A passionate family: Reflections on the WSSCC Global Forum on Sanitation and Hygiene

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This was the first ever Global Forum on Sanitation and Hygiene. There have been the regional meetings – Sacosans, Africasans and so on, but never one for the whole developing world. WSSCC (and most notably Archana Patkar, who got a standing ovation at the end) did a great job in imaginative and thorough planning. The facilitation by Archana, Barbara Evans and others was outstanding. WSSCC had brought together some 450 of us. There was fuller representation of Africa than usual, and fewer Indians than one might have expected. There was a family feel about it for those of us who pitch up for the regional ‘Sans’, and a sense of common purpose and commitment which was stronger than before. That augurs well. I didn’t pick up any sense of institutional rivalries.

What stands out now the four main days are over?

  • Passion And it is a common passion. Jon Lane set the tone with an eloquent unscripted introduction in which he drew on Gandhi and Mandela. He mentioned that worldwide about half of the toilets constructed for people were either not used or used for other purposes. Demand-led, not supply led…
  • Behaviour change This was a good idea, a plenary in which people from different fields gave their insights into what leads to behaviour change. ALL of their contributions fitted, supported and helped to explain CLTS, more or less like these soundbites distilling what they said:

‘No health education, please!’ (Yes, that really was said)

Telling people to send girls to school does not work (Yes that really was said)

Focus on want, need, desire

For behaviour to change, experiences have to be ‘radical, real, immediate and dramatic’

Let choice be compelling so that there is no choice

When frames of mind change, behaviour change is easy

For behaviour change, social norms must change

  • Equity and inclusion. These were big, big themes throughout. We had previously excluded people who here came to talk to us in small groups – rehabilitated manual cleaners, slum dwellers, disabled, minorities…..as part of a whole morning on this, well set up by Louisa Gosling of WaterAid who has written authoritatively on this. Everyone will go away with this firmly imprinted. A lot on the shift from the MDG approach, which is filling the glass, how full is it? – to right-holders and duty bearers, and the concept that as long as the glass is not full, and people are excluded, are we as duty-bearers not guilty of discrimination?. This from Archana. And this orientation came across powerfully from my nomination for the wittiest speaker award – she had us in stitches – Nomathemba Neseni, Commissioner, Human Rights Commission, Zimbabwe.
  • CLTS Bushfire in Africa was Kamal’s title for his rousing presentation, and that imagery seems increasingly justified. Jane Bevan said she thought those in credibly ODF communities in Africa might now number not 4 but 5 million, sustaining the sense that much spread there is exponential (though of course not everywhere). Sammy Musyoki impressed with his presentations on urban CLTS in Mathare, and on the use of mobiles in monitoring. Kamal and I (mainly Kamal) did a four hour CLTS ‘training’ which we re-christened a familiarisation. Though in competition with field visits in Mumbai, we still got about 25 people, and had fun taking over and messing up some of the paved area outside the hotel with a role play of triggering and lots of (yuk!) yellow rangoli powder which stayed on your hands….. The joint IDS/ CLTS Foundation stall was well set up by Andii Paul, and attracted a great deal of attention – much material was picked up, many signed up for the bi-monthly e-newsletter….There were country meetings around CLTS – Nigeria, Uganda, Tanzania,Madagascar. Lots of energy…
  • CLTS ‘debate’ or moving forward? A debate had been planned but the atmosphere was different. There isn’t much debate about CLTS – yes or no – now. The sceptics are fewer. It is an extraordinary change, and has happened fast. I noticed the same at the WEDC conference a couple of months ago in Loughborough. Instead of a debate we split into topic groups and brainstormed. Old ground had to be covered in the groups to bring people up to date, but that was all right. The PHAST issue seems to have subsided – there doesn’t seem to be much argument there any more – it is so painfully obvious why PHAST is incompatible with and undermines, inhibits, slows, stops CLTS. All the same, we still need practitioners to record their experiences. The concerns now (except still in much of India, the elephant in the room) are how to do better with and through CLTS, how to go to scale with quality and sustainability, and Louis Boorstin of the Gates Foundation called for going straight to scale, without pilots (there is a debate to be had there, but perhaps it’s a question of semantics) and realism ‘call it like it is’ and convened a breakout meeting on going to scale with CLTS and total sanitation – experiences of how to do it.
  • Handwashing surprise Steve Luby from the ICDDR astonished with his finding from rigorous research in Bangladesh that of the five times when you are meant to wash your hands – after shitting, after handling children’s shit, before eating, before preparing food, and before feeding a child, only two had a significant effect on the incidence of diarrhoea. Which two do you think? The answer is at the end of this blog.
  • Nepal number 15 The first 14 countries can welcome a new member to the club. In the week before the Forum, Nepal adopted CLTS as national policy for rural sanitation, making it the 15th country to do so, and the second outside Africa, the other being Indonesia.
  • India Still underplayed. The gross enormity of OD in India, and its impacts on undernutrition of children, on livelihoods, on poverty, is still not really recognised as it should be. If India still has 56-58% of the OD in the world, we need to get our minds around this, and so does the Indian Government. The Hindustan Times carried an article about undernutrition in Mumbai, and quoted Lawrence Haddad that India was an economic powerhouse but a nutritional weakling. A third of the children in Mumbai are undernourished.
  • Shit transect Visits were organised to slums, one of which didn’t seem from the video to be a slum at all, but it wasn’t necessary to go far. Sammy, Naomi and I walked ten minutes only from our 5 star hotel to an area I had found when jogging – in the early morning children crapping in the middle of a tarmac road, 6 men in a small plot of vegetation where they must surely have been stepping on the stuff, and shit on raised flat concrete surfaces, all gross, disgusting and smelly, and oh a disused toilet block, and another quite dirty one actually in use, all of these apparently draining into a stream that feeds into the (beautiful?) lake of which we had such a good view from our lap of luxury. Back in the hotel, I washed my trainers.
  • ‘Shit’ is OK The word was widely used, even in the concluding plenary. This is a watershed passed, a mini but meaningful tipping point from which there is no return. We collected more words for the international glossary

So, well done and thank you WSSCC, and let’s look forward to a summary from this Forum. May the ripples spread wide. Some may be through the Communities of Practice that were launched (see WSSCC website). And don’t let this be the last Forum but the first, so that we can look forward to the next!

PS: The answer is after shitting, and before preparing food.

Robert Chambers is a Research Associate at the Institute of Development Studies, Brighton, UK and part of the CLTS Knowledge Hub that is based there.

Date: 17 October 2011
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Comments

Submitted by Anonymous (not verified) on

I was recently in northern Uganda facilitating an inter-district workshop on sanitation, including CLTS.
There were representatives of the central government level, actually from the National Work Group on Sanitation. If I understood well the Ugandan experience so far is far from being positive.
Triggering is easy, monitoring over time is however not done. Informal evidence has it however that many triggered communities do not remain shit free (ODF).

Question: is there a website (GLAAS like?) that provides a portal to country level information on where CLTS is promising and where not (yet?).

Thanks, Peter

Submitted by Anonymous (not verified) on

Hi Peter,
If not mistaken, that is the experience where over 56 villages were triggered in Gulu, kitgum and pader and none had reached ODF except one village triggered by Oxfam. And yes, monitoring is one of the key issues as to why communities never get to ODF. Plan Uganda started with CLTS in 2008 and many villages were triggered but not followed up; thus we did not have as many ODF as would have been. We since learned from this and currently our CLTS planning cycle involves at least 3 phases of monitoring, including verification and certification by the district and plans for the what next after ODF. We are progressing better and many villages are getting to ODF. Note that this was also captured in the national CLTS manuals recently developed for Uganda.

As long as ODF is not the end objective of CLTS triggering [thereby no monitoring] no ODF will be attained. But there are also other factors at play, for example; how skilled are the facilitators who conduct the triggering and what is the triggering outcome? Note that the skill of the facilitator and the quality of triggering impacts on the sustainability of ODF. We have also learned that communities need to be minimally supported beyond ODF for example by periodic monitoring for at least 2 years after ODF. Sanitation marketing [ to help communities move up the sanitation ladder ] by promoting/ selling durable latrines and interventions with hygiene promotion are introduced after ODF to propel communities to sustain ODF.

Plan Uganda [which is also part of the National Sanitation Working Group CLTS sub-committee] has had good and successful experiences with CLTS from which you can visit and learn. On your title  CLTS to go- no more discussion; Whereas there is no blue print for sanitation promotion and that CLTS has favorable and unfavorable conditions, there is no doubt that CLTS is the solution to Uganda’s sanitation challenge. This owes to the fact that if done well, CLTS as a community Led Initiative can even be more than Sanitation improvement, but a social movement that can trigger other development initiatives in communities and uniquely addresses the needs of men, women, children and the marginalized groups in a community.

Last week for example, I was in Tororo district and in Ongorom Village [declared ODF in November 2010] something different was brewing….the Village Health Team members were in a process of registering a Loans and Savings scheme as a group; this was also the case in Nakinyama Village of Kikube parish in Luweero district [Declared ODF in August 2011] . All this progress was attributed to the social cohesion attained from CLTS processes. Most importantly, the teams are also determined to support their fellow community members to maintain the ODF structures.

Finally, for better coordination and maximum results, we need a home for CLTS among the line ministries, which in this case- the Ministry of Health. In this way we can strategically roll out CLTS in the country under the guidance of the line ministry , harmonize better and learn from experiences from actors in the different parts of the country.

Submitted by petra on

Dear all,

In addition to points raised by Carolyne and Prakash (effective triggering and regular follow-up in order to stop opened defecation without subsidies), Village also requires bylaws to achieve and sustain ODF status. On this, we know of LC1 chairperson yapacooro village Lamwo District arrested for acting outside the law in an attempt to achieve ODF.

ASB triggered 19 villages between June and August 2011 report shared with UNICEF and Mr Otai Justine (National trainer MOH) for CLTS national update, we also supported District to follow-up of previously triggered villages and 2 of the 6 triggered villages we supported by following have claimed ODF (Odube village in Lamwo and Wangcol village in Pader) the District is yet to conduct confirmation assessment so that they can be officially pronounced ODF.

How to sustain ODF status have been discussed and in addition to periodic follow-up, CLTS marketing and integration in to microfinance schemes mentioned above, events such as (1)annual celebration of ODF status be encouraged by Parish chiefs, and (2)open award of ODF certificate which can be openly withdrawn up on loosing ODF status was agreed up on.

With a new culture of dependency created in Northern Uganda, CLTS could be a good approach to undermine it guaranteeing O&M of water points in villages.

Hurrying the process of ODF may not be healthy to its sustainability since change is a slow process, District and Sub county leaders (technical and political) should come clear behind CLTS so that sustainable WASH development can be attained.

Felix Achunge

NPM ASB Uganda

Submitted by petra on

People of Northern Uganda have experienced the conflict over 22 years and have received humanitarian support for many years, through the Ugandan Government and through NGOs and UN agencies. As Northern Uganda moves into a recovery situation, most of the humanitarian organizations still continue to provide humanitarian support in areas where it is needed, as well as support to early recovery and recovery interventions. Most IDPs still have mind setting of “receiving dependency syndrome”, which is one of the major challenges faced by the development partner.

Despite of these challenges, many development partners, namely Oxfam, ASB, Goal, WVI, ACF and district local government with the support from UNICEF have already initiated the sustainable approach like CLTS to improve the sanitation situation in the Northern Region. I must acknowledge that success rate of achieving ODF villages, specially in Northern Region, is in slow pace than our expectation. However, the water and sanitation sector performance report 2011 based on data available from Agago, Nwoya and Pader districts showed that sanitation coverage increased from 22% to 49% after CLTS intervention. Hence, I would see that CLTS is gaining momentum with strong leadership and support from the Ministry and Local District government in positive direction. I am sure that our partners working in that region may have more to say….

Best Regards

Prakash Lamsal

Water, Sanitation and Hygiene (WASH) Specialist; UNICEF Country Office, Uganda

Submitted by Anonymous (not verified) on

The author above mentions “it is so painfully obvious why PHAST is incompatible with and undermines, inhibits, slows, stops CLTS”. Has anyone truly studied this and is there supporting documentation? I would like to read up on this.

Submitted by petra on

This is indeed a hot topic. We are hoping to get together a note based on experiences from practitioners that have worked with both approaches this year. In the meantime, here are some reflections (by Robert) on the differences between the approaches which gives you an idea of why they are incompatible.

Fundamental to this discussion is the contrast between PHAST and CLTS. There is often an assumption that PHAST shares the same participatory learning principles as CLTS.

No. They share some rhetoric but their learning practices differ quite radically. PHAST comes out of SARAR. CLTS comes out of PRA. SARAR and PRA are very different. SARAR relies on preset cards, charts and pictures (and often paper). PRA uses none of these but relies on people doing their own analysis in media with which they are comfortable, often the ground (and not often paper). SARAR and PHAST have predetermined and extended processes with controlled steps (and a framework – health, diarrhoeas) towards an objective followed over quite a number of meetings, and often involve smaller groups. PRA and CLTS are more open-ended, with a versatile and opportunistic repertoire, take less time, are less controlled and more emergent, and often involve larger groups, touching whole communities. The paradigmatic difference between the two is masked by common language. The PHAST manual talks about facilitation and empowerment but means something very different from the facilitation and empowerment of CLTS.

Their differences show up in facilitators’ behaviours. In effective CLTS the approach is very hands-off. ‘We are only here to learn’ ‘We are not here to teach you anything’ and at a certain point ‘If you want to go on eating one another’s shit, that’s your affair.’ There is an element of performance, of theatre almost, in good facilitation. Not everyone can do it…but those that can, can have a dramatic and consistent effect (An experienced Indian facilitator – not Kamal – when I asked him if he was nervous before a triggering he was about to do with very influential policy-makers observing said No, it always works! So I asked him how many triggerings he had done – over 300!). PHAST facilitators have to have a very different relationship.

A major reason why CLTS evolved and was adopted because PHAST and subsidies were not working. That was why PLAN adopted it. And the sickness risk motivation assumed in PHAST simply isn’t anything like as strong as disgust/self respect/convenience (especially for females).

The question is whether the two can mix effectively. I am sceptical, even if CLTS comes first. Showing people pictures of latrine/toilet types at the time of triggering can hardly fail to inhibit action. People then want something they cannot go for immediately, and cannot do for themselves. They want to keep up with their neighbours. There is no explosion in a gas station, no way. As in a community I visited in Cambodia, people have no latrine because they would feel ashamed with a pit latrine. There is a tipping point which is then missed.

Submitted by Anonymous (not verified) on

There has been much reported on the “success” of CLTS. There are many reports of the large numbers of ODF communities because of CLTS. This may be so immediately following CLTS being conducted in communities. However, I wonder what a reasonable time period is after CLTS has been conducted where a community can be declared “sustainably ODF”. After all, CLTS is a relatively new approach.

Submitted by Anonymous (not verified) on

It is true that CLTS creates large numbers of ODF communities, especially soon after the triggering date; this is not an insignificant achievement and we should celebrate this success. However, this doesn’t necessarily mean that we should stop working after ODF achievement. (In fact, I would guess this is where the real work begins.) Sustainability is something that we are unsure of and in my understanding, very little formal research has been conducted on this subject.

In Malawi, we recognize that during the rainy season latrines made from locally available materials are prone to collapse and therefore puts ODF sustainability at risk. However, there are methods and strategies which can be adopted in order to mitigate these risks. Two initiatives we’re pursuing in Malawi are integrating CLTS into routine health extension staff work, and introducing sanitation marketing.

Integrating CLTS into routine health staff work means that during routine village visits, ODF status is checked and support is provided in order to maintain their status. Health surveillance assistants regularly interact with community members and therefore have ample interactions which provide opportunities to encourage ODF sustainability. When latrines collapse during the rains, they are able to remind communities of their commitment to becoming ODF, and provide support as needed to find alternate options for defecation until a new latrine is built. This might mean sharing temporarily until they can rebuild when the rains end, or finding some other alternative aside from reverting to OD. These health extension staff reinforce and support communities’ commitments to their behaviour change, and provide technical support when needed which assist the maintenance of ODF status.

Sanitation marketing of course is another alternative which is being pursued in many countries. We are at very early stages of its implementation in Malawi, but we see it as a potential approach for increasing sustainability after communities are declared ODF. The one thing to ensure when beginning sanitation marketing promotion is that the community is actually ODF, otherwise it might confuse communities into thinking that latrines made from local materials are unacceptable. Of course latrines made from local materials are perfectly acceptable, however we are starting to see that they might be temporary solutions, or even inappropriate for certain communities which have already been ODF for a long time. We’ve seen communities near the lakeshore in Malawi suffer from constant latrine collapse and have to go through the process of rebuilding year after year, which have discouraged them to maintain their behaviour changes because of the significant effort attached to it. This obviously affects the sustainability of these particular communities’ ODF status. Therefore, being able to provide options for permanent solutions for these types of communities is important to consider for sustainability, hence the potential for sanitation marketing.

In summary, it might be useful to view CLTS not as a stand-alone, one time initiative that stops after a community reaches ODF, but part of a continuous process that facilitates the initial behaviour change from OD to ODF, then is supplemented by other mechanisms or approaches which reinforce these behaviour changes and supports eventual movement up the sanitation ladder. I don’t have an exact answer to how long it takes to declare a community “sustainably ODF”, but in Malawi I suspect it requires multiple years of maintaining the behaviour change and seeing a shift in the norms of a community throughout multiple rainy seasons before we can comfortably call it “sustainable”.

Jolly Ann Maulit, EWB Canada, Malawi