Ethiopia

Background
There has been a great deal of progress in the sanitation and hygiene sector in Ethiopia during the past five years, much of it achieved through the Government’s Health Extension Programme and the subsequent introduction and spread of Community Led Total Sanitation. According to Government figures, about 60% of the total population now have access to sanitation facilities (56% in rural areas). Internationally published estimates are lower (e.g., the 2010 JMP estimates rural sanitation access, including basic and shared facilities, at 29% as of 2008. However, disparities between various sets of WASH sector statistics should soon be narrowed, as Ethiopia is currently in the process of carrying out a nationwide WASH Inventory which will catalogue all community, school, health facility, and many household WASH facilities throughout the country. Results should be available during the second half of 2011, and will be factored into national, regional and district level WASH planning to help target geographic areas and populations most in need.). Access to sanitation is highly variable among the regions in Ethiopia, with some reporting access in excess of 70%, and others less than 10% (mainly pastoralist areas).

History
The first effective and large-scale sanitation in Ethiopia was undertaken in the Southern Nations Nationalities and Peoples Region (SNNPR) starting in 2003-4. The programme made it compulsory for each household to have and use latrine facility. No hardware subsidies were provided, and the programme sought to achieve Open Defecation Free (ODF) status throughout all villages in the region. CLTS (and CLTSH) have since been introduced to SNNPR (as well as most other regions). Today, SNNPR reports 75% access to sanitation, the highest of any region in Ethiopia.

Owing to the large gap in sanitation and hygiene access to be filled, innovative approaches to accelerate progress were clearly needed. Since the introduction of CLTS in 2006 by Kamal Kar and the Irish NGO Vita, much has been done to further the practice of CLTS in Ethiopia. Plan International introduced it to its programme areas in 2007, around the same time frame that the “Learning by Doing” project was introduced in Amhara region by the Regional Health Bureau, USAID, AED, and WSP. Encouraged by these successful efforts, the Government of Ethiopia (GoE) mainly with support from UNICEF and its development partners have now rolled out CLTSH in nearly every region of the country.

Progress
To date, over 20,000 communities have been ignited and over 15,000 have attained ODF status. Many hundreds of health workers, including Health Extension Workers (HEWs), Health Extension Program Supervisors, Environmental Health Officers, local government officials, teachers, School cluster Supervisors, members of civil society (LNGOs and INGOs), and international organisations have been given hands-on CLTSH training at Federal, Regional and Woreda (District) levels. Ethiopia is therefore well on its way to institutionalising and scaling up CLTSH.

Challenges
Ethiopia has adopted ambitious water, sanitation and hygiene targets through its Universal Access Plan, which seeks to reach 98.5% and 100% access to safe water and sanitation respectively by 2015. The Health Sector Development Program (HSDP IV) of the Federal Ministry of Health envisages attaining ODF status in 84,000 Kebeles in the coming two years. Therefore, the scale of the sanitation and hygiene challenge is great, regardless of which current levels of access are referenced. Other challenges faced in Ethiopia are on hygiene behaviour front; including hand washing and water handling in the home (these are part of “CLTSH”, the Ethiopian variant of CLTS which includes “H” for hand washing safe management of water in the home.

Though the progress has been impressive, CLTSH requires further strengthening and expansion. In particular, it has been challenging to ensure that the “post-triggering” phases of CLTSH receive sufficient attention. Ensuring the drive to achieve ODF status is completed (including full usage of toilets constructed), that constructed toilets are properly designed and maintained, that hand washing with soap and water are practiced, and drinking water is safely handled in the home all remain areas where additional emphasis is needed. Further, ensuring that communities have sufficient year-round water supplies (a critical linkage to hygiene), and that schools and health facilities have adequate WASH facilities, remain major challenges.

Ways Forward
To harmonise, strengthen, and scale up CLTSH, the Federal Ministry of Health (FMoH) with support from UNICEF and the National Hygiene and Sanitation Task Force prepared draft guidelines on CLTSH and ODF verification protocol. These CLTSH guidelines are now in the process of being finalised, along with preparation of a CLTSH monitoring and reporting framework to improve information flow and management.

The GoE is also supporting a number of other strategic initiatives to further harmonise the hygiene and sanitation sector, and direct more resources into it. FMoH and its partners are in the process of finalising a National Hygiene and Sanitation Strategic Action Plan; a national hand washing strategy and campaign aimed at school children; revising and updating a Memorandum of Understanding between the Health, Education, and Water sectors to promote integrated WASH at all levels; expanding CLTSH into the four “Developing Regional States” where access to sanitation is very low and with limited access to the Health Extension Programme; and carrying out research to strengthen sanitation “upgrades” and engagement of the private sector. UNICEF, WSP, SNV, Plan International, and many other organisations are working closely with FMoH on all of these initiatives under the auspices of the NHSTF.