Better Sanitation, Better Life

Nepal Country Paper

On Sixth South Asian Conference on Sanitation (SACOSAN-VI)

11-13 January, 2016

Dhaka, Bangladesh

National Sanitation and Hygiene Coordination Committee, Nepal

Abbreviations

CBOs: Community Based Organizations CBS: Central Bureau of Statistics CREAM: Clear, Relevant, Economic, Adequate and Monitorable DDC: District Development Committee DoE: Department of Education DPs: Development Partners DWSS: Department of Water Supply and Sewerage ECGDA: Environment, Child, Gender, Disabled and Aged people EFLG: Environment Friendly Local Governance ESS: Environmental Sanitation Section FUGs: Forest Users Groups GESI: Gender Equality and Social Inclusion I/NGOs: International Non Governmental Organizations JSR: Joint Sector Review MAF: Millennium Development Goal Acceleration Framework MCPM: Minimum Condition and Performance Measure MDG: Millennium Development Goal MICS: Multiple Indicator Cluster Survey MoE: Ministry of Education MoF: Ministry of Finance MoFALD: Ministry of Federal Affairs and Local Development MoHP: Ministry of Health and Population MoUD: Ministry of Urban Development NGOs: Non Governmental Organizations NMIP: National Management Information Project NPC: National Planning Commission NDHS: Nepal Demographic and Health Survey NSHSC: National Sanitation and Hygiene Steering Committee NSHCC: National Sanitation and Hygiene Coordination Committee NWSSTC: National Water Supply and Sanitation Training Center ODF: Open Defecation Free PDNA: Post Disaster Need Assessment R/D/M/V-WASH-CCs: Regional/District/Municipality/VDC WASH Coordination Committees SACOSAN: South Asian Conference on Sanitation SEIU: Sector Efficiency Improvement Unit SLTS: School Led Total Sanitation SSG: Sector Stakeholders Group SSHE: School Sanitation and Hygiene Education SWAp: Sector Wide Approach TBC: Total Behavioral Change TNA: Training Need Assessment VDC: Village Development Committee WASH: Water Supply, Sanitation and Hygiene WAN: Water Aid Nepal WSPs: Water Service Providers WUSCs: Water Users and Sanitation Committees

Table of Contents

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

1.1 COUNTRY PROFILE ................................................................................................................................. 1 1.2 DEVELOPMENT AND PLANNING FRAMEWORK ................................................................................ 1 1.3 INSTITUTIONAL FRAMEWORK AND LEGAL INSTRUMENTS .......................................................... 2 1.4 COVERAGE DEFINITION ........................................................................................................................ 3 1.5 COVERAGE (HYGIENE BEHAVIOR) ...................................................................................................... 4 1.6 POLICIES AND STRATEGIES .................................................................................................................. 4 1.7 MONITORING SYSTEM IN PLACE AND PARTNERSHIP ..................................................................... 5 2. ACHIEVEMENTS ........................................................................................................................................ 6

2.1 REFORM AND POLICY CHANGES ......................................................................................................... 6 2.2 INVESTMENT MADE ............................................................................................................................... 7 2.3 GOOD EXAMPLES .................................................................................................................................... 9 2.4 SOCIAL ADVANCEMENT ..................................................................................................................... 14 3. GAPS AND CHALLENGES ....................................................................................................................... 14

3.1 COVERAGE ............................................................................................................................................. 14 3.2 TECHNOLOGY ....................................................................................................................................... 16 3.3 HEALTH AND NUTRITION ................................................................................................................... 16 3.4 EQUITY AND RIGHTS............................................................................................................................ 17 4. FUTURE PLANS ....................................................................................................................................... 18

4.1 SANITATION BEYOND MDG ................................................................................................................ 18 4.2 SUSTAINABILITY .................................................................................................................................. 18 4.3. OVERCOME THE BARRIER AND CHALLENGES .............................................................................. 19 4.4 UNIVERSAL COVERAGE AND IMPROVING THE SERVICE LEVEL ................................................ 20 5. CONCLUSIONS ......................................................................................................................................... 21

REFERENCES................................................................................................................................................ 23

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1. INTRODUCTION

1.1 COUNTRY PROFILE

Nepal is a land locked country situated between India to the south, east and west and China to the north. It is the country of the Mount Everest and birthplace of Lord Buddha. Nepal is a multi-ethnic, multi-cultural, multi-religious and multi-lingual country, with more than 126 caste and ethnic groups and 123 dialects. Nepali is the lingua franca. Kathmandu is the capital city of the Federal Democratic Republic of Nepal. Rich in cultural and biological diversity, Nepal occupies an area of 147,181 square kilometers. The country consists of five physiographic regions: the Terai or plains (14 % of the total land area), the Siwaliks (13 %), the Mid Hills (30 %, the High Mountains (20 %) and the High Himalayas (23 %). Nepal has a population of 26.66 million, with an annual growth rate of 1.35 % (CBS 2011). It is a developing country with Human Development Index 0.541. The literacy rate of the country is 65.0% and life expectancy is 69 years. Similarly, the per capita income is USD 1,160. As of 2011, approximately 25 % of the population still lived below the international poverty line of $1.25 per day according to the World Bank. Nepal faces multiple hazards, including floods, landslides and earthquakes. The Government of Nepal has set a target to achieve universal coverage of water supply and sanitation by 2017. The aim of the water supply and sanitation sector intervention is to improve the health and dignity of people and national productivity. The government, through enforcement of the Sanitation and Hygiene Master Plan 2011 (hereinafter referred to as the Master Plan), is firmly dedicated to promote the nationwide Open Defecation Free (ODF) and total sanitation campaigns in collaboration with stakeholders. Nepal's national sanitation movement has gained strategic directions and substantial progress due to the country’s engagement in the South Asian Conference on Sanitation (SACOSAN). Sanitation has become a priority agenda of the national development as the government has initiated a separate budget head for sanitation and the country has adopted massive ODF and total sanitation initiatives. Similarly, issues like human right, gender sensitivity, inclusion and menstrual hygiene management have achieved considerable attention in policies, plans and programs. It is important to note that the devastating earthquake of April 2015 has aggravated challenges to achieving the national sanitation targets within the given timeframe. Hence the accelerating progress and investments are inevitable. Water Supply, Sanitation and Hygiene (WASH) Sector Development Plan is in the preparation phase and is expected to build on the work achieved through the Master Plan and meet new demands for ensuring Environment, Children, Gender, Disabled and Aged People (ECGDA) friendly sanitation facilities.

1.2 DEVELOPMENT AND PLANNING FRAMEWORK The Government of Nepal has recognized sanitation as the priority one program (P1 program) and the cross-cutting theme of development. For this, inputs of multi-sectoral stakeholders (e.g. health, education, local development, etc.) are sought in participatory planning, financing, implementation and monitoring under the basket plan arrangements. This basket plan is popularly known as the strategic plan/plan of action of sanitation at operational level. In Nepal, school and community based approaches and advocacy campaigns are held to promote sanitation and hygiene with hardware and software linkages. “Triggering” approach is adopted to accelerate ODF and total sanitation campaign ensuring proper hygiene behaviors. The development of the WASH sector in Nepal is guided by the national development framework of the National Planning Commission (NPC) and budget allocated by the Ministry of Finance (MoF) in coordination

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with Development Partners (DPs) and International Non Governmental Organizations (I/NGOs). The Ministry of Urban Development is the institutional lead for WASH sector. WASH initiatives are also coordinated by different Ministries and Departments considering the institutional boundaries and responsibilities. For sanitation promotion, the government allocates budget through stand alone sanitation program and water supply and sanitation projects. The water supply and sanitation sector policies have made provision to allocate 20% budget of the sector for sanitation and hygiene promotion. Apart from it, the government has allocated resources for WASH in school, health institutions and public places. In addition, the DPs and I/NGOs collaborate with the government and mobilize their resources to accelerate pace for achieving the sectoral target. Community's self help contribution occupies significant share in the WASH sector financing. Some WASH sector stakeholders are yet to fully comply sector policy provisions in terms of budget allocation for sanitation. After enforcement of the Master Plan, National Sanitation and Hygiene Steering Committee (NSHSC), National Sanitation and Hygiene Coordination Committee (NSHCC) and Regional/District/Municipality/Village Development Committee (VDC) level WASH Coordination Committees (R/D/M/V-WASH-CCs) have led formulation and execution of the strategic plan/plan of action in respective levels. The sector actors work under this unified plan with common target, principles and approaches.

1.3 INSTITUTIONAL FRAMEWORK AND LEGAL INSTRUMENTS

1.3.1 Institutional Framework

The Ministry of Urban Development (MoUD) is the lead Ministry of the WASH sector. The Department of Water Supply and Sewerage (DWSS) under MoUD, with its regional and district offices, is the lead agency of the WASH sector to facilitate the execution and monitoring of the WASH sector projects nationwide. The Sector Efficiency Improvement Unit (SEIU) of the MoUD coordinates to harmonize the WASH sector activities through Sector Stakeholders Group (SSG) meetings and Joint Sector Review (JSR) process. The High Powered Committee for the Integrated Development of Bagmati Civilization is dedicated to cleanliness of the Holy Bagmati River. Rural Water Supply and Sanitation Fund Development Board under MoUD executes the rural WASH program through local NGOs. Similarly, the Department of Urban Development and Building Construction, Kathmandu Upatyaka Khanipani Limited, Nepal Water Supply Corporation, Solid Waste Management Technical Support Center, Metro/Sub-Metropolitan Cities and Municipalities work for sanitation management in urban areas. The Ministry of Federal Affairs and Local Development (MoFALD) through the Department of Local Infrastructure Development and Agricultural Roads and District Technical Offices facilitate implementation of small scale rural water supply and sanitation projects. The MoFALD also provides guidance and support to the District Development Committees (DDCs), Municipalities and VDCs for implementing the WASH programs. The Ministry of Education (MoE), with its department, regional and district offices, coordinates and implements school WASH programs across the country. The Ministry of Health and Population, through its department, Regional and District offices and grass roots networks, is responsible for promotion of health, hygiene and sanitation with awareness raising activities. In order to facilitate and implement the national sanitation campaign in a coordinated fashion, the multi-stakeholder coordination structures (NSHSC, NSHCC, R/D/M/V-WASH-CC) are activated from national to sub-national levels. All these coordination mechanisms are led by the government. NSHSC comprises members from NPC and concerned Ministries, whereas other coordination structures include UN agencies, DPs, I/NGOs and concerned stakeholders. Diverse taskforce provide technical assistance to these coordination structures.

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The Master Plan has institutionalized the coordination mechanism and WASH-CCs up to the level of municipalities and VDCs (the lowest administrative and development unit), such WASH-CCs are formed and activated up to school's catchment, Ward, clusters and Tole levels too. District Level Journalist WASH Coordination Committees emerged in few districts has proved to be catalytic in strengthening media partnership to raise WASH agenda in more strategic manner. The national and regional level coordination mechanisms provide policy and planning level strategic guidance while others work for executing the ODF and total sanitation campaigns. This coordination mechanism has promoted horizontal and vertical linkages, communication and synergy among stakeholders, strengthened co-funding opportunities and promoted self-monitoring and follow up process. The linkage of these committees institutionalized by the Master Plan is as follows:

National Sanitation and Hygiene Steering Committee (NSHSC)

National Sanitation and Hygiene Coordination Committee (NSHCC)

Regional Water Supply, Sanitation and Hygiene Coordination Committee (R-WASH-CC)

District Water Supply, Sanitation and Hygiene Coordination Committee (D-WASH-CC)

Municipality/VDC Water Supply, Sanitation and Hygiene Coordination Committee (M/V-WASH-CC)

Apart from it, such coordination mechanism also exists in the local level (e.g. women's committees, child club's committees, youth's committees, etc.) to achieve the sanitation target set locally. Importantly, the Water Users and Sanitation Committees (WUSCs) and their federation, Forest Users Groups (FUGs), Tole Lane Organizations, Community Based Organizations (CBOs), schools, student's clubs, women groups, local clubs, micro finance institutions, Female Community Health Volunteers and religious leaders are playing instrumental role for sanitation and hygiene promotion in collaboration with local bodies (i.e. DDC, Municipality and VDC). The Master Plan has thus created an enabling environment and streamlined all sector stakeholders to work in a collaborative manner. 1.3.2 Legal Instruments

The Constitution of Nepal 2015 has included people's right to safe water and sanitation as the fundamental right under the health right. The Water Resource Act 1992 and Regulation 1993 have made WUSCs accountable towards water and sanitation service delivery. The Local Self Governance Act 1999 has provided the legal basis for the devolution of authorities to local bodies to lead local development process in a decentralized manner including water supply and sanitation sector activities. Similarly, Water Supply Service Operational Procedures 2014 has focused on quality of water, sanitation and service delivery of the water utilities. The Implementation Directives of the National Drinking Water Quality Standards 2005 has set the parameters of the water quality standard and maintenance of proper sanitation in the water supply systems.

1.4 COVERAGE DEFINITION Toilet is a key indicator to measure coverage of sanitation. The Master Plan has recommended for promoting permanent structure of the toilet (pour flush toilets or dry ecological toilets) at least up to the plinth level. As stated in the Master Plan, the government and the WASH sector stakeholders have considered ODF as the

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bottom line of all sanitation interventions through attainment of universal (100 %) coverage and use of toilets by all households, school, institutions and public places.

1.5 COVERAGE (HYGIENE BEHAVIOR)

Sanitation has been commonly understood in terms of usage of toilet and excreta management from the point of defecation to its disposal, treatment or re-use. And hygiene is known as the practice of keeping oneself and one's surroundings clean, especially in order to prevent illness or the spread of diseases. The total sanitation focuses on sustainability of ODF and hygiene behaviors as well as solid waste and wastewater management aspects. Hand washing with soap at critical times and use of safe water are the important indicators widely accepted to measure the hygiene behavior. The Master Plan and Total Sanitation Guidelines 2015 have clearly recognized these indicators as the vital components of ODF and total sanitation interventions. The issue of menstrual hygiene management has occupied prime focus for promoting health, safeguarding dignity and sustaining total sanitation.

There are very few national level research findings on hygiene behaviours, especially hand washing with soap and its implications on public health. The data from Joint Monitoring Program of WHO and UNICEF 2015 shows that only 46% have access to hand-washing facilities. According to the Multiple Indicator Cluster Survey (MICS) 2014, only 14 percent of households with unimproved water used a treatment method, water tested in 82.2 % of households had high E. coli, and only half households safely disposed off the stools of children under two.

1.6 POLICIES AND STRATEGIES The National Sanitation Policy and Guidelines for Planning and Implementation of Sanitation Programs 1994, the first sanitation policy, has focused on software and hardware aspects of sanitation and hygiene. Enforced in 1998, the National Water Supply Sector Policy has introduced the principles of decentralization, empowerment of WUSCs and sanitation as an integral component of the water supply projects. The Rural Water Supply and Sanitation National Policy, Strategy and Sectoral Strategic Action Plan 2004 have mandated to allocate 20% budget of the water supply and sanitation sector for sanitation promotion activities. It has explicitly spelt out the key roles and responsibility of WUSCs, NGOs, schools and CBOs at operational level. The Urban Water Supply and Sanitation Policy 2009 has also addressed the need of water supply and sanitation in urban areas and stated need of cost recovery principles and Public Private Partnership approaches with provision of Output Based Aid (OBA) targeting ultra poor people. Nepal Health Sector Strategy (NHSS) III (2016-20) has incorporated progress indicators like households with specific place for hand washing, population using an improved drinking water source and health facilities segregating and disposing health care waste. Similarly, School Sector Reform Plan 2009-15 has envisioned minimum enabling conditions in all schools. The National Framework of Child Friendly School 2010 has set minimum and expected standards including separate toilets for girls and boys and one toilet for every 50 students. The government enforced the Master Plan to unify stakeholders' efforts, fulfill resource gap in the sector, harmonize working procedures and run sustainable ODF and total sanitation campaigns through local body's leadership, multi-stakeholders' collaboration/partnership and communities’ ownership adopting the following guiding principles (Box 1).

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Box 1 : Guiding Principles of the Sanitation and Hygiene Master Plan ODF should be the bottom line of all sanitation interventions. Ensure universal access to sanitation in the water supply and sanitation project areas. Communities should have informed technological choices for household toilets. Local bodies should lead all sanitation sector activities. VDC and municipality should be the minimum basic unit of all sanitation program intervention. Locally managed financial support mechanism should be promoted. Mandatory provisions of sanitation facilities in all institutions. Mandatory provision of toilet in new built up buildings. Focus should be laid on hand washing with soap and hygiene behavior promotion.

The guiding principles have helped to maintain the uniformity and standard of the sanitation and hygiene activities conducted by the sector actors such as government, local bodies, DPs, I/NGOs, NGOs and CBOs.

Nepal Millennium Development Goal Acceleration Framework (MAF) 2012 has identified key sector bottlenecks and their remedial measures. It has outlined that government makes public announcements to 'prohibit open defecation' and promote 'no toilet no school' initiative. The Vision Paper on Clean City Program 2013 aims to promote ODF and ensure environmental sanitation in the city areas. The Environment Friendly Local Governance (EFLG) Framework 2013 has focused on toilet promotion, ODF declaration and environmental protection.

The Guidelines for Mainstreaming Gender Equality and Social Inclusion (GESI) 2013 provides guidance on integrating GESI in all aspects of policies, institutions and in its project/program implementation in the WASH sector programs. Newly drafted Total Sanitation Guidelines 2015 has aimed to achieve sustainability of institutions, facilities and behaviors for the envisaged health outcomes. The guideline has shed light on menstrual hygiene management and water quality to sustain ODF and ensure health outcomes. The draft WASH Sector Development Plan 2015 has set strategic outlook and direction for sector harmonization and Sector Wide Approach (SWAp). The country has realized the importance of coordinated policies and actions. Therefore, processes of formulating Umbrella WASH Act and WASH Sector Development Plan are almost in the final stage of endorsement.

With the announcement of new Sustainable Development Goal 6 is dedicated for WASH “Ensure availability and sustainable management of water and sanitation for all” and its inter-linkage with other goals like End Poverty, Quality Education, Healthy Lives, Gender Equality, etc will be duly considered for future sector policies, plans and programs.

1.7 MONITORING SYSTEM IN PLACE AND PARTNERSHIP

Multi-disciplinary and multi-sectoral perspectives are applied for promoting and monitoring sanitation and hygiene behaviors. The MoUD formulated a WASH sector monitoring and evaluation framework in 2009 with key sectoral indicators. The framework has proposed nine CREAM (Clear, Relevant, Economic, Adequate and Monitorable) indicators, which include: safe water, accessible water, adequate water, access to improved sanitation, equity, improved health, improved work/economy and sustainability over time. Planning, Monitoring and Foreign Aid Division of the MoUD is responsible for facilitating and periodically updating progress and performance of the sector. A dedicated Monitoring and Evaluation unit under the same division is responsible for collecting and disseminating information on a regular basis. The SEIU is operational to align and harmonize

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sectoral efforts considering NPC's result based monitoring framework. National Management Information Project (NMIP) under DWSS provides data feedback for sector planning and monitoring.

For enhancing the monitoring and evaluation, the Master Plan focuses on: i) establishment of a monitoring and evaluation system with WASH-CCs at different level, ii) monitoring indicators compatible with WASH, health, education and local development sectors, iii) integration of data and information with the monitoring and evaluation unit at the MoUD, iv) development of input, process, output, outcome and impact level indicators, v) strengthening of documentation and reporting mechanism at DDC, municipality and VDC level, vi) mobilization of the monitoring team at VDC, Municipality, District, Regional and National levels and vii) declaration and validation of ODF and total sanitation. Similarly, the Total Sanitation Guidelines 2015 has fixed six indicators (use of toilet, hand washing with soap, personal hygiene, access to and use of safe water supply, use of safe food, clean and healthy households, schools and institutions and environmental sanitation) to promote and monitor total sanitation campaign. All Districts have developed strategic plans/plan of action on sanitation and operated systems to monitor, validate and certify ODF and total sanitation declaration process. The use of traffic light system is a key monitoring tool to assess the sector effectiveness in general and progress of SACOSAN commitments. In addition, joint monitoring by the NSHCC, National Sanitation Taskforce and R/D/M/V-WASH-CC and self monitoring by the schools and local communities have become pivotal to monitor performance, validate data, verify achievements, certify actions and declare ODF and total sanitation. Besides, MoFALD, Department of Education (DoE) and Department of Health Services and other concerned ministries and stakeholders have considered sanitation and hygiene as one of the key progress indicators in their development frameworks.

2. ACHIEVEMENTS

2.1 REFORM AND POLICY CHANGES Due to continuous and collaborative efforts by the government, DPs, civil society organizations and I/NGOs over years, the recently promulgated Constitution of Nepal 2015 has recognized access to safe water and sanitation as citizen's fundamental right. The periodic plans have focused on total sanitation. Issues of urban sanitation have become more prominent after establishment of the MoUD and implementation of the Clean City Program 2013. One of the key achievements is the sector harmonization through SSG, JSR, Master Plan, MAF and WASH Sector Development Plan. These notable sectoral achievements have been resulted due to policy frameworks and successive SACOSAN declarations. The major reform and policy changes are summarized in the Box-2:

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Box-2: Major Reform and Policy Changes A move from centralized planning, financing, implementation and monitoring to the

decentralized arrangements of sanitation programs. Formulation of a separate WASH Umbrella Act for providing a strong legal and regulatory basis

for the WASH sector activities. Introduction of a separate committed budget for sanitation and hygiene through government's

periodic plan. Introduction of new governance in the sector through a move from the individual project

enterprise to multi stakeholders' collaboration. Aligning for action and harmonization of sector activities leading to a single target, unified plan

and common result framework. Institutionalization of local level social norms and code of conducts to prohibit open defecation

practice. Adoption of universal coverage approach for sanitation and hygiene promotion through political

commitments, government's leadership, stakeholders' partnership, private sector's market ship and community's ownership.

Adoption of 'community triggering' and 'sector triggering' process for capacitating stakeholders, generating awareness on health and hygiene, building inter and intra-sectoral collaboration, fulfilling resource gaps and reducing dependency syndrome.

2.2 INVESTMENT MADE

Development of WASH is a priority program of the government. The government has regular water supply and sanitation programs nationwide. The funding for water and sanitation are mainly through three ministries MoUD, MOFALD and MoE. The government allocates the annual WASH sector budget through sector Ministries, Departments and local bodies. The DPs and I/NGOs channelize the sector budget through their implementing agencies in coordination with the MoF, Social Welfare Council and local bodies.

Apart from it, local level Micro-Finance Institutions, saving and cooperative groups and FUGs have invested considerable resources to accelerate ODF campaign. The private entrepreneurs are part of supply chain. On top of that, the huge resource is managed by communities themselves. The exchange of labor (locally known as parma) for household toilet construction also prevails in several communities in the country. This also occupies a good share of investment for sanitation and hygiene promotion.

Sector funding requirement has been analyzed based on the funding requirement for unreached, functionality and meeting need of municipalities in ten years. The budget trend of the government has been summarized in the Table-1. An annual funding of 170 Million USD for water supply including 60 Million USD for upgrading urban water supply is needed. Similarly, for sanitation annual funding of about 30 Million USD is required.

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Table-1: Budget Allocation and Utilization Trend for Water and Sanitation Sector ( in Million USD) Year→

Budget Type

↓

03-04 04-05 05-06 06-07 07-08 08-09 09-10 10-11 11-12 12-13 13-14 14-15

Government 11 12 17 21 29 36 43 48 48 52 67 79

Foreign 23 24 34 41 24 43 48 45 42 40 63 74

Total Budget 34 36 51 62 53 79 91 93 90 92 130 153

Used % 75 55 53 66 88 89 71 66 68 76 81 N/A

Source : Joint Sector Review II Report, 2015

It is assumed that the budget of about 10 million USD might have been spent in the water and sanitation sector as off-budget funding. The average expenditure of the allocated budget for last three year is about 75%. Similarly, off-budget sources of NGOs are also not taken in to account.

The government budget for fiscal year 2014-15 is about USD 153 Million including USD 53 Million (40%) for the Kathmandu valley. The government has a policy to fund part of the water supply and sanitation cost through community contribution. For water supply there is no direct contribution for Kathmandu valley and large towns, but there is 30% in small-towns and 20% in the rural water supply projects. Similarly for sanitation infrastructure, there is no contribution sought in the Kathmandu valley and large towns with an exception of 15% in small towns and 20 % in the rural sanitation. Construction of household toilets is the major responsibility of the people, but some minimum supports are provided for the ultra-poor and people themselves in difficulties through local bodies based on community decisions.

Based on the trend of last three years, the budget of water sanitation sector is about 2.5% of the total national budget. Similarly, the budget of health is 5% and that of education is 15% of the national budget, respectively. The total current budget on water and sanitation is about NRs. 150 million USD and the trend of expenditure based on last three years’ data is 75%. It is encouraging to mention that Department of Education has initiated process for investing on school toilet construction with specific focus on girl toilets from FY 2010/11 and the investment up to FY 2015/16 is USD 41.65 million. The government has taken step to formulate the WASH Sector Financing Strategy and doing preparatory actions for the Sector Wide Approach. These important steps will clearly figure out the disaggregated data on sector financing categorically on water and sanitation, rural and urban and hardware and software.

The scenario of the sector financing changed significantly after the destructive earthquake of April 2015. The Post Disaster Need Assessment (PDNA) report produced by NPC shows that out of a total 11,288 water supply systems in the 14 severely affected districts, 1,570 sustained major damages and 3,663 were partially damaged and that approximately 220,000 toilets were partially or totally destroyed. The net total value of damages and change in economic flows to the water and sanitation sector is estimated at USD 114 million at pre-disaster prices, of which USD 105 million pertains to infrastructure and physical assets. The total needs for recovery and reconstruction using the principles of Building Back Better (BBB) and Disaster Risk Reduction is estimated as USD 181 million, of which 25% is needed for upcoming fiscal year 2015-16, 40% for fiscal year 2016-17 and 35% for fiscal year 2017-18. Hence, the WASH sector requires an aggressive collaboration for financing and rapid actions to recover the WASH coverage and bring back the situation in normal condition as well as to meet the universal coverage by 2017.

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2.3 GOOD EXAMPLES Nepal has become a fertile land for several sectoral innovations. These innovations have enriched the sanitation sector activities nurtured amid enabling policy environment. Emergence of sanitation in the form of social movement is one of the key achievements. There are many sectoral innovations at strategic, operational, capacity development, technology and outcome levels. These innovations have cultivated the collaborative culture among stakeholders and contributed to narrow down the resource gaps. Some of these innovations, good examples and learning are as follows:

Sector Alignment:

Sector Convergence and Harmonization: SSG meetings, JSR process, Master Plan, MAF, WASH Sector Development Plan and other sector assessments have converged the WASH sector activities, enhanced collaborative planning, harmonized actions, minimized resource overlap and maximized outputs. The rapid pace of the nationwide ODF declaration is a clear manifestation of the sector convergence and harmonization.

Thematic Working Groups and Task Force in Action: Under JSR initiatives, eight different thematic groups have been formed and engaged to work out vision, identify bottlenecks and recommend solutions: i) institutional framework and capacity building, ii) sector financing, iii) monitoring and evaluation, iv) functionality and sustainability, v) sanitation and hygiene, vi) water quality, vii) gender equity and social inclusion and viii) disaster risk reduction and climate change adaptation. Each theme comprises of the representatives from the government and DPs. This inclusive framework has worked well to solicit sectoral learning frame, evidence based planning and promote sector innovations. Similarly, the Task Force institutionalized at national, regional, district, municipality and VDC levels have provided technical inputs to respective coordination mechanisms for planning, programming, implementation, monitoring and follow up.

Uniformity and Standard in Program Process: Compliance to the guiding principles of the Master

Plan and code of conduct and social norms delineated by WASH-CCs in the local level strategic plan/plan of action have significantly contributed to maintain uniformity and standard in program process, financing modality, technological choice, monitoring and outcomes of all ODF and total sanitation interventions. The strategic plan/plan of action formulated by D/M/V-WASH-CC has unified stakeholders' efforts and resources for achieving a common target of sanitation and hygiene. Inspired by its impacts, the practice of integrated water resource management (IWRM) and WASH plan are being replicated.

Capacity Enhancement and Knowledge Management:

Training Need Assessment: National Water Supply and Sanitation Training Center (NWSSTC) of the DWSS has undertaken the Training Need Assessment (TNA) of the WASH sector in collaboration with DPs and stakeholders based on evidence and market research. The TNA has identified some key shortcomings on the front of WASH sector capacity development: incompatibility in contents of the similar trainings, non-compliance with policy provisions, lack of standard in contents and methodology, more focus on theoretical and conceptual aspects and low consideration of behavioral change, livelihood and skill development, lack of modifications of concept and contents of trainings and poor consideration of interdisciplinary expertise. The finding of the assessment has become a cornerstone to promote systematic capacity development in the sector through NWSSTC and DPs.

Application of Sector Triggering: Unlike the narrowly held traditional triggering approach, the sector triggering innovated in Nepal has triggered the different development sector actors to work collectively with full responsibility and accountability for national sanitation movement. Sector triggering gives due focus on broad based alliance, wider sectoral linkages, comprehensive planning, effective community

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mobilization, massive resource pooling arrangements and wider political mobilization for the scaling up of sanitation in an accelerated manner. The rapid increase in ODF coverage in the country is due to wider application of the sector triggering approach.

Sanitation Conferences: Innovated in Achham District in 2013, the sanitation conference is being scaled up across the country. It has significantly accelerated ODF process. The district conference on sanitation has proved to be instrumental to promote mutual trust and consensus among stakeholders, strengthen collective sentiment, trigger mass actions, accumulate their energy and resources, share learning, cross-fertilize ideas, promote innovations, enhance accountability, synergize efforts, identify sectoral bottlenecks and recommend practical action steps to achieve ODF situation in unified ways. The sanitation conferences held in center, region, district, municipality and VDC levels have declared firm commitments with resolutions and hence created a very powerful environment so that the non-ODF districts have preponded the district's ODF declaration date to 2016--one year ahead of their initial plan.

Joint Learning Visit: Stakeholders' joint learning visits held as part of the JSR, national sanitation

week campaign and ODF monitoring and validation have strengthened collaborative culture, learning alliance and evidence based joint planning for the sector effectiveness.

WASH Expo: The WASH sector stakeholders in Nepal organized the historical WASH Expo at National Water Supply and Sanitation Training Center of the DWSS on the occasion of the World Water Day 2015. The WASH Expo was attended by more than 1500 persons comprising of policy makers, planners, politicians, senior government officers, representatives of DPs, UN Agencies and I/NGOs, NGOs, members of WUSCs and their federation, sector professionals, researchers, academia, business houses, media, students and general communities. On the occasion, different WASH technologies, research documents, awareness raising materials, project based learning and sector innovations were displayed and shared. The WASH Expo has cultivated the collaborative culture among concerned sector stakeholder for achieving better sector outcomes through learning, network building, innovations and scaling up best practices. Importantly, the exchange of knowledge and skills reinforced by the WASH Expo remained crucial to open further avenues for joint collaboration.

Campaign and Sanitation Movement:

Total Sanitation Campaign: Nepal has framed a clear outlook and committed mission for total sanitation. Total sanitation has begun with attainment of ODF situation and encompasses hand washing with soap, personal hygiene, proper use of toilet, safe water and food, cleanliness of households, schools and institutions and environmental sanitation. For total sanitation, adoption of and access to safe water is one of the prerequisites. The total sanitation campaign has stimulated communities to self-regulate collective community actions for healthy living.

Clean and Healthy House and School: Under total sanitation campaigns, the innovative and popular concept of clean and healthy house and school are being introduced in Nepal. This concept is promoted as a continuous process of sanitation and hygiene promotion and established as the integral part of total sanitation and CLEAN NEPAL recognized by the Declaration of National Workshop on Post-ODF Campaign 2014.

Increasing Political Commitments: Nepal's sanitation sector has sought strong political commitments

for increasing government's budgetary inputs and mobilizing extended political networks. Such political commitments are demonstrated through sanitation resolutions and declarations and political leaders' proactive involvement in ODF declaration ceremonies. For example, the presence of the president, vice-president, prime minister, speaker of the parliament, ministers, law makers and senior political leaders in the ODF declaration ceremonies has reinforced community's ownership and creative engagement.

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Special Sanitation Mission: The dismal sanitation and hygiene condition in the Terai districts has drawn adequate attention of the government and stakeholders. The government has a strong realization that achieving national goal of sanitation within the given timeframe of 2017 is almost impossible given the existing slow pace and progress in the Terai region where country's nearly half of population resides. So, the NSHCC has launched the special sanitation mission targeting the low sanitation coverage Terai districts. This initiative has proactively engaged law makers, political leaders and general communities for ODF process. Based on learning from Terai, the government is replicating its learning to other districts where pace of sanitation is slow.

Bagmati Cleaning Campaign: The holy Bagmati River is admired as the life line of people, basis of

human civilization, emblem of religious faith and identity of the Nepalese. Now it has lost her beauty and life and turned into a figureless and lifeless condition due to poor compliance of the regulatory frameworks and insufficient infrastructures. Considering this horrible situation, the senior government officials and sanitation campaigners have launched Bagmati Safai Maha Abhiyan (Bagmati Cleaning Mega Campaign) with great vigor. This mega triggering tools of sanitation promotion has largely vibrated the entire nation for maintaining cleanliness of the Bagmati River and other River systems too.

Sanitation Fairs and Festivals: Socio-cultural avenues like sanitation fairs and festivals have been proven effective for wider advocacy and awareness. For example, launching of the sanitation fairs, festivals and mass gatherings in Tanahun (Bandipur), Chitwan, Kaski and other Districts in the country have strongly sensitized the community people to end open defecation practices and live with dignity, identity and pride. Further, speech of religious leaders on sanitation, duet songs, street drama, dance and audio visual materials demonstrated during the ODF and total sanitation declaration ceremonies have profoundly drawn public concern in matter of sustainable sanitation and hygiene.

Reward and Recognition: Reward and recognition have stimulated sanitation social movement.

Publication of success stories, letter of appreciation, exposure visit, praise, cash award and public recognition of toilet promoter are some commonly held practices. Prize could be provided to ‘sanitation champions’, ‘households’, 'institutions' and 'communities' who have made outstanding contributions to sanitation promotion. Likewise, other development support could be offered as incentives to schools, communities and VDCs which achieve ODF status on their own. Recognition to Local Development Officer as the 'sanitation ambassador' and declaration of an actress as a 'sanitation brand ambassador' are good initiations. Similarly, the government has declared two famous national actors as 'sanitation ambassador' in order to raise the profile of sanitation and boost the campaign.

Religious Leaders in Sanitation Movement: The pressing issues of sanitation are highlighted by

religious leaders. The religious leaders trigger and persuade the people for ending open defecation practices. The locally held cultural ceremonies have become useful in promoting sanitation behaviors in joyful ways so that religious minded people are united for sanitation campaigns. For example, proactive engagement of the local priest (of the Hindu community) and Maulana (of the Muslim community) in Chitwan and Sunsari districts respectively had largely contributed to achieve ODF status. The creative engagement of such leaders of other religions has been becoming popular successively.

Use of Sanitation Cards and Local Level Norms: Nepal's ODF movement has gained considerable strengths through the enforcement of local level norms and code of conducts. Declaration of open defecation as a social crime and penalty to polluters are some examples. Local bodies, WASH-CCs and communities have initiated to issue sanitation card as a basis to monitor the sanitation facilities in households and receive public services. Also, local level FUGs have made announcement to ban forest products to those households which lack use of toilet in their households. However, the FUGs provide wood to the pro-poor households to assists them for toilet construction. Such supports have become effective especially in Dang, Nawalparasi and Chitwan Districts.

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Total Behavioral Change: Total Behavioral Change (TBC) approach has occupied considerable space to reinforce the sustainable behavioral changes. TBC is achieved through triggering, rigorous monitoring, facilitation and follow-up. For this, a community fund is established for stimulating and sustaining the ODF status and hygiene behaviors with community's ownership.

Sanitation Café: Sanitation café is an interactive workshop that aims to strengthen the supply chain and

meet the demand for sustainable sanitation and hygiene. This initiation has been held in Mahottari and Sarlahi districts to systematically share the findings of the consumer preference and supply chain analysis as a basis for formulating district-specific pragmatic and result oriented strategic actions to stimulate ODF process.

Cross-sectoral Linkages:

Sanitation and Hygiene as the National Agenda: Sanitation and hygiene has occupied central focus particularly in education, health, local development, environment, women and children development sectors. Good investment in school WASH program,, integration of sanitation and hygiene components in health sector plans, integrating hygiene promotion in ongoing health campaigns like routine immunization, mainstreaming of sanitation and hygiene issues in local development governance through EFLG framework; consideration of ECGDA friendly facilities in households, schools, health facilities, institutions and public places. WASH sector's IEC and BCC materials with consideration of cross-sectoral issues clearly shows that sanitation and hygiene have become the common agenda of different sectors for promoting health, dignity and development.

Sanitation as Development Ladder: The sanitation sector in the country is uniquely characterized. The scope of sanitation is expanding gradually covering health, education, environment, livelihood and development aspects. Along with the ODF declaration, the declaration of ‘smoke free houses', ‘alcohol free communities’ and ‘plastic bags free villages’ are becoming popular. The total sanitation campaign has stimulated to achieve 'total immunization village', 'total enrolment households' and 'total literate communities'. Thus, the sanitation campaign has become the first step of the development ladder. This is an innovative and exclusive functional model of the governance as well.

Children as the Change Agent: Promoted through the School Sanitation and Hygiene Education

(SSHE) and School Led Total Sanitation (SLTS) programs, children have worked as change agent and model figure to demonstrate good hygiene behaviors. The children have effectively persuaded their parents to defecate in toilet, wash hands with soap, drink safe water and promote other hygiene behaviors. The mass hand washing with soap held by the students during the Global Hand Washing Day has magnified the importance of hand washing amid wider target audiences. The SSHE and SLTS programs have largely empowered children as change agent for ODF and total sanitation campaigns too.

Sanitation and Education: Department of Education is engaged in promoting sanitation in schools with environment, child, gender and person with disability friendly sanitation facilities emphasizing on girl friendly toilets for addressing needs of menstrual hygiene management. It has also initiated process for preparing WASH in School Guideline for streamlining sanitation promotion endeavors with WASH sector initiatives.

Sanitation Marketing: The sanitation marketing approach is becoming popular for fulfilling the supply

generated by a number of triggering and advocacy campaigns. This approach engages local entrepreneurs in producing and supplying sanitation materials like concrete rings and pans and consumers are triggered to purchase the affordable materials on 'one stop shop'. This has helped mainstream private entrepreneurs and fulfill resource gap in sanitation.

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Sanitation-Nutrition Linkages: The Multi Sectoral Nutrition Plan 2012 includes sanitation and hygiene as integral measures to reduce widespread malnutrition among children. This program, known as 1000 Golden Days, is being launched in the country. Suaahara (good nutrition) initiative which aims to improve nutritional status among children under two and their mothers and promote sanitation, hygiene and ODF. An integrated initiative like Knowledge Based Sustainable Agriculture and Nutrition is implemented to improve food security and income through integrated agriculture, nutrition and sanitation activities.

Sanitation and Livelihood: Application of ecological toilet, use of urine as fertilizer, promotion of

organic farming, reuse of waste and promotion of organic and ecological village are some of the good initiatives towards resource recovery, income generation, livelihood promotion and sustainable sanitation promotion.

Jeevika and Jagaran Initiatives: Two innovative initiatives such as Jeevika and Jagaran Karyakrams

are applied in water supply and sanitation projects. The Jeevika Karyakram which is known as livelihood program strengthens Women Technical Support Services and focuses on economic empowerment of women groups members to help ensure economic sustainability. The Jagaran Karyakram, a social accountability promotion based program, has a mechanism in which stakeholders, community institutions, support organizations and project facilitator follow a downward accountability approach to measure the performance of service providers.

Technological Options:

Decentralized Waste Collection: Particularly in Kathmandu valley and other metropolitan cities, the practice of household level waste collection is becoming an effective and financially viable approach. For this, each household pay certain charge to the service providers on monthly basis for their service. The waste thus collected is later integrated with the municipal waste collection, management and disposal systems. This has largely helped re-use and recycle fraction of waste and maintain the cleanliness in the core and outskirts of the urban areas.

Health Care Waste Management in Health Facilities: Discussion on management of health care waste commenced since 1997. WHO and several agencies have supported the Ministry of Health and Population and also individual hospital in surveys, training and technology support. So far, few hospitals (e.g. Bir Hospital, Civil Service Hospital and Gangalal Hospital) have already set model Health Care Waste Management (HCWM) in Health Facilities system and further more hospitals are in line to replicate the same. The National Health Care Waste Management Guidelines has been developed with updated information for the safe treatment of HCWM. Similarly, Nepal Health Sector Strategy (2016-20) has recently incorporated indicators on health facilities managing health care wastes.

Monitoring:

Quality Monitoring: For the quality output of the ODF campaigns, Arghakhanchi district has introduced Quality Monitoring as per D-WASH-CC decision. For this, the D-WASH-CC has developed a comprehensive guideline which has clearly stated multi-tire monitoring of institutions, facilities and behaviors by district, Municipality, VDC, school's catchments level WASH-CCs and Journalist WASH-CC. This monitoring arrangement considers the holistic aspects of ODF and total sanitation process like quality of facilities, good hygiene behaviors, proper operation and maintenance, pro-activeness of WASH-CCs, local level financing, stakeholders' willingness for sustainability and policy compliance as outlined by the Master Plan.

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2.4 SOCIAL ADVANCEMENT It is obvious that Nepal's sanitation campaign has brought about a wide range of stakeholders in a common platform, reinforced community unity, fostered harmony among several actors, opened the door of further development opportunities and enhanced inclusive and participatory governance in sanitation and hygiene development process. Since sanitation has appeared as a development ladders, it has been cultivating 'sanitation civilization' and transforming the society towards healthy and productive condition and eventually enhancing people's quality of life.

Consideration of GESI aspects in policy, institutions, plan and technology; participatory planning at local level, use of socio-cultural forums and avenues and popularization of issues of dignity are some of the social factors that have come up with far reaching consequences in unifying the sanitation sector actors and activities.

Leadership development and empowerment of women, youth and child clubs, promotion of group dynamics through WASH-CCs and improvement in public health and productivity are some of the tangible results on the front of the social advancement. The improvement of school's learning environment could be attributed to good sanitation and hygiene condition. It has been found that there is significant reduction in students' dropout rate, especially of girls, through school WASH interventions. Similarly, reduction in sanitation related drudgery and deaths has helped reduce the heavy socio-economic burdens. As a consequence, the government has recognized investment in sanitation as the wise investment.

3. GAPS AND CHALLENGES

3.1 COVERAGE Access to toilets is the commonly used indicator to measure sanitation coverage in Nepal. Until 1980, access to latrines was limited to only about 2 %. The overall sanitation coverage increased substantially from 1990 onwards. The data released by the National Management Information Project (NMIP)/DWSS in 2014 shows

Figure-1: Trend of Toilet Coverage

Source: CBS 2001, NLSS 2003/2004, Mishra 2007, Tenth Plan, NMIP/DWSS 2010 and 2014 and CBS 2011

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70.28% toilet coverage (Figure-1). So far the country has achieved the MDG target of 73% of water supply and 53% of sanitation. The data published by the Central Bureau of Statistics (CBS) in 2011 shows that there was a prominent gap in different poverty quintiles (poorest quintile: 4%, second poorest: 11%, third quintile: 29% and fourth quintile: 57%) and disparity in ecological zones (Hills: 87.14%, Mountains: 74.48.0% and Low land (Terai): 56.94%).

Likewise 30% of urban households have toilets connected to sewer systems while 48% had toilets connected to septic tanks. Many of the septic tanks are not designed properly, and there are no proper systems yet for treating the fecal sludge from septic tanks. Similarly, access to sanitation among the richest quintile was about 80 %, while among the poorest quintile it is only 10%. And access to improved sanitary facilities has increased over time, but 94% among the wealthiest use improved facilities while only 3% of the poorest do so. The latest data collected by the Water Supply and Sanitation Division/Sub-Division of the DWSS shows that sanitation coverage has already reached about 81% while water supply coverage is about 85% by the end of July 2015.

Country’s sanitation coverage has increased notably within the period of five years (2011-2015) after the enforcement of the Master Plan and massive expansion of ODF campaign in the form a social movement. The data produced by the Environmental Sanitation Section (ESS) of the DWSS (secretariat of the NSHCC) shows that 1 zone, 27 districts, 81 municipalities and 2032 VDCs have been declared as ODF zone with increasing trend of ODF declaration of the last 5 years as illustrated in Table-3.

Table-2: Trend of ODF Coverage Year VDC (Total: 3157) Municipality (Total: 217) District (Total: 75) Zone (Total: 14)

2011 234 4 1

2012 468 6 2

2013 995 10 8

2014 1516 17 15 1

2015 2032 81 27 1

Sources: NSHCC Secretariat, November, 2015 Nepal's ODF declaration and expansion of sanitation coverage is happening in highly encouraging trends. The following factors (Box-3) have refueled for the success of Nepal's sanitation social movement: Box-3: Factors Contributing to the Success of Nepal's Sanitation Social Movement

Effective implementation of policy through enforcement of guiding principles and unified planning Adoption of ‘sanitation for all and all for sanitation’ strategy for universal and inclusive sanitation

coverage. Reinforcement of collaborative efforts of policy makers, politicians, professionals and people. Enhancement of collaboration among inter and intra-sectoral stakeholders for fulfilling resource gaps

and synergizing actions. Enforcement of sanitation declarations to synergize collaborative efforts and adopt local social norms

to discourage open defecation. Optimal mobilization of local resources and reduction on external dependency for household toilet

construction and paying due care to ultra-poor people in the meantime. Promotion of healthy competition among stakeholders for achieving ODF status in line with national

target. Application of teaching, triggering, advocacy, reward and recognition and other motivational tools to

trigger feelings of self realization, identity, pride and dignity. Training needs assessment of WASH sector and conduction of systematic capacity development

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3.2 TECHNOLOGY The WASH sector policies, Master Plan and guidelines have given special thrust for promoting Environment Friendly, Child Friendly, Gender Sensitive, Disabled Friendly and Aged People Friendly (ECGDA Friendly) sanitation facilities in households, schools and institutions. There is massive construction of toilet through ODF campaign. However, stakeholders' concern towards ground water pollution through on-site sanitation options has been more pronounced these days especially in Terai districts. The availability of ECGDA toilets is another critical dimension.

Nepal is a vulnerable zone from climate change and disasters perspectives. So, the technology should be climate change and disaster resilient. For example, toilets requiring 'low water' and 'no water' need to be promoted in water scarcity zones and other areas that are severely affected by the climate change.

Raised toilets, mobile toilets, movable toilets and easy toilets are some of the options that are used for disaster prone and densely populated areas. Urine diverting ecological toilets and bio gas connected toilets are found feasible technologies for the country. Similarly, technology for menstrual hygiene management (e.g. incinerator, pad dispose bin, etc,) are introduced in schools, public offices and market places. Single and double pit pour flush toilets are common toilet options in Nepal.

For urban and semi-urban areas, the application of decentralized technologies like reed bed based treatment system and low cost sewer are promoted. However, the septic wastewater has been discharged directly to water bodies without prior treatment due to lack of sewerage treatment facilities in many places across the country. Drain to kitchen garden/or soak pit, garbage pit/compost pit, improved smokeless stoves and Chaang (utensil drying racks) are also important technologies promoted at local level. From total sanitation perspective, it is a high time for Nepal to ensure ECGDA friendly WASH facilities in households as well as public places (schools, institutions, health facilities, high ways, market hubs, religious shrines, hotel and restaurants) so that the public health outcomes of the WASH sector interventions will be sustained optimally. For this, the application of the local knowledge of WASH-CCs and their leadership is instrumental. In nut shell, the following issues need to be well accounted for sustainable use, operation and maintenance of WASH facilities:

Upgrade and scale up of facilities in line with the norms and standard of total sanitation. Maintain functionality and sustainability of structures through provision of operation and maintenance

fund and mechanism. Undertake research and development activities to promote standard technological option considering

different users, geographical situation and rural-urban contexts. Engaging private investors to address growing funding gaps especially for high cost technologies for

urban areas with consideration of cost effective and locally appropriate fecal sludge management. Promote and scale up disaster and climate change resilient technologies especially to prevent

communities inclined back to open defecation. Introduce site specific uniform technological standards for households, schools and institutions.

3.3 HEALTH AND NUTRITION The WASH sector policy documents mention that improvement of health and productivity is the ultimate goal of the sector. For this, bringing behavioral change of individual is a key step. However, there is inadequate research and development on impact of sanitation and hygiene on nutrition, health, education, productivity, tourism and national productivity.

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It has been found that the fatal diarrheal outbreaks that occurred in the districts from the Mid Western Development Region of Nepal in 2009 and Eastern Development Region in 2014 are caused by open defecation practices and poor personal hygiene and food hygiene behaviors.

The data shows that there is gradual reduction of child mortality and morbidity in national and local contexts along with expansion of awareness campaigns on sanitation and hygiene. For example, Gela VDC of Kalikot district which has systematically scaled up sanitation promotion from last quarter of 2010 and was been able to declare ODF in May 2011, has been able to reduce 32% of diarrheal morbidity till it arrived in 2012/13. Similarly, the statistics of Kalikot, Bhaktapur, Rukum and Jajarkot districts (out of 27 ODF declared district in the country) has been able to significantly decrease the diarrheal morbidity (more than 25%) in under five children than other ODF declared districts.

WHO estimates that improved water supply reduces diarrhoeal morbidity by 21 %, while improving sanitation by 37.5 %. An estimated 14 million Nepalese (around 37% of the population) wash their hands with water after defecation. Of these, only about 12% (3.4 million) wash with soap (Equity in Health Report, MOHP, 2006 as quoted from WAN 2011). The Nepal Demographic and Health Survey 2011 shows a significant reduction both (under 5 and under 1) mortality from 235 per thousand in 1990 to 56 in 2011 which indicates correlation between sanitation and health. It shows that 14 % of Nepalese children under five suffered from diarrhoea. Prevalence of diarrhoea was the highest (24 %) among children 6–23 months old. The report of the Department of Health Services (2010/11) shows strong linkage between ODF campaign and WASH-related diseases for the past two or three years. For example, the Out-Patient Department visits in the first ODF-declared Kaski district are 8.82 %, whereas the trend in Saptari, the lowest sanitation coverage district, is as high as 22.62 %. Nepal’s high rates of chronic and acute malnutrition among children are of significant concern, with 41% of children stunted, 11 % wasted, and 29 % underweight (NDHS 2011). Nepal’s large reduction in stunting of more than 2% points per year is lauded in the 2014 as per Global Nutrition Report. However, according to the Department of Health Service (DoHS) 2011, there has been no progress in reducing wasting or acute malnutrition; most alarming is that wasting is worst and very high in infants 9-11 months (25%), mainly due to poor complementary feeding practices and diarrhea.

In Nepal, linkage between sanitation and nutrition, introduction of Water Safety Plan (WSP) and subsequent improvement in water quality and promotion of hand washing with soap are key factors that have very positive role to curb diarrhea. It is worth mentioning that the cases of outbreaks of water-borne diseases found very insignificant even aftermath of devastating earthquake of July 2015. It might be one of the reasons that those districts were effectively penetrated by the ODF and massive mass media awareness campaigns. Importantly, the awareness level among the community people increased and health seeking behavior increased for diarrheal treatment.

3.4 EQUITY AND RIGHTS

The WASH sector policies have addressed the issues of Gender Equality and Social Inclusion (GESI). However, a large number of people residing in geographically remote areas, disadvantaged group, ultra poor and informal settlers in the cities, girl students, senior citizens and person with disabilities, people living with HIV/AIDS do not have easy and adequate access to sanitation services and facilities. During menstruation (called Chhaupadi) in the Far and Mid Western Development Region of Nepal, women are not allowed to use toilet and public water points. Most of the public toilets are not gender and disabled friendly. In addition, travelers, pedestrians, street vendors, street children, homeless people living on the road are also unreached due to the lack of and access to public toilets especially in urban centers.

Constitutional recognition to water and sanitation as citizen's fundamental right, enforcement of GESI operational guidelines by MoUD, adoption of universal coverage approach by the Master Plan, introduction of ‘one household one toilet’ policy by the government, stakeholders' meaningful and inclusive engagement in

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decision making processes through WASH-CCs, growing concern towards ECGDA friendly facilities, implementation of GESI Action Plan in the Small Towns Water Supply and Sanitation Sector Projects, focus on menstrual hygiene management in schools and institutions, women focused livelihood programs, conduction of local level campaign against Chhaupadi and special humanitarian support to disaster affected persons are some of the progressive move towards equity, inclusion and social development in the WASH sector in Nepal.

4. FUTURE PLANS

4.1 SANITATION BEYOND MDG Nepal has already achieved the Millennium Development Goal (MDG) in sanitation (53% by 2015) and moving towards achieving sanitation for all by 2017. The country has set a new outlook to achieve total sanitation by 2030 in line with Sustainable Development Goal (SDG) on WASH (safe drinking water, sanitation and hygiene, water quality, water efficiency, water resource management and water related ecosystems). The draft Sector Development Plan 2015 and Total Sanitation Guidelines 2015 have also envisaged improved service level of WASH facilities to all the Nepalese people by 2030. The sanitation sector in Nepal has envisioned the following post-MDG perspectives considering the dynamics and sustainability of the sector activities:

Institutionalize the sector governance through strengthening of the existing institutions and delineating their clear roles, responsibilities and accountabilities along with revision of the Master Plan.

Ensure equity with effective enforcement of GESI perspectives in planning, programming, financing and monitoring.

Upgrade and scale up quality and sustainability of facilities and services by maximizing private sector inputs and empowering WASH-CCs as well as WUSCs and their federation.

Adopt business model through Public Private Partnership approach in financing and service delivery. Systematize research and development (R&D) activities by engaging researchers, sector professionals

and research institutions. Produce quality human resources by undertaking periodic TNA, developing the WASH Sector Capacity

Development Master Plan and conducting competency based systematic capacity development. Intensify the stakeholders' efforts for fecal sludge management by means of increased advocacy,

research and development and institutional capacity development. Promote sanitation-based income generating and livelihood activities through scaling up of ecological

approach in sanitation and other locally appropriate productive enterprises. Promote disaster and climate change resilient institutions and technologies by establishing collaboration

with research institutions and strengthening the capacity of the sector actors.

4.2 SUSTAINABILITY The WASH sector has considered pro-activeness of institutions, functioning of facilities and continuation of behaviors as the core elements of sustainability. For this, compliance to sectoral policies and Master Plan, enforcement of community level norms, provision of ECGDA friendly technologies, mobilization of local resources, local capacity to sustain the facilities and behavior and functioning of institutions are key factors. On top of that, adoption of total sanitation approach has created a strong foundation for the sustainability of ODF and other hygiene behaviors. However, functionality of the water supply and sanitation facilities continue to appear as the pressing issue.

Out of the national gross water supply coverage of 83.59 % as reported by the NMIP/DWSS 2014, 25.4% piped water system are in well functioning stage, 36.1% belong to the needs of minor repair category, 9.2 % are in major repair status, 19.8 % need rehabilitation, 8.6 % need reconstruction and 0.9 % are in non functional

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condition. Likewise, amongst 70.28% of the households covered by a toilet in Nepal, 7.3 % have poorly managed toilets that were insanitary while 0.7 % was not in use. The study showed that the percentage of well-functioning water supply system increased by 7.5 % whereas the need of minor repair, major repair, rehabilitation, reconstruction and non-functional decreased by 2.8 %, 2.6%, 1.2%, 0.5 % and 0.7 % respectively as found during 2010-2012 due to sectoral efforts in overall improvement of functionality status in water supply systems. Similarly, the insanitary and unused figure of toilet was decreased by 4.4% and 1.1 % respectively in 2012. This situation thus calls for an urgent action for maintaining sustainability of the existing WASH facilities for better sector outcomes. SEIU initiated Benchmarking and Performance Assessment of Water Service Providers (WSPs) program in early 2013 and produced WSPs data book. The program aims to develop capacity for monitoring functionality and performance of WSP as an instrument for improving the service delivery and performance of the urban water supply sector.

Hence, the government and stakeholders have taken some of the key steps for maintaining the sustainability of the sector activities: a) ensured stakeholders participation and equity in local level planning, financing, technology selection, implementation and monitoring, b) formulated and applied total sanitation and public toilet management guidelines, c) conducted TNA of the WASH sector, d) conducted ODF sustainability study for evidence based planning, e) developed and used BCC guidelines and sanitation marketing strategies, f) introduced income generation and livelihood promotion activities, g) conducted learning visits for soliciting practical learning on approaches and technologies, f) framed an extensive disaster resilient training package for WASH-CCs and WUSCs and f) preparing guidelines on disaster and climate change friendly technologies.

4.3. OVERCOME THE BARRIER AND CHALLENGES The measures for mitigating the aforementioned perceived barriers and challenges in the WASH sector are presented in the Table-3.

Table-3: Sectoral Barriers and Challenges and Mitigation Measures

SN Barrier and Challenges Mitigation Measures 1. Socio-cultural dogma like Chhaupadi

and socially established norms for open defecation

-Use of sensitization and triggering materials and tools -Enforcement of local norms and code of conduct against harmful socio-cultural dogma and open defecation practice -Community persuasion by religious and political leaders

2. Very close time period of national target vis-à-vis current pace of sanitation promotion.

-Maximization of sector harmonization through SEIU -Launch of intensive sanitation mission -Maximum mobilization of local resources -Special backing to low sanitation coverage districts -Wider adoption of sector triggering approach -Launch of media advocacy -Adoption of sanitation marketing

3. Retaining ODF situation across highways.

-Implementation of Public Toilet Management Guidelines 2015 -D/M/V-WASH-CCs are promoting public toilets and enforcing local norms in coordination with petrol pump owners. -Local level NGOs, CBOs, clubs and hotel and restaurant owners are involved in launching awareness campaigns

4. Proper use, operation and maintenance of toilets in schools and institutions

-WASH facilities are being promoted in school through School Improvement Plan -MAF has set a norms: no toilet no school -DoE is formulating the WASH in school guidelines -Conducted research study on public toilet management -Total sanitation campaigns has covered WASH facilities in schools and institutions

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SN Barrier and Challenges Mitigation Measures -School child clubs are activated under SSHE and SLTS programs in coordination with M/V-WASH-CCs

5. Inadequate facilities for persons with disabilities at households and public places

-Master Plan and Total Sanitation Guidelines 2015 have adequately emphasized promotion of such facilities -There is strong advocacy on users friendly facilities at national, regional and global levels -Conducted research study on public toilet management and technology

6. Combating issues of Menstrual Hygiene Management

-Master Plan and Total Sanitation Guidelines 2015 have covered promotion of such facilities -There is strong advocacy and awareness raising activities at national, regional and global levels -Conducted research study on public toilet management

7. Complexity in attainment and management of ODF in urban areas

Total Sanitation Guideline, Clean City Program and WASH Sector Development Plan have spelt out strategies and promotional activities -Small Towns Water Supply and Sanitation Sector Projects and Urban Environment Improvement Project have created firm basis

8. Slow progress of sanitation in Terai region

-Conducted research on Terai sanitation -Launched special program package on sanitation in Terai -Conducted Terai conference on sanitation for wider advocacy, awareness and participation -Launched sanitation marketing activities -Regular backstopping of NSHCC and R-WASH-CC

9. Massive damage of toilets during flood, landslide, earthquake and similar disasters.

-Conducted PDNA by NPC -Capacity development of WASH-CCs -Endorsement of disaster focused WASH guidelines by NSHCC -Activation of WASH clusters and Thematic Working Groups -Increasing budgetary support by the government and DPs -Promotion of Build Back Better approach by the government

10. Inadequate disaster and climate change resilient capacity in local level.

-Conducted POWER-Training (Post Disaster WASH Reconstruction-Training) by targeting D-WASH-CC members from the earthquake affected districts -The secretariat of National WASH cluster has been regularly supporting districts and stakeholders -Capacity Gap Assessment is being undertaken -Central level monitoring team and Thematic Working Groups visiting to the earthquake and other disaster affected districts

11. Inadequacy of water -Improving the functionality of water supply system -Used rain water harvesting technology -Promoted dry toilets -Promoted tipi taps in schools -Climate change resilient technologies are being promoted -Focused on household and institutional level water recycling management practice -Conducted training on reduction of Non Revenue Water

4.4 UNIVERSAL COVERAGE AND IMPROVING THE SERVICE LEVEL Nepal has targeted to achieve universal coverage in basic water supply and sanitation by 2017. The concept of the coverage on sanitation got new outlook after the enforcement of the Master Plan which has institutionalized ODF as the bottom line of all sanitation and hygiene interventions. The ODF initiative is thus inclusive process that ensures collective community action. The current ODF campaign requires sanitation facilities not only to households but also to schools, health facilities, institutions and public places. Importantly, services rendered to disaster affected households have largely contributed to maintain equity and ODF sustainability. Total sanitation approach has further strengthened the quality of facilities and service delivery. Likewise, recognition of

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sanitation by EFLG framework, promotion of sanitation and hygiene through school curriculum, adoption of business model (e.g. sanitation marketing) with optimum private sector participation and linkage with monitoring framework of the health, local development and education sectors have helped improve sanitation governance as well as quality of facilities and services. It could be argued that inclusion of sanitation as one of the core indicators in the Minimum Condition and Performance Measure (MCPM) introduced by the MOFALD would significantly raise local body's added ownership and accountability to scale up sanitation and to strengthen decentralized governance for sanitation and hygiene promotion.

5. CONCLUSIONS

Over the time, the perception of sanitation has changed significantly in Nepal. Sanitation, historically treated as add on activity of drinking water supply project, has got a new identity in the domain of national development framework. It has been also recognized as the cross-cutting theme of developments. The traditional notion of sanitation has undergone a significant transformation from a mere toilet building enterprise to the attainment of ODF and total sanitation situation. Sanitation often defined as a means of public health has become the instrument to maintain human dignity and the entry point of other development as well. Due to the expansion of sanitation social movement triggered by the nationwide ODF initiatives, the sanitation coverage has raised significantly at national level. Therefore, Nepal is very likely to achieve the national target of sanitation for all by 2017 if the current efforts are continued along with establishment of new values innovations. However, disparity in sanitation coverage in terms of ecological and different social and economic categories stands as a big threat from equity and inclusion perspectives. Likewise, ODF slippage at some places has appeared as a prominent challenge due to lack of water supply facilities, locally appropriate infrastructures and willingness to change. The prevailing cultural dogmas have further challenged the sustainability of ODF. Community's easy acceptance of open defecation has lowered ODF process particularly in the Terai regions. Moreover, climate change and disasters have posed big threats to sustainability of overall sanitation interventions.

The challenges we faced in achieving access to sustainable WASH for all have amplified by the recent earthquakes. Early estimates of NPC suggest that an additional 3% of the population has been pushed into poverty as a result of the devastating earthquake. The earthquake has had differential impact on people, with those already in poverty.

The universal access to sanitation target can only be met with an annual progress rate of 13%. This also means stepping up ODF to comprehensively look at hygiene behaviors. Only 48% of people are reported to have proper hand washing facilities, but there is no adequate data to tell us how many use it properly. The PDNA 2015 estimates there is need of sustained sanitation for 1.04 million people in 14 districts, to provide toilet access to people who lost toilets due to the earthquake.

It is pertinent to adopt a holistic approach to improved sanitation and address challenges such as safe disposal of excreta without affecting the surrounding environment of water bodies. It cannot be looked at separately from sustained hygiene behaviors. There are still some cultural taboos on menstruation hampering proper hygiene.

Sanitation and water are two sides of a coin for integrated WASH programs. It’s incomplete to talk about sanitation without looking at access to water. 92% of the population in Nepal is reported to have access to improved water sources (JMP 2015). However, the recent data says that water coverage reached about 85%. The earthquake has now damaged several water points across the affected districts.

Around 1.14 million people in these districts are in need of water treatment and sustained water supply. There is need for targeted recovery and rehabilitation programs on water and sanitation. This not only impacts WASH

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targets but also affects health, education, livelihoods and women’s empowerment outcomes. Reducing time spent on collecting water and having safe sanitation are critical steps in the empowerment of women and girls. Improving access to water and sanitation is critical to increasing income of individuals and households living in poverty.

Strategies for water and sanitation should embed equity, integration, resilience and hygiene promotion. The government, the private sector and civil society has to continue to work towards sustainable management of shared water resources and total sanitation with a common interest in the long-term delivery of the Sustainable Development Goals.

This situation thus requires a new strategic outlook for evidence based planning supplemented by innovative policy frameworks, cross-sectoral partnership, capacity to stimulate change, adequate financing mechanism, ECGDA friendly technologies and robust monitoring arrangements. Hence, this country paper has included a two year country plan of action for the 6th SACOSAN (Table-4) to maximize the sectoral outcomes and overcome the challenges.

Table-4: Country Plan of Action for the 6th SACOSAN

S.N. Activities Time frame Key Responsibility 1. Conduct baseline study on total sanitation

indicators December 2016 NSHCC, ESS/DWSS and DPs

2. Completion of ODF sustainability study June 2016 NSHCC, ESS/DWSS and DPs 3. Develop training manual on Total Sanitation October 2016 NSHCC, ESS/DWSS and NWSSTC 4. Development of Urban Sanitation Plan June 2017 NSHCC, MoFALD, MoUD and DPs 5. Develop Nepal State of Sanitation and

Hygiene Report : sector innovations, technological options, sanitation social movement, behavioral building up and social norms

December 2017 NSHCC, ESS/DWSS and DPs

6. Develop Total Sanitation Strategic Plan for ODF declared areas

December 2017 WASH-CCs and DPs

7. Implementation of WASH in School Guideline December 2017 DoE, NSHCC, DWSS and DPs 8. Prepare and implement WASH specific

Disaster Preparedness and Response Plan December 2017 DDMC, NSHCC, WASH-CCs and DPs

9. Prepare Systematic Capacity Development Plan for strengthening WASH Sector

June 2017 NSHCC, DWSS/NWSSTC and DPs

10. Achieve sanitation for all by 2017 with special focus in low coverage zones emphasizing Terai and earthquake affected areas

December 2017 NSHCC, WASH-CCs, MoUD/DWSS, MoFALD/DoLIDAR and DPs

23

REFERENCES

Central Bureau of Statistics (CBS), National Population and Housing Census 2011 (National Report),

November, 2012 CBS and NPC Secretariat, Nepal Living Standard Survey (NLSS) 2003/2004 Department of Water Supply and Sewerage (DWSS) and UNICEF, Guidelines on School Sanitation and

Hygiene Education Guidelines 2000 DWSS and UNICEF, Guidelines on School Led Total Sanitation Guidelines 2006 Declaration of South Asian Conference on Sanitation (SACOSAN), 2003,2006, 2008, 2011 and 2013 Declarations of Joint Sector Review, 2011 and 2014 Bhojendra Aryal, Total Sanitation Program, Sarsafai Sandesh (sanitation newsletter), National

Sanitation and Hygiene Coordination Committee (NSHCC), 2014 Government of Nepal, Constitution of Nepal 2015 Government of Nepal, Sanitation and Hygiene Master Plan 2011 Kamal Adhikari, Sanitation in Nepal: Past, Present and Future, Kunti Bhoomi Memorial Trust, 2015 Ministry Housing and Physical Planning (MHPP), National Sanitation Policy and Guidelines for

Planning and Implementation of Sanitation Programs 1994 MHPP, National Water Supply Sector Policy, 1998 Ministry of Physical Planning and Works (MPPW), Rural Water Supply and Sanitation National Policy,

Strategy and Sectoral Strategic Action Plan 2004, MPPW, Urban Water Supply and Sanitation Policy 2009 Ministry of Urban Development (MoUD), Nepal Country Paper on Sanitation and Hygiene, 2013 MoUD, Guidelines for Mainstreaming Gender Equality and Social Inclusion, 2013 MoUD, Clean City Program, 2013 Ministry of Federal Government and Local Development, Environment Friendly Local Governance

Frameworks 2013 Ministry of Health and Population (MoHP), Health Sector Implementation Plan-II (2010–15) MoHP, Nepal Demographic and Health Survey, 2006 and 2011 National Planning Commission (NPC) and UNICEF, Multiple Indicator Cluster Survey, 2014 Nawal Kishor Mishra, Water Supply and Sanitation in Nepal, Technical Journal of Society of Public

health Engineers in Nepal, 2007 Ministry of health and Population, National Demographic and Health Survey 2011 National Management Information Project (NMIP)/DWSS, Nationwide Coverage and Functionality

Status of Water Supply and Sanitation in Nepal, 2011 NMIP/DWSS, Nationwide Coverage and Functionality Status of Water Supply and Sanitation in Nepal,

2014 NPC and UNDP, Millennium Development Goal Acceleration Framework 2012 NPC, Multi Sector Nutrition Plan for Accelerating the Reduction of Maternal and Child Under-nutrition

in Nepal (2013-2017), 2012 NSHCC, Total Sanitation Guidelines 2015 NSHCC Secretariat/DWSS, Database on ODF declared VDCs and Municipalities in Nepal, 2015 Sector Efficiency Improvement Unit (SEIU)/Ministry of Urban Development, WASH Sector Status

Report 2014 SEIU/MoUD, WASH Sector Development Plan, 2015 Water Aid in Nepal, Universal Access to Sanitation and Drinking Water for All by 2017, An Appeal to

People’s Representatives, Politicians, Policy-Makers and Government Officials, 2011 WHO and UNICEF, JMP Report, 2015