Learnings from our East and Southern Africa workshop

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On reaching the last mile and moving up the sanitation ladder: learnings from the East and Southern Africa Sharing and Learning Workshop

At the recent CLTS Knowledge Hub regional sharing and learning workshop held in Arusha 16-20 April, it was encouraging to see that the discourse and programming in the region has matured since the early days of CLTS (and early days of these sharing and learning workshops!). In the past workshops that I’ve attended in the region, our discussions focused on how to improve the effectiveness of CLTS and how to take the approach to scale. Last week, the participants appeared to be ‘old hands’ at CLTS, and almost all (if not all) countries present have taken CLTS to scale as a nationally endorsed approach. Effectiveness and scale were no longer the questions plaguing practitioners in the region (though further work may still be needed on these aspects). Instead, they are grappling with novel challenges that have emerged as CLTS has gone to scale and as the SDG targets have been put in place. Two discussions that stood out for me the most were on reaching the last mile and moving up the sanitation ladder.


Reaching the last mile: Who is the last mile in your country of operation? This question challenged participants to think about who is not being reached by CLTS, and who may be neglected by current national strategies and policies. Answers ranged from areas with technical challenges such as rocky or sandy soils, or areas with high groundwater, to cultural challenges such as beliefs against latrine use, and social challenges such as marginalised populations and areas with low social cohesion including temporary fishing villages or small-scale miners.

I facilitated the discussion on technical challenges, and had a group of enthusiastic participants who shared the solutions available in their countries. These ranged from arborloos and other ecological sanitation options, to raised pit latrines and new technologies such as floating latrines. When probed on how these solutions were reaching the last mile, participants admitted that for the most part, manuals and design guidelines exist for these challenging contexts; however, adoption of these technologies is a key challenge. Sometimes solutions were not acceptable to communities, but most often affordability was the main barrier.  The discussion then shifted towards other solutions that could be easily adopted by communities. Experiences included digging off-set pits in areas with unstable soils, or shallow but wide pits in areas with rocky soils, among others. It was encouraging that some participants also recognised the issue of inclusivity when considering toilet designs. For example, someone mentioned that although raised pits were suitable for flood-prone areas, they will require modification to be accessible for people with disabilities and children.

In discussing areas of further exploration at the end of this session, the question of how appropriate CLTS is for last mile communities facing technical challenges emerged, given the experience that CLTS most often results in households building unimproved toilets. In areas with high groundwater, as in the community seen during our field visit to Karatu district, is it alright to encourage households to build any type of unimproved toilet, which may overflow and increase the risk of disease and environmental contamination during the rainy season? Should there be a different approach, or a blended CLTS approach, that includes technology options for these types of communities? This is a key question to consider, and one that is already being tested in various countries (see below).


Moving up the sanitation ladder: In relation to technical challenges, a key issue that plagues the region is the difficulty of moving households up the sanitation ladder. CLTS has rapidly increased the construction of toilets, but many households are now stuck with unimproved toilets, and progress seems to have stagnated at this stage. In my experience of working in the region, when the topic of moving households up the sanitation ladder is brought up, it seems that sanitation marketing (sanmark) is the first approach (and sometimes the only approach) that comes to mind. This is problematic as there has been limited success of sanmark in the region. Many market-based initiatives have been tried, but for the most part these have failed to scale and have been unlikely to reach the poorest households. Further work is required to accelerate progress in moving up the sanitation ladder. I was therefore excited to learn of different ideas that are being considered and tried to put a fresh spin in our efforts to improve sanitation facilities in the region.  
1) Upgrading incrementally, using locally available materials. This approach to moving up the ladder does not always involve market based solutions, but supports households to make incremental improvements to make their toilets more durable, using materials that are easily available. In Tanzania and Uganda, households are trained on toilet improvement strategies, including smearing of slabs, adding a roof, and conducting other minor improvements to increase durability. In Eritrea, materials used for refrigeration in fishing communities are used to line pits to prevent collapse. I find the use of local solutions, instead of externally created, market-based solutions, to be one of the most promising for the region (which has few functional markets and a large population of poor households with limited income).

2) Introducing technology options in the CLTS process. Experience in multiple countries have shown that often, the CLTS process results in unimproved toilets that have not always met the needs of communities. Some households with a higher ability to pay may wish to move immediately to an improved toilet, while others with difficult technical conditions simply need to have an improved option as a first step to stop practicing open defecation. In Ethiopia, Tanzania, and Uganda, practitioners shared that they are now introducing technology options at either the triggering or follow-up stage. Everyone agreed that ‘demand’ must be there from the start, so this approach does not discount the power and importance of CLTS for behavior change, but takes into account the specific needs and context of each community.

3) Increasing affordability. An interesting approach being tried in Ethiopia is incremental upgrades via seasonal roadshows that target households at a time when they have more income. At these roadshows, a range of sanitation and hygiene products are showcased and households are encouraged to buy whichever materials they can afford at that time, instead of a full, improved toilet package. At the next seasonal roadshow, they could then purchase additional products to continue upgrading their sanitation and hygiene facilities over time.

Other initiatives include small pilots through village savings and loans, flexible payment options (payment through installments or through the exchange of goods for services), and partnerships with microfinance institutions. Whether these mechanisms reach the poorest households is debatable, and the question exists on whether alternative financing options are needed for these groups (such as targeted subsidies, which have been tried in several Asian countries).

4)  Market shaping and improving the enabling environment. Novel ideas that were proposed by participants included market shaping to improve access to affordable sanitation and hygiene products and accelerate the pace of change. These could include facilitating meetings with the private sector to demonstrate the potential market for sanitation products and services, and encouraging governments to incentivize private sector engagement, such as through tax breaks.

For this and the other ideas above, there is a need to monitor the costs and results of these initiatives, and to share them with others. This will enable understanding on which approaches have potential to scale in the region, and whether they are reaching the poorest households.

Overall, the key takeaway for me from the Arusha workshop was the need to move beyond our current practices if we want to achieve the SDGs. We must systematically consider the last mile in our programming and move past ‘low hanging fruits’. We also need to move beyond sanmark as the only solution for supporting communities to move up the sanitation ladder – as we have learnt from the workshop, there are more possibilities on the horizon!

Jolly Ann Maulit is an independent WASH Consultant

Date: 4 May 2018


Submitted by Ajith Kumar (not verified) on

Interesting to read that CLTS has been taken to scale. When you say, "...taken CLTS to scale as a nationally endorsed approach", what does this mean. Yes CLTS has been accepted in official policy and strategy documents as THE approach which will be followed by these countries. But does this mean that implementation at scale through CLTS, leading to outputs/outcomes at scale has been achieved? It would be useful to get some examples with evidence on this. 


Submitted by Elaine on

Hi Ajith, thanks for your comment. Yes in many cases it does mean implementation at scale, for example in countries like Malawi, Zambia, Ethiopia and Kenya, I believe CLTS is the primary approach used by implementers from both government and non-governmental organizations, and it is implemented throughout the country. In terms of outputs and outcomes at scale, I guess the question is what threshold do we use to define ‘scale’? In my mind, implementation is at scale if it has been included in national policies and government systems, including institutional arrangements, and CLTS has been implemented in a significant proportion of the country. For example, as of 2016 in Zambia CLTS covered 69% of the country, and in Malawi all districts have CLTS implementation. If we are speaking of communities triggered and ODF, then these also have very large numbers. Zambia for example in 2016 had over 10,000 communities declared ODF, including 4 ODF districts and 40 ODF chiefdoms, with almost 2 million people living in ODF communities (based on the national CLTS monitoring database). Meanwhile in Malawi 67% of communities were triggered as of 2016 according to the Ministry of Health, with 40% of villages declared ODF (almost 19,000 communities), including 3 out of 28 districts. I’m not as familiar with the Ethiopia and Kenya figures, but based on a quick search I learnt that almost 5000 kebeles/communities were declared ODF as of 2015, which encompasses 24.5 million people according to government figures. For Kenya, they have a national monitoring database online (http://wash.health.go.ke/clts/index.jsp) which states that over 24,000 communities have been triggered (35% of all communities), and over 10,000 communities certified ODF (approximately 15% of communities). Based on these figures, and also my conversations and interactions with the participants from these countries, CLTS certainly appears to have gone to scale in these countries. Cheers! Jolly Ann