IDS in action: sharing and learning on CLTS and sustainability

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Life on the beach – the stunning location of the AfricaSan 4 Dakar conference, in a grand hotel perched on the Senegalese coast, was not enough to distract the participants of the IDS CLTS sharing and learning workshop from their task. As usual, the workshop was held the day before the main AfricaSan conference to profit from the gathering together of so many experienced WASH professionals. The event proved almost too popular – something like 90 participants turned up – making it quite challenging and time-consuming to capture and discuss the diverse views of the large group. One of the ice-breaking activities, in which participants had to position themselves in a global map in relation to Senegal, showed that the WASH practitioners and experts present had travelled from the USA, from Europe and from all over Africa, from South and South-East Asia, and even one person from Australia!

Sustainability was high on the agenda of most participants. Social, technical and institutional sustainability were discussed in detail, with Kamal Kar arguing strongly that institutional sustainability – ensuring that governments have policies, strategies, capacity and budgets that support CLTS and enable long-term sanitation improvement – was more critical than the other areas. In his words, without the government budget and support, the technical and social approaches will never be scaled up or sustained.

Many of the discussions at the sharing and learning event were on familiar issues, but a few issues stood out.

Is sanitation marketing effective in reaching the poor?
Despite recognition that sanitation marketing is a growing and important component of sanitation improvement, several participants asked whether sanitation marketing is effective in reaching the poor, and whether microfinance is relevant in poor African countries where even productive loans are difficult to sell. It was suggested that the products promoted by sanitation marketing remain unaffordable for many, and that genuinely poor households often struggle to take out toilet loans. One participant from Cambodia, the home of two of the most successful sanitation marketing projects in the world, went as far as to suggest that sanitation marketing producers “profit from the poor” by promoting expensive facilities, and convincing poor households to sacrifice other spending priorities in favour of toilet purchases.

There wasn’t enough time to discuss these issues in detail during the session, but I question whether these poor households are forced to purchase the toilets, however powerful and effective the demand creation activities. And I would hope that the toilets installed bring many benefits to the user household. Nonetheless, the point is pertinent – too many sanitation marketing interventions end up promoting products that are expensive for poor households – our target group, as this group usually includes those with the highest disease burden. Formative research and human centred design processes seem to lead to the production and promotion of aspirational products, often influenced by expectations raised by subsidized facilities provided by previous projects.

As far as I know, few genuinely affordable products have emerged from sanitation marketing efforts – products that cost less than USD 10, which poor African and Asian households might consider purchasing to upgrade or improve their simple toilets. This may explain why few sanitation marketing programs have gone to scale – I know of several well-designed programs that have sold fewer than 100-200 sanitation products after 3-4 years of expensive research and development.

The SaTo flapper pan developed by American Standard costs only USD 1.50 to manufacture (with local manufacture now being developed in Uganda and Nigeria), and offers the first glimpse of an affordable and desirable sanitation product, which might be attractive to national wholesalers and local suppliers. Until we see more of this sort of truly low-cost and innovative product, I question whether sanitation marketing will have the impact that we all hope to see?

Why are ODF success rates so much higher in Africa than in Asia?
The participants were asked to share any information available on ODF success rates in their countries – the number of communities triggered, and the number currently verified to be ODF. Numbers were provided from seven different countries, although most were partial data collected by specific programs (including data from Global Sanitation Fund programs in four countries).

The first striking feature of the data presented was the scale and reported success rate of the GSF Madagascar program: more than 12,600 communities triggered, and an 87% ODF success rate, resulting in nearly 11,000 ODF communities. While an impressive achievement, and reinforced by a strong and positive presence by the Government of Madagascar at the AfricaSan conference, these data inevitably raise questions over the speed and efficacy of the achievement; the quality of the verification processes; and the risk of sustainability problems in this huge, new ODF population. As Robert Chambers noted, the lesson from India, where premature claims of large-scale success (since disproved by the 2011 Census data) have significantly undermined sanitation efforts, should remind us that reliable verification processes, and regular checks on the quality and effectiveness of these processes, are critical in building confidence in ODF outcomes. Furthermore, while some studies have suggested that rapidly achieved ODF outcomes tend to reflect genuine and sustainable processes, the sheer scale of some of these achievements will present significant challenges to monitoring and support systems in these countries.

The second interesting feature was the much lower ODF success rate reported in Cambodia. The five African countries reported ODF success rates ranging from 46% to 96%, with even the lowest African country (Nigeria) reporting almost double the 25% success rate found in the GSF Cambodia program. These data seem to confirm that ODF success rates are much higher in Africa than in Asia – a 2012 regional CLTS study in the East Asia and Pacific region found that ODF success rates ranged from 4% to 36% (with Cambodia reporting the highest rates in the region).

When CLTS was first spreading in South Asia, in the early to mid-2000s, many African sanitation stakeholders refused to believe that CLTS was suitable for Africa – it was suggested that CLTS only worked in Asia because of the higher population densities, and that triggering effects were particular to the social and cultural contexts found in Asia. Today, we are starting to see the opposite – that CLTS may be more successful in Africa, perhaps because simple pit latrines tend to be more acceptable and appropriate in poor African communities than in Asian communities (where pour-flush toilets and washing after defecation are often preferred). More work is required to be sure that the impressive ODF gains made in Africa can be sustained, as several countries already report high levels of reversion to open defecation. Which brings us back to the sustainability discussion!

IDS AfricaSan session on CLTS and sustainability
The IDS session on CLTS and sustainability attracted a large and attentive audience. Matt Bond (FH Designs) presented on the learning from disseminating the findings of a four-country study on ODF sustainability. Matt suggested three elements had been important to their knowledge management strategy:
• Crowding in
• Planning
• Collaboration

Crowding in concerns the involvement of key stakeholders, including the country project teams and communities, in the process. The aim is to avoid an extractive process, whereby outsiders come in and generate learning that is then shared with the donors and project managers, without much effort to share this learning with those who did the work, or were affected by it. Matt suggested that they deliberately involved a range of stakeholders in the design and implementation of the study, and built in feedback sessions with the country teams and other project stakeholders at the end of the process.

This approach requires explicit planning from the start. Recognition that these sharing and learning activities are important and often require budget, capacity and time, thus need to be designed and scheduled at an early stage of the work. All too often, the focus is on completing the evaluation, and only afterwards do thoughts turn to how best to disseminate the findings.

Matt’s final point was around collaboration. He noted that the ODF sustainability study recruited a panel of peer reviewers, who reviewed the design, implementation findings and analysis, and were involved throughout the process. This collaboration opened the study team to learning and information from a number of other similar studies, which informed and influenced the design and implementation; and also greatly increased awareness of the study, and expanded the networks for sharing and discussing the study findings.

Social norms for ODF sustainability
Mike Gnilo (UNICEF headquarters toilet team) shared an interesting presentation on how social norms relate to ODF sustainability. UNICEF has talked about social norms as an important aspect of CLTS programming for some time, but it has remained – for me, at least – a fairly abstract concept with little information on how it may benefit policy, programming or practice.

Mike elaborated the concept, explaining that where social norms have changed or strengthened the chances of sustained outcomes improve – people are more likely to cooperate to sort out problems, and tend to be more committed to sustaining the new practices or outcomes. A randomised control trial (RCT) on CLTS in Mali found significant benefits in improved sanitation and hygiene practices, and in health outcomes, but also found that people within the ODF communities were more likely to cooperate with each other.

The suggestion was that programming should encourage the formation and strengthening of social norms around improved sanitation and hygiene: creating aspirations for improved behaviours and outcomes; encouraging pledges, plans and other collective commitments; and recognising (for example, through verification) achievements to generate a sense of pride and efficacy in the new outcomes.

Mike explained how this thinking was incorporated into the implementation of a phased approach to sanitation development in the Philippines. Sanitation and hygiene goals were broken down into a series of more achievable steps to encourage the sense of efficacy; and verification of each step required the development of a plan and a pledge to reach the next step, thus reinforcing the sense of progress and aspiration towards the higher (and more valued) goals.

Sanitation finance for sustainability and equity
My presentation on sanitation finance for sustainability and equity, which also draws on experiences from the development and implementation of the phased approach to sanitation development in the Philippines (mentioned in Mike’s presentation on social norms) elicited some interesting questions from the audience.

Several participants asked whether the provision of post-ODF incentives, including financial incentives such as targeted subsidies and conditional grants, might encourage communities to short-circuit the ODF process in order to gain these incentives, with the risk that the outcomes are not sustainable.

Evidence of similar problems is widely available in India, where the Nirmal Gram Puraskar (a higher level award to Gram Panchayats that are verified to be meet a selection of sanitation and hygiene criteria, including ODF status, 100% improved sanitation in households and institutions, solid and liquid waste management, and handwashing with soap) was found to generate a large number of temporary gains (and sometimes fraudulent gains) because of the political and financial lure of the awards. However, the NGP is a different creature – it was a one-off award that required achievement of a large and difficult set of collective outcomes, with few mechanisms to encourage the sustainability of these outcomes after the event.

In contrast, the phased approach to sanitation development includes a series of simpler steps – three steps in the UNICEF Philippines program – that are designed to be easier to achieve, with verification of each step that includes re-verification of the previous step to check sustainability. The second step also includes verification of a community sustainability monitoring system, which must track toilet use as well as what happens to full pits and septic tanks.

As a result of this longer and phased process of monitoring and verification, there are checks that reveal what happens to the post-ODF incentives – whether they are converted into improved outcomes, or not – and whether previous outcomes have been sustained. The process is not just about grabbing the incentives and then stopping, as it encourages communities to work towards higher levels of sanitation and hygiene improvement through a continuous process of support and follow-up.

The phased approach provides a framework for sustained support and follow-up, something which is often lacking where a time-limited project drives the activities. The sanitation finance within the phased approach is then designed to provide incentives to progress beyond ODF, demonstrate to other communities that ODF achievement has other benefits (such as further support and assistance), accelerate progress towards the higher level objectives, and tackle the weaknesses of previous approaches in reaching the poorest and most disadvantaged households with sustainable sanitation and hygiene improvements.

Andy Robinson is an independent WASH consultant.

Date: 15 June 2015
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Comments

Submitted by samuel Musyoki (not verified) on

I am glad to see that radical views about sanitation marketing as the magic bullet for sustainability of CLS was hot during the AfricaSan 4.  Reading this makes me as the question if  Sanitation Marketing is being overrated. Is is Sanitation Marleting really working for the poor? New research is showing that microfinace is not working for the poor how then do we expect the poor to borrow for household sanitation?

Like you Andy I have not yet seen anything in the Region of Easterna dn Southern Africa than is affordable to most poor families. The private sector is still expecting to come up with products that INGO will buy and distribute to the poor family. They still do not seem to get it! I know WSP supported some  research in Kenya but it seems the plastic pans that have developed out of this are still not that affordable. I also think the points rasied by Kamal are valid. While there is commitment to CLTS, what we have not yet seen is demonstration of such commitment. The investiments in-terms of budget, Human Resources and working tools is still not there to desirable levels that can drive scaling up. Possibly once scale is achieved finding technological solutions to sustainability will follow with little push. 

Submitted by Pippa Scott (not verified) on

Thanks for sharing this Andy, Robert Chambers referred me to your blog as this is a topic of interest for the BMGF Building Demand for Sanitation grantees recently which has informed the topic for an upcoming webinar on measuring CLTS, community outcomes and behavior change. 

I've signposted this blog post on the webinar dicussion thread, hosted on the Susana forum, which also contains registration details if interested: http://forum.susana.org/forum/categories/5-clts-community-led-total-sanitation-and-other-community-led-approaches/14097-what-constitutes-success-for-clts--measuring-community-outcomes-and-behavior-change-webinar-on-wed-22-july-2015-at-1500-london-time#14251

Warmest regards,

Pippa

Submitted by Simone Klawitter (not verified) on

Embedded in Philippines National Sanitation Roadmap - PhATS – Philippines Approach to Total Sanitation was developed in a comprehensive governmental consultation process led by the WASH cluster following the devastating impact of Typhoon Yolanda/Hayan affecting hundreds of thousands of people in 2013. It provides a holistic systemic planning and implementation framework not only focusing on basic sanitation with an incremental phased Community Led Total Sanitation (CLTS) component reaching out to about a million affected people. Prioritizing sanitation demand creation is anchored in the promotion of supply-side interventions and multiple enabling environment conditions that fit within and support the socio-cultural, political and investment climate of the Philippines:

1. Good governance,
2. Knowledge Management and Accountability,
3. Basic Sanitation, Hygiene and Safe Water in Communities using a “phased approach”,
4. Basic Sanitation, Hygiene and Safe Water in Learning Institutions incl. DCC reaching out to more than 1000 schools and day care centers,
5. Sustaining Demand through Supply Side Interventions, and last but not least
6. Achieving Total Sanitation through Safe Water Supply, Solid & Liquid Waste Management, Drainage.

Thus, the above-mentioned Phased Approach is an important but integrated element of a systemic approach, which goes much beyond. The emphasis and success of the large scale post emergency program is on changing social norms using the emergency as an opportunity (including massive funding for WASH).  At the same time we were working on governance, materializing on strong WASH in Schools learning’s in partnership with DepEd supported by IMC, sanitation marketing, microcredit’s, ideation (e.g. SP, Oxfam, Single Drop, decentralized waste water treatment (pilots by each partner, including Tacloban City), conditional cash transfer, different forms of targeted but limited subsidies in cash and kind in each of the Barangays before reaching ODF – from G0 to G1 (10% of population with exemptions in high water level areas mostly done by CRS), cash and non cash rewards for achievements, standardized mobile phone to web ODF monitoring by government (DoH). The partnership between governments at different levels, 12 international NGOs and UNICEF in all regions providing support at different governance levels and changing over time depending on the phase of emergency transition to development during 2 years of program implementation was most crucial.

The recently published overview on status of CLTS in East Asia and Pacific Region (UNICEF et al) highlights that “as of May 2015 the Philippines has triggered 677 Barangays and 473 (70 per cent) have been certified ODF. Haiyan/Yolanda area has been most successful with 364 Barangays so far declared ZOD out of 431 triggered (84 per cent success rate). UNICEF’s development programme (e.g. Masbate Province with a focus on demand creation only) has a 29 per cent success rate (101 triggered, 30 ODF); and WSP a 54 per cent success rate (145 triggered, 79 ODF).”  Sustainability of PhATS post Yolanda still needs to be assessed, while the draft post KAP for Yolanda affected regions done in late 2015 shows approx. 50% of communities still being strictly ODF while focus group discussions show that the other 50% mostly (again) go open when working in the field and/or never went from shared latrines (G1) to household level latrines (G2). Note: We started off in Yolanda affected regions with 94% of population defecating in the open in April 2014 when we shifted from classic humanitarian life saving needs activities to PhATS approach post Yolanda. We have learned from PATS in Pakistan and adjusted the approach to Philippines post Yolanda context with quite a large outreach, taking the learning forward. A systemic holistic approach including but beyond phased CLTS embedded in a partnership model which points towards early and steadily increasing involvement of the governmental partner is the way to go.

For more information on PhATS post Yolanda see the Philippines country page.

I was the head of UNICEFS WASH emergency team based on Tacloban, Philippines from January 2014 until the Yolanda response was successfully reintegrated into UNICEFs development program in 2015.
Simone Klawitter