actions. He develops himself by what he does; he develops himself by making his own decisions by increasing his understanding of what he is doing, and why; by increasing his own knowledge and ability, and by his own full participation—as an equal—in the life of the community he lives in (Nyerere, 1973: 60).

•ADOPTING CLTS ALLOWS THIS OPPORTUNITY.