Eritrea

According to the UNICEF/WHO Joint Monitoring Programme (JMP) and a national assessment report, Eritrea is one of the countries with the lowest sanitation coverage and is not on track to meet the MDG sanitation target of 54% by 2015 (Rapid Assessment of Rural Water Supply and Sanitation in Eritrea-Water Resources Department & UNICEF, 2006; UNICEF/WHO JMP,2006). Improved urban sanitation coverage stands at 32%, and rural sanitation coverage is just 2-3%. Approximately 2.8 million people in rural areas do not currently have any form of latrine facility.

This makes Eritrea’s challenge to meet the MDG sanitation target a tremendous one. It is estimated that over the years 2007–2015, 448,000 Eritrean households in rural areas will have to give up open defecation, and construct and use their own latrine to meet the MDG sanitation target.

Out of this recognition, and the need to nationally scale up sanitation coverage, the Government of the State of Eritrea, with support from UNICEF, in late 2007 adopted the Community Led Total Sanitation (CLTS) approach

Prior to the introduction of CLTS, sanitation interventions carried out in the country were focused on producing “high end” toilets with a subsidy that included five bags of cement, iron bars for reinforcing, vent pipes and re-useable mould for the floor slab. Almost all these were built using Government and or donor funds as most families in the rural areas could not afford to build this type of toilet on their own due to financial constraints. As funds were limited and families were waiting for subsidy, very few toilets were built, and the actual usage of the constructed latrines is unclear.

The adoption of the CLTS approach entailed a paradigm shift in hygiene and sanitation promotion. Consequently it demanded considerable amount of capacity building of all stakeholders and social mobilization at various levels. Therefore, the Ministry of Health, together with UNICEF engaged an international consultant who conducted a training of trainers on CLTS for 30 people in December 2007. CLTS was then introduced in 2008, and in March of the same year, the MoH (Maekel and Anseba Zone) focused on two pilot villages of Adi-Habteslus and Halibmentel.

To further entrench the programme, regional advocacy workshops on CLTS were carried out in six regions which were attended by more than 400 participants (including regional governors, sub-regional administrators, higher government officials, religious leaders, regional assembly members and implementers of sanitation programmes) between July 2008 and February 2009. These workshops helped generate much needed interest and create awareness on the CLTS approach, and sub-region administrators committed themselves to introduce CLTS in one village of each sub region.

In October 2008 the first pilot village (Adi Habteslus) achieved 100% sanitation coverage with every household having and using a toilet. It declared Open Defecation Free status during the National Sanitation and Hygiene Week (2008). The declaration ceremony was widely covered by the media and this created further interest in the other regions. Additionally, the entire ceremony was documented and was used in the advocacy workshop in one region, and in the subsequent nationwide training of 250 public health technicians and implementers of CLTS at sub regional level.

In early 2009, the Ministry of Health through their Environmental Health Unit were ready to go to scale with CLTS and launched their nationwide sanitation programme with the assistance of UNICEF in 46 villages. CLTS is a revolutionary approach to rural sanitation, where hands-off facilitation, community appraisal, analysis and action are key. In view of this, and out of the recognition of the limited technical capacity to effectively implement CLTS, the ToT of December 2007 was hybrid of CLTS and PHAST and upon the invitation of the Ministry of Health, one of the brains behind the Community-Led Total Sanitation (CLTS) approach (Dr Kamal Kar) conducted a 3 week mission in June 2009 to review, strengthen, further advocate, support develop the necessary framework, implementation guidelines, and training for enhanced, coherent implementation of the CLTS. During his mission, a week long national “hands-on” CLTS ToT training for 46 participants (public health technicians, sanitarians, community Integrated Management of Child Illnesses (IMCI) focal persons and nurses) from all over the country was conducted; reviewed CLTS implementation progress within two Zones/Zobas (Maekel & Anseba); conducted a one day advocacy session targeting public health technicians and administrators from Maekel region, sub region and villages; and an awareness raising session for the first batch of graduates from the College of Health Sciences. This visit was supported/facilitated by UNICEF.

As of November 2009, 95 villages have been triggered in the six regions with eleven villages already certified as open defecation free (ODF). Nineteen villages are presently under ODF verification. Since the CLTS programme begun in 2007, 11,184 households (or an estimated 55,920 people) have stopped open defecation in all the six regions of the country. 1500 village health promoters were trained. The National Rural Sanitation Policy and Strategy Direction was launched in October 2009 and this policy fully supports the CLTS approach.