Community-Led Total Sanitation in East Asia and Pacific

Progress, Lessons and Directions

Progress, Lessons and Directions

Review of the status of community-led sanitation implementation in East Asia and Pacific, March 2013

Supported by UNICEF Community-Led Total Sanitation in East Asia and Pacific: Progress, Lessons and Directions

Cover photographs from left to right: © UNICEF Timor-Leste/2010/Mie Matsuo © UNICEF Myanmar/2013/Myo Thame © Kiribati/2013/Henry © UNICEF Myanmar/2013/Myo Thame

Design and layout: Quo, Bangkok, Thailand (www.quo-global.com)

UNICEF East Asia and Pacific Regional Office 19 Phra Atit Road Bangkok 10200 Thailand Tel: (66 2) 356-9499 Fax: (66 2) 280-3563 E-mail: [email protected] www.unicef.org/eapro

ISBN: 978-974-685-141-1 Preface

The latest 2012 Joint Monitoring Programme (JMP) Progress Recognizing the key role that Community-Led Total Sanitation on Drinking Water and Sanitation report shows that the East (CLTS) can play in eliminating open defecation and hence Asia and Pacific region has seen extraordinary improvements improving sanitation and hygiene, this regional review was in water supply and sanitation. In 2010, some 677 million undertaken as the first phase of a larger effort to better more people had access to improved drinking water than 20 understand: how CLTS implementation is working in the years ago. Today, 823 million more people now use improved region; why progress differs across and within countries; and sanitation facilities. what more could be done to support, improve and scale up CLTS as part of wider approaches to achieve sanitation and Despite the progress, pneumonia and diarrhoea remain hygiene objectives within the region. the biggest killers of children under five in the region. Most of the preventable child deaths occur in the poorest Open defecation must end. The Sanitation Drive to 2015 – a call to families. Malnutrition, which remains high, is a contributing end open defecation – urges us to tackle this issue by prioritizing factor. It is estimated that around 200 million people still support to the poorest and most marginalized populations. do not have access to improved water while 671 million people in East Asia and the Pacific remain without access Drawing extensively on the country-level experiences and to improved sanitation. Stark disparities between urban data, this report provides insights into some of the CLTS and rural populations, poorest and richest quintiles prevail. success factors, and offers recommendations for better An estimated 100 million people in the region still practice strategic planning to support wider and better quality uptake open defecation, with three countries from this region of CLTS in these countries. The document also provides an (Indonesia – 63 million, China – 14 million and Cambodia – 8.6 up-to-date summary of CLTS status, lessons and experiences million) among the 12 countries in the world with the largest from the region, and aims to help in accelerating efforts for populations practicing open defecation. reaching open defecation free (ODF) status and universal sanitation and hygiene improvement.

Community-Led Total Sanitation in East Asia and Pacific iii Acknowledgements Data Sources and Notes Main sanitation dataset: from Progress on Drinking Water and Sanitation: 2012 Update, WHO/UNICEF Joint Monitoring Programme for Water Supply The regional review of Community-Led Total Sanitation in East Asia and and Sanitation (JMP). Supplemented by data from the Pacific was commissioned by UNICEF East Asia and the Pacific, jointly nationally representative household surveys, such as with Plan International, WaterAid Australia and the World Bank’s World censuses, where these surveys have taken place since Bank’s Water and Sanitation Program – East Asia and the Pacific (WSP-EAP). the last JMP update. Andy Robinson, Water and Sanitation consultant, deserves huge credit for undertaking the review across 14 countries with multiple partners in the region Country-specific data: provided by country review and for preparing this report. The review was undertaken under the overall teams (including data from national and project leadership of Chander Badloe – Regional WASH Adviser, UNICEF East Asia monitoring systems, and supplementary information and Pacific Regional Office. The review greatly benefitted from the continuous from programme evaluations, research studies, support from Almud Weitz, Principal Regional Team Leader and Susanna interviews and personal communications by the author Smets, Senior Regional Water Supply and Sanitation Specialists from the WSP- with regional and national stakeholders). EAP; James Wicken, Head of Policy and Campaigns from WaterAid; and Hilda Winartasaputra, Regional WASH Specialist from Plan International. UNICEF does not warrant that the information contained in this publication is complete and correct This report has been produced based on experiences and lessons on the and shall not be liable for any damages incurred as a implementation of Community-Led Total Sanitation (CLTS) from Cambodia, result of its use. China, DPR Korea, Indonesia, Kiribati, Lao PDR, Mongolia, Myanmar, Philippines, Papua New Guinea, Solomon Islands, Timor-Leste, Vanuatu, and Viet Nam.

Special appreciation is noted for the innumerable colleagues at country level for generously providing their time and effort in collecting the country-level data on CLTS implementation and reviewing the draft country profiles with their respective Government and NGO partners (see Annex 1 for details on Country Review Teams).

iv Community-Led Total Sanitation in East Asia and Pacific 3. Recommendations 42 Contents 3.1 Improve CLTS enabling environments 42 3.2 Strengthen CLTS monitoring systems 42 3.3 CLTS quality 42 3.4 ODF sustainability 43 Acronyms vi 3.5 Latrine hardware subsidies 43 Executive Summary 1 3.6 Non-ODF communities 44 Introduction 7 3.7 Assistance to new CLTS countries 44 Objectives 7 3.8 Further research 44 Methodology 8

References 47 PART I: REVIEW OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS 13 PART II: COUNTRY OVERVIEWS 49 Cambodia 50 1. Findings 14 China 56 1.1 Country contexts 14 DPR Korea 59 1.2 Country CLTS overviews 16 Indonesia 62 1.3 CLTS enabling environment 24 Kiribati 68 1.4 Regional CLTS overview 30 Lao PDR 71 1.5 CLTS regional issues 33 Mongolia 76 Myanmar 80 2. Conclusions 38 Papua New Guinea 84 2.1 CLTS works 38 Philippines 89 2.2 Basic CLTS data not readily available 38 Solomon Islands 94 2.3 CLTS scale up takes time 38 Timor-Leste 98 2.4 Limited CLTS impact on national Vanuatu 105 sanitation coverage 39 Viet Nam 109 2.5 CLTS has influenced enabling environments 39 2.6 Sustainability of CLTS outcomes 40 Annex 1: Country Review Teams 115 2.7 CLTS variations within the region 40 Annex 2: Data from regional CLTS review 117 2.8 Is the role of CLTS being maximized in Annex 3: Evidence: ODF Sustainability 118 the EAP region? 40 Acronyms

ACF Action Against Hunger MDG Millennium Development Goal ADB Asian Development Bank MHAA Myanmar Health Assistant Association ADB CWSH Asian Development Bank Community Water Services and Health MoCM Ministry of City Management (DPR Korea) ADRA Adventist Development and Relief Agency MRD Ministry of Rural Development (Cambodia) AFMET Alliance of Friends for Medical Care in East Timor NAS Nak Akphivath Sahakum (Cambodia) ASDSW A Single Drop for Safe Water (Philippines) NGO Non-governmental organization AusAID Australian Agency for International Development NGP Nirmal Gram Puraskar (India) BESIK East Timor Rural Water Supply and Sanitation Program NPHCC National Patriotic Health Campaign Committee (China) BPL Below poverty line NTF Naroman Timor Foun (Timor-Leste) CAPS Center for Advanced Philippine Studies NTP National Target Program (Viet Nam) CATS Community Approaches to Total Sanitation OD Open defecation CESVI Cooperazione e Sviluppo (Italy) ODF Open defecation free CFED Cambodian Farmer Economic Development PAKSI Community Action Plan for Sanitation and Hygiene (Timor-Leste) CHED Cambodian Health Education Department PAMSIMAS Penyediaan Air Minum dan Sanitasi Berbasis Masyarakat (Indonesia) CLTS Community-Led Total Sanitation PHAST Participatory Hygiene and Sanitation Transformation CR-SHIP Cambodia Rural Sanitation and Hygiene Improvement Program PDRD Provincial rural development offices CSR Corporate Social Responsibility PNPM National Program for Community Empowerment (Indonesia) CVTL Cruz Vermelha de Timor-Leste PPSP Accelerated Sanitation Development for Human Settlements (Indonesia) CWS Church World Service PSI Population Services International DANIDA Danish International Development Agency RWC RainWater Cambodia DHS Demographic and Health Survey RWSS Rural Water Supply and Sanitation DILG Department of the Interior and Local Government (Philippines) RWSSH Rural Water Supply, Sanitation and Hygiene DNSAS National Directorate for Water Supply and Sanitation (Timor-Leste) SLTS School-Led Total Sanitation DNSSB National Directorate for Basic Sanitation Services (Timor-Leste) SNV Netherlands Development Organisation DOH Department of Health SSH4A Sustainable Sanitation and Hygiene For All DRHC Department of Rural Health Care (Cambodia) STBM National Strategy for Community-Based Total Sanitation EAP East Asia and Pacific TSC Total Sanitation Campaign (India) ETDA East Timor Development Agency TSSM Total Sanitation and Sanitation Marketing EOHO Environmental and Occupational Health Office (Philippines) TTU Touching the Untouchables (Papua New Guinea) EU-RWSSP European Union Rural Water Supply and Sanitation Programme UNICEF United Nations Children’s Fund GRET Research and Technological Exchange Group USAID US Agency for International Development GSF Global Sanitation Fund VIHEMA Viet Nam Health & Environment Management Agency GTZ German Technical Corporation (now GIZ) VIP Ventilated improved pit latrine HTL Hafoun Timor Lorosae (Timor-Leste) VWU Viet Nam Women’s Union HWWS Hand washing with soap WASH Water, sanitation and hygiene (sector) ICC International Cooperation Cambodia WCA West and Central Africa iDE International Development Enterprises WHO World Health Organization IEC Information, Education and Communication WSP World Bank Water and Sanitation Program IFRC International Federation of Red Cross YDD Yayasan Dian Desa (Indonesia) IRC International Rescue Committee YMP Yayasan Merah Putih (Indonesia) JMP WHO-UNICEF Joint Monitoring Program for Water Supply and Sanitation YPCII Yayasan Pembangunan Citra Insan Indonesia LGU Local Government Units ZOD Zero open defecation M&E Monitoring and Evaluation vi Executive summary

Introduction Methodology

Despite rapid economic growth, inadequate sanitation and hygiene remain The regional CLTS review was a remote review made possible by the significant problems in the East Asia and Pacific (EAP) region with many considerable assistance provided by the review teams established in each countries off-track to reach their Millennium Development Goal (MDG) country. The review teams were primarily comprised of UNICEF, Plan sanitation target by 2015. Around 100 million people in the region continue International, WaterAid and WSP water, santitation and hygiene (WASH) to practice open defecation, with three EAP countries – Indonesia, China specialists in the review countries, with additional assistance from key and Cambodia – among the 12 countries in the world that have the largest government staff in several countries. A country CLTS overview was populations practicing open defecation. prepared for each of the 14 review countries, and the information in these country overviews formed the main basis for the review. Supplementary Community-Led Total Sanitation (CLTS) is a community-wide behaviour information was obtained through questions to the country review teams change approach that mobilizes communities to undertake their own and interviews with key national and regional informants that filled gaps appraisal and analysis of sanitation issues and take their own actions to and helped improve understanding of key issues. become open defecation free (ODF). CLTS is now being promoted in 50 countries across Asia, Africa and Latin America. Plan International, UNICEF, Review limitations WaterAid, Water and Sanitation Program (WSP), Institute of Development Studies (IDS) and the CLTS Foundation, as well as many other The regional CLTS review commenced in mid-July, allowing only six weeks organizations, have been supporting CLTS in East Asia and the Pacific, with for the compilation, processing and review of relevant documentation CLTS now being implemented across 12 countries in the region. and data before the Third East Asia Minsisterial Conference on Sanitation and Hygience (EASAN-3), held in Bali in September 2012. The different Little formal monitoring, reporting or analysis of CLTS progress in the stages of CLTS progress in each country, and the different levels of CLTS region has been carried out. This regional CLTS review was envisaged by investment and priority, meant that the volume and quality of the its supporters – UNICEF, WaterAid Australia, Plan International and the CLTS information available within the short timeframe of the review Water and Sanitation Program (WSP) – as the first phase of a larger effort varied significantly. to understand better how CLTS implementation is working in the region, why progress differs across and within countries, and what more could be done to support, improve and scale up the use of CLTS approaches to achieve regional sanitation and hygiene objectives.

Community-Led Total Sanitation in East Asia and Pacific 001 Presentation of review findings introduced was ranked for the 14 indicators examined in the country CLTS overviews, and the ranking scores were then aggregated. No effort The initial findings of the regional CLTS review were discussed with was made to score or weight these indicators to reflect their relative the regional review partners on arrival in Bali, and were then presented importance, as the intention was simply to gain some idea of relative CLTS informally at the EASAN-3 side event on CLTS and Scaling Up Rural performance across the review countries. Sanitation held on 08-09 September 2012. The findings were also formally presented at a parallel session of the main EASAN-3 conference on 11 The regional CLTS ranking (see figure following) orders the review September 2012. countries according to the date of CLTS introduction. The review found that the two early adopting countries (Cambodia and Indonesia) and Timor- Leste performed better in almost every area examined: FINDINGS • more CLTS spread; • greater CLTS scale; The review covered 14 countries in the East Asia and Pacific region. • higher CLTS effectiveness; and • better CLTS enabling environments.

East Asia South-East Asia Pacific The mid-term adopting countries took the next four places in the regional 1. China 4. Cambodia 11. Kiribati 2. DPR Korea 5. Indonesia 12. Papua New Guinea ranking, led by Viet Nam and Lao PDR, with Myanmar, despite only 3. Mongolia 6. Lao PDR 13. Solomon Islands introducing CLTS in 2010, closing in on the rankings of Papua New Guinea 7. Myanmar 14. Vanuatu and the Philippines. Unsurprisingly, the late adopting countries where 8. Philippines little or no implementation had taken place – Mongolia, Solomon Islands, 9. Timor-Leste Kiribati and China – filled the bottom rankings. 10. Viet Nam Key findings

The 14 review countries, show open defecation (OD) rates varying from The review data show that CLTS has scaled well in two early adopting 0-72 per cent: countries, with Cambodia and Indonesia triggering 2,000-7,300 rural • less than 10 per cent OD in DPR Korea, China, Vanuatu, Viet Nam communities; and reveal that Myanmar has joined the five mid-term and Myanmar. countries in implementing CLTS in 200-850 rural communities since 2008. • 10-30 per cent OD in Philippines, PNG, Kiribati and Mongolia Little progress has been made outside these eight countries, due to the • 30-50 per cent OD in Solomon Islands, Timor-Leste, Indonesia and Lao PDR recent introduction in Mongolia, Solomon Islands and Kiribati, and the on- • 72 per cent OD in Cambodia going re-introduction of CLTS in China.

Of the 14 countries, two of them (DPR Korea and Vanuatu) have yet to In all, 3.1 million people across the 14 review countries were reported to implement CLTS. Each of the 12 review countries in which CLTS has been live in ODF communities. However, despite this significant achievement,

002 Community-Led Total Sanitation in East Asia and Pacific Overall ranking of the CLTS review countries (by date of CLTS introduction)

0 20 40 60 80 100 120 Spread: geographical

Cambodia Spread: institutional (2004)

Indonesia Scale: OD population (2005) Timor-Leste Scale: triggered communities (2007) Viet Nam Scale: ODF communities (2008) Lao PDR Scale: CLTS capacity (2008) Papua New Guinea Enabling: CLTS policy (2008) Philippines Enabling: CLTS planning (2008) Myanmar Enabling: CLTS finance (2010) Enabling: CLTS integration Mongolia (2011) Enabling: CLTS monitoring Solomon Islands (2012) Effectiveness: ODF success rate Kiribati (2012) Effectiveness: triggered China communities per facilitator (2005 and 2012) progress has been quite slow. Optimistic progress reports presented at the A comparison of the number of communities triggered against the number 2009 Regional Workshop on CLTS in the South-East Asia and Pacific, held in of trained CLTS facilitators confirms the greater implementation efficiency Cambodia,1 suggested that CLTS would have made significant impacts on of the two early adopting countries and Timor-Leste (see Figure 1.7): all national sanitation coverage in both Indonesia and Cambodia before 2012. three report more than eight triggered communities for every facilitator trained, whereas the other countries report an average of around one The review found a surprising consistency in the national ODF success triggered community per trained facilitator. rates reported across the East Asia and Pacific region (see Figure 1.5): • early adopters and Timor-Leste reported 34-36 per cent ODF success rates; The review of CLTS enabling environments highlighted the large amount • mid-term adopters reported 17-22 per cent ODF success rates; and of work still required to strengthen and improve enabling environments • two late adopters reported only 5-10 per cent ODF success rates. across the region. However, the review also showed the progress made by 1 About 60 participants from eight countries in the EAP region gathered in November 2009 in Phnom the two early adopting countries and Timor-Leste, which all now Penh to discuss CLTS progress and issues: http://www.communityledtotalsanitation.org/resource/ regional-workshop-clts-south-east-asia-and-pacific-region

Community-Led Total Sanitation in East Asia and Pacific 003 have sanitation policies supportive to CLTS, and are making progress in 4. CLTS has had limited impact on national sanitation coverage improving other key areas of the CLTS enabling environment. The review suggests that the lack of national impact is the result of ad hoc implementation and limited government investment in CLTS – few of the Surprisingly, given that as many as 3.1 million people are now living in ODF review countries have national strategies for CLTS, provide government communities, the review found that none of the national governments in the finance to national CLTS programmes, or have developed formal CLTS 14 review countries have financed large-scale CLTS programmes. While rural capacity development or monitoring systems. sanitation finance remains generally low in the region, where governments have invested in rural sanitation, they have financed the provision of 5. CLTS has influenced enabling environments latrine hardware subsidies, often either in similar areas to existing CLTS The review confirms that the early adopting countries have made programmes, or explicitly linked to CLTS activities in order to take advantage significant progress in improving CLTS enabling environments since CLTS of the sanitation demand created. was introduced. While it is hard to determine what drove these reforms, this review argues that CLTS has had a significant influence on national discussions on sanitation finance, technical standards, sustainability, cost- CONCLUSIONS effectiveness, scaling up, equity and targeting.

1. CLTS works 6. Sustainability of CLTS outcomes The review confirms that CLTS is working in East Asia and the Pacific. CLTS An analysis of seven recent studies of ODF sustainability in Africa, South has already spread to 12 countries, triggered sanitation improvements in Asia and South-East Asia suggested that the sustainability of ODF and more than 12,000 rural and peri-urban communities, and led to more than other CLTS outcomes was linked to the quality of the CLTS process. While 3.1 million people living in 2,300 ODF communities. intuitive, the review of these studies confirmed that sustainable outcomes can be achieved by CLTS interventions, and that widespread reversion to 2. Basic CLTS data are not readily available OD is not an inevitable result of CLTS. CLTS monitoring remains a significant weakness, at both national and project levels. The review found that, in most countries, even basic CLTS 7. CLTS variations within the region progress data were not readily available. Few countries have mechanisms The review found that Indonesia has responded to its rural sanitation that require routine reporting or analysis of monitoring data, thus there is challenge well, making more CLTS progress since 2005 than all of the other little demand for the data. review countries combined: 2.3 million people in Indonesia are now living in ODF communities, 72 per cent of the total ODF population in the region. 3. CLTS scale up takes time Timor-Leste was another strong CLTS performer. Despite only introducing The review findings suggest that CLTS spread, scale and effectiveness CLTS in 2007, Timor-Leste was found to have one of the best CLTS have taken time to develop, but that CLTS progress appears remarkably programmes in the region, and is the only country reviewed where CLTS is consistent despite the very different contexts and challenges found across thought to have made a significant impact on national sanitation coverage. the review countries.

004 Community-Led Total Sanitation in East Asia and Pacific In contrast, few of the Pacific island states introduced CLTS until relatively C. CLTS quality recently. As in other countries previously, experiences in Papua New The review recommends more detailed monitoring and assessment of Guinea and the Solomon Islands now suggest that cultural differences do CLTS implementation quality and capacity development. More effort not prevent CLTS from working, and that the approach has great potential needs to be made to track the number of trained facilitators that become in remote island communities where market goods and services are active, and assess the relative effectiveness of active facilitators and expensive and hard to access. support staff. Analysis of the factors that lead to higher ODF success rates and more sustainable outcomes – for instance, why outcomes are 8. Is the role of CLTS being maximized in the EAP region? better in one programme area than another – should be an essential part The main conclusion of the review is that the potential of CLTS in the East of any CLTS intervention. Asia and Pacific region has not been maximized. While the review found that CLTS is working and spreading, progress has been much slower than D. ODF sustainability anticipated even in the early adopting countries. The review highlighted a strong regional demand for information on ODF sustainability and, therefore, recommends that further work is undertaken to collate ongoing and recently completed studies on ODF sustainability RECOMMENDATIONS within the EAP region.

A. Improve CLTS enabling environments E. Latrine hardware subsidies Scaling up CLTS progress and improving CLTS effectiveness and The next phase of the regional CLTS review would make a significant sustainability will be dependent on the further strengthening of enabling contribution to the sub-sector if it was able to clarify and disseminate environments for rural sanitation in the review countries. Few governments better the existing evidence base on latrine hardware subsidies (and smart or development partners in the region have yet to develop strategic subsidies), and encourage greater and more rigorous efforts to evaluate sanitation plans that elaborate the role of CLTS in creating large-scale ongoing and completed latrine subsidy and CLTS programmes, and demand for sanitation, or financed national implementation programmes compare the results. that combine CLTS with other approaches. F. Non-ODF communities B. Strengthen CLTS monitoring systems It is recommended that the next phase of the regional CLTS review should The review recommends more detailed monitoring and evaluation of examine appropriate post-CLTS strategies and programme options for these CLTS progress and effectiveness. The main problem seems to be the triggered but non-ODF communities, and compile more reliable data on the lack of mechanisms that encourage the regular collection, analysis and extent and sustainability of the sanitation gains made in these communities. reporting of CLTS or other sanitation performance data. Annual strategic reviews, ideally linked to the monitoring of CLTS progress against strategic G. Assistance to new CLTS countries sanitation targets, and local government benchmarking systems are The review recommends that the agencies supporting the regional useful mechanisms for pulling monitoring data and reports up through CLTS review should take a proactive role in the Pacific to provide CLTS government and programme systems. assistance and guidance in order to accelerate progress and effectiveness

Community-Led Total Sanitation in East Asia and Pacific 005 gains in these new CLTS countries. In particular, lessons from the rapid and helped or hindered their scale, effectiveness and sustainability. It is also relatively successful development of CLTS in Timor-Leste are likely to be recommended that visits be made to some of the countries that have relevant to these small Pacific island states. either recently or not yet introduced CLTS – perhaps two of the Pacific island states and one of the three East Asian states – in order to examine H. Next stage of the regional CLTS review how best to use the learning from the rest of the region to speed up CLTS A second phase of the regional CLTS review would enable the more development and accelerate progress. detailed and specific study required to respond to the strong demand for more detailed knowledge about how best to strengthen CLTS enabling A large number of issues were highlighted for further study through the environments, improved CLTS effectiveness, tackle sustainability concerns, second phase of the review. The body of the report includes two lists: the complement CLTS with other approaches, and accelerate scaling up. first comprises review areas that require more detailed documentation of data and knowledge that is available, but which was not possible to collect This first phase of the review recommends that in-country visits should be or document in the short time available to the first phase of the review; and made to the three highest performing countries – Indonesia, the second list is of areas that require further investigation and assessment, Timor-Leste and Cambodia – to understand better the evolution of CLTS and may require some primary research. approaches and programmes in each country, and the factors that have

006 Community-Led Total Sanitation in East Asia and Pacific Introduction

Community-Led Total Sanitation (CLTS) is now being promoted in more further review or research activities will be informed by the findings of this than 50 countries in Africa, Asia and Latin America. The rapid spread and regional CLTS review. scaling up of this innovative approach to triggering sanitation improvement is remarkable, but it has been suggested that CLTS progress in Asia – the The review partners recognize that the CLTS approach is only one part of birthplace of CLTS – has been slower than recent progress in Africa. the broader set of interventions and activities required to develop, scale up and sustain sanitation improvements in the region. Supply strengthening, Despite rapid economic growth, inadequate sanitation and hygiene enabling environment improvement, and other forms of sanitation demand remain significant problems in the East Asia and Pacific (EAP) region creation will be critical to the sector’s combined efforts to achieve regional with many countries off-track to reach their MDG sanitation target and national sanitation objectives. Nonetheless, CLTS has spread rapidly by 2015. Around 100 million people in the region continue to practice and become an important approach in the region, thus the review partners open defecation, with three EAP countries – Indonesia, China and felt there was value in better understanding how CLTS is performing, Cambodia – among the 12 countries in the world that have the largest and whether more could be done to maximize its potential and its populations practicing open defecation. complementarity with other key approaches to sanitation improvement.

The use of CLTS approaches is growing in the EAP region, but it has not yet been introduced in some countries, and in other countries resistance to Objectives the non-subsidy CLTS principle is thought to have limited its growth and success. Anecdotal reports of sustainability problems, including latrine The main purpose of the regional CLTS review is to provide detailed durability issues and reversion to open defecation, may threaten scaling up information on the current status of CLTS implementation in 14 countries in and institutionalization of the CLTS approach. the region,2 and to aggregate and analyse the findings from these country CLTS overviews into a regional review report that summarizes the key However, little formal monitoring, reporting or analysis of CLTS progress in successes, issues and challenges. the region has been carried out. This regional CLTS review was envisaged by its supporters – UNICEF, WaterAid Australia, Plan International and the The country CLTS overviews are designed to highlight the strengths and Water and Sanitation Program (WSP) – as the first phase of a larger effort weaknesses of CLTS implementation in each different national context; to understand better how CLTS implementation is working in the region, assess whether CLTS principles have been included in national policies, why progress differs across and within countries, and what more could strategies and programmes; and establish potential bottlenecks to the be done to support, improve and scale up the use of CLTS approaches scaling up and improvement of CLTS implementation. to achieve regional sanitation and hygiene objectives. The design of any 2 Cambodia, China, Indonesia, Kiribati, DPR Korea, Lao PDR, Mongolia, Myanmar, Papua New Guinea, Philippines, Solomon Islands, Timor-Leste, Viet Nam and Vanuatu. Community-Led Total Sanitation in East Asia and Pacific 007 The review partners agreed that their main long-term research objective is Each country CLTS overview included the following sections: to gain a better understanding of the reasons for differential CLTS progress, and differential general progress in scaling up rural sanitation improvement, 1. Summary table (with regional ranking for main indicators) across the region in order to maximize the potential of CLTS. To understand 2. JMP rural sanitation data (including OD population) why things have happened, the review must first try to document what has 3. CLTS history and geographical spread happened and identify any gaps in the knowledge and evidence base. This 4. CLTS institutional spread (including major exceptions) review is, therefore, the first phase in a longer term review effort, and has 5. CLTS variations and practice the secondary objective of identifying areas that require further and more 6. CLTS scale (number of ODF communities and size of ODF population) detailed review and research. 7. CLTS capacity 8. ODF success rate The timing of the regional CLTS review was designed to utilize the gathering 9. CLTS impact on national coverage of regional sanitation stakeholders at EASAN-3 in Bali, first at the side 10. CLTS enabling environment (including comments on policy, strategy, event held from 8-9 September 2012 and then at the main conference held finance, integration with other approaches, and monitoring) from 10-12 September, as an opportunity to present, discuss and verify the 11. CLTS weaknesses and bottlenecks review findings. 12. CLTS strengths and opportunities

The country CLTS overviews were based on information taken from Methodology the documents provided by the country review teams, which included programme progress reports, evaluations, research studies, monitoring The regional CLTS review was a remote review that was only made reports, and project publications; with supplementary information obtained possible by the considerable assistance provided by the review teams through specific questions to the country review teams and to key national established in each country during the inception phase. The review teams and regional informants in order to fill in any gaps and better understand were primarily comprised of UNICEF, WaterAid, WSP and Plan WASH key issues. specialists in the review countries, with additional assistance from key government staff in several countries. Annex 1 details the composition of Review limitations the review teams involved in each country. The regional CLTS review commenced in mid-July, allowing only six weeks for the compilation, processing and review of relevant documentation and Country CLTS overviews data. In addition, the different stages of CLTS progress in each country, and A standard template for the country CLTS overviews was agreed by the the different levels of CLTS investment and priority, meant that the volume regional review team following an initial examination of the documents and and quality of the CLTS information available within the short time frame of data provided by the country review teams. The overview template was the review varied significantly. limited by the information available across the majority of the countries, and by the desire to keep the overviews concise and easy to read. Despite ODF sustainability being a major topic of interest, little evidence or information were available because few countries in the region have

008 Community-Led Total Sanitation in East Asia and Pacific sufficient CLTS history to generate a representative selection of ‘older’ ODF achieve ODF status; and that there remains limited hard evidence that ODF communities that could be studied, and few countries or programmes have status confers significantly higher benefits than, say, 80 per cent improved invested in this sort of research. sanitation coverage.

Another area of weakness was the reporting of ODF community status. There are two main reasons for the focus on ODF progress: the first is In some cases, monitoring data reported numbers of self-declared ODF practical – few programmes are able to provide reliable data on incremental communities; in other cases different implementing agencies certified ODF increases in sanitation coverage following CLTS interventions, as this status but each applied different ODF criteria in their project or programme information requires detailed baseline coverage data, which is rarely collected, areas, sometimes with local government assistance and sometimes aggregated or well documented; furthermore, the assessment of coverage without; and, in a few cases, national ODF verification processes have been gains from CLTS interventions also raises complex questions of contribution developed and are being implemented, but even here the national expansion and attribution (particularly when parallel programmes, such as sanitation of the systems is on-going, and it proved difficult to separate out verified marketing projects, are promoting sanitation; or when rapid economic growth ODF communities from declared but non-verified ODF communities. has resulted in high background rates of sanitation progress).

The country CLTS overviews and regional CLTS review reflect the number In contrast, ODF progress is relatively easy to measure, as a baseline is of ODF communities reported by the country review teams on the basis that rarely required; and it is usually one of the key indicators monitored by these are the best data available within the short timeframe of this review. CLTS interventions. In some cases, these data will include self-declared ODF communities that may not be 100 per cent ODF, thus over-estimate progress; and in other The second reason for focusing on ODF progress is more abstract: one cases the reported numbers reflect national monitoring systems that have of the key differences between the CLTS approach and conventional not been recently updated, or do not capture progress made by some sanitation improvement approaches is the aim of achieving an ODF non-government stakeholders, thus under-estimate progress. Additional community (or larger population unit). This community-wide or collective work (and time) will be required to update, extend and clean the national sanitation outcome requires that every household and individual stops OD monitoring data, and to look more deeply into the number and proportion of and uses a hygienic sanitation facility – one that separates human excreta ODF communities that have been reliably verified and, ideally, re-verified to from human contact – which means that interventions have to be inclusive, check the sustainability of the reported sanitation improvements. and encourages approaches that reach poor and vulnerable households. It has already been noted that CLTS interventions do not always succeed Focus on ODF progress in this aim, but the ODF concept is one of the defining characteristics of The country CLTS overviews deliberately focused on ODF achievement as the CLTS approach, and is becoming an important strategic goal for local the main indicator of CLTS progress. Some stakeholders have questioned and national governments with the explicit objective of achieving universal this focus, noting that ODF success rates3 remain relatively low in the EAP sanitation coverage. region, hence the majority of CLTS ‘triggered’ communities do not

3 ODF success rate = proportion of triggered communities that are successful in achieving ODF status.

Community-Led Total Sanitation in East Asia and Pacific 009 Durability of CLTS latrines Several reviewers suggested that some of the indicators would be more There remains some debate on the durability and benefits of the simple relevant if reported relative to population size – notably the number of latrines often built as a result of CLTS interventions, reinforced by the communities triggered and ODF, and the number of facilitators trained, suggestion that some of the latrines built may not be hygienic, and the as these three indicators would be expected to be much higher in larger understanding that ODF achievement sometimes relies on shared use countries, while lower indicator scores would be more significant at a of household latrines. The review process collated evidence of latrine national scale in smaller countries. In practice, the relative novelty of durability and sustainability problems, but was unable to talk to the issue CLTS in the region meant that few large countries benefitted from the use of whether the latrines were hygienic or not, or the effect of latrine sharing, of absolute indicators, while one of the smallest – Timor-Leste – ranked due to the lack of documentation or evaluation material available on these second overall reflecting the counter-balancing provided by the other 11 topics. Further work will be required to investigate these prominent issues. indicators. Therefore, the country CLTS overviews retained the absolute summary indicators, but elaborated relative performance in the text CLTS regional ranking sections that followed. The country CLTS overviews ranked CLTS status and performance using 14 indicators, which were broadly divided into four categories: In general, the country CLTS overviews focused on the information • CLTS status (date of introduction, geographical spread, institutional spread) available, with the intention that the regional review report would draw • CLTS scale (OD population, communities triggered, ODF communities, attention to key issues that were not well documented at national level, facilitator capacity developed) or to elaborations that were not well suited to the concise format of the • CLTS enabling environment (policy, plans, finance, integration and country CLTS overviews. monitoring) • CLTS effectiveness (ODF success rate, communities triggered per facilitator) Country CLTS overview consultation process Draft country CLTS overviews were submitted to the country review teams Each indicator was ranked for each country, and these rankings were then in the week preceding the EASAN-3 side event. The country review teams added up to allow an overall ranking which was intended to provide a were tasked with ensuring that key government officials were able to review simple estimate of overall CLTS status and performance. and comment on the draft overviews, and for compiling review comments from key stakeholders at national level. Ten out of the 14 country review The CLTS review indicators were selected based on the information that teams provided formal written comments on the draft overviews, with as was readily available for each country, and on a brief analysis by the many as seven sets of review comments provided by some countries. regional review team of the major factors that influence CLTS status and performance. No effort was made to weight the indicators according to As the draft overviews were almost entirely based on the documentation their relative importance, or to develop a theory of change on which the and data provided by the country review teams, there were few major indicator framework could be based.4 revisions required. A full set of draft country CLTS overviews was sent to each country review team prior to the EASAN side event, and it was

4 Initial investigations and consultations with key informants suggested that there were no relevant noted that several EASAN country delegations included elements of the theories of change that could be easily applied, thus it was decided to keep the indicator and draft overviews in their official presentations to the EASAN-3 conference. ranking system as simple and transparent as possible.

010 Community-Led Total Sanitation in East Asia and Pacific Regional CLTS analysis Presentation of review findings The regional review findings were based on a comparative analysis of the The initial findings of the regional CLTS review were discussed with country CLTS overviews, supplemented with information obtained from a the regional review partners on arrival in Bali, and were then presented review of regional and global CLTS documents, and by interviews with key informally at the EASAN-3 side event on CLTS and Scaling Up Rural regional stakeholders. Sanitation held on 8-9 September 2012, which was jointly planned and supported by the Institute of Development Studies (IDS), UNICEF, The regional analysis recognized that the data available from the country WaterAid, Plan and WSP, and the findings were also formally presented at CLTS overviews and regional review related largely to national and a parallel session of the main EASAN-3 conference on 11 September. programme processes and outcomes, with little reliable information or evaluation data available on the reasons for the different outcomes found Feedback on the country CLTS overviews and the regional review findings in different countries. Furthermore, even these findings were collected was obtained from many of the 60 participants at the side event, and from through a rapid review process that may have overlooked some relevant other EASAN-3 participants who attended the parallel session. Specific and important information. efforts were also made to discuss data gaps and national issues that required further elaboration with the country review teams and national Therefore, the regional analysis concentrates on what can be learnt delegations. Additional data has been provided by three countries since from a comparison of the different outcomes found by the review, with the EASAN-3, and have been incorporated into the final country CLTS a deliberately superficial analysis provided of the proximate or ultimate overviews and the regional review report. causes of these outcomes and differences. It should be understood by the reader that any deeper analysis in a second stage of the review would The regional review partners (UNICEF, WaterAid Australia, Plan require a more thorough and specific research process, including visits by International and WSP) held a wrap-up meeting on 12 September to reflect the review team to the key countries under review. on the feedback to the regional review findings, and to plan the next steps of the review. It was agreed that the review partners should follow up on the development of knowledge packages on key issues such as national ODF verification processes, and identify one major regional research issue on which the regional review partners could collaborate.

Community-Led Total Sanitation in East Asia and Pacific 011 © Kiribati/2013/Henry PART I

REVIEW OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS 1. Findings

The review covered 14 countries in the East Asia and Pacific region. Efforts 1.1 Country contexts were made to cover as many countries in the region as possible, but the final selection was limited to those countries where sanitation remains The review highlighted the significantly different contexts and sanitation a major challenge (which excludes Brunei Darussalam, Japan, Malaysia, situations found across the region. Table 1.1 summarises some key Singapore, Republic of Korea, Thailand), and to countries that were able to development indicators: with population ranging from 100,000 people to provide sanitation information to the review. 1.3 billion; gross national income (GNI) per capita from US$ 760 to US$ 4,260; the proportion below the international poverty line (US$ 1.25 per day) from 13-37 per cent; and under-five mortality rates from 14-66 deaths East Asia South-East Asia Pacific per 1,000 live births. 1. China 4. Cambodia 11. Kiribati 2. DPR Korea 5. Indonesia 12. Papua New Guinea Table 1.1 Key development indicators (ranked by population) 3. Mongolia 6. Lao PDR 13. Solomon Islands

7. Myanmar 14. Vanuatu Country Population GNI per capita Poverty (% below Stunting 8. Philippines (2010) US$ (2010) $1.25) (%)5 East Asia 9. Timor-Leste China 1,341.3 million $4,260 16% 10% 10. Viet Nam DPR Korea 24.3 million - - 32% Mongolia 2.8 million $1,890 22% 27% South-East Asia The findings are presented starting with a comparative analysis of progress Cambodia 14.1 million $760 28% 40% Indonesia 239.9 million $2,580 19% 37% for each parameter examined by the 14 country CLTS overviews, followed Lao PDR 6.2 million $1,010 34% 48% by the overall regional findings from these analyses. The next section Myanmar 48.0 million - - 35% examines specific regional CLTS issues raised in the review countries and, Philippines 93.3 million $2,050 23% 32% where relevant, in other regions; including a brief comparative analysis Timor-Leste 1.1 million $2,220 37% 58% Viet Nam 87.8 million $1,100 13% 31% of the EAP regional review findings against those from a similar UNICEF Pacific review undertaken in West and Central Africa. The last section presents Kiribati 0.1 million $2,010 - - some initial thoughts on the drivers, bottlenecks and other factors that Papua New Guinea 6.9 million $1,300 36% 43% might explain the differences in progress and experiences reported across Solomon Islands 0.5 million $1,030 - 33% Vanuatu 0.2 million $2,760 - - the region. Total 1,866.6 million

Source: UNICEF online statistical information (accessed September 2012). 5 Moderate and severe (latest data available from www.childinfo.org). 014 Community-Led Total Sanitation in East Asia and Pacific Figure 1.1Ruralpopulationpracticingopendefecation(percent) Community-Led Total Sanitation inEast Asia andPacific • this ODpopulation residesinthreeof thereviewcountries: people practicingODin21 millionhouseholds.Remarkably, 83per centof In total,the14reviewcountries containaruralpopulationof85million • • • • situation inthe14reviewcountries,withODrates varying from0-72percent: As showninFigure1.1,therearealsodramaticvariations inthesanitation Source: JMPprogressreport,2012. Papua NewGuinea Solomon Islands Indonesia: 48.1 millionODruralpopulation (57percentregional total) 72 percentODinCambodia. 30-50 percentODinSolomonIslands,Timor-Leste, Indonesia,andLaoPDR 10-30 percentODinPhilippines,PapuaNewGuinea, Kiribati,andMongolia and Myanmar less than10percentODinDPRKorea,China,Vanuatu, Viet Nam, T Philippines DPR Korea imor Cambodia Indonesia Myanmar Mongolia V Lao PDR V iet Nam Kiribati anuatu -Leste China 0% 0% 2% 2% 6% 8% 12% 18% 21% 26% 33% 36% 36% 29% 41% 19% 20% 26% 19% 42% 44% 72% 29% 40% 41% 9% 45% 25% 38% 46% • • • population usingimprovedandunimprovedsanitation facilities: Figure 1.1alsoillustratessomevariationsintheproportions oftherural • • Cambodia and LaoPDR. less than10per centunimprovedorshared sanitationcoverage in Viet Nam,andDPRKorea) countries (Indonesia,Solomon Islands,Kiribati,Philippines,Myanmar, 15-39 percentunimproved andsharedsanitationcoverageinsix countries (Timor-Leste, Mongolia,PapuaNewGuinea,Vanuatu, andChina) over 40percentunimprovedandsharedsanitation coverage infive Cambodia: 8.1millionODruralpopulation(10per centregionaltotal). China: 13.5millionODruralpopulation(16percent regionaltotal) 60% 73% 71% 69% 68% 8% 56% 54% 80% 50% 50% 41% 39% 29% 29% 20% 18% 100% Improved sanitation Unimproved sanitation OD lessthan10% OD 10%to29% OD 50%to30% OD morethan50% 015

PART I 1. Findings 8 in China; while in the Solomon 7 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total ); UNICEF was involved in China and Myanmar, and Myanmar, ); UNICEF was involved in China 6 Through a number of mechanisms, including study tours to countries where CLTS had study tours to countries where CLTS Through a number of mechanisms, including Kar), and extensive knowledge trainers (including Dr. already scaled up, hiring of key CLTS management and advocacy efforts. Supply and Sanitation Collaborative Council. Water immediately after EASAN in September 2012, Timor-Leste Kar made his first visit to Dr. after it learned that he would be following a request from the government of Timor-Leste the attending the regional conference in Bali (which is only a two-hour flight from Dili, capital of Timor-Leste).

with significant support from WSSCC 6 7 8 Islands, CLTS was introduced as a direct result of an initiative by an was introduced as a direct result of an initiative by Islands, CLTS sector. individual working in the WASH – was involved in Kamal Kar – the originator of CLTS Dr. Remarkably, of these development process in eight introducing or supporting the CLTS training courses in six countries, and conducted countries. He ran CLTS high-level government official in policy and advocacy workshops with island states (Kiribati, Papua New another two. Only the three Pacific Kar. not visited by Dr. were Timor-Leste Guinea, and Solomon Islands) and CLTS was first introduced into China by Plan International in 2005, but 2005, but in International by Plan China into introduced was first CLTS overriding pilots due to after the initial was not adopted the approach No further approaches. for subsidy-based and NGO support government UNICEF and government July 2012, when was made until progress in Jilin province workshop training CLTS organized another counterparts (CATS) Sanitation to Total Approaches capacity for its Community to build villages of five provinces. programme in 50 processes introduction a range of different CLTS The review revealed responsible reflecting the diverse stakeholders and purposes, perhaps least four cases, into these 12 countries. In at for introducing CLTS programmes into their country introduced CLTS international NGOs in Cambodia, WaterAid in other countries (CONCERN in following success Nam); in three other Guinea, SNV in Viet Oxfam in Papua New Timor-Leste, or either as part of a larger programme countries, WSP introduced CLTS sanitation” programme (Indonesia, as a precursor to a “scaling up rural Philippines and Lao PDR 2012 Kiribati Solomon Islands China-2

This year China: CLTS reintroduced China: CLTS 2011 Mongolia

1 year ago 2009 2010 Myanmar

2 years ago China: CLTS reintroduced China: CLTS Lao PDR Philippines Papua New Guinea Nam Viet 2008

4 years ago Timor- Leste

2007 2006

5 years ago China-1 Indonesia

2005

7 years ago Date of CLTS introduction CLTS Date of overviews CLTS Country 2010-12 ‘Late adopters’: Myanmar, Mongolia, Kiribati, Solomon Islands, Mongolia, 2010-12 ‘Late adopters’: Myanmar, and China 2007-08 ‘Mid-term adopters’: Timor-Leste, Lao PDR, Philippines, Papua Lao PDR, 2007-08 ‘Mid-term adopters’: Timor-Leste, Nam New Guinea, and Viet 2004-05 ‘Early adopters’: Cambodia and Indonesia 2004-05 ‘Early adopters’: Cambodia Cambodia

2004 8 years ago 016 • • The timeline suggests three groups: • Timeline: Date of introduction of CLTS Date of introduction Timeline: CLTS was first introduced into the region in 2004, reaching 12 of the 14 in 2004, reaching into the region first introduced was CLTS Korea and DPR below. as illustrated in the timeline figure countries by 2012 CLTS examined by the review where were the only two countries Vanuatu had not been introduced. 1.2.1. 1.2

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific 9 constrains programmespread been introduced,intheunderstandingthatgeographicaltargetingoften number ofprovincesordistrictstowhichCLTS implementationhad (see Sections1.2.4and1.2.5),withthisindicatorusedtoexaminethe countries reviewed.ThescaleofCLTS activitywasmeasuredseparately The reviewalsoexaminedtheextenttowhichCLTS hasspreadwithinthe 1.2.2 geographical spread. the Philippines,largerprogrammesareplannedthat willincreasethe WSP andPlanprogrammeareas.However, inCambodia,Viet Namand Philippines, withimplementationtodateconfined totherelativelysmall two-thirds ofthecountry. TherearenomajorCLTS programmesinthe of UNICEF, SNV, PlanandWorld Vision, whichhavenotyetreached Viet Nam,CLTS interventionsareconcentratedintheprogrammeareas yet implementingintheNorth-EasternandSouthern provinces.In provinces ofthecentralandTonle Saplakeareas,withfewprogrammes Most ruralsanitationinterventionsinCambodiaareconcentratedthe processes andprogrammeenvironmentsinthesecountries. the differencesinrateofspreadreflectdifferentCLTS evolution Viet NamandthePhilippines(29percent10cent).Ingeneral, spread hasbeenrelativelylowinCambodia(48percent),andis term adoptingcountries,buthighlightedsomeanomalies:geographical The reviewconfirmedthatCLTS hasspreadfurthestintheearlyandmid- in eachsub-nationalunit. country evenifimplementationwasonlyinafewlocationsorcommunities recognized countrieswhereCLTS hadbeenintroducedthroughoutthe

six ruralprovinces whereUNICEFfocuseditssupport. and theUNICEF SethKomaWASH programmeinCambodia,which introducedCLTS tothe in all29districts withintheprovince,didnotfinance anyimplementationin other provinces; For example,the2007-2011WSP TSSMprogrammeinEastJava,whichwasimplemented Geographical spread 9 tospecificprovinces.Thisindicator 100 Figure 1.2GeographicalspreadofCLTS implementation (per centofprovinces) the growing institutional supportfor CLTS. were known to beactivelypromoting orimplementingCLTS –confirmed The dataoninstitutional spread –thenumberofsectororganizationsthat 1.2.3 indicators, suchastherateofstunting,suggestthat theneedisgreatest. targeting ofCLTS interventionstoareaswhere ODratesandhealth in somecountries,andtounderstandbetterthefactors thatencourage Further workisrequiredtoexaminethereasonsbehind thelimitedspread influence ontargetingcriteriathansanitationstatus. where ruralwatersupplystatusandroadaccessoften haveabigger interventions aresometimesincludedinbroader WASH programmes, show demandandcommitmenttosanitationimprovement. However, CLTS high ratesofopendefecationandareaswheresub-nationalgovernments country andprogramme,mostsanitationprogrammestargetareaswith While thereasonsbehindgeographicalprogrammetargetingvaryby 10 20 30 40 50 60 70 80 90 0 2004 Cambodia Institutional spread Indonesia 2005 2006 T imor 2007 -Leste Philippines 2008 V Lao PDR Papua NewGuinea iet Nam 2009 2010 Mongolia Y ear ofCL Myanmar TS introduction 2011 China Islands Solomon Kiribati 2012 017

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total being promoted by major agencies. Support for CLTS has by major agencies. Support for CLTS being promoted 11 Such as sanitation marketing, the provision of up-front latrine hardware subsidies, and the Such as sanitation marketing, the provision of up-front latrine hardware subsidies, combined demand creation and hardware subsidy approach. ADB’s

grown, but some significant institutions promote latrine hardware subsidies significant institutions promote grown, but some review is needed In this case, a more in-depth and alternative approaches. (or not), and the CLTS of institutions that support to examine the proportion programmes. and effectiveness of their scale, finance, duration on the Nam, where consensus different in Viet The situation is slightly institutional and to have developed fairly recently, appears value of CLTS institutions has not yet translated into support among non-government suggest that the while early indications large programmes. However, Third Phase (NTP-3) will utilize the Programmes WASH National Target approach, there remain concerns that the NTP-3 may continue CLTS could undermine the spread and to subsidize latrine hardware, which interventions. effectiveness of CLTS across government departments, with Only limited spread was observed reporting more than one Nam) Viet just two countries (Indonesia and cases, In most or implementing CLTS. government department promoting institutions reflects both low support limited spread among government that among infrastructure-focused departments, and the reality for CLTS – often the health department – has only one government department activities. and behaviour-change responsibility for environmental health able to examine how the spread among A more in-depth review would be programming influence policy, central and local government departments and practice. 11 low geographical spread; and the situation was similar in Viet Nam, with Nam, with in Viet similar was the situation and spread; geographical low but a introduction, since CLTS in the four years support good institutional the country. coverage across low implementation relatively with several sector, and NGO has a large development Cambodia improvement sanitation (sometimes complementary) competing approaches 20 10 Government INGO Donors 15 10 5 0 China -Leste Kiribati iet Nam Lao PDR V Mongolia Myanmar Indonesia Indonesia Cambodia Cambodia imor Philippines T Solomon Islands Countries ordered by date of CLTS introduction Countries ordered by date of CLTS

Papua New Guinea Papua New Guinea 018 10 The review highlighted some differences between geographical and The review highlighted some differences institutional spread: Cambodia has the highest institutional spread, particularly among the large group of international NGOs, but relatively As with geographical spread, the institutional spread is strongly associated As with geographical spread, the was introduced – with greater with the length of time since CLTS adopters, and only two or three spread amongst the early and mid-term the late adopters. organizations involved in each of Key: Dev. agencies = Multi-lateral and bi-lateral development support agencies. agencies = Multi-lateral and Key: Dev. Figure 1.3 Number of organizations promoting or implementing CLTS or implementing promoting organizations of 1.3 Number Figure

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific scaling upof theCLTS approach. might beexpected tosignificantlyinfluence theadoption,evolution and introduction processes,and sanitationenablingenvironments,allofwhich this intuitionneglectssignificant differencesincontext,history, CLTS greater progress,andthat mid-termcountrieswouldbenotfarbehind, While itmayseemintuitive thattheearlyadoptingcountrieshavemade two tofouryearsago. differences intheprogressmadebyfivecountries thatintroducedCLTS greater progressmadebytheearlyadopters,and pointstorelativelysmall by thetimeinyearssinceCLTS wasintroduced. Thischarthighlightsthe number oftriggeredandODFcommunities,with the orderdetermined Figure 1.4chartsthescaleofCLTS activitiesby country, intermsofthe declaration, butinwhichsomehouseholdshavesincerevertedtoOD. fully metODFcriteria,andothercommunitiesthatweregenuinelyat may includesomecommunitiesthatwereself-declaredODFbuthavenot very fewsustainabilitycheckshavebeencarriedout.Therefore,thesedata all oftheODFcommunitiesreportedhadbeenverifiedindependently, and or localgovernments.Noneofthereviewcountrieswereabletoconfirmthat communities, andODFcommunitiescertifiedbytheimplementingagencies implementing agencies.Thesedataincludeamixtureofself-declaredODF country reviewteamsbasedlargelyoninformationthattheyreceivedfrom presented inFigure1.4arethenumberofODFcommunitiesreportedby status orcheckwhetherODFoutcomesaresustained.Therefore,thedata Few countriesintheregionhaveoperationalsystemstoverifyODF improved outcomes. of thescaleCLTS implementationineachcountry, andthescaleof number ofODFcommunities.Theseindicatorsprovidesomemeasure where CLTS hadbeenusedtotriggersanitationimprovement;andonthe CLTS scalewasmeasuredbycollatingdataonthenumberofcommunities 1.2.4 CLTS scale 12 Cambodia, 2009 RegionalWorkshop onCLTS inthe South-EastAsiaandPacific,heldin progress hasbeenquiteslow. Optimisticprogressreportspresented atthe live inODFcommunities. However, despitethissignificant achievement, In all,3.1millionpeopleacrossthe14reviewcountries werereportedto ODF impactonnationalsanitationcoverage on-going re-introductionofCLTS inChina. recent introductioninMongolia,SolomonIslands andKiribati,the Little progresshasbeenmadeoutsidetheseeight countries,duetothe countries inimplementingCLTS in200-850rural communitiessince2008. rural communities;andrevealthatMyanmarhas joined thefivemid-term adopting countries,withCambodiaandIndonesia triggering2,000-7,300 In practice,thereviewdatashowthatCLTS hasscaledwellinthetwoearly Figure 1.4CLTS progress(numberoftriggeredandODFcommunities) national sanitation coverage in both Indonesia and Cambodia before 2012. national sanitation coverageinbothIndonesia andCambodia before 2012. 1000 1200 1400 1600 1800 2000

200 400 600 800

org/resource/regional-workshop-clts-south-east-asia-and-pacific-region Phnom Penhto discussCLTS progressandissues: http://www.communityledtotalsanitation. About 60participants fromeightcountriesinthe EAPregiongatheredinNovember 2009in DPR Korea 0

V anuatu 12 0 suggestedthatCLTS wouldhavemadesignificantimpactson China 0

Solomon Islands 0

Kiribati 0 Y ODF communities(no) T 0.6 riggered communities(no) ears sinceCL 0 0 0.7

Mongolia 2 TS introduced 0.8 0

Myanmar 10 1.5 1 Philippines 224 12 2.6 Papua New Guinea Lao PDR 211 4.6 36 217 36 4.6

V 400 iet Nam 21 4.6 T imor 829 145 -Leste 4.6

Indonesia 761 262 5.6

Cambodia 7325 1279 7.6 1998 019 717 8.6

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total ODF success rate 1.2.5 the proportion of triggered communities thatThe ODF success rate, defined as implementation. is a key indicator of the effectiveness of CLTS become ODF, us anything about the quality orThe ODF success rate does not tell outcomes, but it is a key indicator of CLTS sustainability of collective sanitation as programmes spread and scale up.effectiveness that can highlight problems to decrease as programmes scale up,The ODF success rate might be expected conditions and challenging social contextsdue to the more difficult physical facilitation maintaining the quality of CLTS encountered, and the challenges of substantial reviews find practice, most CLTS and processes on a larger scale. In both large and small programmes, andvariations in ODF success rate across the same programme. even under the same conditions within The review has focused on ODF achievement because only limited data data only limited because achievement on ODF focused review has The latrines built and – the number of achievements on non-ODF were available achieve ODF that do not in communities coverage achieved the sanitation of around two-thirds suggest that from Timor-Leste data status. However, found in ODF interventions were from CLTS toilets that resulted the new latrines were new household a further 12,000 which suggests communities, communities. built in non-ODF latrines that the number of new and rehabilitated These data suggest significant – about 50 per ODF communities is likely to be triggered outside according to the found in ODF communities cent of the new toilets the importance of follow-up data – and also highlight Timor-Leste that do not growing number of project communities interventions in the in order to sustain these interventions following CLTS achieve ODF status sanitation facilities and practices among outcomes and attempt to improve the remainder of the population.

The ODF population in Indonesia is much larger than in other countries both because of the The ODF population in Indonesia is much high number of ODF communities achieved and because the STBM secretariat in Indonesia provided data using the larger village (desa) unit whereas most country review teams 19,000 reported using the smaller sub-village unit. Programme data suggest that more than sub-village communities (dusun) have been triggered in Indonesia, and that 4,200 of these dusun have achieved ODF status.

Incremental increases in sanitation coverage Incremental increases in sanitation interventions is on achieving ODF While the main focus of CLTS a significant proportion of triggered communities and areas, there remains status. Incremental increases in communities that do not reach ODF of these triggered communities, with sanitation coverage occur in most coverage. some achieving 80-95 per cent latrine In many respects, as detailed in the following sections, Timor-Leste’s following sections, Timor-Leste’s In many respects, as detailed in the to the performance is closer to those of the two early adopters than CLTS has been of this review Timor-Leste mid-term adopters, thus for the rest the early adopting countries. grouped with and compared against The one exception is Timor-Leste, where the relatively small rural where the relatively small rural is Timor-Leste, The one exception that moderate CLTS 750,000 people in total – means population – only the last four years. a significant national impact over progress has had ODF communities, are estimated to live in the 262 119,000 people Today, than one in seven of the rural population – more which is 16 per cent rural households. Timorese but even this major achievement represents only 1.7 per cent ODF rural only 1.7 per cent represents this major achievement but even ODF communities, living in 717 575,000 people Cambodia reports population. while progress Similarly, of the rural population. to 5.1 per cent amounting small and the numbers remain adopters, across the mid-term is consistent – less thanmost of these countries impacts in yet to make national is CLTS in Lao PDR,rural population live in ODF communities 1 per cent of the the Philippines and Myanmar. Nam, Papua New Guinea, Viet 020 13 Indonesia now has 2.27 million people living in 1,279 ODF communities, 1,279 ODF living in people million has 2.27 now Indonesia

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific 14 important componentofanyCLTS evaluation. rate, andanalysisofthefactorsbehinddifferentODFeffectivenessisan of thebestperformingdistricts.ManyfactorsinfluenceODFsuccess only 8percentinlowperformingdistrictstoashigh99one Sanitation Marketing(TSSM)project.Yet theODFsuccessratevariedfrom of theEastJavaprovinceIndonesiaunderitsTotal Sanitationand The WSPpromotedthesameimplementationapproachesinall29districts examine thevalidityand sustainabilityofthereportedODFoutcomes. reversion toODiscommoninCambodia.Further workwillberequiredto process wasfollowed,andseveralevaluationshave suggestedthat ODF successrateinCambodiahasbeenquestioned, asnoODFverification adopting countries).Forinstance,thevalidityof reported36percent ODF declarationstookplaceseveralyearsago(particularly intheearly community meetsthelocalagreedODFcriteria,and thatsomeofthese ODF wereself-declared,thatiswithoutindependent verificationthatthe However, itshouldbenotedthatmanyofthecommunitiesreportedas that countriesintheregionarefollowingaformoflearningcurve. was morerecentlyintroduced,andincreasesovertime.Thesedatasuggest above –averageCLTS effectivenessseemstobelowerincountrieswhereit These dataappeartoshowtheoppositeofscaleproblemmentioned • • • rates reportedacrosstheEAPregion(seeFigure1.5): The reviewfoundasurprisingconsistencyinthenationalODFsuccess

learning fromEast Java,TheWorld Bank, Water andSanitationProgram, report.) outcomes (Mukherjee etal,2012,Achievingandsustaining opendefecationfree communities: understand the triggering processes,theirconsequences, andthefactorsthatinfluenced WSP conductedactionresearch in80CLTS communitiesinEastJava (Indonesia)tobetter late adoptersreportedonly5-10percentODFsuccess. mid-term adoptersreported17-22percentODFsuccessrates;and success rates; early adoptersincludingTimor-Leste reported34-36percentODF 14

Figure 1.5ODFsuccessrate(percentage) Bank supported PAMSIMAS programme,which hastriggeredalmost proportion of CLTS progressinIndonesia wasreportedby theWorld rate ofonly17percent.Further investigationrevealedthatasubstantial provided bytheSTBMSecretariat suggestedanationalODFsuccess The maindiscrepancywas inIndonesia,wherethelatestprogressdata to seeinthesethreehigherperformers). larger scaleprogressandgreatereffectiveness(which wearenowstarting that ittakestimeforCLTS policy, programmesandpracticetotranslateinto at differentstagesofbroadlysimilarCLTS development trajectories;and Indonesia andTimor-Leste, thesedatasuggestthatthereviewcountriesare and challengesfoundin,forexample,earlyadopting countries–Cambodia, developed andstrengthened.Whilesurprisinggiven thedifferentcontexts the countryprogrammes,sectorcapacityandenabling environmentshave Nonetheless, thesedatasuggestasteadyincrease inODFsuccessrateas the higher35percentrateachievedbyprogrammesotherthanlarge-scalePAMSIMAS. Note: dataforIndonesiareflectthe17percentaveragenationalODFsuccessrate,aswell Papua NewGuinea T Philippines imor Cambodia Indonesia Myanmar Mongolia V Lao PDR iet Nam -Leste 0% 5% 10% 5% 17% 17% 17% 17% 10% 22% 15% 34% 36% 20% 25% 18% Late adopters Mid-term adopters Early adopters 30% 35% 40% 021

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total capacity development and facilitator training across the region (particularly (particularly region across the training and facilitator development capacity countries). in the Francophone WSP was instrumental the EAP. was found in approach A less coordinated and South Asia to Indonesia, approach from the CLTS in transferring and Lao PDR. But the Philippines its spread to in encouraging subsequently into more than CLTS were involved in introducing few other organizations or of evidence of any regional approach, and there was little one country, model. training or capacity development the use of a common a consistent feature: he involvement was Kamal Kar’s Dr. As noted earlier, facilitator training different agencies to provide CLTS worked for several was introduced, and approach countries as the CLTS in six of the review following earlier in another two review countries workshops ran CLTS a core group of activities produced Kar’s introduction and training. Dr. in the countries in half of the CLTS well-trained and committed facilitators and levels of government involvement region, but the different processes training did not always lead to larger in each country meant that this initial training programmes. scale capacity development or cascade in seven had been successfully introduced and was expanding By 2009, CLTS a group of key stakeholders (Institute ofcountries in the region, which led WSP, International, UNICEF, Plan Development Studies at Sussex University, and SNV) to support a regional Australia, Swiss Red Cross, LienAid WaterAid part, workshop in Cambodia. Participants from eight countries took CLTS had not yet been introduced). including Myanmar (at that time, CLTS was workshop the regional CLTS One of the key issues to emerge from implementation quality are critical to the that, while facilitator training and and commitment are central triggering phase, government involvement needed for post-triggering follow- to the long-term institutional support The side event that preceded the recent up, monitoring and sustainability. group EASAN-3 conference in Bali was the first time that this regional CLTS had reconvened since the 2009 workshop. The 15 is 36 per cent, which closely matches the 34-36 per cent ODF closely matches the 34-36 per is 36 per cent, which 16 Capacity developed Data from PAMSIMAS website provided via WSP Indonesia. The rapid scaling up of this website provided via Data from PAMSIMAS programme, which also implements water supply projects through huge community WASH is a significant factor in the relatively low effectiveness data. the Ministry of Public Works, progress in Indonesia was under the WSP TSSM project in 93 per cent of the other CLTS 7 per East Java (6,672 sub-villages triggered and 2,399 declared ODF) with the remaining cent attributed to UNICEF and Plan Indonesia programmes.

022 CLTS was introduced to Papua New Guinea in 2008, and has made rapid to Papua New Guinea in 2008, was introduced CLTS system, there is no formal monitoring years. However, strides in recent to find. The EU- reliable progress data were hard which meant that an end of programme evaluation programme recently conducted RWSSP resulting from interventions in more that reported 11,000 new latrines a national NGO called Touching than 400 communities. In addition, 5,000 new latrines achieved in 77 The Untouchables (TTU) reported data were No ODF declared ODF. communities, with 17 communities programme, hence the average ODF available from the larger EU-RWSSP Guinea was based on the TTU NGO success rate quoted for Papua New programme in the Eastern Highlands. success rates achieved in Cambodia and Timor-Leste. in Cambodia and Timor-Leste. success rates achieved reason for the low ODF success rate in the PAMSIMAS programme was not programme PAMSIMAS rate in the the low ODF success reason for up of CLTS and dramatic scaling that the rapid but it seems likely reported, the If factor. a significant has been by this programme implementation ODF success case, the considered a special progress data are PAMSIMAS by other programmes dusun communities triggered rate across the 7,000 in Indonesia 15 16 The rollout of CLTS in West Africa was aided by two regional CLTS Africa was aided by two regional CLTS in West The rollout of CLTS one Anglophone – in 2008 and 2009, workshops – one Francophone and regional office to develop national and by formal efforts from the UNICEF training courses, arrange exchange visits and provide technical CLTS training institute, Centre UNICEF supported a regional support. In particular, to provide reliable (CREPA), Supply and Sanitation for Low Cost Water 1.2.6 communities in the last two years, but has only has only but two years, in the last communities dusun sub-village 12,000 (1,663 ODF communities). success rate a 14 per cent ODF managed

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific 18 17 • • • trained, withthemainexceptionsbeing: review teamsreportedthataround100-400CLTS facilitatorshadbeen In countrieswhereCLTS wasintroducedatleast twoyearsago,thecountry • • Two maincapacityquestionsneedtobeaddressed: examine facilitatorperformance. to determinethenumberofactiveCLTS facilitatorsineachcountry, and CLTS facilitators.Amorecomprehensivecapacityreviewwillberequired become activefacilitators,andfewerstillwouldbeclassedaseffective In addition,onlysomeofthosetrainedasCLTS facilitatorsperseveredto trained specificallyasCLTS facilitators. groups invitedtoraiselocalawareness;whileothersreportedonlythose attended CLTS trainingworkshops,whichthenincludedlargerstakeholder reports variedsignificantly–somereviewcountriesreportedeveryonethat of CLTS facilitatorstrained,butfurtherinvestigationrevealedthatthese development. Mostofthereviewcountriesprovidedapproximatenumbers review country, butfoundthattherewas littleformaltrackingofcapacity The reviewexaminedtheextentofCLTS capacitydevelopmentineach CLTS capacity

programme. 3,000 individuals (facilitatorsandnaturalleaders) weretrainedinEastJavaunder itsTSSM 1,300 individuals havebeentrainedbyCLTS orSTBM relatedprogrammes,and thataround Data reportedbytheSTBMsecretariat. However, WSPIndonesiasuggeststhataround on activefacilitators). better bothnationalCLTS implementationcapacityandeffectiveness (basedonreliabledata only thoseexplicitlytrainedas CLTS facilitators.Furtherworkwill berequiredtounderstand trained, howeverperipheraltheir involvementinimplementation;whileothersreported that differentcountriesreported differentthings–somereportedeveryonethathasbeen The reviewreportsthedatasubmittedbycountryteams, butitshouldbenoted Viet Nam:1,132facilitatorstrained. Indonesia: 530facilitatorstrained Timor-Leste: only85facilitatorstrained Is CLTS capacitybeingtranslatedintoprogress? Is sufficientCLTS capacityavailabletoachievenationalgoals? 18 17 committed CLTS facilitators. but thattherealchallenge istobuildupacadreofeffectiveand these countrieshaverealized thatitisrelativelyeasytotrainfacilitators, adopting countriesgenerally onlyreportedonactiveCLTS facilitators, as good ratioofCLTS facilitators toODhouseholds.However, theearly that hadreceivedsome form ofCLTS training,whichpresentsarelatively development process.Thelateradoptingcountries reportedeveryone These differencesalsoreflectdifferentstagesof thecapacity facilitator per23,000ODhouseholdsreportedinIndonesia. than onefacilitatorforevery2,000ODhouseholds, withonlyonetrained 1,000 ODhouseholds,whereastheothercountries havetrainedless Guinea andViet NamhavetrainedatleastoneCLTS facilitatorforevery without toiletsineightofthereviewcountries.Timor-Leste, PapuaNew by comparingthenumberoftrainedCLTS facilitatorsper1,000households sanitation requirementsineachcountry. Figure1.6highlightsthisaspect The capacityassessmentshouldrecognizethedifferentpopulationsizeand Figure 1.6NationalCLTS implementationcapacity Papua NewGuinea T Philippines imor Cambodia Indonesia Myanmar V Lao PDR iet Nam -Leste 0.0 CL TS facilitatorsper1,000ODhouseholds 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 023 2.0

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total While this issue relates to the variable reporting the variable reporting issue relates to While this 20 These two countries have also made the greatest progress progress the greatest made have also two countries These 19 CLTS enabling environment CLTS Except in the PAMSIMAS programme, which reported only 14 per cent ODF success rate. Except in the PAMSIMAS active facilitators rather than this may reflect these countries only reporting As noted earlier, all those trained as facilitators.

in scaling up CLTS, yet have the lowest capacity when assessed against capacity when assessed have the lowest yet up CLTS, in scaling requirements. national mentioned above, it also reflects the huge rural sanitation challenges rural sanitation reflects the huge above, it also mentioned cent of the contain 66 per between them two countries, which in these (56 million people). OD in the region that practices population 19 20 1.3 on the enabling summarize the review findings The following sections 1.2 summarizes Table in each of the review countries. CLTS environment for overviews, with CLTS findings from the country the enabling environment approach was adopted. according to when the CLTS the countries ordered basic review presents of the regional CLTS This summary of the first stage in each enabling environment of the CLTS information on the current status examine why or the review does not attempt to However, review country. have developed because of the how the different enabling environments all 14 countries) from the rapid review limited information available (across enabling environments, and the conducted. The complexity of sanitation suggest that more of causality, difficulty of any accurate determination better understand the key factors that have detailed work will be required to environments. influenced and improved enabling amount of Table 1.2 highlight the large The significant “red” sections in improve enabling environments work still required to strengthen and the progress made the table also demonstrates across the region. However, all three of which now and Timor-Leste, by the two early adopting countries in and are making progress to CLTS, have sanitation policies supportive environment. improving other areas of the enabling success rates. success 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 riggered communities per trained facilitator riggered communities per trained facilitator T -Leste iet Nam Lao PDR V Indonesia Myanmar Cambodia imor Philippines T Papua New Guinea 024 Cambodia and Indonesia appear to have the most efficient and effective Cambodia and Indonesia appear to have the most efficient and effective ODF facilitators, in terms of both numbers of triggered communities and A comparison of the number of communities triggered against the number A comparison of the number of communities efficiency facilitators confirms the greater implementation of trained CLTS (see Figure 1.7): all and Timor-Leste of the two early adopting countries communities for every facilitator three report more than eight triggered report an average of around one trained, whereas the other countries facilitator. triggered community per trained Figure 1.7 Efficiency of trained CLTS facilitators of trained CLTS Figure 1.7 Efficiency This issue is illustrated Figure 1.7, which graphs the number of triggered of the number graphs 1.7, which Figure illustrated issue is This difference betweenand highlights the facilitator, per trained communities in the as trained facilitators” of those “reported efficiency the triggering indicator This efficiency review countries. mid-term adopting early and order to get a success rate in the ODF be considered alongside needs to rapid triggering of facilitation, as effectiveness of the overall better measure results. may not lead to good

PART I 1. Findings “Indirect” =indirectfinancialsupportprovided(orange);“No”notinplace(red). Key: “Yes” =enablinginplace(green);“Draft/Planned/Maybe”partially(yellow); Community-Led Total Sanitation inEast Asia andPacific Indonesia was thefirstgovernmentin theregiontoadoptaCLTS-friendly that subsidies shouldnotbeprovided forhouseholdsanitary facilities. effective sanitaryfacility to breakthetransmissionofdisease–andstated strategy) inIndonesiaprovided adefinitionforanimprovedlatrine– The 2008NationalStrategy forCommunity-LedTotal Sanitation(STBM Indonesia sanitationpolicy promoted theprinciplesofCLTS approach. and Timor-Leste reportedgovernmentpoliciesthatrecognizedand effectiveness ofCLTS programmes.However, onlyCambodia,Indonesia and technicalguidelineswereimportantfactorsin thescalingupand The countryCLTS overviewssuggestthatgovernment sanitationpolicy 1.3.1 Table 1.2SummaryofCLTS enablingenvironment Kiribati Solomon Islands China Mongolia Myanmar Late CLTS adopters Viet Nam Timor-Leste Philippines Papua NewGuinea Lao PDR Mid-term CLTS adopters Indonesia Cambodia Early CLTS adopters Country CLTS ingovernmentpolicy No No No No Maybe Maybe Yes No No Maybe Yes Yes Policy No No No No No No Draft Yes No Yes Yes No Plans No Indirect No No Indirect Planned Indirect Indirect Indirect Indirect Yes Indirect Finance No No No No No Maybe Maybe No No Maybe Yes Maybe Integration No No No No No No Yes No No Planned Yes Maybe Monitoring million iDEsanitationmarketingprogramme, – includingtheUS$5millionGlobalSanitationFund programme,US$5 Several majorruralsanitationprogrammesarenow underwayinCambodia conflicting sanitationpolicies,programmesand practices toflourish. development forseveralyears,whichhasallowed arangeofsometimes The CambodiannationalRWSSH strategyhas beenunderdiscussionand and alternativemechanismsshouldbeprioritized.”(page8) hardware subsidiesshouldbeusedwithcautionandonlyasalastoption, to buytoilets,andreachthevisionof100percentcoverage,direct While targetedhardwaresubsidiesmaybeprovidedtopoorhouseholds that householdspayfortheirowntoilets.Thosewhocanshouldpay. and developtheenablingenvironment(includingaffordableproducts)so “For sanitation,publicfinanceshouldmainlybeusedtostimulatedemand 2011-2025 inAugust2012.Theprincipleonsanitationfinancingstates: National StrategyforRuralWater Supply, SanitationandHygiene(RWSSH) The RoyalGovernmentofCambodiaformallyapprovedandissuedits Cambodia sanitationpolicy harmonization ofprogrammeapproachesandpolicies. interventions aheadofhardwaresubsidies,andhasencouragedthe government commitmenttodemandcreationandbehaviour-change subsidies bysomeprojectsandprogrammes,ithasdemonstrated STBM strategyhasnotpreventedtheprovisionoflatrinehardware policy and,whiletheexplicit“nohardwaresubsidy”statementin 22 21 programme inViet NamandCambodia Project, andUS$11millionEastMeetsWest SanitationandHygiene component oftheADBSecondRuralWater SupplyandSanitation Sector the nationaldevelopment objectives. to complementeachother inimprovingsanitationatscaleandachieving principles promotedbythe nationalstrategywillenabletheseprogrammes

programme. A largeproportion oftheprogrammefinance is allocatedtothe Viet Nam componentofthe Foundation, and theWater andSanitationProgram. Jointly financedandsupported bytheBillandMelindaGatesFoundation,Stone 22 –anditishopedthatthe 21 US$8millionsanitation 025

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total CLTS in government plans CLTS 1.3.2 found to be strategies and plans were Government development Philippines; with the in Indonesia, Lao PDR and the supportive of CLTS process of developing a National in the Government of Timor-Leste objectives in the Plan to operationalize the policy Strategic Sanitation Sanitation Policy. recently approved National Basic sanitation strategies even in the handful of countries where However, is little evidence that these planning and plans appear supportive, there or more effective programmes frameworks translate into larger scale or outcomes. plan 2005-2009 included 100 previous five-year development Indonesia’s for 2009, but neglected to support this per cent ODF coverage as a target investment or implementation ambitious target with either the required has now been set for 2014, although programmes. The same plan target PPSP to the over-arching this time with greater finance attached currently only 1.7 per cent this review finds that programme. However, that it is which suggests are ODF, of the 75,000 plus villages in Indonesia will be met within the next two years. extremely unlikely that the target Plan developed by the the 2011 National Sustainable Sanitation Similarly, sets a target of 10 per cent ODF Department of Health in the Philippines is villages in 2012, rising to 60 per cent ODF by 2016, yet this plan target not supported by any substantial investment, implementation or capacity of the development programmes. The review estimated that only 36 out Policy relating to the provision of latrine hardware subsidies remains a a remains subsidies hardware of latrine provision to the relating Policy subsidies of latrine hardware expectations with household central issue; of the review in seven to sanitation progress as a constraint mentioned another policy constraint standards were Rigid technical countries. the government in China where most notably by the review, identified to concerns with leach pits due allow latrines standards do not technical groundwater contamination. about the risk of and states that “households that “households and states 23 Rural sanitation policy approaches toEmphasis on creating demand through community-based Strategy). (in 2012 National RWSSH contribute to achieving ODF communities definition of hygienic 2011 National technical regulation: principle-based guidelines circulated approach; draft CLTS latrine that is supportive to CLTS by the Ministry of Health. National Sustainable Sanitation Plan but the 2011 No formal national policy, targets, and is seen to provide of the Department of Health includes ODF guidance on implementation in rural areas. promote the CLTS 2012 National Sanitation Campaign will (reportedly) approach. latrine pits and tanks, and 2003 technical standards require leak-proof (NPHCC) promotes relatively National Patriotic Health Campaign Committee the role of CLTS. expensive standard designs, which limits standards in rural areas. Government building codes define construction The minimum requirements of a hygienic toilet are that it: prevents human contact with humanThe minimum requirements of a hygienic toilet are that it: prevents human contact with excreta; prevents the discharge of human excreta into open spaces, drains and water bodies; raisedprevents flies, other insect vector and animal contact with human excreta; includes a solid, platform with a smooth and easy-to-sweep finish; and prevents the emission of bad smells. Country Supportivepolicy framework but no formal policy Lao PDR Nam Viet Philippines Myanmar Non-supportive policy framework China DPR Korea No sanitation policy Islands, Vanuatu Kiribati, Mongolia, Papua New Guinea, Solomon

Table 1.3 Sanitation policies in other countries Table shall be responsible for the construction and maintenance of their own maintenance construction and responsible for the shall be handwashing facility,” including a hygienic toilet and sanitation facilities, other household of household toilets and and that “the construction in specific situations shall not be subsidized except sanitation facilities recent approval of the are disadvantaged”. Despite where the households principles had already adopted the policy most sector stakeholders policy, during the four-year following extensive consultations in their programmes process. long policy development 026 23 Timor-Leste sanitation policy sanitation Timor-Leste Sanitation its National Basic approved of Timor-Leste The Government is for the main policy objectives first of the four January 2012. The Policy in policy defines environment”; the defecation free of “an open achievement to five principles; toilet according a hygienic

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific 24 Table 1.4Ruralsanitationstrategiesandplans strategic prioritiesenroutetothesetargets. assessments ofhowtargetswillbereached,oranyattempttomapoutthe sanitation strategiesorplansthatappeartobebasedonrealistic,costed sector investmentsandimplementationprogramming,withfewnational sanitation targets,strategiesandplans(wheretheyexist), The reviewsuggeststhatthereisasignificantdisconnectbetweennational represents lessthanonehundredthofthe2012plantarget. 42,000 barangaysinthePhilippines(0.1percent)arecurrentlyODF, which Aninter-agency collaborationdevelopedthrough aTechnical Working Group oftheNational Kiribati, Mongolia,Myanmar, PapuaNewGuinea,SolomonIslands,Vanuatu No sanitationstrategyorplan Viet Nam Cambodia planningframework Non-supportive Timor-Leste sanitationstrategiesandplansunderdevelopment Supportive Philippines Lao PDR Indonesia ofCLTSSanitation strategiesandplanssupportive Country Economic andDevelopment Authority(NEDA) Infracom Sub-committeeonWater Resources. household latrinecoveragerather thanODFtargets. National Target ProgramRWSS IIIPhase2012-2015 focusesonincreasing approaches tobeevaluatedforhygienebehaviourchange. Sanitation andHygiene,althoughCLTS ismentionedasoneofthe No ODFtargetsinthe2012NationalStrategyforRuralWater Supply, operationalizing the2012NationalBasicSanitationPolicy. Draft NationalStrategicSanitationPlanunderdevelopment,with theaimof targets northeCLTS approach. 2010 PhilippinesSustainableSanitationRoadmap for 60percentzeroopendefecation(ZOD)barangaysby2016.However, the 2011 NationalSustainableSanitationPlanoftheDepartment Healthaims proportion ofODFvillagesachieved. lowest wealthquintile)andlatrineusage;proposesmonitoringofthe includes strategictargetsforimprovedsanitationcoverage(includinginthe 2012 NationalStrategyforRuralWater Supply, SanitationandHygiene Settlements (PPSP)programme. to beprovidedthroughtheAcceleratedSanitationDevelopmentforHuman 100 percentODFvillagesnationallyby2014,withfinancefor20,000 2010-2014 NationalMid-Term DevelopmentPlan(RPJM-N)setsthetargetof Rural sanitationstrategiesandplans 24 mentionsneitherODF by theseactivities. CLTS activities inordertotakeadvantage ofthesanitation demandcreated either insimilarareasto existing CLTS programmes,orexplicitlylinked to they tendedtofinancethe provisionoflatrinehardwaresubsidies,often review foundthat,where governmentshadinvestedinruralsanitation, While ruralsanitationfinance remainsgenerallylowintheregion, improvement programmes. support toplan,developandimplementCLTS andwidersanitation but manylocalgovernmentsrequiretechnicalassistance andinstitutional are increasingasawarenessandpriorityforthisnational strategygrows, Local governmentinvestmentstoimplementIndonesia’s STBMstrategy by WSPsupportprogrammesratherthanlocal prioritiesorpolicies. province (Philippines),buttheseinvestmentswere triggeredanddirected of localCLTS projectsinEastJavaprovince(Indonesia)andSarangani District andprovincialgovernmentshavefinancedtheimplementation in the14reviewcountrieshavefinancedlarge-scaleCLTS programmes. ODF communities,thereviewfoundthatnoneofnationalgovernments Surprisingly, giventhatasmany3.1millionpeoplearenowlivingin costs andperdiemsbytheexternalagencies. involvement isenabledthroughthepaymentoffieldallowances,transport externally financedprogrammes.However, inmostcases,governmentstaff and facilitiesforthemanagement,implementationmonitoringof finance toCLTS activities,throughtheprovisionofcounterpartstaff Governments insevenothercountrieswerereportedtoprovideindirect Bank supportedPAMSIMAS programmeandADBCWSHprogramme. finance tothePPSPprogramme,andcounterpartfinancing World that investsdirectlyinCLTS activities,throughsupporttoSTBM environment intheEAPregion.Indonesiaisonlynationalgovernment Government financingforCLTS isoneoftheweakestareasenabling 1.3.3 CLTS financedbygovernment 027

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total CLTS sustainable monitoring sustainable CLTS Basic CLTS monitoring data were not readily available at either national or monitoring data were not readily available at either national Basic CLTS to provide out of 12 review countries were unable programme levels. Ten for progress data without contacting implementing agencies current CLTS updates, and some of these implementing agencies were unable to provide offices.progress data without first contacting specific project and sub-national 1.3.5 Supply and Sanitation Program (RWSSP-2) in Cambodia, intend to employ to employ intend in Cambodia, (RWSSP-2) Program and Sanitation Supply also offering sanitation while demand for rural to create CLTS a form of of The cost-effectiveness local suppliers. subsidies through hardware with significant not been tested, approach have or ‘hybrid’ this combined will hardware subsidies reliance on latrine that the project concerns component, and of any CLTS the effectiveness the process, limit dominate long and expensive process. result in an overly was the best example programme in East Java (Indonesia) The WSP TSSM the CLTS that was effective in combining of a large-scale programme and behaviour-change on sanitation marketing approach with interventions approaches promoted by The scaling up of the integrated communication. strategy, STBM was assisted by the government’s the TSSM programme thus autonomy, in Indonesia have considerable but local governments and sanitation both the CLTS while the majority of districts embraced district in East Java continued to use marketing approaches, at least one programme efforts to promote a more latrine hardware subsidies despite integrated approach. is financing a rural sanitation programmeThe Global Sanitation Fund (GSF) and supply demand creation CLTS-based in Cambodia that aims to combine achievements marketing. The initial CLTS strengthening through sanitation but the sanitation in this review, of this programme were included advanced to determine the scale,marketing component was not sufficiently this integrated approach. effectiveness and sustainability of CLTS integrated with other approaches integrated with other CLTS 028 The review found few examples of the effective integration of CLTS the effective integration of CLTS The review found few examples of this lack of integration reflects the with other approaches. In large part, hardware subsidies discussed in the governments’ preference for latrine countries reported problems related previous section. Most of the review programmes, subsidies alongside CLTS to the provision of latrine hardware of sanitation demand because with multiple references to the suppression – households in communities where of the rationing of hardware subsidies for the latrine hardware subsidies have been provided often prefer to wait next tranche of subsidies rather than invest in their own simple facilities. Some programmes, such as the ADB-supported Second Rural Water In light of the growing enthusiasm for sanitation marketing (and other new In light of the growing enthusiasm examined the extent to which CLTS approaches) in the region, the review have been integrated with other planning, implementation and monitoring highlight cases where efforts had been approaches. The intention was to programmes and practices required by made to ensure that the policies, had been harmonized to complement different implementation approaches approaches and programmes where competing each other and, conversely, each other. clash, undermine or detract from 1.3.4 This issue appears to be the most significant in the region: consensus on consensus in the region: significant be the most to issue appears This and spreading, to be growing appears of CLTS and effectiveness the utility and practice, policies, plans way into government to find its and is starting to more to be allocated finance continues of government yet the majority because approaches, perhaps and infrastructure-based hardware-focused and can in faster progress approaches result that these of the perception to determine of service. Further study is required deliver a higher level i.e. is there decisions are evidence-based, whether these investment more cost- in faster, hardware subsidies have resulted evidence that latrine – or whether this regional and better sanitation outcomes effective progress legacies, institutional more from the political economy, preference derives or other factors. information gaps

PART I 1. Findings motivation tomaintainlarge-scale systems. such asthisreview, generateabriefflurryofactivity, butareinsufficient reports upthroughthesystem.Sporadicattempts toreportonprogress, as annualstrategicreviews,thatregularlypullsanitation progressdataand national monitoringsystemsarelinkedtogovernance mechanisms,such require monitoringdatatoreportagainsttheirresults frameworks,butfew The centralproblemappearstobealackofdemand forthedata–projects sanitation monitoringsystemsprovesustainable. by computersystems,trainingandtechnicalassistance,butfewofthese establish monitoringsystems,ofteningovernmentdepartmentssupported reporting. Thisissueisasystemicproblem–large-scaleprojectsroutinely maintain monitoringsystemsthroughregularcollection,processingand progress data(orothersanitationdata)diminishesincentivesto The reviewconfirmsthatthelimiteddemandfor, andutilizationof,CLTS database asignificantundertaking. in thesanitationsub-sectormakesregularmaintenanceofCLTS revealed thatthelargenumberofimplementingorganizationsnowactive since 2010.SubsequenteffortstoupdatetheprogressdataforCambodia database hadnotbeenmaintainedinCambodia,withlittledataadded from themonitoringsystemsinbothIndonesiaandTimor-Leste, theCLTS communities. However, whileup-to-dateprogressdatawereavailable collect CLTS progressdata,suchasthenumberoftriggeredandODF reported nationalsanitationmonitoringsystemsthatweredesignedto The twoearlyadoptingcountries(Cambodia,Indonesia)andTimor-Leste doubt remainingoverthereliabilityofdatainseveralcases. Community-Led Total Sanitation inEast Asia andPacific 25 As aresult,thedatacollectionprocesswaslonganditerative, review teamsin chasing, collatingandverifyingthe CLTS progressdatausedinthis review. The authorwould liketoacknowledgetheconsiderable andurgenteffortsmadeby thecountry 25 with some withsome used asaresourcebyother countries. documentation offunctional ODFverificationprocessesintheregiontobe should beincludedinthenextphaseofregional review, includingthe of nationalODFverificationprocesses.Furtherwork onODFverification on theprogressofreviewcountriestowards institutionalization The reviewwasunabletogathersufficientlydetailed informationtoreport progress data,andoftenencouragesgovernment involvement. sustainability ofsanitationoutcomes,itprovides a morereliablesourceof agency. WhileanODFverificationprocesswillnottellusmuchaboutthe ODF statuswasoriginallydeclaredbythecommunityorimplementing have beenassessedbyanindependentgroupsometimeafterthe commonly agreedODFcriteriahavebeenreached,andthatthese ODF verificationisimportantbecauseitprovidessomeguaranteethat some householdstosharelatrineswithinODFcommunities. whereas inothercountries,includingTimor-Leste, theODFcriteriaallow require thateveryhouseholdownsandusesanimprovedsanitationfacility, environments ineachcountry:thestringentODFcriteriaIndonesia others. Nationalprocessesalsoreflectthedifferentpolicyandprogramme and followdifferentprocesses,withsomereportedtobelessrigorousthan different implementingagencieswerereportedtoadoptcriteria In severalcountrieswherenationalcriteriahadnotyetbeenagreed, government approvalinIndonesia. finalized atthenationallevel,althoughprocesshasnotyethadofficial were theonlycountrieswhereanODFverificationprocesshasbeen ODF achievementwereacommonconstraint.IndonesiaandTimor-Leste Inconsistent criteriaandproceduresfordeclaring,certifyingverifying ODF verification 029

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Effectiveness: ODF success rate Effectiveness: triggered communities per facilitator Spread: geographical Spread: geographical Spread: institutional Scale: OD population Scale: triggered communities Scale: ODF communities capacity Scale: CLTS policy Enabling: CLTS planning Enabling: CLTS finance Enabling: CLTS integration Enabling: CLTS monitoring Enabling: CLTS 120 The regional CLTS ranking (see Figure 1.8 below) orders the review the orders 1.8 below) Figure (see ranking CLTS regional The suggests that introduction, and date of CLTS according to the countries high- than the other slightly more slowly has progressed Cambodia the review In particular, and Timor-Leste. countries, Indonesia performing was less well in Cambodia for CLTS the enabling environment found that two countries. than in the other developed four places in the adopting countries took the next The other mid-term closing Nam and Lao PDR, with Myanmar led by Viet regional ranking, 100 80 60 4040 20 were then aggregated. No effort was made effort was made aggregated. No were then 26 0 China (2008) (2008) (2008) (2010) (2011) (2012) (2012) (2008) (2004) (2005) (2007) Kiribati Lao PDR Viet Nam Viet Mongolia Myanmar Indonesia Cambodia Philippines Timor-Leste CLTS overview CLTS Regional (2005 and 2012) Solomon Islands 10 points was scored for a first place ranking; 9 points for second; 8 points for third and so 10 points was scored for a first place ranking; 9 points for second; 8 points for third scores on, with 1 point scored for a 10th, 11th or 12th place ranking (hence possible ranking were 13 – 130 points).

Papua New Guinea to score or weight these indicators to reflect their relative importance, as these indicators to reflect their to score or weight performance CLTS simply to gain some idea of relative the intention was countries. across the review 030 26 (by date of CLTS introduction) review countries (by date of CLTS ranking of the CLTS Figure 1.8 Overall Each of the 14 review countries in which CLTS has been introduced was has been in which CLTS 14 review countries Each of the overviews, CLTS in the country examined all of the 13 indicators ranked for ranking scores and the 13 1.4

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific 28 27 sanitation coveragewas higher inruralareas; apparently lowerinthePhilippines andMyanmar, where improved The urgencyandpriority accordedtoruralsanitationdevelopmentwas improved sanitationfacilities? reports thehighestpercentage(82percent)ofrural populationwithout Cambodia hasthehighestproportionofODin region;andTimor-Leste countries? Eventoday, Indonesiahas48millionpeoplepracticingOD; arose becausethescaleofruralsanitationchallenge waslargerinthese in promotingandintroducingCLTS; orperhaps bothoftheseconditions or becausethesupportagenciesworkinginthese countrieswereproactive progressive andreceptivetonewapproachessanitation development; Was CLTS introduced earlierbecausethesecountriesweremore followed alongsimilarlinesornot. others, andwhetherthedevelopmentofCLTS processesandcapacity understanding ofwhyCLTS wasintroducedearlierinthesecountriesthan performed betterthantheotherreviewcountries.Thiswillrequireadeeper Further workwillberequiredtodeterminewhythesecountrieshave • • • • Indonesia) andTimor-Leste performedbetterinalmosteveryareaexamined: The reviewfoundthatthetwoearlyadoptingcountries(Cambodiaand Associations betweenhigh-rankingcountries Kiribati andChina–filledthebottomrankings. little ornoimplementationhadtakenplace–Mongolia,SolomonIslands, introducing CLTS in2010.Unsurprisingly, thelateadoptingcountrieswhere in ontherankingsofPapuaNewGuineaandPhilippinesdespiteonly

JMP progressreport. 72 percentinthe Philippines,82percentinMyanmar accordingtotheestimates inthe2008 Accordingtothe 2010Timor-Leste PopulationandHousing Census. better CLTS enablingenvironments. higher CLTS effectiveness;and greater CLTS scale; more CLTS spread; 27 28 andinChina, environments forruralsanitation. these reforms,andtherole thatCLTS hasplayedinimprovingenabling years. Again,furtherwork wouldassistinunderstandingthedriversfor cycles, whichtendtolead tonewpoliciesandstrategieseveryfiveor10 these reformsmayalsohave resultedfromnormalpolicyandplanning contributed toimprovementsintheenablingenvironment. However, adopted inIndonesia,Timor-Leste andCambodiasuggestthatCLTS has The progressivesanitationandWASH policiesandstrategiesrecently the CLTS approach. creation) hasbeenimprovedbythedevelopment and institutionalizationof behaviour-change communicationandotherformsofsanitationdemand enabling environmentforruralsanitation(including supplystrengthening, focused snapshotdoesnotallowanassessmentofwhetherthebroader stronger intheearly-adoptingcountriesandTimor-Leste, butthisCLTS- The reviewconfirmsthattheenablingenvironmentforCLTS ismuch rural sanitationandhygiene. in theenablingenvironmentandresourcescapacityallocatedto challenged thestatusquoinmanycountries,andstimulatedimprovements effectiveness andslowprogress.Whileconsensusisstilldeveloping,CLTS in thefaceofevidenceineffectiveorbadlytargetedsubsidies,lowcost- forcing agenciesandcountriestoreviewimprovepolicypractice encouraging theevaluationandcomparisonofcompetingapproaches, of CLTS strengthenedtheruralsanitationsub-sectorinthesecountries, Another hypothesisemergingfromthereviewisthatearlyintroduction these twoformerlycentralizedeconomies. perhaps becauseofthemoretraditionalandrisk-aversegovernmentsin coverage (31percentinMongolia2006),wereslowertoadoptCLTS – either highOD(56percentinLaoPDR2006)orlowimprovedsanitation Possible exceptionswereLaoPDRandMongolia,whichdespitehaving Papua NewGuineaandViet Nam,whereODrateswerebelow20percent. 031

PART I 1. Findings Community-Led Total Sanitation in East Asia and Pacific Community-Led Total

34 Although since the WCA regional review, CLTS has apparently been re-launched in Burkina CLTS Although since the WCA regional review, Faso with Presidential support.

As in the EAP region, CLTS has become one of the main rural sanitation has become one of the CLTS As in the EAP region, countries that have WCA region, with only two large approaches in the Republic of Congo). (Gabon and the Democratic CLTS not yet introduced which took place a year review, The slightly later start (and the earlier in lesser overall progress – the WCA before the EAP review) has resulted and around 1 million people living in review reported 2,100 ODF villages early scaling up in the FAS the recent rapid these ODF villages. However, progress figures may in suggests that the WCA adopters and Timor-Leste the regional review was completed in have advanced considerably since July 2011. – two early adopting countries The progress data are also similar villages; then a group of seven progressed rapidly to trigger 2,100-2,600 and a final group of eight countries countries that triggered 80-400 villages; As in the EAP region, the country that have triggered only 25-60 villages. rate: in programme also has a low ODF success with the largest scale CLTS cent ODF success rate (compared to 17 this case, Nigeria with only 16 per whether this low success rate is the per cent in Indonesia). It is not known programme, as postulated in Indonesia, result of rapid scaling up by a large effectiveness issue in Nigeria. or whether there is a more widespread 34 of the other 13 review countries is similar at around 308 million. The million. 308 at around is similar countries review other 13 of the in the WCA 100 million are also comparable: practicing OD populations million OD the 13 the EAP region (including 85 million in region, and in China). population including three in 18 countries, progress CLTS review examined The WCA (Ghana, Nigeria and was introduced in 2007-08 CLTS early adopters where was introduced in 2009- 14 countries where CLTS Sierra Leone), another beyond the initial did not progress Faso, where CLTS 2010, and Burkina in 2008. pilots in five villages

31 2007-2012 programme 30 ). This AU$ 41 million 29 The WCA region is smaller in population than the EAP The WCA region is smaller in population and World Vision. In early 2012, their combined efforts In early 2012, their combined Vision. and World 33 32 A review of the UNICEF roll-out of the CLTS approach in West and Central approach in West Bevan J (2011) A review of the UNICEF roll-out of the CLTS Africa, 35th WEDC International Conference, Loughborough University. US$ 42.2 million. A second phase US$ 44 million BESIK-2 is due to start in 2013. de Timor-Leste). Red Cross (Cruz Vermelha Timor-Leste The project is widely known by its Tetum acronym: Be’e Saneamentu no Ijieneiha The project is widely known by its Tetum Komunidade (BESIK).

Comparative analysis with other regions Comparative analysis with other and Central Africa review in West CLTS UNICEF conducted a comparable (WCA) in 2011. resulted in the approval of the National Basic Sanitation Policy, the Basic Sanitation Policy, resulted in the approval of the National for Basic Sanitation Services, and a establishment of a National Directorate budget allocation rural sanitation. significant increase in the government region, with a population of around 350 million spread across 25 countries. region, with a population of around rural population large population is excluded, the when China’s However, 032 33 30 31 32 29 A significant factor in this achievement has been the high level of support in this achievement has been A significant factor and Supply Rural Water East Timor provided by the AusAID-supported (BESIK Sanitation Program Rapid CLTS progress in Timor-Leste in progress CLTS Rapid both Timor-Leste, made by progress rapid CLTS highlighted the The review and in interventions, its CLTS effectiveness of the scale and in improving now of the rural population with 16 per cent national impacts, achieving to live in ODF communities. reported In a relatively small country, not only this major WASH programme but WASH not only this major In a relatively small country, stakeholders have been actively a large number of external sanitation efforts to improve sanitation: including engaged in supporting government DH, Oxfam, ChildFund, Triangle Plan, WaterAid, UNICEF, USAID, WSP, CVTL, AFMET, included significant sanitation components, financing full-time sanitation sanitation components, financing included significant and monitoring, capacity building bringing in policy, staff since 2009; systems and specialists to develop sanitation sanitation marketing coordination, providing resources to support sector institutions; and development and learning exchanges. evaluation, capacity

PART I 1. Findings reliable andcomparablesanitationcostdata. assessment frameworksthatencouragethedocumentation andanalysisof and effectivenessintheregionmoredetail, toagreecommon However, furtherworkisrequiredtoexamineCLTS programmecosts which foundtotalCLTS costsaveragedUS$89 pertoiletconstructed. Community-Led Total Sanitation inEast Asia andPacific 37 36 35 ADB studyonsanitationfinanceinCambodia Some costdataareavailablefromtheEAPregion,includinga2010WSP- or mis-matchedcomparisons. effectiveness, butalltoooftenthesecostdataarepartialandleadtounfair support). Reliablecostdataareimportanttoanycomparisonofprogramme development, projectoverheads,managementsupport,localgovernment included directandindirectprogrammesupportcosts(suchascapacity basis ofthesecostassessmentswasnotclear, forinstancewhetherthey The WCAreviewalsopresentedsomeCLTS costdata.However, the 17 countries,comparedtoanaverageofonly21percentintheEAPregion. was significantlyhigherintheWCAregion–averaging33percentacross programme sizesintheWCAcountries,butgeneralODFsuccessrate per centODFsuccessrates.Thislargevariancemayrelatetothesmaller Cameroon, withfourmoderatesizedcountryprogrammesreporting41-74 WCA region,whichrangedfrom3percentinChadto93 One majordifferenceisthevariationinODFsuccessratefound support costs; costs ofUS$48pertoiletconstructed,plusanother40inprogramme

Shapiro Jetal(2009) Timor-Leste Joint SanitationEvaluation:astudy ofprogramoutcomes. Robinson A(2012) SanitationfinanceinCambodia. Water andSanitationProgram,technicalpaper). sanitation forthepoor:asixcountry comparativereviewandanalysisTheWorld Bank, review offinancingon-sitesanitation forthepoor(Tremolet etal,2010Financingon-site This studyusedthesamecost assessment frameworkasthesix-countryWSPcomparative 36 anda2009JointSanitationEvaluationinTimor-Leste, 35 thatreportedCLTS software 37

further studyandanalysisarerequired. highlighted intheconclusionsandrecommendationsasareaswhere countries, thustheissuesarediscussedbelowingeneralterms,and comparative analysisofexperiencewiththeseissuesinthereview In mostcases,insufficientinformationwasavailabletoconductany event andconferencesessions. the countryCLTS overviews,orinthediscussionsheldatEASAN-3side interviewed forthereview, inthedocumentsreviewedpreparationof regional CLTS review. Theseissues were raisedeitherbykeyinformants The followingsectionssummarizethekeyissueshighlightedby 1.5 38 technical guidance, latrines, whichareoftenbuiltrapidlyfollowingCLTS triggeringwithout review. Ingeneral,theseconcernscentredonthedurabilityoflow-costpit improvements gainedfromCLTS interventionswereapparentfromthe Widespread concernsaboutthesustainabilityofsanitation 1.5.1 1.5 below). These studies showed a wide range of outcomes: three studies (in 1.5 below).Thesestudiesshowed awiderangeofoutcomes:threestudies(in ODF sustainabilitywerereviewed (detailedinAnnex3andsummarisedTable In aseparateexercisetothe countryCLTS reviewprocess,sevenstudies on years toelapsebeforeanevaluationofsustainability canbeundertaken. of evaluationwithintheruralsanitationsub-sector, andtheneedforseveral available onreversiontoOD.Thisgapinthedatareflects boththelowlevel of CLTS sanitationoutcomesintheEAPregion, thuslittlereliabledataare Unfortunately, fewevaluationshavetakenplaceaddressingthesustainability to sanitationimprovementoncethemainintervention iscompleted.

standard latrine designs. problems, which generallyprecludestheprovision oftop-downtechnicalguidance suchas One ofthetenets ofCLTS istoencouragehouseholds tosolvetheirownsanitation CLTS regionalissues Reversion toopendefecation 38 andonthesustainabilityofcommunitycommitment 033

PART I 1. Findings

41 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total the quality of the CLTS process; CLTS the quality of the is well implemented; andwhether the process environment was operating within a supportive whether the programme for rural sanitation improvement. The projects and programmes studied were not started at the same time that CLTS was The projects and programmes studied were not started at the same time that CLTS introduced. This finding relates to the hypothesis that the improved enabling environment processes and more earlier encourages better quality CLTS in countries that adopted CLTS effective institutional support systems.

41 only one to three years after CLTS had been introduced to these countries. only one to three years after CLTS The three studies of CLTS interventions in the EAP region (Indonesia, Lao (Indonesia, EAP region in the interventions of CLTS three studies The or low performing either moderate all classified as Cambodia) were PDR and in these to OD found high levels of reversion to the relatively cases due OD confirmed that outside the region studies from other studies. However, most households even where some programmes, levels are low in reversion and Uganda Sierra Leone in Bangladesh, pit latrines. Studies use low-cost in 82 communities. per cent OD across 5,000 households found less than 3 of the reasons given of these study findings, and A preliminary analysis suggests that good for the different OD reversion rates, by these studies to: performance is linked i) ii) iii) was process better where the CLTS Outcomes were found to be much facilitators were well trained, committed comprehensive and well-designed; and government and development and supported (often by NGO partners); practices were aligned with the CLTS partner policies, programmes and approach was newly introduced; CLTS approach. In contrast, where the with only limited training, where local government was implementing sector policies and practices were less experience or support; and where higher. approach, OD reversion rates were much supportive of the CLTS more countries, where in older CLTS The better ODF outcomes were found to refine the approach,time and experience had allowed implementers the enabling environment: the studyimprove implementation and strengthen after four in Himachal Pradesh of CLTS; in Bangladesh was made after 11 years The studies that found and in Sierra Leone after five years of CLTS. years of CLTS; Lao PDR and Cambodia were conductedless successful outcomes in Nigeria, Study size ODF Unions 3,000 households in 53 300 households in 15 ODF communities 1,851 households in 57 ODF villages 821 households in 20 ODF villages 1,860 households in 19 ODF villages 512 households in 20 ODF villages 3 ODF communities 20 ‘quickly ODF’ communities 20 ‘late ODF’ communities 3 ODF villages 6 non-ODF villages 10 ODF villages 40 – 29 per cent reported a ‘dig and bury’ practice during flooding and bury’ practice cent reported a ‘dig – 29 per Main study findings 3% OD sanitation 8% use of unimproved facilities 10% OD 10% shared use of improved sanitation facilities Ethiopia: 9% OD Kenya: 8% OD Sierra Leone: 1% OD Uganda: 1% OD 0-18% OD 76% OD in excluded tribal group 1 ‘quickly ODF’ community with some OD (19 others still ODF) 20% OD in ‘late ODF’ villages 0-19% OD in ODF villages 2-25% OD reversion in non-ODF villages 29% ‘dig and bury’ and 28% OD or shared latrine use 39 Although only 84 per cent of households owned latrines when these communities were Although only 84 per cent of households owned latrines when these communities latrines. with another 16 per cent reported to share other people’s declared ODF, interventions. among households that had built new latrines following CLTS High performing cases Bangladesh (2011) Himachal Pradesh, India (2010) Africa (2012) Moderate performing cases Nigeria (2008) Indonesia (2011) Lao PDR (2009) Country Low performing case Cambodia (2008) were In the case of non-ODF villages, the reported rates of reversion to open defecation Table 1.5 Summary of ODF sustainability studies 1.5 Summary of ODF sustainability Table that prevented them using their latrines, and another 28 per cent were either another 28 per cent their latrines, and them using that prevented latrines. other people’s practicing OD or sharing Source: Annex 3 Evidence: ODF sustainability. 034 40 39 South Asia and Africa) reported 1-10 per cent OD in formerly ODF communities; ODF in formerly cent OD 1-10 per reported Africa) Asia and South PDR, found 0-19 and Lao studies in Indonesia studies, including another three in Cambodia, and the final study, ODF communities; OD in previously per cent in previously ODF using latrines were not 57 per cent of households found that communities

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific 43 42 Campaign (TSC)inIndia A 2011WSPassessmentofthefirstdecade Total Sanitation Association betweenprocessandoutcomes tended tofocusonlatrineconstructionratherthanbehaviourchange. implemented inthe‘lateODF’communities,andthatprogressmonitoring OD reversion.Thestudyreportedthata“lowerqualityCLTS process”was those thatwereslowtoachieveODFstatus,thestudyfound20percent be classedasahighperformingcase;whereasin‘lateODF’communities, to havesustained100percentcoverageoffunctionallatrines,whichwould months oftriggering,19ODFcommunities(out20studied)werefound strata: in‘quicklyODF’communities,whichdeclaredODFstatuswithintwo slippage. However, thisstudyexaminedtwodifferentODFperformance six yearsafterCLTS wasintroducedyetreportedmoderatelevelsofOD Once again,theexceptionisIndonesiastudy, whichwasconducted indicators hasbeengood, the processesandoutcomes–wherevercombinationofprocess process elementsaremostcriticaltoCLTS outcomes. high ODreversionratesreportedintheEAPregion; andtoexaminewhich the reasonsforODreversion,andinparticular reasonsfortherelatively rural sanitationimprovement.Furtherworkisrequired tounderstandbetter process anditsimplementation,ofthelocalenabling environmentfor of theCLTS approach,butratherareflection of thequalityCLTS regional CLTS review:ODreversionisnotnecessarily aninherentweakness These findingsconcurwiththepreliminaryanalysis conductedforthis effectively orinthespiritintendedbyTSCguidelines. was laggingbehind,thelocalgovernmentshadnotusedTSCprocesses

chain; financing andincentives;monitoring. capacity; approach tocreatingdemandandscaling up;technologypromotion andsupply Process indicators included:strategyforTSCimplementation, institutionalstructure and Main report. outcomes, NewDelhi:TheWorld Bank,Water andSanitationProgramSouthAsia,Volume 1 WSP (2011)ADecadeoftheTotal SanitationCampaign:rapidassessmentof processes and 42 found“astrongandpositivecorrelationbetween 43 soaretheoutcomes”.Wheredistrictprogress facilities. While there is evidence that poor households have to repair and facilities. While thereisevidencethatpoor householdshavetorepair and and rebuilding costsfacedbyruralhouseholds thatusenon-durable sanitation Similar concernshavebeen expressedaboutthepotentiallyfrequentrepair hygienic sanitationfacilities. (and other)supporttoencourage thelong-termuseandmaintenanceof on thesustainabilityofCLTS outcomes,andthe bestformoftechnical enhance ourunderstandingoftheinfluencethese technicalfactors Some well-designedresearchandevaluationinthis areawouldgreatly genuine behaviourchangethatissubvertedbylatrine durabilityproblems. behaviour changeamonglatrineusers,andgood implementationand CLTS implementation,whichcanresultinlimited convictionandtemporary reports areanecdotal,anditisoftendifficulttodifferentiate betweenpoor termite damageanddifficultgroundconditions. However, manyofthese countries, aswereconstructionanddurabilityproblemsrelatedtoflooding, Unhygienic latrineswerementionedasCLTS constraintsinseveral latrine abandonment. and riskofcontamination(frombadlycontainedexcreta),pitcollapse latrines, useofnon-durablematerialsanddesigns,unhygienicfacilities, during thelatrineconstructionphaseoftenresultsinbadlyconstructed innovation. Otherstakeholderssuggestthatalackoftechnicaladvice latrines withlocalmaterialswillencourageownership,commitmentand and thattheexerciseofsolvingtheseproblemsthroughbuildingsimple communities andhouseholdsshouldsolvetheirownsanitationproblems, communities. OneofthecoretenetsCLTS approachisthat A relatedissueconcernstheprovisionoftechnicaladvicetoCLTS in theEAPregion. how thisissueaffectsODFsustainabilityandODreversion,wereavailable country CLTS overviews.Littledataonlatrinedurability, orassessmentsof Latrine qualityanddurabilitywerehighlightedasconstraintsinthree 1.5.2 Latrine quality 035

PART I 1. Findings found that only 47 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Robinson A (2012) Sanitation finance in Cambodia.

10 per cent of subsidized latrines reached the poor households targeted latrines reached the poor 10 per cent of subsidized construction services that the latrine components and by the programme; as much as similar programme cost more than twice provided by this that the subsidy available from the private sector; products and services options available to the beneficiary programme limited the choice of programme had constrained the households; and that the large-scale and construction businesses. development of local latrine production now focus on the provision of ‘smart Discussions of sanitation subsidies outcome-based, cost-efficient, and subsidies’ that are well targeted, for customers and avoid disruption designed to promote competition of the implementation of few examples to local markets. Unfortunately, or evaluation of the practical ‘smart subsidies’ exist, and no documentation subsidies were found by the review. application and effectiveness of smart to pilot a range of smart subsidies, Ongoing projects in Cambodia plan rebates and cash transfers, but from latrine vouchers to outcome-based that these ‘smart subsidies’ are effective there is as yet little or no evidence and market integration of latrine in improving the targeting, cost efficiency can be provided without undermining subsidies; or that ‘smart subsidies’ facilities. interventions and affecting the self-provision of sanitation CLTS can be provided through hardware subsidy programmes tend to be more to be more tend programmes subsidy hardware through be provided can achieved whether ODF outcomes and question and more durable, hygienic of coverage than high levels are more beneficial pit latrines with low-cost slabs. to clean concrete that have easy latrines with pour-flush achieved available the little evidence thin, and base is surprisingly The evidence and contexts programmes of particular the shortcomings often reflects hardware subsidies characteristic of either latrine more than any inherent programmes. or CLTS on sanitation finance in Cambodia A 2010 WSP study 47 was identified as

46 45 In contrast, more expensive In contrast, more 44 Latrine hardware subsidies Direct subsidies are usually provided in the form of subsidized or free latrine materials and Direct subsidies are usually provided in the form of subsidized or free latrine materials construction services. In terms of the value of the materials and labour. In terms of the value of the materials and and Bank, Water Robinson A (2012) Sanitation finance in rural Cambodia. The World Sanitation Program, guidance note.

latrines with rendered brick enclosures required fewer repairs, but repair brick enclosures required fewer latrines with rendered due to the need for higher (averaging US$ 45 per latrine) costs were much and masonry skills. market-bought materials, transport Despite the successful spread of CLTS across the region, there remains little across the region, there remains CLTS Despite the successful spread of subsidies in sanitation development. consensus on the role of hardware advocates suggest that the provision of subsidized latrine CLTS interventions services disrupts CLTS components and latrine construction an adequate level of service; by raising local expectations regarding in the self-provision of facilities; and suppressing household investments local producers and service providers. constraining the development of standard of latrines that subsidy advocates note that the higher Conversely, perhaps the biggest challenge to the scaling up and effectiveness of CLTS the scaling up and effectiveness of CLTS perhaps the biggest challenge to in the EAP region. 036 46 44 45 The continuing use of direct latrine hardware subsidies The continuing use of direct latrine 1.5.3 The household survey conducted for Phase 2 of the Economics of conducted for Phase 2 of the The household survey the average imputed (ESI-2) in Cambodia found that Sanitation Initiative programme was US$ latrines built under the Plan CLTS cost of the dry pit repairs to the latrine 20 per cent of owners had made 13, and that around valued at ‘zero cost’. enclosures that they rebuild facilities on a fairly regular basis, particularly those living in areas living those particularly basis, regular on a fairly facilities rebuild problems,or high groundwater flooding rainfall and seasonal with heavy burden on poor any unnecessary these costs place evidence that there is less on arebuilding their housing to repairing and who are used households built using locally low cost, latrines are extremely Most of these regular basis. cost very little. repairs generally materials, thus the available

PART I 1. Findings Community-Led Total Sanitation inEast Asia andPacific achieved whenprogrammestackleweaknessesin sanitationsupplychains. evidence thatgreaterscale,effectiveness,sustainability andbenefitscanbe supply-side factorsinfluenceCLTS outcomes, andwhetherthereisany were available.However, thenextphaseofreviewshouldconsiderhow beyond theusualareasaddressedbyCLTS interventions,thusfewdata The regionalCLTS reviewdidnotexaminesupply-sidefactorsastheseare of toilettobuild. household decisionsaboutwhetherornottobuildatoilet,andwhattype in theavailabilityandaffordabilityofsanitationgoodsservices, The conditionoflocalsanitationsupplychainscanbeanimportantfactor improve facilities,andpromotethesustaineduseofhygienictoilets. about thesegoodsandservices,toallowruralhouseholdsupgrade appropriate andaspirationalsanitationgoodsservices,information Increasing effortsarebeingdirectedatimprovingthesupplyofaffordable, provide aneffectiveorsustainablesolutiontolocalsanitationproblems. interventions donotmeettheaspirationsofthesehouseholds,or sanitation needs.Insomecases,thesimplelatrinesthatresultfromCLTS available resourcestobuildanduseaffordablelatrinesthatmeettheir The CLTS approachfocusesontriggeringruralhouseholdstouselocally 1.5.4 Supply-side interventions sustained accesstohygienicsanitationfacilities. on howbesttoensurethatpooranddisadvantaged householdsgain outcomes areovertime,andwhetherthereisany learningfromtheregion CLTS process.FurtherworkisrequiredtodeterminehowequitableCLTS materials, landtenureandlabourshortages),orthosemarginalizedinthe close totheirhomes(dueproblemsincludingaffordability, lackof that didnotmanagetobuilddurableandhygienicsanitationfacilities CLTS approachcanbelost.ThosethatreverttoODareoftenhouseholds and communitiesquestionswhethertheassumed‘equitybonus’of can beeffective,evidenceofreversiontoODbysomeCLTS households including disgust,peerpressureandcollectiveaction.Whilethesetriggers behaviour changeamongthepoorestandmostdisadvantagedhouseholds, CLTS usesanumberofdifferentmechanismstoencouragesanitation build andusesanitationfacilitiesthatarewithintheirmeans. who generallyhavethehighestdiseaseburden–andencouragingthemto around reachingthepoorestandmostdisadvantagedhouseholds–those sanitation behaviour. Asaresult,thebiggestchallengeofCLTS isoften community, howeverpoorordisadvantaged,stopsODandimprovestheir achievement ofanODFcommunityrequiresthateverymemberthe One ofthestrengthsCLTS approachisitsinclusivenature– 1.5.5 CLTS andequity 037

PART I 1. Findings 2. Conclusions

2.1 CLTS works progress data were not readily available. Few countries have mechanisms that require routine reporting or analysis of monitoring data, thus there The review confirms that CLTS is working in the EAP region. Despite is little demand for the data. As a result, monitoring systems are rarely concerns that CLTS was not appropriate to the cultural and social contexts maintained or sustained, and the reliability of monitoring data is rarely in the region, CLTS has already spread to 12 countries, triggered sanitation checked. In part, this weakness reflects the lack of CLTS or sanitationimprovements in more than 12,000 rural and peri-urban communities, and related objectives in national plans and strategies, which limit high-level led to more than 3.1 million people living in 2,300 ODF communities. The interest or the need for regular reporting of CLTS progress and outcomes. review found that CLTS implementation and support are growing across the The country CLTS review teams often had to collect data directly from region, and that enabling environments are become increasingly supportive. implementation agencies in order to compile national summaries of CLTS progress, and there remain questions about the reliability and accuracy of CLTS alone will not be enough to meet rural sanitation objectives in the some of the data reported. region, and this review recognizes that the approach has weaknesses (see following conclusions). Nevertheless, the 12 country CLTS overviews suggest that CLTS has been more effective than previous approaches to sanitation 2.3 CLTS scale up takes time development in triggering sanitation improvement and behaviour change, and in raising government awareness and priority for rural sanitation. The review findings suggest that CLTS spread, scale and effectiveness have taken time to develop, but that CLTS progress appears remarkably CLTS still faces substantial obstacles in the region, not least being strict consistent despite the very different contexts and challenges found across technical regulations in China and DPR Korea which limit the use of low- the review countries. cost sanitation facilities, and the incompatibility of current latrine subsidy programmes with CLTS. Nonetheless, the review found that CLTS is It was anticipated that the different CLTS introduction processes and spreading and scaling up in the region, and has already led to improved sectoral dynamics would influence overall country outcomes significantly. sanitation for several million people. However, the review suggests that the CLTS ‘learning curve’ is a more critical factor. Progress after CLTS introduction is relatively slow, as efforts are made to show that CLTS can work, attract more implementers and 2.2 bASIC CLTS data not readily available develop a more supportive policy environment.

CLTS monitoring remains a significant weakness, at both national and The two early adopting review countries and reported consistently greater project levels. The review found that, in most countries, even basic CLTS progress and performance than the mid term-adopting countries: ODF

038 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific review countrywhereCLTS hasachievedsignificantimpactonnational Timor-Leste’s relativelysmallruralpopulationmeanthat itistheonly only alimitedimpactonnational sanitationcoverageinthereviewcountries. managed toachievereasonablespread,scaleandeffectiveness, CLTS hashad Despite thereviewfindingsthatCLTS works,and thattheearlyadopters 2.4 the scaleofCLTS implementationinthelasttwo years. the PAMSIMAS programme,whichappearstohavedramatically increased low ODFsuccessrateinIndonesiawasaffectedbythepoorperformanceof quality CLTS implementation,andtolowerprogrammeeffectiveness.The The reviewalsohighlightedtheriskthatrapidscalingupcanleadtolower impacts andattractlarge-scalegovernmentfinance. scale, effectivenessandsustainabilityareinapositiontogeneratenational conditions, ithastakenmorethanfiveyearstoreachastagewhereCLTS priority andcommitment.However, despitethesesupportivestarting attracted moreexternalsupportandencouragedgreatergovernment the earlyadoptingcountries,CambodiaandIndonesia,Timor-Leste, The reviewrecognizesthatthelargerruralsanitationchallengesfacedby scale andspread. the CLTS-friendly policies,plansandprogrammesthatallowprogressto consensus onwhatworks,refineimplementationprocesses,andelaborate The reviewarguesthatittakestimetobuildanevidencebase,develop and only17-22percentintheothermid-termadopters. success rateswere34-36percentinCambodia,IndonesiaandTimor-Leste, sanitation coverage Limited CLTS impact onnational government’s sanitationobjectives. that lacktheresources,capacityandpriorityneededtoachieve development plans,andinvestmentimplementationprogrammes there isoftenadisconnectbetweenruralsanitationtargets,strategiesand capacity developmentormonitoringsystems.Thereviewconfirmsthat finance tonationalCLTS programmes,orhavedevelopedformalCLTS review countrieshavenationalstrategiesforCLTS, providegovernment implementation andlimitedgovernmentinvestmentinCLTS –fewofthe The reviewsuggeststhatthelackofnationalimpactisresultadhoc of theseODFoutcomesisinquestion. cent oftheruralpopulationliveinODFcommunities,butsustainability non-ODF communitieshavebuiltnewtoilets.Cambodiareportedthat5per in ODFcommunities,andanother8percentoftheruralpopulationliving sanitation coverage:16percentoftheruralpopulationarereportedtolive policies, strategiesandprogrammes. decision-makers, whichhas ledtorecentimprovementsinsanitation rural sanitationimprovement amongsectorspecialistsandgovernment and programming,leadingtogreaterawareness engagementwith targeting throughouttheregion.CLTS challenged conventionalthinking standards, sustainability, cost-effectiveness,scalingup,equityand influence onnationaldiscussionssanitationfinance, technical of thesereforms,thisreviewarguesthatCLTS hashadasignificant since CLTS wasintroduced.Whileitishardto determinethetruedrivers have madesignificantprogressinimprovingCLTS enablingenvironments The reviewconfirmsthattheearlyadoptingcountries and Timor-Leste 2.5 environments CLTS hasinfluencedenabling 039

PART I 2. Conclusions Community-Led Total Sanitation in East Asia and Pacific Community-Led Total ximized in the being ma Is the role of CLTS EAP region? 2.8 the in is that the potential of CLTS The main conclusion of the review is While the review found that CLTS EAP region has not been maximized. has been much slower than anticipated working and spreading, progress penetrated has not Furthermore, CLTS even in the early adopting countries. China and DPR Korea. far into the Pacific island states, in more effectiveness in the EAP region appears to be lower than that CLTS greater programmes in WCA. This is surprising given the generally recent CLTS EAP region, but may reflect the greaterresources and capacity found in the implementation tension between the use of latrine hardware subsidies and CLTS in the EAP region, or perhaps the higher expectations of this rapidly urbanizing region (which constrains the adoption and use of simple pit latrines). programmes in the region, and is the only country reviewed where CLTS is CLTS where reviewed only country is the and in the region, programmes coverage. on national sanitation impact to have made a significant thought until relatively introduced CLTS island states few of the Pacific In contrast, before 2012, CLTS Guinea implemented Only Papua New recently. committed efforts of a few dependent on the up currently with scaling and Kiribati Solomon Islands into the was introduced CLTS individuals. has not yet reached Vanuatu. during 2012, but both the perception engagement in the Pacific reflects The lack of CLTS island states would contextual differences in these that the cultural and and the lack of Pacific and effectiveness of the approach, limit the relevance to the region CLTS of the key agencies that introduced engagement by some many other countries Plan International). As in WaterAid, UNICEF, (WSP, Islands now New Guinea and the Solomon experiences in Papua previously, and from working, do not prevent CLTS suggest that the cultural differences in remote island communities wherethat the approach has great potential and hard to access.market goods and services are expensive within the region variations CLTS outcomes of CLTS ility b Sustaina 040 Timor-Leste was another strong CLTS performer. Despite only introducing performer. was another strong CLTS Timor-Leste was found to have one of the best CLTS in 2007, Timor-Leste CLTS The review highlighted the significant sanitation challenge faced by The review highlighted the significant population of the 14 review countries Indonesia: 57 per cent of the rural 48.1 million people in total. The review that practices OD lives in Indonesia, to this challenge well, making more found that Indonesia has responded progress since 2005 than all of the other review countries combined: CLTS now living in ODF communities, 72 per 2.3 million people in Indonesia are the region. Indonesia also came first in cent of the total ODF population in made performance, the only country to have the regional ranking of CLTS areas. progress in all five enabling environment 2.7 The analysis also noted that two of the review country studies on ODFThe analysis also noted that two of conducted within one to three in Lao PDR and Cambodia, were sustainability, facilitator when implementation processes, years of the introduction of CLTS, enabling environments were relatively under-developed. training and CLTS The review was unable to shed much light on the sustainability of CLTS of CLTS on the sustainability shed much light was unable to The review However, from the region. evidence available due to the limited outcomes Africa, South sustainability in studies of ODF of seven recent an analysis of ODF and Asia suggested that the sustainability Asia and South-East process: the CLTS was linked to the quality of outcomes other CLTS to result in significant implemented processes tended inadequate or badly tended whereas good processes low sustainability, reversion to OD and While intuitive, sustainability and low slippage rates. to result in good outcomes can be studies confirmed that sustainable the review of these reversion to OD is not interventions, and that widespread achieved by CLTS step in the process. an inevitable next 2.6

PART I 2. Conclusions © UNICEF/NYHQ2008-1276/Estey Community-Led Total Sanitation inEast Asia andPacific The roleofCLTS intheregionisimportant:arecentpaper subsidies alongsideCLTS interventions. policy alignmentissuesarecreatedbytheprovisionoflatrinehardware few formalcapacitydevelopmentprogrammesexistforCLTS; andmajor other behaviourchangeandsanitationhygienesoftwareactivities); there islimitedgovernmentinvestmentinCLTS implementation(orin absent frommanynationalstrategiesandimplementationprogrammes; Further enablingenvironmentdevelopmentisrequired:CLTS remains 51 50 49 48 stunting, andthatmoreattentionshouldbepaidto thiscriticalissue. they dosuggestthatODandsanitationcoveragearestronglylinkedto India, While thesestudiesdonotestablishacausaleffectofsanitationonheight, open defecation. villages aretallerthanchildrenlivinginwithless50percent openly defecatearetaller, onaverage”,andthatchildrenlivinginODF years old. 54 percentofcross-countryvariationsintheheightchildrenunderthree health surveys(DHSs)tofindthatsanitationcoveragealoneexplained height andsanitationdatafrom140nationallyrepresentativedemographic

communities with moreOD. As childrenand familieswithotherdisadvantages maysortintoneighborhoods and Policy Forum2012. Delhi: NationalCouncilofApplied EconomicResearchandTheBrookingsInstitution,India Spears D(2012a)Policylessons fromimplementingIndia’s Total SanitationCampaignNew Delhi: NationalCouncilofApplied EconomicResearch,IndiaPolicyForum2012). (Spears D,2012aPolicylessons fromimplementingIndia’s Total SanitationCampaignNew such aselectrification,watersupply, politicalautocracyorestimatesofcaloriedeficits including forGDP, withnosimilareffectfoundforotherplausible cross-countrydifferences This resultisnotdrivenbytimetrends,androbusttotheinclusion ofcontrolvariables height: evidencefrom140nationallyrepresentativehousehold surveys.RICEworkingpaper. Spears D(2012)Sanitationandopendefecationexplaininternational variationinchildren’s 50 foundthat“childrenwholiveinvillageswherefewerhouseholds 49 Anotherstudybythesameauthor, ofhouseholdsurveydatain 48 analysedchild 041 51

PART I 2. Conclusions 3. Recommendations

The recommendations provided in this review report are general in nature 3.2 Strengthen CLTS monitoring systems because of the limited secondary data and information on which the rapid review was able to draw. More specific and detailed recommendations The review recommends more detailed monitoring and evaluation of would need to be based on an in-depth examination of country-level issues CLTS progress and effectiveness. The main problem seems to be the and in-country consultations. lack of mechanisms that encourage the regular collection, analysis and reporting of CLTS or other sanitation performance data. Annual strategic reviews, ideally linked to the monitoring of CLTS progress against strategic 3.1 Improve CLTS enabling environments sanitation targets, and local government benchmarking systems are useful mechanisms for pulling monitoring data and reports up through Scaling up CLTS progress and improving CLTS effectiveness and government and programme systems. sustainability will be dependent on further strengthening of enabling environments for rural sanitation in the review countries. Few governments The review also suggests that there is a need for more regular regional or development partners in the region have yet developed strategic updating and reporting of national CLTS and other sanitation progress sanitation plans that elaborate the role of CLTS in creating large-scale data. The two to three year EASAN conference cycle is too long, and the demand for sanitation, or financed national implementation programmes biennial JMP progress report contains insufficient detail. Therefore, it is that combine CLTS with other approaches. recommended that the review partners consider whether an annual update of national sanitation progress and performance data can be made part of Further work is required to examine the sort of interventions that can any existing regional processes or monitoring mechanisms. influence the political economies, institutional legacies, information gaps and other areas that determine government direction on rural sanitation. 3.3 CLTS quality While some of these areas are resistant to sector interventions, there is growing evidence that governments are willing to reform and adopt new The review confirmed strong demand for information on how best to approaches where credible evidence is available that new approaches and improve CLTS quality and accelerate progress. Most stakeholders agreed arrangements are appropriate and cost-effective. Realistic, costed and well- that CLTS facilitation, process and follow-up quality were critical, but there prioritized strategic sanitation plans are central to persuading governments were few concrete suggestions on what needs to be done to improve in the region, which historically prefer infrastructure investments, that it is implementation and follow-up. in their interest to allocate more finance and capacity to behaviour-change programmes like CLTS which can reach the poor and reduce health costs.

042 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific (and non-ODF)communities. best practicesforthelong-term institutionalsupportandmonitoringofODF in plans,programmesand practice,andthateffortsaremadetodocument recommends thatgreater prioritybeallocatedtopost-triggeringactivities are allocatedtotheseareasbyprojectsorprogrammes. Thereview CLTS triggeringarecriticaltosustainability, littlefinanceorcapacity Despite frequentsuggestionsthatfollow-upandlong-term supportafter within theEAPregion. to collateongoingandrecentlycompletedstudies onODFsustainability sustainability and,therefore,recommendsthatfurther workisundertaken The reviewhighlightedstrongregionaldemandfor informationonODF 3.4 and bestpracticetokeyprogrammesinstitutionsaroundtheregion. assessment ofCLTS quality, andbe responsible fordisseminatinglearning institute couldprovidestandardtrainingpackages,encourageroutine or developingaregionalCLTS traininginstitute.Thisregional countries intheregionsuggeststhattheremaybeadvantagestosupporting of implementation.ThelimitedspecialistCLTS capacityfoundinmany institutions asafactorintheconsistentscalingupandimprovement The regionalCLTS reviewinWCAhighlightedtheuseofregionaltraining should beanessentialpartofanyCLTS intervention. – forinstance,whyoutcomesarebetterinoneprogrammeareathananother factors thatleadtohigherODFsuccessratesandmoresustainableoutcomes the relativeeffectivenessofactivefacilitatorsandsupportstaff.Analysis made totrackthenumberoftrainedfacilitatorsthatbecomeactive,andassess implementation qualityandcapacitydevelopment.Moreeffortneedstobe The reviewrecommendsmoredetailedmonitoringandassessmentofCLTS ODF sustainability facilitation quality, post-ODFfollow-upandsupply-sidefactors. the understandingofrelativeimportancekeyfactorssuchasCLTS sustainability. Furtherworkisrecommendedinthisareatocontribute supply-side factorsonlatrinedurability, facilityupgradingandODF and thebenefitsgenerated.Thisreviewdidnotexamineroleof goods, servicesandinformation,canalsoinfluenceODFsustainability Supply-side factors,suchastheavailabilityandaffordabilityofsanitation support andenhancethesustainabilityofODFoutcomes. attention isgiventotestingandimplementingmechanismsthatencourage, provided topost-ODFcommunities.Thereviewrecommendsthatfurther useful mechanismthroughwhichtoincreasethemonitoringandsupport more conventionalconditionalgrantsandfinancialrewards,offersa available, whichincludenumerousnon-financialawardsinadditionto their useintheEAPregion.Nonetheless,broadfamilyofincentives collective sanitationimprovementonsustainabilityappeartohavelimited Concerns aboutthepossiblenegativeeffectsofinstitutionalincentivesfor able toclarify anddisseminatebetter theexistingevidencebase onlatrine review wouldmakeasignificant contributiontothesub-sectorifitwas base thatinformsthesedebates. ThenextphaseoftheregionalCLTS partner agencies),andthe limitedextentandreliabilityoftheevidence oppose latrinehardware subsidies (evenamongtheregionalCLTS review sessions highlightedthe strong polarityofthosethateithersupportor The discussionsheldattheEASAN-3sideeventand mainconference other interventionsdesignedtoimproveruralsanitation andhygiene. can beimprovedandbetteralignedwithCLTS, sanitationmarketingand government and development partnerpoliciesonlatrinehardwaresubsidies emotive andimportantissue.Moreeffortisrequired tounderstandhow The reviewconfirmedthatpolicyonlatrinehardware subsidiesremainsan 3.5 Latrine hardware subsidies 043

PART I 3. Recommendations Community-Led Total Sanitation in East Asia and Pacific Community-Led Total her research Furt countries new CLTS to Assistance 3.8 review was envisaged as the first stage in a collaborative The regional CLTS in the region, increase understanding effort to assess the progress of CLTS and ensure that the potential benefits of of how best to accelerate progress, approach were being maximized. the CLTS was able to collate and document The rapid review reported herein progress data, and highlight the key issues raised by the various CLTS this first stage of the teams. However, country review and regional review detailed review also confirmed the strong demand in the region for more most stakeholders knowledge on a wide range of issues – in particular, and its main strengths and weaknesses, but are now familiar with CLTS 3.7 in the were involved coordinated efforts suggested that The review adopting of the early in several of CLTS and evolution introduction from these was developed and capacity Significant learning countries. to benefit the countries which should now be utilized country processes, introducing CLTS. that are currently the regional CLTS that the agencies supporting The review recommends assistance to provide CLTS a proactive role in the Pacific review should take effectiveness gains order to accelerate progress and and guidance in rapid and lessons from the countries. In particular, in these new CLTS to be are likely in Timor-Leste development of CLTS relatively successful small Pacific island states. relevant to these conference should be called the As noted at EASAN-3, the next regional Conference on Sanitation (EAPSAN), and East Asia and Pacific Ministerial to support and include the Pacific efforts should be made in the interim forums and networks. island states in sanitation development Non-ODF communities 044 Few CLTS programmes offer any solution in these cases, with most programmes offer any solution in these cases, with most Few CLTS triggering or to following up with ODF activities directed towards repeat that the next phase of the communities. Therefore, it is recommended strategies review should examine appropriate post-CLTS regional CLTS triggered but non-ODF communities, and and programme options for these extent and sustainability of the sanitation compile more reliable data on the gains made in these communities. This regional CLTS review has focused on progress in achieving ODF review has focused on progress in achieving This regional CLTS success rates in the region the relatively low ODF communities. However, almost 80 per cent of the CLTS-triggered remind us that, at least at present, in the 12 review countries that have communities do not reach ODF status: total of to date, 9,500 triggered communities (out of the introduced CLTS 12,000) did not reach ODF status. 3.6 Programme costs Programme of the scaling any discussion be central to cost data should Programme development approach. and sustainability of a sanitation up, effectiveness but should start with of cost-effectiveness is difficult, Proper assessment support and capacity costs (including indirect reliable data on programme efforts are made to The review recommends that development costs). agencies in each implementing from the major CLTS collect cost data of the relative order to encourage informed discussion review country in of different processes and approaches. costs and benefits hardware subsidies (and smart subsidies), and encourage greater and more and greater encourage and subsidies), smart (and subsidies hardware subsidy and completed latrine ongoing and efforts to evaluate rigorous compare the results. and programmes, CLTS

PART I 3. Recommendations Community-Led Total Sanitation inEast Asia andPacific 5. 4. 3. 2. 1. Areas tobedocumentedfurther: primary research. require furtherinvestigationandassessment, whichmayrequiresome available tothefirstphaseofreview;second listisofareasthat products whichwerenotpossibletocollectordocument intheshorttime require moredetaileddocumentationofavailabledataandknowledge second phaseofthereview. Thefirstlistcomprisesreviewareasthat A largenumberofissueswerehighlightedforfurtherstudythroughthe region tospeedupCLTS developmentandaccelerateprogress. states –inordertoexaminehowbestusethelearningfromrestof – perhapstwoofthePacificislandstatesandonethreeEastAsian to someofthecountriesthathaveeitherrecentlyornotyetintroducedCLTS effectiveness andsustainability. Itisalsorecommendedthatvisitsbemade in eachcountry, andthefactorsthathavehelpedorhinderedtheirscale, understand bettertheevolutionofCLTS approachesandprogrammes highest performingcountries–Indonesia,Timor-Leste andCambodia–to the reviewrecommendsthatin-countryvisitsshouldbemadetothree of and specificstudyrequiredtorespondthesedemands.Thefirstphase A secondphaseoftheregionalCLTS reviewwouldenablethemoredetailed accelerating thescalingupofsanitationimprovement. sustainability concerns,complementingCLTS withotherapproaches,and environments, improvingtheeffectivenessofCLTS programmes,tackling would liketoknowhowbestgoaboutstrengtheningCLTS enabling CLTS quality: existingassessments ofkeyfactors. their relativeeffectiveness. Capacity development:data onthenumberofactivefacilitators,and ODF sustainability:existing evaluationfindings. communities verifiedto date (oratvariousstagesintheprocess). ODF verificationprocesses: existingandplannedprocesses;numberof hardware subsidiesandCLTS. Existing evidencebaseontherelativeeffectiveness andbenefitsof 7. 6. 5. 4. 3. 2. 1. Areas toberesearchedfurther: 12. 11. 10. 9. 8. 7. 6. capturing localinnovations), roleofsanitationmarketing. Technical factors:roleoftechnicalsupportinCLTS (informedchoice, CLTS improvements in non-ODFcommunities? Progress inNon-ODFcommunities: bestpracticeforachievingpost- larger scale,moreeffective andmoressustainableprogrammes? CLTS quality:howtoaccelerateprogress?What isthebestpracticefor facilitation, andtheeffectivenessofCLTS facilitator training? Capacity development:whatfactorsincreasethe effectiveness ofCLTS OD reversion;bestpracticetoimproveODFsustainability. ODF sustainability:bestpracticeforpostmonitoring; reasonsfor ODF verificationprocesses. ODF verificationprocesses:bestpracticeforscaling upandsustaining help orhinderCLTS andotherdemandcreation approaches? Evidence baseonsubsidies:doestheprovisionofhardwaresubsidies programmes (size,durationandsustainability). that implementorpromoteCLTS, andthescaleorinfluenceoftheir Institutional spread:documenttheproportionofsectororganizations CLTS monitoringsystems. Monitoring: documentbestpracticesandlessonslearnedfromexisting cost assessments. subsidy programmes;examinecostcomponentsincludedinthese Cost data:collateexistingcostdataonCLTS andlatrinehardware approaches (CLTS andsanitationmarketing,orotherapproaches). Combined approaches:collateexistingevaluationsofcombined of similarprocessesinothercountries. from IndonesiaandTimor-Leste andusethesetoinformdevelopment Enabling environment:documenttheenablingenvironmentlessons services; numberoftoiletssoldinCLTS programmeareas. Technical factors:availabilityandaffordabilityofsanitationgoods latrines builtinnon-ODFcommunities. Progress inNon-ODFcommunities:dataonnumberandqualityofnew 045

PART I 3. Recommendations © UNICEF Timor-Leste/2012/Afrianto Kurniawan Timor-Leste/2012/Afrianto UNICEF © Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Enabling environment: what were the factors that environments to that environments factors were the what environment: Enabling or not improved? improve and sanitation practice for CLTS approaches: best Combined marketing. to scale up? what does it cost Cost data: sustainable to encourage best practice mechanisms Monitoring: monitoring for spread – the spread: examine best practice Reasons for limited outside the parent approaches into new areas (e.g. introduction of new programme areas). Sanitation and hygiene in nutrition programmes: whether increased Sanitation and hygiene in nutrition inadequate sanitation and stunting understanding of the link between and hygiene components into large can be utilized to build sanitation nutrition programmes. Handwashing with soap: how best to integrate the handwashing with Handwashing with soap: how best and other rural sanitation programmes. soap interventions with CLTS Child excreta disposal: how best to integrate the improvement of child Child excreta disposal: how best programmes (implementation excreta disposal into rural sanitation and monitoring). Sanitation solutions in difficult conditions (cold climates, flooding, Sanitation solutions in difficult conditions areas). collapsible and rocky soils, congested Technical thresholds: relationships between level of service, coverage thresholds: relationships between level of service, Technical generated. levels, outcomes and the benefits 046 v) iv) iii) ii) Participants at the EASAN-3 side event also recommended a number of EASAN-3 side event also recommended Participants at the of this first stage of research that were beyond the scope additional areas for the scope of a of these suggestions are beyond Some review. the regional CLTS for the sake of completeness: but have been included multi-stakeholder review, i) 9. 10. 11. 12. 8.

PART I 3. Recommendations References

• Curtis V, Danquah L, and Aunger R (2009) Planned, motivated and • Robinson A (2011) Scaling up rural sanitation in Indonesia: enabling habitual hygiene behaviour: an eleven country review Health Education environment endline assessment World Bank, Water and Research Advance Access, doi:10.1093/her/cyp002. Sanitation Program. • JMP (2008) Progress on drinking water and sanitation: special focus • Robinson A (2012) Sanitation finance in rural Cambodia The World Bank, on sanitation Geneva and New York: WHO-UNICEF Joint Monitoring Water and Sanitation Program, Guidance Note. Programme for Water Supply and Sanitation. • Rosensweig F, Perez E and Robinson A (2012) Scaling up rural sanitation: • JMP (2012) Progress on drinking water and sanitation Geneva and Policy and Sector Reform to Accelerate Access to Improved Rural New York: WHO-UNICEF Joint Monitoring Programme for Water Sanitation Washington DC: World Bank, Water and Sanitation Program, Supply and Sanitation. working paper. • Journal of the Republic (2012) Government Resolution No.8/2012 • Royal Government of Cambodia (2012) National Strategy for Rural Water 14th March: National Basic Sanitation Policy Democratic Republic of Supply, Sanitation and Hygiene 2011-2025 Ministry of Rural Development. Timor-Leste, Journal of the Republic Series 1, No.10 14th March 2012 • Shapiro J, Soares R, Robinson A and Bond M (2009) Timor-Leste Joint (unofficial translation). Sanitation Evaluation: a study of program outcomes Dili: Democratic • Kar, K and Pasteur, K (2005) Subsidy or self-respect? Community-led Government of Timor-Leste, Ministry of Health, report. total sanitation: an update on recent developments Brighton: University • Spears D (2012) Sanitation and open defecation explain international of Sussex, Institute of Development Studies, IDS Working Paper 257. variation in children’s height: evidence from 140 nationally • Kar, K and Milward, K (2011) Digging in, spreading out and growing up: representative household surveys RICE working paper. Introducing CLTS in Africa Brighton: University of Sussex, Institute of • Spears D (2012a) Policy lessons from implementing India’s Total Development Studies, IDS Practice Paper: Volume 2011 Number 8. Sanitation Campaign New Delhi: National Council of Applied Economic • Ministry of Health (2008) National Strategy for Community-Led Total Research, India Policy Forum 2012. Sanitation (CLTS) Jakarta: Ministry of Health of the Republic of Indonesia • WSP (2011) A Decade of the Total Sanitation Campaign: rapid (unofficial translation). assessment of processes and outcomes New Delhi: The World Bank, • Mukherjee N, Robiarto A, Effentrif S and Wartono D (2012) Achieving Water and Sanitation Program South Asia, Volume 1 Main report. and sustaining open defecation free communities: learning from East Java The World Bank, Water and Sanitation Program, report. • Robinson A (2005) Scaling up rural sanitation in South Asia: lessons learned from Bangladesh, India and Pakistan World Bank, Water and Sanitation Program, Report.

Community-Led Total Sanitation in East Asia and Pacific 047 © UNICEF Myanmar/2013/Myo Thame PART II

COUNTRY OVERVIEWS Cambodia

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2004 1 100% Status CLTS introduced: % of country 48% 4 CLTS coverage: major organizations 16 1 OD population (2010, millions) 8.1m 10 Communities triggered (number) 1,502 2 Scale 80% ODF communities (number) 608 2 Capacity developed (trained facilitators) 214 5 CLTS in government policy Yes 1 72 CLTS targets in government plans No 8= 60% Enabling CLTS financed by government Indirect 5= 89 CLTS integrated with other approaches Maybe 3= CLTS sustainable monitoring Maybe 3

ODF success rate 40% 1 Coverage (%) Effectiveness 40% Triggered communities per facilitator 9.3 2 Summary CLTS potential maximized? Yes 3 4 Performance 4 20% High

Middle 5 20 Indirect* 1 5 Scale of rural sanitation challenge Low 0% 1995 2010 * Indirect finance Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 72% 1,730,300 8,132,400 Shared sanitation Unimproved sanitation facilities 4% 96,100 451,800 Unimproved sanitation Shared sanitation facilities 4% 96,100 451,800 Open defecation Total without improved sanitation 80% 1,922,500 9,036,000

Source: 2012 JMP estimate; UN population forecast.

050 Community-Led Total Sanitation in East Asia and Pacific

Community-Led Total Sanitation inEast Asia andPacific CLTS institutionalcoverage per cent of rural householdsdid not have a toilet, while a further 16 per cent The 2010 National Sanitation and Hygiene KAP survey confirmed that 70 sanitation facility. than 1.7millionruralhouseholds(8.1people)donotuseanyformof cent in2010.ODwasestimatedtobe72percent,whichsuggeststhatmore coverage inruralareasfromalowbaselineof5percent1995to20 The JMPestimatesuggestsasteadyincreaseinimprovedsanitation Rural: improvedsanitationcoverage CHED CFED NAS National NGOs Santi Sena RWC GRET Knoll Mary ICC Vision World International NGOs CWS SNV Plan French Red Samaritan’s Cross Purse Swiss Red Cross Musim CESVI Ais Bilateral programmes 48 percentoftheprovinces). has sincespreadto11outof23provincesintheCambodia(introduced and PlanCambodiastartedtoimplementatalargerscalein2006,CLTS Introduced byCONCERNWorldwide in2004,butnotfollowedup.UNICEF CLTS status rural sanitationcoverageby2015,and100percent2025. toilet whenathome.Nationaldevelopmentplanssetthegoalof30percent reported burying theirfaeces,andanother 3 percentused their neighbours’ CR-SHIP (Plan) GSF Multi-lateral agencies UNICEF WSP International NGO: iDE,LienAid Bilateral: USAIDWaterSHED Sanitation marketing World BankKetsanaERRP Multilateral: ADBRWSSP-2; Government: IMF-MDRI Subsidy programmes Major Exceptions Government Rural HealthCare MRD 051

PART II Cambodia Community-Led Total Sanitation in East Asia and Pacific Community-Led Total IP: CLTS + Sanitation Marketing Global Sanitation Fund CR-SHIP: CLTS Program Improvement Hygiene and Sanitation Rural Cambodia GSF The the in 2,000 villages. Plan Cambodia, (CR-SHIP) plans to implement CLTS also will there that reports programme, the GSF agency for implementing implemented by partners to improve be sanitation marketing projects goods and services in the of sanitation the availability and affordability programme provinces. (i) support is required to help sustain the behaviour-change aspects and to and to aspects the behaviour-change sustain to help required is (i) support barriers to the and institutional technical the social, economic, overcome may construction latrine for support (ii) facilities; sanitation of construction is a ‘learning- ODF status, as there 100 per cent a village achieves start before not include the the latrine should the total cost of effect; and (iii) by-seeing’ superstructure. cost of the and LienAid, are including iDE, USAID WaterSHED Several organizations, designed to generate marketing programmes implementing sanitation goods and services, strengthen the supply of sanitation demand for toilets, using increase the population that sell toilets producers to and assist local programmes have utilized facilities. While some of these improved sanitation promotion activities, the in demand creation and latrine tools some CLTS is incremental these sanitation marketing programmes main objective of through private toilet sales. As a result, increases in sanitation coverage collective action goals (ODF community these programmes do not have pro-poor or equity objectives. targets) and contain few specific variations and practice CLTS 1. scale CLTS in Cambodia, 486,000 people, are About 4 per cent of the rural population While the proportion of ODF estimated to live in 608 ODF communities. it ranks second in the relatively low, communities in Cambodia appears region behind Timor-Leste.

052 Major exceptions Cambodia have used a programmes in Several major implementation There is growing institutional support for the CLTS approach, particularly particularly approach, CLTS for the support institutional is growing There Rural Sanitation (GSF) Cambodia Sanitation Fund The Global among NGOs. implementing recently started Program (CR-SHIP) Improvement and Hygiene sanitation demand to trigger that uses CLTS million programme a US$ 5.1 of affordability availability and to improve the marketing and sanitation goods and services. sanitation is “(i) is to recognize that CLTS The ADB hybrid approach is designed (ii) promotes behaviour change, and (iii) effective generally in the dry season, is building” while cautioning that “CLTS contributes to institutional capacity the commonly-built latrine (unlined dry- not sustainable in some areas, as failure from flooding, loose soil conditions, pit) is not durable and is prone to advocates no subsidies for termites and ants, and constant use. While CLTS that latrine construction, DRHC (Department of Rural Health Care) believes ADB RWSSP-2: programme methodology based around a ‘CLTS-hybrid’ programme methodology based around a ‘CLTS-hybrid’ ADB RWSSP-2: to create approach from the CLTS approach that is intended to use elements by project support (subsidies) for sanitation demand, which is followed design envisaged that a US$ 75 sanitation latrine construction. The project covering the cost of an improved grant will be provided to each household latrine with a concrete ring-lined pit (subground and hygienic dry-pit may be applied in the construction of structure only). The sanitation grant on household preference and latrine based or a pour-flush a water-sealed affordability levels. subsidy-based approach, notably the ADB RWSSP-2 (US$ 5.25 million (US$ 5.25 notably the ADB RWSSP-2 subsidy-based approach, sanitation (US$ 4.25 million IMF-MDRI RWSSP sanitation component), Reconstruction and Bank Ketsana Emergency World component) and these Together (US$ 1.6 million sanitation component). Rehabilitation Project sanitation investments for about half of current rural programmes account in Cambodia.

PART II: Cambodia Community-Led Total Sanitation inEast Asia andPacific coverage isreached. with theprovincialruraldevelopmentoffices(PDRD)when100percenttoilet ODF verification–villagesaredeclaredbythecommunityinagreement have beendeclaredODF. However, noformalprocesshasyetbeenagreedfor Cambodia hasahighODFsuccessrate:40percentoftriggeredcommunities ODF successrate 12,075 717 1,281 Not triggerednotODF T Living inODFcommunities Rural communities riggered notODF 9,691,404 575,465 1,028,132 Not triggerednotODF T Living inODFcommunities Rural population riggered notODF coverage. Insufficient datawereavailabletoassessCLTS impactonnationalsanitation CLTS impactonnationalsanitationcoverage communities triggeredforeveryfacilitatortrained. Kandal). Thefacilitatoreffectivenessappearsgood,withmorethannine in fiveprovinces(KampongCham,KampongSpeu, Takeo, SvayRiengand of July 2012, with trainees from government and national NGOs that work The GSFprogrammehadtrainedatotalof214CLTS facilitatorsbytheend CLTS capacity 053

PART II Cambodia Community-Led Total Sanitation in East Asia and Pacific Community-Led Total develop the enabling environment so that households pay for their own toilets”. “While targeted toilets”. “While targeted pay for their own so that households enabling environment develop the vision and to reach the sector to buy toilets, to poor households may be provided hardware subsidies and only as a last option”. be used with caution subsidies should direct hardware of 100% coverage, 2025. services by The GSF programme aims to combine CLTS and sanitation marketing, with supply strengthening marketing, with supply strengthening and sanitation aims to combine CLTS The GSF programme provided by its partners. latrine subsidies. promotion themes. to track progress in Cambodia, but this database is no longer regularly updated. The collection of to track progress in Cambodia, but this database of implementers using different indicators and monitoring reliable progress data from a large group with few incentives for the timely provision of data to systems is a significant monitoring challenge, the central database. “Public finance should mainly be used to stimulate demand and be used to stimulate should mainly “Public finance Strategy for RWSSH: 1. National sanitation water supply and will have access to safe rural communities every person in 2. 2003 NPWSS: plans. Strategic or other government development strategy for RWSSH No ODF targets in national media and evaluate approaches such as develop the following action “identify, Objective 2 includes hygiene behaviour”. to change CLTS sanitation and other rural support to CLTS Health Care (DRHC) provides central The Department of Rural the government has PDRD. However, implementation support provided through programmes, with local implementation. finance to CLTS not yet allocated any 1. iDE sanitation marketing pilot used a shortened CLTS approach to create demand for the Easy Latrine. approach to create demand for the Easy pilot used a shortened CLTS 1. iDE sanitation marketing to trigger demand for are planning to use CLTS notably the ADB RWSSP-2, 2. Several programmes, and hygiene school WASH sanitation marketing, CLTS, 3. Newly formed sub working group to discuss 1. Department for International Development (DFID) finance was used to establish a CLTS database (DFID) finance was used to establish a CLTS 1. Department for International Development approach. an MRD evaluation of the CLTS 2. UNICEF and Plan Cambodia financed Sanitation and Hygiene (RWSSH) (2012) and Hygiene (RWSSH) Sanitation (NPWSS) (2003) Sanitation ) manual (Khmer hygiene formative evaluation 1. National Strategy for Rural Water Supply, Supply, Strategy for Rural Water 1. National Supply and Policy on Water 2. National guidelines and training CLTS 3. Government Government support to programmes Government support 2012 National Strategy for Rural Water for Rural Water 2012 National Strategy and Hygiene Sanitation Supply, 1. Sanitation marketing 2. Hardware subsidies on sanitation and 3. Sub-working group 1. MRD CLTS database 1. MRD CLTS in Cambodia: 2. UNICEF-MRD (2009) CLTS Yes No Indirect Maybe Maybe Policy in government CLTS policy Strategy targets CLTS in government strategies or development plans Finance by financed CLTS government Integration with integrated CLTS other approaches Monitoring Sustainable M&E of CLTS 054 CLTS enabling environment enabling CLTS

PART II: Cambodia Sources: KunthyandCatalla(2009)Community-LedTotal SanitationinCambodia:aformativeevaluation report,DRHC-MRDevaluationreport;Davis(2011)SanitationinCambodia–areview, ADRACambodia. Community-Led Total Sanitation inEast Asia andPacific CLTS strengths andopportunities CLTS weaknessesandbottlenecks Sources: Kunthy andCatalla(2009)Community-Led Total SanitationinCambodia:a formativeevaluationreport,DRHC-MRD evaluationreport;Davis (2011)SanitationinCambodia –areview, ADRA Cambodia. 1. CLTS workedbetterindensesettlementswithfew Lessons learned 1.Prioritization ofhygieneandsanitation bycommunecouncils Opportunities? 3. Horizontallearningactivities 2. Reinforcingactivities 1. Areasuncontaminatedbysubsidies Success factors? 3. RelativelyhighODFsuccessrates 2. Committedleadersincommunes 1. GoodcollaborationbetweenDRHCandimplementers What’s working? 3. Localculturedoesnotencourageself-provision 2. Termite andantdamage 1. Floodingandhighwatertables Context issues? 3. Overlycoerciveapproachbysomelocalleaders 2. Someunhygieniclatrinesbuilt 1. ReversiontoODduringtherainyseason What’s notworking? 2. ODFdeclarationoftendependenton 1. Multipleexternalprogrammesconfuselocal Lessons learned 4. Poorcollaborationbetweengovernment 3. Lowqualityfacilitation 2. Demandforpour-flush latrines 1. High-levelsupportforsubsidies Constraints andbottlenecks? disposal options or initiative unsustainable latrinesharing government andcommunities departments

3. In some cases, CLTS was viewed as atop-down process because village and commune chiefs were being given responsibility for 2. ReportsofCLTS latrinecontentsbeingaccessibletoanimals,andprovidingsitesforflybreeding. 1. Problemsofdurabilityandfunctionalitylow-costdrylatrinesresultinginreversiontoODduringtherainyseason. 2. 2009formativeevaluationfoundthatonly79%ofhouseholdsinODFcommunitieshadbuiltlatrines,withtherestreported toshare 1. Presenceoftoomanyexternalprogrammesandstakeholdersinonearea,oftenwithdifferentpolicies,objectivesapproaches,can 4. Lackofcollaborationandcoordinationbetweengovernmentdepartmentsinvolvedinruralsanitationhygieneimprovement. 3. ShortageofexperiencedandhighqualityCLTS facilitators. 2. CommunityexpectationsareoftenhigherthanthesimplepitlatrinesthatgenerallyresultfromrapidCLTS interventions.Mostrural 1. LatrinehardwaresubsidyprogrammesinCLTS areasunderminedemandandinterestinCLTS programmes.Limitedhigh-levelsupportforCLTS. 3. Localculturehighlyvaluesdonations,charityandtheprovisionofgiftstopoor, ruralcommunities. 2. Termite andantdamagedecreasingthedurabilityofsimplelatrinesbuiltfromlocalmaterials (oldwood,bamboo,thatchandpalmribs). 1. Problemsforrapidlyconstructed,low-costlatrines.PitcollapseandreversiontoODoftenattributedfloodingorhigh watertable achieving ODFvillages,whichledtooverlycoerciveapproaches. latrines. ManyofthosereportedtobesharinglatrineswerelaterfoundhaverevertedOD. confuse localgovernmentsandcommunities. households wouldprefertohaveapour-flush latrine. problems duringrainyseason. 1. UNICEF programme evaluation found that CLTS worked best in Prey Veng, where settlement patterns were denser and 1. Prioritizationofhygieneand sanitation activitiesincommunedevelopmentplansand investmentplans. 3. Village exchangevisits,attendanceatnationalsanitationevents,villagevisitsby officialsandinternationalguests. 2. Reinforcingactivitiessuchasvillagecleanupdays,national sanitation days,andglobalhandwashingdays(raiseawareness 1. CLTS worksbetterinareaswhere nolatrinesubsidieshavebeenprovided. 2. Strongandcommittedleadersatcommunelevel,suchasmembers ofthecommunecommitteesforwomenandchildren. 1. Goodcooperationbetweengovernment,localauthoritiesand implementingagencies,withgoodimplementationsupport fewer ODandunsafe disposaloptionswereavailable. and interest). from DRHCandPDRD. 055

PART II Cambodia China

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2012 10= 100% 2 Status CLTS introduced: % of country 15% 7 9 CLTS coverage: major organizations 2 10= OD population (2010, millions) 13.5m 11 28 Communities triggered (number) 0 11 Scale 80% ODF communities (number) 0 10= Capacity developed (trained facilitators) 53 9 CLTS in government policy No 9= 14 CLTS targets in government plans No 8= 60% Enabling CLTS financed by government No 11= 72 CLTS integrated with other approaches No 9= CLTS sustainable monitoring No 8=

ODF success rate 0% 10= Coverage (%) Effectiveness 40% Triggered communities per facilitator 0 11= Summary CLTS potential maximized? No 12 Performance 1 56 High Middle 20% 4 Low

Scale of rural sanitation challenge 0% 1990 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 2% 4,085,800 13,483,000 Shared sanitation Unimproved sanitation facilities 28% 57,200,600 188,762,000 Unimproved sanitation Shared sanitation facilities 14% 28,600,300 94,381,000 Open defecation Total without improved sanitation 44% 89,886,700 296,626,000

Source: 2012 JMP estimate; UN population forecast.

056 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific CLTS institutionalcoverage 93 percentofruralhumanexcretaisusedasorganicfertilizer, withmost human excretaasorganicfertilizerinfarming.Ithasbeenreportedthat OD islimitedinruralareasofChinabecausethelonghistoryusing rural householdsuseeitherunimprovedorsharedsanitationfacilities. more than4millionruralhouseholdspracticeOD,andafurther86 2 percentinruralareas.Nevertheless,thehugepopulationmeansthat reduced from72percentto28cent,withtheODrateestimatedatonly in Chinacontinuetouseunimprovedsanitationfacilities,butthishasbeen 1990 to56percentin2010.Asignificantproportionoftheruralpopulation sanitation coverageinruralareasfromabaselineofonly15percent The JMPestimateforChinasuggestsadramaticriseinimproved Rural: improvedsanitationcoverage Government andmostNGOs Subsidy programmes Major Exceptions National NGOs International NGOs Plan Bilateral programmes CLTS hasbeenintroducedin15percentoftheprovincesnationwide). in 50villagesoffiveprovinces(out33provinces,whichwillmeanthat training workshopinJilinprovincetobuildcapacityforaCATS programme 2012, whenUNICEFanditsgovernmentcounterpartsorganizedanother preference forlatrinesubsidies.NofurtherprogresswasmadeuntilJuly not adoptedaftertheinitialpilotsduetoover-riding governmentandNGO Introduced byPlanChinainShaanxiprovince2005,buttheapproachwas CLTS status only around30percentofthepopulation. some researchsuggeststhattheuseofhumanexcretaisnowpracticedby households usingsomeformoflatrinetocollecttheexcreta.However, Multi-lateral agencies UNICEF Government HEALTH NPHCC 057

PART II China Community-Led Total Sanitation in East Asia and Pacific Community-Led Total environment, with the target of increasing rural sanitation coverage by 10% by the end of 2012. target of increasing rural sanitation coverage environment, with the from flies and maggots, odourless, and harmless treatment of faeces. and harmless treatment and maggots, odourless, from flies septic tank latrine - double-urn tank latrine - biogas septic - urine-diverting eco-latrine septic tank latrine - three compartment latrine with sewerage - pour-flush twin-pit latrine - elevated alternating NBS conducts annual household surveys, which now categorise according to the JMP sanitation definitions. NBS conducts annual household surveys, subsidy programme, which will include collecting data on latrine PHCCO is evaluating the government latrine quality and usage. the sanitation monitoring system. Government recognizes the need to strengthen Latrine subsidy approaches remain the default, with little information available how CLTS will integrate with with little information available how CLTS Latrine subsidy approaches remain the default, to promote ‘sealed tank’ latrines is linked to high latrine costs and subsidy programmes. Government policy the perceived need for subsidies. Central and local government will provide implementation support to UNICEF CATS programme. No direct to UNICEF CATS will provide implementation support Central and local government to support has indicated that it may be willing activities to date, although the government finance of CLTS to climb the sanitation ladder. supply strengthening to enable ODF communities 1. Medium and long-term plan for the health sector until 2020. 1. Medium and long-term to strengthen the urban and rural led to a 2010-2012 national programme 2. 2010 NPHCC Action 1. Health-based policy to support rural sanitation improvement. policy to support 1. Health-based clean, free tanks, airtight covers, leak-proof walls, roofs, seepage-free, of sanitary latrines: 2. Requirements harmless sanitary latrine: six types of 3. NPHCC promotes pits designed to limit groundwater latrines all have leak-proof tanks or These ‘harmless’ sanitary of rural households. sustainable development for millions contamination and ensure Committee Office (PHCCO) system National Urban and Rural National Urban and Rural 2010 Environmental Sanitation development of rural sanitation development latrines household (GB19379-2003) Patriotic promoted by National Health Campaign Committee (NPHCC) 1. National Bureau of Statistics (NBS) 2. Patriotic Health Campaign Subsidy approaches No finance to date 1. Healthy China by Year 2020 1. Healthy China by Year Up the 2. Action to Speeding 1. 2002 Requirements for 1. 2002 Requirements standard for rural 2. 2003 Hygienic sanitary latrine’ types 3. ‘Harmless latrines have seepage-free and leak-proof tanks or pits, which greatly constrains the construction of simple pit latrines made from local materials. latrines have seepage-free and leak-proof untreated and used on fields, often within one week. untreated and used on fields, often within 1. As in many countries, rural households often perceive that sanitary toilets are unaffordable. 1. As in many countries, rural households strict technical specifications for toilet construction. Hygienic standard for rural household latrines requires that all2. Most sanitation programmes adhere to 1. Many rural households use unimproved toilets (open pits, no pits, buckets) with severe smell and fly problems. Accumulated excreta are collected toilets (open pits, no pits, buckets) with severe smell and fly problems. Accumulated 1. Many rural households use unimproved excreta and water seals. 2. Sub-zero winder conditions cause frozen the government for sanitation improvement. 3. Rural households expect assistance from No No No No No prescriptions Monitoring Sustainable M&E of CLTS Integration integrated with other CLTS approaches Finance by government financed CLTS Strategy in government targets CLTS plans strategies or development What’s not working? What’s implementation to date No CLTS Context issues? 1. Open pit and bucket toilets 2. Cold winter conditions 3. Long subsidy history Constraints and bottlenecks? 1. Belief that toilets are expensive 2. Previous technical Lessons learned lessons to date No CLTS Policy in government policy CLTS CLTS in China: feasibility study and first orientation workshop, Plan China; UNICEF (2011) China State of Sanitation report, UNICEF China. in China: feasibility study and first orientation workshop, Plan China; UNICEF (2011) China State of Sanitation Sources: Kar (2005) CLTS 058 CLTS weaknesses and bottlenecks CLTS CLTS enabling environment enabling CLTS

PART II: China DPR Korea

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction Not yet 14 100% 0 0 Status CLTS introduced: % of country CLTS coverage: major organizations OD population (2010, millions) 0m 1 26 Communities triggered (number) Scale 80% ODF communities (number) 50 3 Capacity developed (trained facilitators) CLTS in government policy

CLTS targets in government plans 60% Enabling CLTS financed by government CLTS integrated with other approaches 2 CLTS sustainable monitoring Coverage (%) ODF success rate 40% Effectiveness Triggered communities per facilitator 71 Summary CLTS potential maximized? No 14 Performance 1

High 48 Middle 20% Low

Scale of rural sanitation challenge 0% 1995 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 0% - - Shared sanitation Unimproved sanitation facilities 26% 629,600 2,518,400 Unimproved sanitation Shared sanitation facilities 3% 72,600 290,600 Open defecation Total without improved sanitation 29% 702,200 2,809,000

Source: 2012 JMP estimate; UN population forecast.

Community-Led Total Sanitation in East Asia and Pacific 059 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Key sanitation issues sanitation Key – some estimates prevalent for fertilizer is highly of human excreta The use with of rural households, up to 80 per cent it is practiced by suggest However, rural communes. and use in many excreta collection systematic practice is issue: the and socio-political a sensitive cultural it remains there is little fertilizers, and of chemical linked to shortages sometimes and application of health risks related to the handling awareness of the latrine pits are utilized, excreta. In many areas, shallow untreated human faeces, that only provide earthen pots to collect urine and sometimes using regularly without storage, thus require emptying one or two months time to kill off pathogens. sufficient composting Enabling environment of existing sanitation raising awareness about the risks UNICEF has been in sanitation improvement amongpractices and the benefits of investment In 2011 after a long period oflocal authorities and the rural population. supported the development of ruraladvocacy and negotiation, UNICEF safe management of human excreta thatsanitation guidelines based around Management (MoCM), the government’s was launched by the Ministry of City which provide straightforward advice on The guidelines, agency. lead WASH human excreta and outlines some low- the risks associated with untreated are now being disseminated nationally tocost, appropriate treatment options, and farmers.local governments, community leaders Opportunities a pilot project in two communi- UNICEF and MoCM are also implementing households) to promote “improved ties (total population of about 1,000 existing latrine” approach. MoCM sanitation for all” using an “improved building code for rural areas and has also agreed to review the national sanitation facilities in the construction incorporate provision for improved as the government builds tens standards. This is a significant development of thousands of new buildings every year in rural areas. Total: 73 per cent using improved sanitation facilities Total: 27.0 per cent pit latrine without slab or open pit (unimproved) 27.0 per cent pit latrine without slab 3.5 per cent VIP latrine (improved) 22.2 per cent pit latrine with slab (improved) 22.2 per cent pit 5.9 per cent flush or pour-flush to septic tank (improved) or pour-flush 5.9 per cent flush 41.4 per cent flush or pour-flush to sewer system (improved) or pour-flush 41.4 per cent flush 060 Institutional mapping partners working in the rural sanitationThere are relatively few development (SDC), Swiss Agency for Development and Cooperation sector: UNICEF, (IFRC), Save the Children and CONCERN.International Federation of Red Cross CLTS status CLTS rates of OD meant low has not been introduced in DPR Korea. Very CLTS rural sanitation as an important issue. that few stakeholders recognized of the relatively high proportion of There is now increasing recognition of the health problems caused by the unimproved sanitation facilities, and excreta in agriculture. widespread use of untreated human • • • • • Both the 2008 Census and the 2009 Multiple Indicator Cluster Survey (MICS) and the 2009 Multiple Indicator Both the 2008 Census areas. The 2009 MICS latrine use in both urban and rural report 100 per cent sanitation coverage: detailed information on rural survey provides more • Rural: improved sanitation coverage sanitation improved Rural: coverage in improved sanitation a rapid rise in estimate suggests The JMP cent in 2010. A in 1995 to 71 per of 48 per cent from a baseline rural areas continue to use in DRP Korea the rural population proportion of significant from 50 per cent been reduced but this has sanitation facilities, unimproved 700,000 rural areas. More than reported in rural cent, with no OD to 26 per facilities. or shared sanitation households use unimproved

PART II: DPR Korea Community-Led Total Sanitation inEast Asia andPacific subsistence farmers. fertilizer, becausethispracticeremainsimportanttoalargepopulationof to demonstratethattheapproachwillnotpreventuseofexcretaas government iswillingtoscaleupimplementation.Itwillalsobeimportant evidence ofeffectivenessandsustainabilityrequiredbeforethe Any newapproacheshavetobeintroducedgradually, withreliable Potential forCLTS sanitation improvementacrossthecountry. be introducedasatoolforscalingupsustainablebehaviourchangeand that community-wideoutcomesarepossible,thenitishopedCLTS can valuable fertilizerandsoilconditioner. Oncethegovernmentisconvinced sanitation statuswithoutcompromisingtheuseoftreatedexcretaasa demonstrate thatitispossibletoachieve100percentODFandimproved UNICEF hopesthatthepilot“improvedsanitationforall”projectwill 061

PART II DPR Korea Indonesia

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2005 2= 100% Status CLTS introduced: % of country 97% 2 CLTS coverage: major organizations 9 5 OD population (2010, millions) 48.1m 14 Communities triggered (number) 7,325 1 36 Scale 80% ODF communities (number) 1,279 1 48 Capacity developed (trained facilitators) 530 2 CLTS in government policy Yes 1= CLTS targets in government plans Yes 1= 60% Enabling CLTS financed by government Yes 1 13 CLTS integrated with other approaches Yes 1 1= CLTS sustainable monitoring Yes 12

5 Coverage (%) ODF success rate 17% 25 Effectiveness 40% Triggered communities per facilitator 13.8 1 Summary CLTS potential maximized? Yes 1

6 Performance 20% 39 High Middle 21 Low Scale of rural sanitation challenge 0% 1990 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 36% 12,028,900 48,115,400 Shared sanitation Unimproved sanitation facilities 12% 4,343,800 17,375,000 Unimproved sanitation Shared sanitation facilities 13% 4,009,600 16,038,500 Open defecation Total without improved sanitation 61% 20,382,300 81,528,900

Source: 2012 JMP estimate; UN population forecast.

062 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific CLTS institutionalcoverage cent geographicalcoverage);andfiveyearslaterithasspreadto234outof Introduced byWSPin2005.By2007,CLTS hadreached54districts(13per CLTS status people) donotuseanyformofsanitationfacility. cent, whichsuggeststhatmorethan12millionruralhouseholds(48 sanitation facilitiesorunimprovedfacilities.ODwasestimatedtobe36per cent in2010.Afurther25peroftheruralpopulationuseeithershared coverage inruralareasfromabaselineof21percent1990to39 The JMPestimatesuggestsarecentincreaseinimprovedsanitation Rural: improvedsanitationcoverage Government: PublicWorks Subsidy programmes Major Exceptions Rumsram YDD Yayasan YPCII National NGOs YMP HARFA CD Bethesda Vision World International NGOs Plan PCI Bilateral programmes IU-WASH Hi-5 and USAID Ministry ofHealth. for sanitationandhygienedemandcreationbehaviourchangetothe subsidized publicsanitationfacilities(MCK),thuspassesonresponsibility PU isaninfrastructure-focusedorganization,withalonghistoryofbuilding non-subsidy approachestoruralsanitationimprovement,suchasCLTS. the World BankPAMSIMAS programme,butremainsambivalentabout The MinistryofPublicWorks (PU)isthemainimplementationagencyfor Major exceptions provinces (97percentgeographicalspread). 405 districtsinIndonesia(58percentnationally)including32outofthe33 PAMSIMAS World Bank UNICEF Multi-lateral agencies CWSH ADB WSP Home Affairs Government BAPPENAS Health MoH 063

PART II Indonesia riggered not ODF Rural population Living in ODF communities T Not triggered not ODF 10,739,356 120,642,789 2,271,855 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total riggered not ODF Living in ODF communities T Not triggered not ODF Rural communities 6,046 67,919 1,279 CLTS impact on national sanitation coverage impact on national CLTS on Insufficient data were available to determine the impact of CLTS national sanitation coverage. some experienced district governments, such as Lumajang in East Java, East Java, in as Lumajang such governments, district experienced some other districts. and staff from courses for NGOs training CLTS have run scale CLTS million people, in Indonesia, 2.3 rural population per cent of the About 1.7 the proportion of (desa). While ODF villages to live in 1,279 are estimated in the region it ranks third appears relatively low, ODF villages in Indonesia in with the number of people living and Cambodia, behind Timor-Leste higher than in any other to be more than four times ODF villages estimated country in the region. ODF success rate cent of triggered ODF success rate: 17 per Indonesia has a moderate government monitoring declared ODF according to the villages have been Plan, UNICEF) report higher (WSP, system. Other programmes in Indonesia 28-43 per cent, but some of these ODF success rates, averaging from (dusun), whereas the lower figures refer to triggering ODF sub-villages by the government figures reflects the overall ODF success rate reported villages (desa). greater difficulty of triggering entire programmes: urban CLTS with some H programmes: urban CLTS USAID Hi-5 and IU-WAS sanitation strategies and utility projects) modifications (linking to citywide (Medan, Surabaya and Makassar) USAID Hi-5 programme in three cities in urban areas with high targets hygiene and sanitation practices to achievement of the STBM and diarrhoea prevalence, it will contribute programme The USAID IU-WASH citywide sanitation strategies (SSK). (PDAMs) and other sector works with government water utilities stakeholders on urban CLTS. M: Five pillar approach (ODF, handwashing with soap, safe drinking handwashing (ODF, STBM: Five pillar approach solid waste, liquid waste management) water and food, sanitation, which a broader conception of total The STBM promotes four other objectives: objective of becoming ODF and includes the CLTS safe management of drinking water handwashing with soap (HWWS), wastes, and safe management of and food, safe management of solid approach is now being adopted and household liquid wastes. The STBM in Indonesia. scaled up by most sanitation practitioners 064 CLTS capacity CLTS facilitators have been trained in Indonesia: Large numbers of CLTS 100 facilitators from faith-based UNICEF reports training 400 sanitarians, organizations; and 30 institutional facilitators; the national government training of trainers courses; most of the large has run several CLTS facilitators; and programmes have trained substantial numbers of CLTS 2. CLTS variations and practice CLTS 1. Since 2005, CLTS has been implemented largely through external external through largely implemented been has 2005, CLTS Since national counterpart government provides although the programmes, multi-lateral and to most of the and support government finance and local was originally PPSPs 2010-2014 US$ 1.6 billion programmes. The bilateral which strategies, on citywide sanitation programme based an urban from careless defecation” “open and the goal of eliminating included areas with the aim of has since expanded into rural 330 cities. The PPSP by 2014. reaching 20,000 villages

PART II: Indonesia Community-Led Total Sanitation inEast Asia andPacific CLTS enablingenvironment CLTS Sustainable M&Eof Monitoring other approaches CLTS integratedwith Integration government CLTS financedby Finance or developmentplans government strategies CLTS targetsin Strategy policy CLTS ingovernment Policy Yes Yes Yes Yes Yes 3. ODFverificationsystem 2. nationalwaterandsanitation 1. STBMSecretariatonline 3. STBM6pillars 2. Citywidesanitationstrategies 1. Sanitationmarketing 3. ADBCWSH 2. World BankPAMSIMAS 1. 2010-2014PPSP Development Plan(RPJM-N) 2010-2014 NationalMid-Term STBM database) information system(NAWASIS monitoring system 3. AnODFverificationsystemhasbeenintroducedandisbeingscaledupthroughthelocalgovernmentsystem.Some 2. ThenationalWASH workinggroup(nationalPokjaAMPL)isdevelopingNAWASIS thatwilltrackinvestmentsand 1. TheSTBMSecretariatisintheprocessofestablishinganonlinemonitoringsystemtotrackprogress 3. SomeprogrammeshaveaddedenvironmentalhealthoranimalwastemanagementcomponentstotheSTBMstrategy. 2. SeveralprogrammesareincorporatingCLTS andSTBMelementsintourbansanitationinterventions. 1. WSPpioneeredTotal Sanitation&Marketinginall29districtsofEastJava,andnow formsofSTBMand 3. CWSH:30%projectcostbycentralanddistrictgovernments. 2. PAMSIMAS: governmentpolicypreventsdevelopmentloansfinancingsoftwareactivities,thusCLTS componentsof 1. ThegovernmentallocatedUS$1.6billiontothePPSPprogramme,whichincludessupportSTBMactivities. only 1.7%ODFvillagesreportedinmid-2012,the2014targetremainshighlyambitious. but wasinadequatelysupportedbygovernmentfinance,capacitydevelopmentorimplementationprogrammes.Given 20,000 villagestobecoveredunderthePPSPprogramme.The100%ODFtargetwasalsoinprevious5-yearplan, RPJM-N: thecurrent5-yeardevelopmentplansetstargetof100%ODFvillagesnationallyby2014,withfinancefor rural households. programmes inIndonesia.Nonetheless,afewprojectscontinuetofloutthispolicybyprovidingsubsidisedlatrines STBM: “Nohardwaresubsidyforhouseholdtoilets”.TheSTBMsetsaclearno-subsidypolicyallruralsanitation reports thatdifferentorganizationsuseverificationcriteria. water supplyprogress. nationally, butcomprehensivedataarenotyetavailablefromthissystem. sanitation marketinghavebeenadoptedbyPlan,UNICEFandothers. the PAMSIMAS programmearefinancedbyexternaldonorgrants. 065

PART II Indonesia . , Ministry of Community-Led Total Sanitation in East Asia and Pacific Community-Led Total often focused on monitoring latrine ownership rather than behaviour change to eliminate OD. than behaviour change ownership rather on monitoring latrine often focused latrine subsidies. or have previously received at critical times). groups share and the toilet can be occupied with OD while sharing (e.g. when large over time, or continue development is not a priority of local governments. scale up the STBM strategy if sanitation central authorities to and support in planning and implementation. non-subsidy approach. government leaders of the benefits of a or blocked. not being repaired or repaired when damaged 1. Evaluations revealed that communities with 100% access to toilets were often not ODF, and that communities that were slow to reach ODF that were slow and that communities often not ODF, access to toilets were with 100% revealed that communities 1. Evaluations utilized. coercive approaches involved in process; those without toilets only leaders and or none used correctly; tools used, 2. No CLTS to invest in their own facilities), from government or donors (thus are unwilling households expect help in cash or kind 1. In some areas, rural of the costs of OD remain low old people. Recognition and awareness and hygiene habits, particularly among 2. Hard to change defecation awareness, skills and capacity. government staff constrain the CLTS 3. Regular transfers of defecation into water to latrine use. next to water bodies tended to prefer 4. Communities located to OD down, and sharers sometimes revert status, but sharing arrangements can break is sometimes a means to achieve ODF sharing 1. Toilet facilities. or upgrade to pour-flush a lack of funds to repair damaged toilets 2. Households report and awareness about toilet technology options. 3. Lack of knowledge which makes it hard for for sanitation to elected district governments, Law No.32/2004 delegated responsibility 4. The Regional Autonomy facilitators at provincial and district levels. 5. Shortage of skilled CLTS also guidance in provincial and district governments will require not only advocacy work, but 1. Institutionalizing the national STBM strategy challenge to convince local is growing, but it remains a including its non-subsidy policy, strategy, of the national STBM 2. Awareness process led to less effective process. 3. Exclusion of community leaders from triggering influential community members, which can slow progress. 4. Revolving funds are open to misuse by problems, often households or community leaders to help achieve ODF had significant durability low-cost or no-cost facilities built by 5. Very limited resulting in few improvements resulting in 3. Local leaders important to process 4. Revolving funds are open to misuse 5. No-cost latrines affect ODF sustainability Context issues? 1. Subsidy expectations 2. Old habits die hard staff 3. Rotation of government water bodies 4. Presence of nearby Constraints and bottlenecks? sharing 1. Toilet or upgrading 2. Limited toilet repair 3. Little technology awareness 4. Local autonomy law facilitators 5. Shortage of skilled Lessons learned 1. Institutionalising the STBM is a big job remains of no-subsidy policy 2. Awareness What’s not working? not What’s toilets ODF by counting 1. Monitoring in some areas process CLTS 2. Poor quality 066 Health and STBM secretariat. Sources: Mukherjee (2012) Achieving and sustaining open defecation free communities: learning from East Java, WSP; personal communications from Plan Indonesia, UNICEF sustaining open defecation free communities: learning from East Java, WSP; personal Sources: Mukherjee (2012) Achieving and CLTS weaknesses and bottlenecks and weaknesses CLTS

PART II: Indonesia Health andSTBMsecretariat. Sources: Mukherjee(2012).Achievingandsustainingopendefecation freecommunities:learningfromEastJava,WSP;personalcommunicationsPlanIndonesia,UNICEF Community-Led Total Sanitation inEast Asia andPacific CLTS strengthsandopportunities 3. Clustering and phasing strategies can be 3. Clusteringandphasingstrategiescanbe 2. Post-triggeringmonitoringisan 1. Contextualdiversityrequiresrangeof Lessons learned 4. CCTNationalProgramforCommunity 3. PPSPprogramme 2. Localstrategiestomanageandcontrol 1. STBMSecretariat Opportunities? 2. Triggering notaccompaniedby 1. Highsocialcapital Success factors? 2. Community-devisedsystemsof 1. Triggering linkedtodemand What’s working? effective inscalingupprogress important sustainabilityelement methods andtools Empowerment (PNPM)programme hardware subsidies technical advice monitoring andsanctioningOD 3. Context,supportandsocialnormsaffectprogress:clustering interventionscanimprovecost-efficiency, saturateareasandchangesocial 2. Regularpost-triggeringmonitoringandfollowupofbehaviourchangewaslinkedtoimprovedoutcomes(andlimited linkedto 1. Indonesiahas33provincesand525districts/municipalitieswithdiversephysicalculturalcontexts,thusrequiresarange ofdifferent 4. WSPhasbeenworkingontheincorporationofODFstatusasanutrition/healthconditionPNPMconditionalcashtransfer scheme.The 3. IncorporatingCLTS (inthebroaderSTBMapproach)intoPPSPprogrammeoffersopportunityfordramaticscalingupand 2. Electedleadersanddistrictlegislatorshavethepowertoregulateuseoflocalfundsforsanitation,includingintroduction ofrules 1. STBMsecretariatdevelopingcapacityandexpanding:responsiblefordevelopmentofworkplanprogramme;M&E; knowledge 2. Triggering wasfoundtobemoreeffectiveinachievingrapidODFwhennotexplicitly linkedtoadviceontoiletbuilding.However, accessto 1. Trusted localleaders,mutualself-helptraditions(gotongroyong)andprideincollectiveachievementswerefoundtobecontextualfactors 2. Community-devisedsystemsformonitoringandsanctioningthepracticeofODwerefoundtobeeffectiveinsustainingODF status. 1. ResultswerebetterwhereCLTS triggeringwasinresponsetocommunitydemand. norms; phasinginterventionscanallowdifferentcontextsand challengestobetackledaslocalcapacity, experienceanddemanddevelop. poor outcomes). methods andtoolsthatallowforthesevaryingcontextsprovidepracticalflexibleguidance. for sanitationimprovementwithsignificantlong-termbenefitspoorcommunities. possible futureinclusionofanODFindicatorinthishugepovertyalleviationprogrammewouldleveragesubstantialresources andcapacity institutionalization oftheapproach. complement otherfinanceandactivitiesratherthanunderminingthem). governing howpublicandexternalfundsareusedtoachievecollectiveimprovedsanitationhygienebehaviouroutcomes (to management; andtechnicalassistance. information onaffordablesanitationgoodsandserviceswasfoundtobeanothersuccessfactor–thussequencingofactivitiesisclearlyimportant. that supportedsustainableODFachievement. , Ministryof 067

PART II Indonesia Kiribati

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2012 11= 100% Status CLTS introduced: % of country 0% 11 CLTS coverage: major organizations 3 10= OD population (2010, millions) 0.012m 1 Communities triggered (number) 0 11= Scale 80% ODF communities (number) 0 10= 53 Capacity developed (trained facilitators) 0 11= CLTS in government policy No 9= 65 CLTS targets in government plans No 8= 60% Enabling CLTS financed by government No 11= CLTS integrated with other approaches No 9= CLTS sustainable monitoring No 8=

ODF success rate 0% 10= Coverage (%) Effectiveness 40% Triggered communities per facilitator 0 11= 23 Summary CLTS potential maximized? No 11 Performance 1 12 High 2 2 Middle 20% Low 21 22

Scale of rural sanitation challenge 0% 1990 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 21% 1,900 11,900 Shared sanitation Unimproved sanitation facilities 25% 2,180 13,700 Unimproved sanitation Shared sanitation facilities 4% 398 2,500 Open defecation Total without improved sanitation 50% 4,478 28,100

Source: 2006 Household Income and Expenditure Survey.

068 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific 52 CLTS institutionalcoverage sanitation coverage which wasnotincludedinthe2012JMPestimate,indicatesthatimproved data fromthe2006HouseholdIncomeandExpenditureSurvey(HIES), thus isnotbasedonanyrecentsurveysorcoveragedata.More The JMPestimateforKiribatiisbasedonthe1990and2000Censuses, Rural: improvedsanitationcoverage • • • • • • •

No disaggregation wasavailablebetweenrural andurbanareas. 21 percentdonotusesanitationfacilities(OD) 6 percentuse“otherfacilities”(unimproved) 18 percentusehanginglatrines(unimproved) 4 percentshareuseofpour-flush latrines(shared) 15 percentusedpitlatrines(improved) 28 percentusedpour-flush latrines(improved) 7 percentwereconnectedtothepublicsewagesystem(improved) National NGOs Subsidy programmes Major Exceptions 52 hasincreasedto50percent: International NGOs Bilateral programmes The programmeisbeingestablished.Nofacilitatorshaveyetbeentrained. CLTS capacity villages across16oftheOuterIslands. No triggeringhasyettakenplace.UNICEFplanstoimplementCATS in70 CLTS scale 1. CLTS variationsandpractice activities havecommenced,butinitialtriggeringhasnotyetbeenundertaken. (EU-KIRIWATSAN-1) programmeinJune2011.Communityengagement Introduced byUNICEFthroughtheWater andSanitationScoopingMission CLTS status Total Sanitation(SLTS), sanitationmarketingandHWWS. CATS involvesarangeofinterventionsincludingCLTS, School-Led UNICEF: CATS Multi-lateral agencies UNICEF Public Works and Utilities Government 069

PART II Kiribati Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Limited data available. UNICEF is introducing its CATS approach, which will combine CLTS, supply strengthening and supply which will combine CLTS, approach, its CATS UNICEF is introducing handwashing with soap. Formal CLTS programme yet to start. However, it appears that the government will support it appears that the government programme yet to start. However, Formal CLTS UNICEF programme. implementation of the No specific ODF targets. Plan recognizes that simple and least costly solutions will be the most appropriate will be the most and least costly solutions that simple ODF targets. Plan recognizes No specific motivation and commitment. ongoing community improvement requires and that service and sustainable; General policy that promotes “enhanced community awareness of sanitation and public health and and public health awareness of sanitation community that promotes “enhanced General policy or programme methodologies references to not contain any specific but does hygiene requirements” requirements. detailed technical No formal monitoring system No formal monitoring CATS No CLTS programme No CLTS National Sanitation National Sanitation Plan (10-year) Implementation 2010 National Sanitation Policy 2010 National resources in the atoll islands. in three outer islands suggests recent data from sampled households wash our hands”. However, reported that “it is our culture that we never are available. somewhere in the home, and 32% have a specific place where soap and water that 74% of households have soap available 1. Inadequate sanitation is at crisis levels and pollution associated with sanitation systems threatens scarce and vulnerable groundwater and pollution associated with sanitation systems threatens scarce and vulnerable 1. Inadequate sanitation is at crisis levels was associated with diarrhoea. mortality rats in the Pacific region. In 2002, 22% of under-five 2. Kiribati has one of the highest infant mortality World Bank). by communities are water and sanitation related (Kiribati Adaptation Program, 3. Seven out of the top 10 priorities identified one villager on acceptable sanitation and hygiene practices. At a recent community consultation, 1. The i-Kiribati hold strong cultural views even by households that own toilets. 2. OD on the beach is a common practice, No No No No No groundwater Monitoring of CLTS Sustainable M and E Integration with other approaches integrated CLTS Finance by government financed CLTS Strategy strategies targets in government CLTS plans or development 2. High infant mortality rate 3. High priority for water and sanitation What’s not working? What’s experience to date Insufficient CLTS Context issues? 1. Inadequate sanitation contaminating Constraints and bottlenecks? 1. Strong cultural views 2. Open defecation on the beach Lessons learned experience to date Insufficient CLTS Policy in government policy CLTS UNICEF (2012) KIRIWATSAN-1 Initial visit – activity progress report, 19 July 2012. brief; UNICEF (2012) KIRIWATSAN-1 sector Sources: ISF (2011) Kiribati: WASH 070 CLTS weaknesses and bottlenecks CLTS environment enabling CLTS

PART II: Kiribati Lao PDR

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2008 5 100% Status CLTS introduced: % of country 47% 5 CLTS coverage: major organizations 7 7 OD population (2010, millions) 1.7m 8 Communities triggered (number) 217 7 Scale 80% 41 ODF communities (number) 36 5 Capacity developed (trained facilitators) 143 7 CLTS in government policy Maybe 5= CLTS targets in government plans Yes 1= 60% 83 Enabling CLTS financed by government Indirect 5= 8 CLTS integrated with other approaches Maybe 3= 1 CLTS sustainable monitoring Planned 3=

ODF success rate 17% 6 Coverage (%) Effectiveness 40% Triggered communities per facilitator 1.5 5 Summary CLTS potential maximized? Maybe 5 1 Performance 50 High 20% Middle 9 Indirect* Low 0 8 Scale of rural sanitation challenge * Indirect finance 0% 1995 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 41% 287,900 1,698,600 Shared sanitation Unimproved sanitation facilities 8% 56,200 331,400 Unimproved sanitation Shared sanitation facilities 1% 7,000 41,400 Open defecation Total without improved sanitation 50% 351,100 2,071,400

Source: 2012 JMP estimate; UN population forecast.

Community-Led Total Sanitation in East Asia and Pacific 071 Health Nam Saat Government Community-Led Total Sanitation in East Asia and Pacific Community-Led Total WSP Multi-lateral agencies Major exceptions Major and often PDR are small-scale activities in Lao rural sanitation Ongoing hygiene using a mix of projects, generally into livelihood integrated Sanitation Hygiene and as Participatory approaches, such promotion projects Most WASH latrine subsidies. (PHAST), and Transformation The offered to households. with few choices latrines, pour-flush promote continue to promote a few other international NGOs Lao Red Cross and (THPC) programmes. The Theun Hinboun in their WASH latrine subsidies to trigger of CLTS planning to use a modified version power project is provided in relocated toilet components being demand for the subsidized subsidy programme Lao PDR continued with its latrine villages. UNICEF with WSP on a 2012- but is now planning to partner until January 2011, of OD, use of designed to accelerate the eradication 2015 programme behaviours. and adoption of other key hygiene improved latrines Bilateral programmes World Vision Plan SNV CARE International NGOs CONCERN Worldwide National NGOs Major Exceptions Subsidy programme Red Cross: IFRC Power project: THPC with PADETC 072

CLTS institutional coverage CLTS CLTS status CLTS has since CLTS in 2008. and CONCERN Worldwide Introduced by WSP provinces in eight out of the 17 out of 143 nationally, spread to 21 districts scale from piloting cent nationally), though at varying in Lao PDR (47 per villages in a province. up to initiatives covering 40-80 two to three villages Rural: improved sanitation coverage sanitation improved Rural: in improved sanitation a rapid increase estimate suggests The JMP 1995 to 50 per of 8 per cent in a low baseline in rural areas from coverage that 288,000 cent, which suggests at 41 per OD was estimated cent in 2010. facility. use a sanitation people) do not (1.7 million rural households

PART II: Lao PDR Community-Led Total Sanitation inEast Asia andPacific 3. 2. 1. remote ruralcontextsfoundinLaoPDR. consensus onsuitableprogrammemethodologiesforthechallengingand small-scale, pilotprojects,suggestingthatthereremainslittleclarityor being pilotedwithCLTS inLaoPDR.Mostoftheseinterventionsare A widevarietyofdifferentapproachesandadditionalcomponentsare CLTS variationsandpractice before commencingCLTS. management, wastewaterandaims totriggerschools promote HWWS,householdwatertreatmentand storage, solidwaste The PlanprogrammeinBokeoprovinceincludes interventions to Plan: Bokeoprogramme communication andWASH governance. supply chainsforsanitationandhygieneproducts, behaviouralchange sanitation andhygieneimprovementswithsupporttomarket-based in 2010,whentheSSH4Aprogrammeintegrateddemandcreationfor to theLaocontext.ThispilotwastakenscaleinSavannakhetProvince SNV commencedalearningprocesswithWSPtotestandadjustCLTS SNV: SustainableSanitationandHygieneForAllprogramme(SS4A) the promotionofHWWSwithCLTS. Sekong provinceswillusetheresultsofformativeresearchtointegrate demand creationcomponentinitsnewprojectsChampassakand its ScalingUpRuralSanitationprogramme.WSPalsoreportsthatthe creation andsanitationmarketingsupplystrengtheningcomponentsin WSP pilotedCLTS, butnowproposestoutilizebothCLTS demand WSP: CLTS andsanitationmarketing(andHWWS) sanitation coverage. Insufficient datawereavailable todeterminetheimpactofCLTS onnational CLTS impactonnationalsanitation coverage Technical Working Group. have beendeclaredODFaccordingtodataprovidedbytheLaoPDRWASH Lao PDRhasamoderateODFsuccessrate:17percentoftriggeredvillages ODF successrate achieve ODFstatus. using theCLTS approach,buttodateonly36villageshavebeenreported reported toliveinODFvillages.Morethan217villageshavebeentriggered Only 0.8percentoftheruralpopulationinLaoPDR,just33,000people,are CLTS scale National CentreforEnvironmentalHealthandWater Supply(NamSaat). from ParticipatoryDevelopmentTraining Center(PADETC), SNVandthe Plan, SNV, World Vision andChildFund.ThemainCLTS trainershavebeen capacity developmentactivitiessupportedbyCONCERNWorldwide, WSP, A totalof143CLTS facilitatorshavebeentrainedinLaoPDR,through CLTS capacity 36 1 1,423 181 Not triggerednotODF T Living inODFcommunities Rural communities riggered notODF 33,342 4,026,746 82,913 Not triggerednotODF T Living inODFcommunities Rural population riggered notODF 073

PART II Lao PDR Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Cross, pending approval of the draft national strategy for RWSSH. Cross, pending approval preference and supply chains study. SNV and Plan on a national consumer with UNICEF, PDR, and is now partnering or progress has yet been made in no investment However, effectiveness and sustainability. and another to examine systems. establishing these monitoring implementation nationally. but it is yet to be revised for adoption and 1. Latrine subsidies are still widely utilized by provincial and district governments, and by other NGOs and the Red governments, and by other NGOs and still widely utilized by provincial and district 1. Latrine subsidies are Plan). WSP, in Lao PDR (SNV, programmes and SLTS has been or will be combined with most CLTS 2. HWWS promotion in Lao of affordable technology options for sanitation into the development and marketing 3. WSP financed research targets; for progress versus annual and multi-year proposes two monitoring systems: one 1. Draft national strategy by local governments, process that has been recognized and Plan have established an ODF verification SNV 2. WSP, Section 4.4.4.2: “More emphasis will be given to creating demand through community-based approaches (for community-based demand through will be given to creating “More emphasis Section 4.4.4.2: [PHAST] to and Sanitation Transformation Participatory Hygiene and [CLTS] Sanitation Led Total example, Community villages”. communities and defecation free (ODF) to achieving open … contribute lowest (rural and among sanitation coverage targets for improved proposes strategic Strategy for RWSSH 2012 National of ODF villages. include the proportion indicators that HWWS; and monitoring latrine usage and wealth quintile), programmes, with local implementation and other rural sanitation to CLTS Nam Saat provides central support to allocate any finance to the government has yet its provincial offices. However, support provided through implementation. CLTS marketing (draft) for RWSSH system 1. Latrine subsidies 2. HWWS 3. Sanitation 1. National Strategy 2. ODF verification National Strategy National Strategy for RWSSH National Strategy for RWSSH Government support to programmes Yes Maybe Maybe Indirect Planned Monitoring Sustainable M&E of CLTS Strategy targets in government CLTS or development plans strategies Finance by government financed CLTS Integration with other integrated CLTS approaches Policy in government policy CLTS 074 CLTS enabling environment enabling CLTS

PART II: Lao PDR Community-Led Total Sanitation inEast Asia andPacific CLTS strengths andopportunities CLTS weaknessesandbottlenecks Sources: Colin(draft) PilotingCLTS inSouthernLao PDR:Lessonsandprospects, WSP;SNV(2009)CLTS pilotevaluation; personalcommunications withPlanLaoPDR. Sources: Colin(draft)PilotingCLTS inSouthernLaoPDR:Lessonsandprospects,WSP;SNV(2009)CLTS pilotevaluation;personalcommunicationswithPlanLaoPDR. 2. Recognitionand rewardshelp 1. Village regulationsreinforceaction Lessons learned 2. ODFverificationprocess 1. Encouragelocalinnovation Opportunities? 2. Strongvillageleadership 1. House-to-housesupport Success factors? 2. CLTS iscost-effective 1. CLTS triggeringiseffective What’s working? 4. Backtobasics:behaviourchange 3. Post-triggeringsupportimportant 2. Localleaderscriticaltoprogress 1. Startineasyvillages Lessons learned 6. Governmentpolicy 5. NamSaatfinanceisinadequate 4. Moreaffordabledesignsneeded 3. Shortageofhumanresources 2. Competitionwithotherprogrammes 1. Fixedattitudesandbeliefsofkeyactors Constraints andbottlenecks? 3. CLTS a‘foreign’approach 2. Pour-flush latrinespreferred 1. Numerousdefecationsites Context issues? 2. Qualityoflatrineconstructionispoor 1. CLTS haslimitedimpactonhygiene What’s notworking? 2. Formalrecognition ofODFstatusisamatter ofgreatprideandshouldbecontinued infutureprogrammes. 1. Supportivevillage regulationscanreinforce communityactiontoimprove sanitation. 2. ThedevelopmentofanODF verification processwillencouragelocalgovernmentinvolvement andmonitoringofprogress,assistin 1. CLTS offersthepotentialtomoveawayfromtop-downtechnical standardstowardsmoreaffordable,practicalandappropriate sanitation 2. Strongvillageleadershiphasbeenacriticalfactorinachieving ODFstatus. 1. House-to-housesupportwasfoundtobethemosteffective modefortriggeringandsustainingbehaviourchange. 2. CLTS canbecost-effectiveifimplemented throughexistinggovernmentandcommunitystructures. 1. CLTS triggeringisaneffectiveapproach tocreate‘initialdemand’forsanitation. harmonizing definitions,criteria andapproaches. technologies andservices. 4. Focusonignitingchangesinsanitationbehaviourandpracticeratherthanlatrineconstruction. 3. Effectivepost-triggeringsupportandguidanceareimportanttoavoidslippageimprovethesustainabilityofoutcomes 2. Theinvolvementoflocalformalandinformalleaderscommunitystructuresiscrucialtokick-startactivitiesmaintain progress. 1. Try toavoidvillagesthathavepreviouslyreceivedlatrinesubsidies.Startineasy villages;clustervillagesgeographicallyforgreaterimpactandspread. 6. NoformalgovernmentrecognitioninpolicyorplansthatODFisanimportantsanitationobjective,demandcreation isimportantfor 5. Very limitedfundswereavailableforfieldworkbyNamSaatstaff,whichlimitstheirroleinimplementing,monitoringorsupportingCLTS activities. 4. Moreaffordablehygienictoiletdesignsareneededtohelpscalingup. 3. Shortageofsufficientlyexperiencedandskilledhumanresources:forparticipatoryfacilitation;technologyadvice;orknowledge management 2. CLTS oftencompeteswithotherprogrammesinneighbouringareas,manyofwhichoffersubsidiesthustendtoundermineCLTS effectiveness. 1. KeyactorsandstakeholdersremainunconvincedthatCLTS works,includingmanygovernmentfacilitators. 3. CLTS isviewedasaforeignapproachthatwillrequirecontinuouslearning,adaptation,innovationandqualityassurancebeforeitcangotoscale. 2. SNVreviewfoundthatHmongvillageshadapreferenceforpour-flush latrines. 1. Lotsofcoverandalternativesitesfordefecationinruralareas. 2. 2009SNVevaluationfoundthatthequalityofCLTS latrineconstructionwasgenerallypoorintheCLTS pilots,perhapsduetoinadequate 1. AWSPassessmentsuggestedthatCLTS “mayhaveonlylimitedimpactonhygienebehaviour”,notablyHWWS. sustainable behaviourchange,whichmakesitdifficulttoconvincelocalgovernmentsendorseorsupportCLTS interventions. (capturing andsharinglessonsinnovations). follow-up, whichledtohighnumbersof‘unhygienic’latrines. 075

PART II Lao PDR Mongolia

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2011 10 100% Status CLTS coverage: % of country 0% 11= CLTS coverage: major organizations 3 9 OD population (2010, millions) 0.27m 6 26

Communities triggered (number) 10 9 39 Scale 80% ODF communities (number) 1 9 Capacity developed (trained facilitators) 15 11 CLTS in government policy No 9= CLTS targets in government plans No 8= 23 60% Enabling CLTS financed by government No 11= 12 CLTS integrated with other approaches No 9= CLTS sustainable monitoring No 8=

ODF success rate 10% 7 Coverage (%) Effectiveness 40% 22 Triggered communities per facilitator 0.7 8 21 Summary CLTS potential maximized? No 10 Performance 1 High Middle 20% Low 28 29

Scale of rural sanitation challenge 0% 1995 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 26% 63,300 272,200 Shared sanitation Unimproved sanitation facilities 23% 56,000 240,800 Unimproved sanitation Shared sanitation facilities 22% 53,500 230,300 Open defecation Total without improved sanitation 71% 172,800 743,300

Source: 2012 JMP estimate; UN population forecast.

076 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific CLTS institutional coverage WASH programmesinMongoliathat donotutilizetheCLTS approach. CLTS isanewapproachinMongolia.ACF, UNDPandtheRedCross have Major exceptions 2012-2016 countryprogramme. workshops havebeenheld,andUNICEFplanstoimplementCATS inits Introduced byWorld Vision inSeptember2011.Two CLTS training CLTS status due largelytoanincreaseintheuseofunimprovedsanitationfacilities. 2010. ODwasestimatedtohavereducedfrom39percent26cent, in ruralareas,risingmarginallyfrom28percent1995to29 The JMPestimatesuggestslittlechangeinimprovedsanitationcoverage Rural: improvedsanitationcoverage Norwegian Lutheran Mission;GTZEcosanPilot Project Ecosan pilotprojects: Major Exceptions National NGOs International NGOs Vision World Bilateral programmes national sanitationcoverage. Insufficient datawereavailabletodeterminetheimpactofCLTS on CLTS impactonnationalsanitationcoverage no otherinformationwasavailableonCLTS progress. urban communitieshavebeentriggeredduringCLTS trainingevents,but households, isreportedtohaveachievedODFstatus.About10small,peri- Only onesmall,peri-urbancommunityinMongolia,comprisingjust16 CLTS scale Vision, withfiveofthesefacilitatorsreportedtobeveryactive. A totalof15CLTS facilitatorshavebeentrainedinMongoliabyWorld CLTS capacity 1. CLTS variationsandpractice 2016 programmeinNailakhdistrictandKhuvsgulaimag. marketing andHWWS.UNICEFplanstoimplementCATS inits2012- CATS involvesarangeofinterventionsincludingCLTS, SLTS, sanitation UNICEF: CATS Multi-lateral agencies UNICEF WHO Government 077

PART II Mongolia Community-Led Total Sanitation in East Asia and Pacific Community-Led Total No monitoring system. No formal CLTS programmes established. No formal CLTS No formal CLTS programmes established. No formal CLTS No CLTS targets in government strategies or national development plans. or national development strategies targets in government No CLTS Sanitation defined as “activities to eliminate adverse natural and social factors having natural and social to eliminate adverse defined as “activities Sanitation diseases”. Normal public health from and to prevent the on public health, potential impact and to live”. for a human to work and safe environment “a healthy sanitary conditions: No progress data No combined approaches No CLTS finance No CLTS No WASH strategy or plan No WASH 1998 Law of Mongolia on Sanitation 1998 Law of No No No No No with groundwater contamination often attributed to inadequate sanitation. with groundwater contamination often attributed human excreta limited composting in winter requiring frequent emptying, scepticism concerning lines, disposal problems, odour problems, the significant wastewater problem. use in agriculture, and a failure to address 1. The provision of latrine subsidies remains the default approach to sanitation improvement. 1. The provision of latrine subsidies remains seal toilets and excreta. by sub-zero temperatures in winter (and hot climate in summer), which freezes water challenges created 1. Technical which house approximately 60% of the national population, peri-urban (ger) areas of Ulaan Baatar, 2. Serious sanitation problems in urban and in the world. 3. Mongolia has the lowest population density behaviours of large nomadic and semi-nomadic populations. 4. Challenges inherent in improving sanitation for sanitation. 1. Lack of clarity over roles and responsibilities coordination or cooperation. 2. Large number of NGOs implementing without costs, frozen urine sanitation toilets were not considered acceptable in peri-urban areas due to high 1. GTZ Ecosan project found that ecological areas Monitoring Sustainable M&E of CLTS Integration with other approaches integrated CLTS Finance by government financed CLTS Strategy strategies or targets in government CLTS plans development What’s not working? What’s 1. Hardware subsidies Context issues? 1. Sub-zero temperatures in winter 2. Urban and peri-urban priority low rural population density 3. Very 4. Nomadic and semi-nomadic population Constraints and bottlenecks? 1. No lead sanitation agency 2. Little sector coordination Lessons learned 1. Ecosan toilets not acceptable in ger Policy in government policy CLTS Sources: Kar (2011) CLTS in Mongolia: report of the first hands-on training workshop; GTZ (2008) ECOSAN: ecological sanitation in Mongolia; personal communication from UNICEF Mongolia. workshop; GTZ (2008) ECOSAN: ecological sanitation in Mongolia; personal communication in Mongolia: report of the first hands-on training Sources: Kar (2011) CLTS 078 CLTS weaknesses and bottlenecks CLTS CLTS enabling environment enabling CLTS

PART II: Mongolia Community-Led Total Sanitation inEast Asia andPacific CLTS strengthsandopportunities Sources: Kar(2011)CLTS inMongolia:reportofthefirsthands-ontrainingworkshop;GTZ(2008)ECOSAN:ecologicalsanitationMongolia;personalcommunicationfromUNICEFMongolia. None todate Lessons learned 1. Highpriorityforsanitation Opportunities? None todate Success factors? 1. ODFcelebrationattractedgovernmentinterest What’s working? 1. 1. ThefirstODFcelebration,inasmall,peri-urbancommunitytriggeredduringtheCLTS training,attractedlocalgovernorsand Ger generated significantinterest. residents, wholiveintheperi-urbanareasofUlaanBaatar, ranked watersupply, drainageandsanitationastheirmostimmediateconcerns. 079

PART II Mongolia Myanmar

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2010 9 100% Status CLTS introduced: % of country 12% 8 8 CLTS coverage: major organizations 7 7 20 5 OD population (2010, millions) 2.5m 9 Communities triggered (number) 224 6 Scale 80% 14 ODF communities (number) 12 7 Capacity developed (trained facilitators) 158 6 24 CLTS in government policy Maybe 5= CLTS targets in government plans No 8= 60% Enabling CLTS financed by government Indirect 5= CLTS integrated with other approaches No 9= 9 CLTS sustainable monitoring No 8=

ODF success rate 5% 8 Coverage (%) Effectiveness 40% Triggered communities per facilitator 1.4 6 Performance 73 Summary CLTS potential maximized? Maybe 8 High 1 Middle 47 Indirect* 20% Low * Indirect finance

Scale of rural sanitation challenge 0% 1995 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 8% 545,200 2,546,000 Shared sanitation Unimproved sanitation facilities 5% 340,700 1,591,250 Unimproved sanitation Shared sanitation facilities 14% 954,100 4,455,500 Open defecation Total without improved sanitation 27% 1,840,000 8,592,750

Source: 2012 JMP estimate; UN population forecast.

080 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific CLTS institutionalcoverage uncertain howmanyofthesefacilitatorsarecurrentlyactive. A totalof158CLTS facilitatorshavebeentrainedinMyanmar, althoughitis CLTS capacity eight districtsinfourregionsandstates(12percentgeographicalcoverage). Introduced byUNICEFandSavetheChildrenin2010.CLTS hassincespreadto CLTS status (2.5 millionpeople)whodonotuseanyformofsanitationfacility. estimated tobe8percent,whichequates545,000ruralhouseholds use eithersharedorunimprovedsanitationfacilities.TheODratewas 1995 to73percentin2010.Afurther19oftheruralpopulation coverage inruralareasfromarelativelyhighbaselineof47percent The JMPestimatesuggestsarapidincreaseinimprovedsanitation Rural: improvedsanitationcoverage National NGOs MHAA International NGOs International Partners Children Save the IRC Bilateral programmes DANIDA national sanitationcoverage. Insufficient datawereavailabletodeterminetheimpactofCLTS on CLTS impactonnationalsanitationcoverage been reportedasODF. been triggeredusingtheCLTS approach,butsofaronly12villageshave people, arereportedtoliveinODFvillages.Morethan220villageshave Only 0.05percentoftheruralpopulationinMyanmar, about16,600 CLTS scale 12 13,404 212 Not triggerednotODF T Living inODFcommunities Rural communities riggered notODF Multi-lateral agencies UNICEF 16,61 31,351,066 1 457,323 Government Not triggerednotODF T Living inODFcommunities Rural population UN-Habitat &USAID Subsidy programme Major Exceptions riggered notODF HEALTH 081

PART II Myanmar Community-Led Total Sanitation in East Asia and Pacific Community-Led Total CLTS variations and practice variations CLTS date. None to Ministry of Health’s 2012 National Sanitation Campaign will promote the CLTS approach. Campaign will promote the CLTS 2012 National Sanitation Ministry of Health’s No CLTS targets in the current government strategies or national development plans, but the or national development plans, but the in the current government strategies targets No CLTS has effectiveness and sustainability to develop a new strategy once CLTS government is planning been evaluated. Government provides staff to support CLTS implementation programmes, but there is no co- implementation staff to support CLTS Government provides financing of programmes. CLTS has not yet been combined with any other approaches, but the continuation of latrine yet been combined with any other approaches, has not CLTS in nearby areas. implementation is likely to undermine CLTS subsidy programmes progress in 10 CLTS system. The government has been monitoring No national monitoring a national M&E system. but has not yet developed or implemented township programme, National Sanitation Campaign No WASH strategy or plan strategy No WASH Indirect government support Indirect government Subsidy approaches Few progress data No No No Indirect Planned 1. Children’s participation in CLTS is limited when they go to school in the next village. is limited when in CLTS participation 1. Children’s improvement. that communities often expect financial assistance from projects for sanitation 1. Previous latrine subsidy programmes mean faced in flood-prone communities and communities with rocky soils. and economic challenges 2. Technical (six months of the year). 3. Progress is difficult in the rainy season needs to recognize time constraints during periods of harvest and transplanting. of interventions 4. Timing that some people are too poor to build their own latrine. 1. Greatest challenge is the widely held view implementation and follow-up. CLTS constraints affect 2. Transport place before or during the sanitation improvement process. and not take should follow CLTS, supply development 1. Water What’s not working? What’s participation 1. Children’s Context issues? 1. Expectations of subsidy 2. Rocky and flooded areas 3. Weather 4. Harvest and transplanting Constraints and bottlenecks? 1. Poverty perception 2. Transport Lessons learned supply development 1. Water Policy policy in government CLTS Strategy in government strategies or targets CLTS development plans Finance by government financed CLTS Integration with other approaches integrated CLTS Monitoring Sustainable M&E of CLTS Sources: Personal communication with UNICEF Myanmar; Kar (2011) CLTS in Myanmar: report of the first hands-on training of trainers workshop, CLTS Foundation; www. in Myanmar: report of the first hands-on training of trainers workshop, CLTS Myanmar; Kar (2011) CLTS Sources: Personal communication with UNICEF communityledtotalsanitation.org (accessed 30 July 2012). 082 CTS weaknesses and bottlenecks Major exceptions Major to be programme WASH million five-year US$ 12 is planning a UN-Habitat construction. will subsidize latrine by USAID that supported CLTS enabling environment enabling CLTS

PART II: Myanmar Community-Led Total Sanitation inEast Asia andPacific CLTS strengthsandopportunities www.communityledtotalsanitation.org (accessed30July2012). Sources: PersonalcommunicationwithUNICEFMyanmar;Kar(2011)CLTS inMyanmar:reportofthefirsthands-ontrainingtrainersworkshop,CLTS Foundation; 3. Two-way communication 2. Healthstaffarekey 1. ODFvillagesencouragespread Lessons learned 1. NationalSanitationCampaign Opportunities? 1. Outdoortriggeringprocess Success factors? 2. CLTS triggering 1. Communityprideandempowerment What’s working? 3. Two-way communicationismoreappropriateandeffectivethantraditionalteaching methods. 2. BasichealthstaffarecentraltothesuccessofCLTS process. 1. OnceafewvillagesinanareareachODFstatus,itbecomeseasiertoadvocateforno-subsidyapproach. 1. TheMinistryofHealthhasbeenholdingNationalSanitationWeeks for14years,buthas decidedthatfrom2012thesanitationweekwill 1. Outdoorareasaremoreeffectiveplacestoconductthetriggeringprocessthaninsideabuilding. 2. CLTS triggeringismoreeffectivethanHealthEducation. 1. CommunitiesarehappywiththeapproachonceODFsuccessisachieved,whichsuggeststhatsustainabilitymorelikely. Communitiesare mainstreaming andscalingupCLTS implementation. be replacedbyaNationalSanitationCampaign.ThecampaignwillincludetheCLTS approach,andprovidesamajoropportunityfor empowered byrealizationthattheycansolveproblemsandissuesthemselves,recognitionthesolutionsresultfrom theirownideas. 083

PART II Myanmar Papua New Guinea

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2008 5= 100% Status CLTS introduced: % of country 95% 3 16 CLTS coverage: major organizations 8 6 18 OD population (2010, millions) 1.1m 7 Communities triggered (number) 477 5 Scale 80% ODF communities (number) 21 7 Capacity developed (trained facilitators) 310 4 CLTS in government policy No 9= 42 CLTS targets in government plans No 8= 41 60% Enabling CLTS financed by government Indirect 5= CLTS integrated with other approaches No 9= CLTS sustainable monitoring No 8=

ODF success rate 1% 9 Coverage (%) 0 0 Effectiveness 40% Triggered communities per facilitator 1.5 4 Summary CLTS potential maximized? Maybe 6 1 Performance

High 20% 42 41 Middle Indirect* Low Scale of rural sanitation challenge * Indirect finance 0%

Rural sanitation coverage 1990 2010 Category Percent Households Population Improved sanitation Open defecation 18% 196,300 1,079,800 Shared sanitation Unimproved sanitation facilities 41% 447,200 2,459,600 Unimproved sanitation Shared sanitation facilities 0% - - Open defecation Total without improved sanitation 59% 643,500 3,539,400

Source: 2012 JMP estimate; UN population forecast.

084 Community-Led Total Sanitation in East Asia and Pacific Papua New Guinea New Papua Community-Led Total Sanitation inEast Asia andPacific CLTS institutionalcoverage following sanitationpracticesforruralhouseholdsinPapuaNewGuinea: assumed tobeunimprovedsanitationfacilities.TheDHS06reportedthe pit latrines’surveyedasimprovedsanitationfacilities,withtheotherhalf from humancontact’,theJMPestimatecountsonlyhalfof‘traditional that sometraditionalpitlatrinesdonot‘hygienicallyseparatehumanexcreta pit latrines’,whichisnotoneoftheJMPsanitationcategories.Givenrisk The DHSsurveycategoriesusedinPapuaNewGuineainclude‘traditional stagnation ofruralsanitationcoverage. the 10yearperiod1996-2006,islikelytobeasignificantfactorin Rapid populationgrowthinruralareas,estimatedat31percentduring and opendefecationrateshavehardlychangedbetween19962006. sanitation progress.Basedonthesetwosurveys,ruralcoverage surveys (1996DHSand2006DHS)thusprovidesalimitedestimateof The JMPestimateforPapuaNewGuineaisbasedononlytwohousehold Rural: improvedsanitationcoverage Oxfam NZ Subsidy programme Major Exceptions TTU National NGOs Vision World Live &Learn International NGOs Oxfam PSI ChildFund Bilateral programmes provision ofsubsidizedlatrineslabsandventpipesforVIPlatrines. Oxfam NZinBougainville:usingCLTS togeneratedemandbutalongside Major exceptions provinces inPapuaNewGuinea(95percentgeographicalcoverage). and Live&Learnin2009.CLTS hassincespreadto19outofthe20 Introduced byOxfamin2008,withimplementationexpandedChildFund CLTS status • • • • • • 0.7 percentusedasharedflushtoilet 1.1 percentusedaflushtoilet 2.9 percentusedanimprovedlatrine 3.5 percentusedhanginglatrinesoverwaterbodies(closetsea/river) 17.7 percentpracticedOD(nofacility/bush/seashore) 73.7 percentusedtraditionalpitlatrines WSP WSP Multi-lateral agencies RWSSP EU HEALTH Government HEALTH 085

PART II Papua New Guinea New Papua riggered not ODF Rural population Living in ODF communities Living in ODF communities T Not triggered not ODF 223,733 5,766,951 8,316 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total riggered not ODF Rural communities Living in ODF communities T Not triggered not ODF 456 5,654 21 CLTS capacity CLTS facilitators have been trained in Papua New Guinea, A total of 310 CLTS of these facilitators are currently active. although it is uncertain how many impact on national sanitation coverage CLTS on determine the impact of CLTS Insufficient data were available to national sanitation coverage. CLTS scale CLTS about 8,300 Papua New Guinea, population in per cent of the rural Only 0.1 villages have More than 470 in ODF villages. reported to live people, are 21 villages have but so far only approach, CLTS using the been triggered a direct are reported as new latrines In total, 16,000 as ODF. been reported on the proportion but few data were available interventions, result of CLTS found in ODF communities. of these that are TTU: CLTS and health training TTU: CLTS into all of its village health CLTS TTU is a national NGO that has built health worker training village birth attendant and community worker, to have resulted in 5,000 new workshops. This approach is estimated latrines within the last two years. ealthy Islands concept Healthy Islands and CLTS the Papua New concept was incorporated into The Healthy Islands health National Health Plan, and encourages Guinea 1996-200 schools, villages such as healthy homes, promotion in sub-settings immunization, covers safe motherhood, child health, and markets; and of life. communicable diseases, and quality protection against finance and support, of the concept previously lacked Implementation of the concept of action for revitalising implementation but a framework fits well with CLTS and there is now evidence that was agreed in 2011, approach. and principles of this Pacific-specific many of the activities 086 2. 1. CLTS variations and practice variations CLTS meet two require that latrines New Guinea in Papua implementers CLTS vent pipe. sealed pit and a provision of a technical criteria: minimum

PART II:

Papua New Guinea Papua New Guinea New Papua Community-Led Total Sanitation inEast Asia andPacific CLTS weaknessesandbottlenecks CLTS enablingenvironment WSP; ISF(2011) PapuaNewGuinea:WASH sectorbrief;personal communicationwithStuartJordan, EU-RWSSP. Sources: Dutton (2011)PNGscopingmissionfor WSPsupporttowatersupply, sanitationandhygiene, WSPreport;Dutton(2011) CouldPapuaNewGuineameet itsMDGforruralsanitation, 2. Improvedmonitoringneeded 1. Involvelocalgovernment Lessons learned 3. Communitiesclosetoroadsandtowns 2. Difficultgroundconditions 1. Historyofhandouts Constraints andbottlenecks? 4. 2009-2011choleraoutbreaks 3. Demographicsandgeography 2. Traditional, patriarchal communities 1. Ruralandinaccessible Context issues? 1. SubsidiesundermineCLTS What’s notworking? CLTS ingovernmentpolicy Policy strategies ordevelopmentplans CLTS targetsingovernment Strategy CLTS financedbygovernment Finance approaches CLTS integratedwithother Integration Sustainable M&EofCLTS Monitoring Indirect No No No No 2. Improvedmonitoringandevaluation ofCLTS isneeded,including betterinformationonhealthstatus,useoflatrinesandcritical hygiene 1. NGOsnotedthatsupportfor CLTS fromprovincialDOHandother governmentstaffleadstosmootherimplementationand localreinforcement 3. Communitieslocatedclosetomainroadsandtownsarethe mostdifficulttoinfluence.Theirprioritiesarearoundearningincome,leavinglittle 2. Additionaltoiletcostsinareaswithahighwatertableorpoor soils(collapsibleorrocky). 1. Difficulttomotivateruralhouseholdsfinanceandbuild their owntoiletsincommunitiesCentralProvincethathavealonghistoryof 4. Choleraoutbreaksinnineprovincesthe2009-2011period. 3. Largeislandwithscatteredpopulationandrapid growth.Widelydifferingprovincesizes,topography, climate,accessibility, natural 2. Traditional andusually patriarchalcommunitiesmanyofwhichareisolatedfrombasicservicessuchashealthcentres,electricityandtransport networks. 1. 85%ruralpopulation,withmanylivinginremoteanddifficult toaccesssettlements. 1. SubsidiesundermineCLTS self-helpandspontaneity. practices suchasHWWS. ceremonies. However, local governmentresponsesremainvariablebecausetherehasbeen nonationalpolicyorguidanceontheuseofCLTS. of behaviourchanges.Localgovernment staffhavebeeninvolvedintriggering,jointinspections, ODFverificationandattending time orinterestinparticipatingCLTS activities. handouts becauseoftheirproximitytothecapital. resources, culture,languageandpopulationdensity. and SanitationServices(draft) National PolicyonWater Supply Strategy (MTDS)2011-2015 Medium-Term Development Indirect governmentsupport marketing 2. CLTS andPHASTsanitation 1. Subsidyapproaches 2. NoODFverificationprocess 1. Nonationalmonitoringsystem have beendeveloped. A draftnationalpolicywasdevelopedin2005,butneverapproved.NofurtherWASH policies New Guineaby2014withtheprovincialdepartmentofhealth(66,000districtpopulation). However, anationalNGO(TTU)hasagreedthetargetof achieving thefirst100%ODFdistrictinPapua external donorstofundWASH programmes.NospecifictargetswereincludedforODFcommunities. MTDS 2011-2015includesambitiousWASH investmentandcoveragetargets,butislargelyrelianton September 2012). staff fromtheUNandprovincialhealthofficesinCLTS approach(duetostartinAugustand triggered 5,000newlatrines.NewlyformednationalWASH teamhasbeengiventheroleoftraining Government financedaCLTS trainingworkshopthattrained40volunteers,oneofwhomhassince Government providesstafftosupportCLTS implementationprogrammes.EasternHighlands approach hasnotyetbeenfullyimplemented. The Information,EducationandCommunication(IEC)materialshavebeenwellreceived,butthe 2. Live&LearnispilotinganapproachthatwillcombineCLTS withPHASTandsanitationmarketing. 1. Mostimplementersarenowreportedtobereplacingprevioussubsidy-basedapproacheswithCLTS. 2. NoformalODFverificationprocesshasbeenagreed. 1. ReliableCLTS progressdatawerehardtoobtain. 087

PART II Papua New Guinea New Papua ASH sector brief; Community-Led Total Sanitation in East Asia and Pacific Community-Led Total tend to be more self-reliant and used to building with local materials, and are often more willing to participate in the triggering process. and are often more willing to participate and used to building with local materials, tend to be more self-reliant properly tested. combined implementation has not been The effectiveness of single or Community Health Evangelism. Islands, and Mipela Yet the Healthy Islands into facilitators and integrated CLTS has already financed the training of 40 CLTS provincial government in Eastern Highlands in 120 villages in the province. health promotion approaches being implemented Community Health Evangelism and Mipela Yet the Eastern Highlands and Simbu provinces. Typically it takes about three months from triggering and training to 100% ODF status. and training months from triggering it takes about three provinces. Typically Highlands and Simbu the Eastern by others. animal excreta. means that benefits of improved sanitation and hygiene before water supply improvement remain low priorities, but experiencing the beneficial to the behaviours when the water supply arrives. The collective action required is also communities are more likely to sustain these their conditions an indicator of communities that are willing and able to work together to improve water supply development process, providing and basic services. 1. Remote rural communities without a history of handouts and latrine subsidies are quicker to change their sanitation practices. Remote communitieslatrine subsidies are quicker to change their without a history of handouts and 1. Remote rural communities interventions. factors in the success of CLTS of formal community leaders, are key leaders to motivate others, and the support 2. The enthusiasm of natural Healthy to hygiene promotion, including PHAST, with other popular approaches works best when integrated that CLTS 3. Implementers report The and social conditions in rural communities. to improve health of CLTS are becoming interested in the potential 1. Provincial governments 1. When implemented well, CLTS can quickly transform sanitation practices – within two to eight weeks from OD to latrine use in some villages in in some villages in from OD to latrine use two to eight weeks practices – within transform sanitation can quickly well, CLTS 1. When implemented of copycat triggering is some evidence villages, and there in their home trigger sanitation improvement been reported to facilitators have 2. CLTS toilet. to build their own those that are unable and assistance to materials of labour, community provision effective subsidy is 3. The most of the penning of animals to prevent the spread of all forms of OD, which has encouraged New Guinea promotes elimination in Papua 4. CLTS CLTS villages. reduction in fly nuisance in successful report a significant 5. Villagers Sanitation and hygiene hygiene and sanitation first, and finish with water supply development. 1. NGOs find that it is more effective to promote hygiene promotion approaches approach interested in the CLTS Success factors? 1. Remote rural communities leaders 2. Natural and formal popular 3. Integration with other Opportunities? becoming 1. Provincial governments Lessons learned last development comes 1. Water What’s working? What’s can work quickly 1. CLTS facilitators 2. Spread through support) (community 3. Internal subsidies animal pens has resulted in 4. CLTS in fly nuisance 5. Reduction Sources: Dutton (2011) PNG scoping mission, WSP report; Dutton (2011) Could Papua New Guinea meet its MDG for rural sanitation, WSP; ISF (2011) Papua New Guinea: W WSP report; Dutton (2011) Could Papua New Guinea meet its MDG for rural sanitation, Sources: Dutton (2011) PNG scoping mission, personal communication with Stuart Jordan, EU-RWSSP. personal communication with Stuart Jordan, 088 CLTS strengths and opportunities strengths CLTS

PART II: Papua New Guinea Source: 2012JMP estimate;UNpopulationforecast. Community-Led Total Sanitation inEast Asia andPacific Scale ofruralsanitationchallenge CLTS summary Philippines Regional Ranking Total withoutimprovedsanitation Shared sanitationfacilities Unimproved sanitationfacilities Open defecation Category Summary Effectiveness Enabling Scale Status CLTS potentialmaximized? Triggered communitiesperfacilitator ODF successrate CLTS sustainablemonitoring CLTS integratedwithotherapproaches CLTS financedbygovernment CLTS targetsingovernmentplans CLTS ingovernmentpolicy Capacity developed(trainedfacilitators) ODF communities(number) Communities triggered(number) OD population(2010,millions) CLTS dateofintroduction CLTS coverage:majororganizations CLTS introduced:%ofcountry Percent 31% 16% 12% 3% Rural sanitationcoverage Households 3,077,400 1,588,400 1,191,200 Indirect Maybe 297,800 5.7m 2008 17% 10% 377 211 Yes 0.6 No No No 36 10 11 Population 14,772,400 7,624,500 1,429,600 5,718,300 9= 9= 9 9 8= 8 7 5= 5= 5= 5 * Indirectfinance Performance 3 3 Low Indirect* Middle High 1=

Coverage (%) 100% 20% 40% 60% 80% 0% JMP 1995 Open defecation Unimproved sanitation Shared sanitation Improved sanitation estimate:Ruralsanitation 45 10 22 23 69 12 16 3 2010 089

Philippines Philippines EOHO Health Government Major Exceptions Subsidy programmes LGU: Municipal toilet bowl distributions Non-specific policy Government: DILG Bilateral: USAID Community-Led Total Sanitation in East Asia and Pacific Community-Led Total UNICEF Multi-lateral agencies WSP CLTS status CLTS Since then, CLTS Samar in 2008. WSP in Eastern introduced by was CLTS per centthe Philippines (10 80 provinces in to eight out of has spread in been concentrated progress has CLTS coverage). However, geographical than half of the with more programmes, CLTS with active a few provinces Sarangani (WSP)Samar (Plan) and in Northern communities found triggered main programme areas. limited activities outside these provinces, and very scale CLTS people, in the of the rural population, 50,000 About 0.5 per cent sitios) that have been the 211 communities (purok or Philippines live in estimated to live in with 0.1 per cent, 8,500 people, triggered by CLTS, and the limited The relatively large rural population ODF communities. that it is yet to have any in the Philippines mean CLTS spread or scale of sanitation coverage. Nonetheless, discernible effect on national or regional sixth in the region (behind the national ODF percentage is ranked Nam). Viet Indonesia, Lao PDR, Cambodia and Timor-Leste, Bilateral programmes Oxfam World Vision Plan Mission Alliance International NGOs Norwegian ACF ASDSW CAPS National NGOs 090

The 2012 JMP estimate assumes a straight-line best fit of the household best fit of a straight-line JMP estimate assumes The 2012 that rural a closer examination suggests However, survey data points. Philippines since 2000. has slowed significantly in the sanitation progress that rural access 2000, the household surveys indicate Between 1990 and cent, whereas in the facilities increased by 17 per to improved sanitation 3 per cent. This analysis coverage increased by only following eight years 10 years, the current to the lower trend over the last suggests that, due that the 2015 MDG be 5 per cent too high, which implies JMP estimate may will not be reached of 73 per cent improved coverage rural sanitation target in rural sanitation improvement. without a substantial acceleration Rural: improved sanitation coverage sanitation improved Rural: coverage in improved sanitation a steady increase estimate suggests The JMP with a dramatic per cent in 2010, cent in 1990 to 69 from 45 per in rural areas this period. facilities during sanitation in the use of unimproved reduction CLTS institutional coverage CLTS

PART II:

Philippines Philippines Community-Led Total Sanitation inEast Asia andPacific specific policyorprogrammingbasedondemand creationorCLTS. of innovationandprogressinurbansanitationdevelopment, buthasno Another majorexceptionistheUSAID,whichhas beenamajorsupporter National SustainableSanitationPlan2010-2016. promoted bytheDepartmentofHealth(DOH)and WSPthroughthe planning andimplementation,incontrasttotheCLTS-based ZODapproach services. To date,the DILGhasfavouredanintegratedapproachtoWASH supporting decentralizedLGUsinthedevelopmentofwaterandsanitation actor intheWASH sectorinthePhilippines, responsiblefortrainingand The DepartmentoftheInteriorandLocalGovernment(DILG)isakey demanded byruralhouseholdsandexpectedlocalgovernments. subsidized approachcanprovidethelevelofsustainableservicethatis been introduced,asmanystakeholdersremainunconvincedthatanon- latrine subsidiescontinuetobedistributedbyLGUsevenwhereCLTS has communities. ArecentrapidassessmentforUNICEFfoundthatin-kind continue tofinancethedistributionoffree‘toiletbowls’inrural Local GovernmentUnits(LGUs),includingmunicipalitiesandprovinces, Major exceptions Drop ofSafeWater (ASDSW). 2012-13 throughpartnerorganizationsincludingACF, OxfamandASingle disaster-prone municipalitieswithlowwaterandsanitationcoveragein with WSP, whichwill implementCATS inatleast27 barangaysinpoor, UNICEF recentlystartedanewfive-year WASH programmeincollaboration support isnotyetreflectedinlarge-scaleinvestmentsorprogrammes. There isgrowinginstitutionalsupportfortheCLTS approach,butthis sanitation coverage. Insufficient datawereavailable toassessCLTS impactonnational CLTS impactonnationalsanitation coverage 71 triggeredcommunities wereODF(41percentsuccessrate). much higherintheWSP-LGUinterventionsSarangani province:29outof communities havebeendeclaredODF. However, the ODF successratewas The Philippineshasamid-rankingODFsuccessrate: 17percentoftriggered ODF successrate has thesecondlargestCLTS capacityintheregion. trained facilitatorsthatremainsactive,thedatasuggest thatthePhilippines 2008. Whilefurtherchecksarerequiredtodetermine theproportionof Philippines asaresultof11differentCLTS trainingcoursesrunsince estimates suggestthatthereare377trainedCLTS facilitatorsinthe (EOHO) oftheDOHhavedevelopedsignificantCLTS capacity. Recent Sustained effortsbytheEnvironmentalandOccupationalHealthOffice CLTS capacity 1. CLTS variationsandpractice their ownsimplesanitationfacilities. next trancheofsubsidiesthanfollowtheCLTS philosophyandbuild unable toobtainasubsidizedfacilityweremorelikelywaitforthe bowl distributioneachyear, andarecentassessmentfoundthatthose rationed bytheLGUsaccordingtobudgetallocatedtoilet approach wasused.Unfortunately, thesubsidizedpansareusually even competition,forthefreelatrinepansemergedwhenCLTS out LGUtoiletbowldistributionsnotedthatsignificantdemand,and bowls) provided.Theruralsanitaryinspectorsresponsibleforcarrying construct functionallatrinesusingthefreepour-flush latrinepans(toilet to persuaderuralhouseholdsmakethecontributionsrequired CLTS hasbeenadoptedbyLGUsthatinthepastfounditdifficult CLTS andtoiletbowldistributions 091

PART II

Philippines Philippines TS review team. Community-Led Total Sanitation in East Asia and Pacific Community-Led Total completion of recent sanitation supply and demand studies. No integrated implementation has yet sanitation supply and demand studies. No completion of recent been attempted. interventions. of CLTS effectiveness and sustainability All LGUs have declared sustainable sanitation as a policy declared sustainable All LGUs have 60% of barangays declared ZOD CBMS has been adopted by the DILG as the local poverty and MDG progress monitoring system, and by the DILG as the local poverty and CBMS has been adopted there is currently no formal and use. However, efforts are underway to scale up its implementation and few other sanitation progress data were available. tracking of the ODF targets in the NSSP, 1. Sanitation marketing will be implemented through the UNICEF-WSP programme, following the will be implemented through the UNICEF-WSP 1. Sanitation marketing implementation has undermined the toilet bowls in parallel to CLTS 2. Distribution of free The 1975 Sanitation Code, in need of updating, focused on technical standards. The 2004 Clean Water Water The 2004 Clean on technical standards. of updating, focused Code, in need The 1975 Sanitation sewerage centralized biased towards conventional management, and is on water resource Act focused and hygiene improvement. to rural sanitation than policy relevant treatment plants rather and septage achieved to have been the following objectives of Health includes by the Department NSSP produced by June 2016: • • targets or does not mention either OD Roadmap, which preceded the NSSP, The Philippines Sanitation approaches. CLTS and local government support of CLTS implementation, but national CLTS No direct finance of implementation. planning, training and willing to accept low-cost sanitation facilities. training and support is likely to develop. demand for CLTS and nutrition. The PPPP programme provides several options for improving sanitation of the link between sanitation, hygiene status and the System, components in parallel to the PPPP and National Household Targeting through the future inclusion of sanitation approaches through its family development sessions. promotion of CLTS-based includes support and spreading as the National Sustainable Sanitation Plan (which sanitation in rural areas, and is gaining institutional 60% ODF target for each LGU by 2016) is disseminated and socialized. NGO involvement encourages the diffusion of Marinduque (municipalities funded by the Norwegian Mission Alliance) suggest that innovation. 1. CLTS has been successful in achieving ODF communities in the Philippines, but generally in remote, tribal communities that are more has been successful in achieving ODF communities in the Philippines, 1. CLTS significant the country, 60 per cent ODF barangays by mid-2016. As the plan is rolled out across 1. The NSSP requires each LGU to achieve recognition focuses on improving health and education outcomes but there is increasing 2. The PPPP conditional cash transfer program the approach has proved effective in generating demand for implementation in the Philippines, 1. Despite significant problems with CLTS the province) and after training provided by CLTS 2. Experiences from La Union (CAPS), Sarangani (multiple local NGOs supporting 1. Visits to ODF communities encourage other communities that ODF is an achievable and realistic goal. to ODF communities encourage other communities 1. Visits Plan (NSSP) 2010-2016 Plan (NSSP) Roadmap 1. Community-Based Monitoring 1. Community-Based System (CBMS) 1. Sanitation marketing distributions bowl 2. Toilet 1. National Sustainable Sanitation Sustainable Sanitation 1. National Sanitation 2. 2010 Philippine to Government support programmes 1975 Sanitation Code 1975 Sanitation Act Water 2004 Clean No No No Yes Indirect communities. conditional cash transfer programme limited evidence of success innovation Monitoring Sustainable M&E of CLTS Strategy targets in government CLTS or development plans strategies Finance by government financed CLTS Integration with other integrated CLTS approaches What’s working? What’s 1. Small-scale success in remote, rural 2. NGO involvement helps diffusion of Success factors? 1. Exchange visits to ODF communities Opportunities? 1. NSSP 2. Pantawid Pamilyang Pilipino Program (PPPP) Lessons learned gaining institutional support despite 1. CLTS Policy in government policy CLTS Sources: Robinson A (2012) Enabling environment for scaling up sustainable sanitation and hygiene in the Philippines – UNICEF report; personal communications with the CL Sources: Robinson A (2012) Enabling environment for scaling up sustainable sanitation 092 CLTS strengths and opportunities CLTS CLTS enabling environment enabling CLTS

PART II:

Philippines Philippines CLTS weaknessesandbottlenecks Sources: RobinsonA(2012)Enablingenvironmentforscaling upsustainablesanitationandhygieneinthePhilippines–UNICEFreport;personalcommunicationswithCL 2. Nofollow-upafterCLTS training 1. AdhocCLTS training What’s notworking? 2. Historyoffree‘toiletbowls’ 1. Highexpectations Context issues? 4. Evidenceofimplementationsuccessis 3. CLTS successiscontextdependent 2. ReliableM&Esystemrequired 1. Inadequatedocumentationoflessons Lessons learned 6. Supplyofsanitationservices 5. Lackoflarge-scaleincentivesystem 4. NoODFverificationprocess 3. Lackofprogressdata 2. CLTS reliantonsanitaryinspectors 1. Subsidydominatedprocess Constraints andbottlenecks? important toscalingup. learned. Community-Led Total Sanitation inEast Asia andPacific 2. Nofollow-upbyLGUsafterCLTS training.ThisroleiscurrentlyallocatedtoregionalDOHoffices,buttheyhavelimitedcapacityormotivation 1. CurrentCLTS trainingisbasedonsporadicrequestsforfromLGUs.Thereaneedtodevelopmorestrategicprogramme 2. ThelonghistoryofthedistributionfreetoiletbowlsbyLGUsandDOHhasresultedinareluctanceruralhouseholds toinvestin 1. Mostruralhouseholdsaspiretohaveceramicflushtoilets,butbelievetheyareexpensiveandunaffordable.Demandfor basicpitlatrinesis tion progress, 4. Thelackofcompellingevidenceimplementationsuccess, which reflectsbothweakmonitoringsystemsandlimitedimplementationprogress, 3. MorestrategicuseofCLTS shouldrecognizethatotherapproachesmaybemoreeffectiveinsomecontexts.CLTS ismoreeffectivein 2. NeedforaformalM&Esystem,possiblyintheformoflocalscorecards. 1. LessonsneedtobesharedwiththesectorandLGUsinorderaccelerateprogressscaleupprogressiveinterventions. 6. Needtolinksupplystrengtheningactivitiesdemandcreationactivities. 5. BestBarangayAward doesnotrelatetoODForCLTS. Needalarge-scaleincentivesystemthatencouragessustainablesanitationimprovement. 4. ThelackofcommoncriteriaforODF/ZOD,oranODFverificationprocess,constrainsprogress. 3. NoformalsystemsexisttocollectCLTS progressandperformancedataatnationalorprovinciallevels.Fewprogrammescanprovideupto 2. TheburdenonruralsanitaryinspectorswillbecomesignificantasCLTS scalesup,withfewincentivesorsupportforthechallengingfieldworkrequired. 1. MostCLTS interventionsinthePhilippinesareaffectedbydistributionofsubsidizedlatrines.Evenwheregenuinedemandisignited,those to carryoutthisfollow-up. capacity development. household latrines. limited outsideremotelocationsandtribalcommunities. d approaches. make ithardtoconvincedecision-makersincreaseresource or capacityallocations,toadoptmoreprogressivepoliciesandapproaches. communities notcoveredbylatrinesubsidyprogrammes. date progressorperformancedata. unable toobtainasubsidizedfacilityaremorelikelywaitforthenexttrancheofsubsidiesthanbuildtheirownsimple sanitation facilities. TS reviewteam. 093

PART II Solomon Islands

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation CLTS date of introduction 2012 11 100% 0 0 Status CLTS coverage: % of country 10% 9 CLTS coverage: major organizations 2 10= OD population (2010, millions) 0.14m 4 Communities triggered (number) 2 10 Scale 80% ODF communities (number) 0 10= Capacity developed (trained facilitators) 40 10 CLTS in government policy No 9= CLTS targets in government plans No 8= 60% 82 82 Enabling CLTS financed by government Indirect 5= CLTS integrated with other approaches No 9= CLTS sustainable monitoring No 8=

ODF success rate 0% 10= Coverage (%) Effectiveness Performance 40% Triggered communities per facilitator 0.1 10 High Summary CLTS potential maximized? No 9 1 Middle

Indirect* 20% Low 0 0 * Indirect finance 18 18 Scale of rural sanitation challenge 0% Rural sanitation coverage 1995 2010 Category Percent Households Population Improved sanitation Open defecation 33% 22,800 143,700 Shared sanitation

Unimproved sanitation facilities 24% 17,000 107,000 Unimproved sanitation Open defecation Shared sanitation facilities 14% 9,700 61,100

Total without improved sanitation 71% 49,500 311,800

Source: 2009 Population and Housing Census.

094 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific CLTS institutional coverage of householdsinruralcommunitiespracticeOD. cent. AnecdotalreportsfromtheSolomonIslands confirmthatthemajority should becategorizedasOD,whichwouldincreasetheODrateto57per although perhapstheuseof“otherfacilities”recordedinCensusdata unclear whythesurveyfindingsaresodifferentfrom2009Census, rate ofOD:74percentODinruralareas,and66nationally. Itis The 2006DemographicandHealthSurvey(DHS06)reportedamuchhigher • • • • • • • cent, andthattheopendefecationrateis33percent: that improvedsanitationcoverageinruralareashasincreasedto29per Housing Census,whichwasnotincludedinthe2012JMPestimate,indicate estimate. Morerecentanddetaileddatafromthe2009Population survey from1999,thusisnotlikelytobearepresentativeorrecent The JMPestimatefortheSolomonIslandsisbasedononlyonehousehold Rural: improvedsanitationcoverage 33 percentdonotusesanitationfacilities(OD) 24 percentuse“otherfacilities”(unimproved) 9 percentshareuseofpitlatrines(shared) 4 percentshareuseofflushorpour-flush latrines(shared) 12 percentusedpitlatrines(improved) 7 percentusedpour-flush latrines(improved) 10 percentusedflushtoilets(improved) Rotary Club ADRA Red Cross World Vision Subsidy programmes Major Exceptions National NGOs International NGOs Live &Learn Bilateral programmes sanitation coverage. Insufficient datawereavailabletodeterminetheimpactofCLTS onnational CLTS impactonnationalsanitationcoverage although itisuncertainhowmanyofthesefacilitatorsareactive. A totalof40CLTS facilitatorshavebeentrainedintheSolomonIslands, CLTS capacity The populationofthetwovillagestriggeredisnotknown. CLTS scale programmes. sanitation marketing,andplanstoimplementthisapproachinitsPacific Live &LearnhasdevelopedanapproachthatcombinesPHAST, CLTS and CLTS variationsandpractice two villages. Water SupplyandSanitationProgram)inMay2012.Initialtriggeringwas with supportfromtheGovernment’s EnvironmentalHealthDivision(Rural Introduced byanAustralianVolunteer forInternationalDevelopment(AVID) CLTS status AVID Multi-lateral agencies Government RWSS EHD 095

PART II Solomon Islands Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Policy is intended to cover water resource management, water supply and sanitation. Policy water supply and resource management, to cover water Policy is intended and a related wastewater disposal” to basic sanitation and “increased access objective of issues” but few other on sanitation community awareness strategy to “strengthen implementing to rural sanitation. references its programmes within focus on public health as part of its strategic activities Includes RWSS plans. strategies or No ODF goals in government Wide Approach. Health Sector in two communities. facilitator training and pilot implementation supported CLTS EHD-RWSS Health Sector is provided by development partners. AusAID most rural sanitation finance However, water and Sanitation Initiative (WSI) finance for included some Water Support Program (2008-2012) in the Solomon Islands. and sanitation development the PHAST approach alongside the interventions in the Solomon Islands use Most rural sanitation latrines. provision of subsidized progress. No data available on National Water Policy (draft) Policy National Water National Health 2011-2015 Strategic Plan Indirect support to pilots PHAST and subsidy programmes programme No formal CLTS system No formal monitoring pendent services. although supply chain limitations threaten the sustainability of technology-de approaches as well suited to remote communities, or repair them. latrines, thus users rarely clean, maintain have not been effective, in part due to sanitation being a ‘taboo previous health education approaches However, effective in changing behaviour. as diarrhoea are caused by bad spirits or by the devil. topic’ and local beliefs that illnesses such and staff. allocates this department any related budget sanitation’. latrines are perceived by many as ‘proper focus of improving their sanitation. initial triggering efforts. participation and limited discussion during to follow-up visits to avoid the embarrassment of not responding to the triggering. No No No No 1. Remote communities scattered across more than 1,000 islands make government interventions difficult and expensive. Community management than 1,000 islands make government interventions difficult and expensive. Community 1. Remote communities scattered across more tsunami. drought identified as increasing risks. Protracted recovery continues from the 2009 2. Flash floods, king tides and prolonged attached to the ‘free’ are reported to be non-functional after three years. Little value or ownership is 3. More than two-thirds of subsidized latrines approach was not either culturally appropriate, or likely to be expressed concerns that the CLTS 4. As in many countries, government officials and Medical Services) as the lead agency for rural sanitation, although the government (Ministry of Health 1. No formal recognition of EHD-RWSS latrines by most previous projects. Pour-flush probably related to the provision of pour-flush water, 2. Local understanding is that sanitation requires from the immediate of triggering as other project activities and requirements distract communities 3. Lack of coordination can lessen the impact which led to poor to be culturally inappropriate for men and women to discuss sanitation openly, 1. In one of the pilot villages, it was found considerably with time, but that latrines were being dug prior 2. Slow follow-up revealed that the initial disgust with sanitation practices lessened Indirect climate change What’s not working? What’s experience to date Insufficient CLTS Context issues? 1. Remote island communities to natural disasters and 2. Vulnerable 3. Many abandoned latrines 4. Cultural beliefs and norms Constraints and bottlenecks? 1. Lead sanitation agency 2. Sanitation needs water 3. Coordination with other projects Lessons learned 1. Cultural setting is important 2. Prompt follow-up is important Policy in government policy CLTS Strategy targets in government CLTS plans strategies or development Finance by government financed CLTS Integration with other approaches integrated CLTS Monitoring Sustainable M&E of CLTS Sources: ISF (2011) Solomon Islands: WASH sector brief; Rankin (2012) CLTS trials in the Solomon Islands: starting to spread the word, not the SHIT! sector brief; Rankin (2012) CLTS Sources: ISF (2011) Solomon Islands: WASH 096 CLTS weaknesses and bottlenecks CLTS CLTS enabling environment enabling CLTS

PART II: Solomon Islands Community-Led Total Sanitation inEast Asia andPacific CLTS strengthsandopportunities Sources: ISF(2011)SolomonIslands:WASH sectorbrief;Rankin(2012)CLTS trialsintheSolomonIslands:startingtospreadword,notSHIT! in theSolomonIslands 1. InitialresultssuggestthatCLTS haspotential Lessons learned 1. Childparticipation Opportunities? 2. CLTS andPHAST 1. ‘Moregentle’CLTS approach Success factors? 1. Triggering costslow What’s working? suitability fortriggeringbehaviourchange. 1. DespitethelimitedexperienceandresourcesofCLTS pilotteam,thepowerofCLTS approachwasapparent,asitscultural 1. Childrenprovedtobefastlearners,andtheirinvolvementhelpedpromotemorediscussioninhouseholds. approach requiredwhenworkingwithPacificcommunities. gentle’, raisingawarenessbutnottriggeringmuchaction.ThecombinationwithCLTS providesmorebite,whileretainingthepatient 2. SomeimplementersreportedthatCLTS andPHASTareagoodcombinationinthePacific.aloneispopularbuthasproved‘too losing thepowerofapproachthroughbeingtoopassive. 1. AmodifiedCLTS approachhasbeentrialledmoregentlyintheSolomonIslands,withsensitivitytowardsPacificculturebutwithout 1. Inthepilots,costofacommunitytriggeringsessionwasfoundtobelessthanbelow-groundlatrinematerials fora single VIPlatrine(approx.US$50). 097

PART II Solomon Islands Timor-Leste

CLTS Summary Regional Ranking JMP estimate: Rural sanitation CLTS date of introduction 2007 4 100% Status CLTS introduced: % of country 100% 1 CLTS coverage: major organizations 10 3 OD population (2010, millions) 0.3m 5 Communities triggered (number) 761 4 43 Scale 80% ODF communities (number) 262 3 55 Capacity developed (trained facilitators) 85 8 CLTS in government policy Yes 1= CLTS targets in government plans Draft 3= 60% Enabling CLTS financed by government Indirect 5= CLTS integrated with other approaches Maybe 3=

CLTS sustainable monitoring Yes 1= 16

ODF success rate 34% 2 Coverage (%) Effectiveness 40% 10 Triggered communities per facilitator 9.0 3 4 Summary CLTS potential maximized? Yes 2 3 37 32 Performance 20% High Middle Indirect* Scale of Rural Sanitation Challenge Low * Indirect finance 0% Rural sanitation coverage 1995 2010 Category Percent Households Population Improved sanitation Open defecation 36% 49,200 269,400 Shared sanitation Unimproved sanitation facilities 39% 53,900 295,500 Unimproved sanitation Shared sanitation facilities 7% 9,200 50,400 Open defecation Total without improved sanitation 82% 112,300 615,300

Source: 2010 Population and Housing Census.

098 Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Sanitation inEast Asia andPacific CLTS InstitutionalCoverage 36 percent,some7centlowerthantheJMPestimate,whichsuggests sanitation coverageinruralareas,atonly18percent.ODwasfoundtobe 2010 PopulationandHousingCensusreportedmuchloweruseofimproved recently published2010PopulationandHousingCensus. JMP estimatedidnotincludesignificantlydifferentcoveragedatafromthe and unimprovedsanitationfacilitiesduringthisperiod.However, the2012 a muchfasterdecreaseinopendefecationduetogreateruseofshared coverage inruralareasfrom32percent1995to372010,with The JMPestimatesuggestssteadyincreaseinimprovedsanitation Rural: improvedsanitationcoverage National NGOs Fraterna CPT NTF HTL Natiles ETDA MALEDOI Mutin Tuna ETADEP AFMET AMAR International NGOs Oxfam HIM Child Fund Triangle DH WaterAid Plan Bilateral programmes D-WASH USAID out of65sub-districts(CLTS introducedin60percentofsub-districts). all 13districtsinTimor-Leste (100percentgeographicalspread),andto39 Introduced byWaterAid Australiain2007.Sincethen,CLTS hasspreadto CLTS status DHS andLivingStandardsSurvey(LSS)householdsurveys. being categorizedasunimprovedsanitationfacilitiesthanintheprevious sanitation facilitiesintheCensussurvey, whichresultedinmorelatrines sanitation coveragederivesfromadifferentcategorizationforimproved that morepeopleareusinglatrinesthananticipated.Thelowerimproved AusAID BESIK Multi-lateral agencies UNICEF MDG Sucoprogramme (NDA) Govt: Infrastructure(DNSSB) Red Cross:CVTL Subsidy programmes Major Exceptions Government Health EHD 099

PART II Timor-Leste Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Total Sanitation Campaign (2010) Total to trigger demand for CLTS campaign that used three-pronged A households to build their own sanitation improvement and encourage to strengthen the local supply of toilets; a mason training programme encourage non-poor households to latrine products and services, and and a vulnerable household latrine upgrade and improve their toilets; National Basic Sanitation Policy) that subsidy component (based on the households and provide them with was designed to identify vulnerable or free construction of a basic latrine. either subsidized latrine materials latrine component was As noted above, the vulnerable household but was found to have problems financed and supported by DNSAS, In addition, and latrine sustainability. with targeting, cost-effectiveness attention was given to the CLTS an evaluation found that insufficient which were financed by the and supply strengthening components, targeting of the vulnerable household BESIK programme, and that poor activities. latrine subsidies undermined the CLTS and sanitation facilities. Unfortunately, the construction cost has proved has proved cost construction the Unfortunately, facilities. sanitation and have been problems considerable higher than anticipated; to be much and willing external services housing sites, in finding suitable reported has been slow. and progress different locations; in so many beneficiaries substantial which receives of the Red Cross, national branch CVTL is the and is an Red Cross network, finance through the international WASH and development in both the emergency relief influential stakeholder to favoured a subsidy-based approach CVTL has sectors in Timor-Leste. stakeholders not and remains one of the key sanitation improvement, implementing CLTS. variations and practice CLTS (known by its Supply and Sanitation Program Water The AusAID Rural variants: several CLTS acronym: BESIK) has implemented Timorese 1. 98 per cent of the subsidized latrines were pour-flush, even in areas were pour-flush, 98 per cent of the subsidized latrines where water was scarce. 40 per cent of the subsidized household latrines visited had not been 40 per cent of the subsidized household used; and many of the latrine subsidies went to households that did not meet the many of the latrine subsidies went a functioning latrine; vulnerability criteria or already had 100 The National Development Agency (NDA) is responsible for building 55,000 The National Development Agency by 2015 under the MDG Suco Program, houses for vulnerable households every with five houses planned in each of the 2,228 communities (aldeias) and basic water year for five years. The housing will include solar energy, • • However, neither the former DNSAS nor the new DNSSB has yet allocated neither the former DNSAS nor the However, behaviour change in its rural sanitation any funds to demand creation or for rural sanitation, which was programmes. The DNSSB budget US$ 2 million in 2012, has been allocated substantially increased to around subsidies to vulnerable households, exclusively to the provision of latrine subsidized latrines by engineering latterly though the construction of provision of vulnerable household latrine contractors. An evaluation of the subsidies in 2011 found that: • Major exceptions Major for Basic Sanitation Directorate National of Infrastructure’s The Ministry division of the 2012, through in early (DNSSB) was established Services (DNSAS) and Sanitation Supply for Water National Directorate previous other for (DNAS) and the for water supply directorates – one into two Health Environmental Health’s the Ministry of (DNSSB). While sanitation and hygiene demand the main responsibility for sanitation Department has offices of the change, the national and district creation and behaviour in Timor-Leste, interventions supported several CLTS former DNSAS have Implementation and facilitators. been trained as CLTS and some staff have the DNSSB recruits the will be further strengthened once support capacity sanctioned as part of sanitation officers that have been additional district new directorate. the creation of the

PART II: Timor-Leste Community-Led Total Sanitation inEast Asia andPacific far thehighest ODFproportionofany countryintheregion– next CLTS progressanda small ruralpopulationhavecombinedtoproduce by 16 percent,120,000people, estimatedtoliveinODFcommunities.Rapid live inthe761communities (aldeia)thathavebeentriggered byCLTS; with About 42percentofthe rural population,316,000people,inTimor-Leste CLTS Scale 3. 2. performing wellandissupportedbykeystakeholders. and support.Whilestillanewapproach,initialreports arethatPAKSI is designed tobeeasierforfieldworkersandcommunities tounderstand as themaintriggerforbehaviourchange,andisa structuredapproach cultural sensitivities,notablybyfocusingondisgust ratherthanshame includes aformofCLTS modifiedtosuit Timorese conditionsand ignition, planningandactiontostopODpromote HWWS.PAKSI The PAKSI approachisaparticipatoryprocessforcommunity-based and thedecisionthatMoHdistrictofficesshouldleadprocess. community actionplanningapproachtowatersupplydevelopment; in theNationalBasicSanitationPolicy;successofBESIK CLTS experiencesinTimor-Leste; thephased sanitationapproach approach isbeingtrialled.PAKSI evolvedfromthelessons oftheearly The CommunityActionPlanforSanitationandHygiene(PAKSI) PAKSI (2012) local leadersandcommunities. ODF achievementsandincentiveawardsledtosomediscontentamong programme wasrelativelyexpensive,andtheinitialfailuretopublicize of latrineconstructionanduseinarelativelyshortperiod.However, the in 57ODFcommunities,an88percentsuccessrate,andhighrates interest andleveragingresourcesforsanitationimprovement,resulting approach wasfoundtobesuccessfulingeneratinglocalgovernment ODF, andimprovedsupplyofsanitationproductsservices.This financial awardsasincentivestosucos(villages)thatwereverified Another CLTS variantwasinitiatedin2011,throughtheadditionof CLTS andincentiveprogramme(2011) cent ofallcommunities triggeredhave beendeclaredODF. However, this Timor-Leste hasoneof thehighestODFsuccessratesinregion:34per ODF SuccessRate and themaindriversofcapacity development. agencies andinternational NGOs)remainthemainprogrammemanagers and externalimplementationagencies(bilateralprogrammes, multilateral However, noformalCLTS capacitydevelopmentprogrammeisinplace, are involvedintheplanning,designandsupport of CLTS programmes. Ministry ofInfrastructure(NationalDirectorate Basic SanitationServices) Both theMinistryofHealth(Environmental Department)andthe trained todate.Furtherresearchwillberequired verifythisfigure. (according tothesanitationworkinggroupreport) with85CLTS facilitators Timor-Leste, arelativelysmallamountofcapacityhasbeendeveloped Despite thelargenumberofCLTS implementersandsupportersin CLTS Capacity triggered ineachofthelastthreeyears. is accelerating,withroughlyatriplingofthenumbercommunities the SectorPlanningTool (seechart)suggestthattheCLTS progress highest isIndonesiawith2 percentODFruralpopulation.Datafrom 1,467 262 Not triggerednotODF T Living inODFcommunities Rural communities riggered notODF 499 434,184 1 Not triggerednotODF T Living inODFcommunities Rural population 19,274 riggered notODF 196,866 101

PART II Timor-Leste Community-Led Total Sanitation in East Asia and Pacific Community-Led Total 15 per cent of new facilities in CLTS communities were ‘hygienic improved improved ‘hygienic were communities CLTS in new facilities cent of 15 per pits, and would with covered fly proof latrines as clean, toilets’, defined per cent to added about 3 have interventions that the CLTS suggest this estimate While in rural Timor-Leste. sanitation coverage improved longer in use), that are no losses (latrines allow for sustainability does not data (2009 household survey well with recent reasonably it corresponds in OD rates, but which suggest rapid decreases DHS and 2010 Census) in improved sanitation coverage. fairly slow progress ODF sucos Hygienic sucos (100% latrine and handwashing coverage) Litter free sucos (free of indiscriminate solid waste) and stagnant water bodies) Foul water free sucos (free of indiscriminate wastewater run-off progress has been achieved. strengthening efforts. In and supply complemented CLTS be provided through latrine vouchers that through free latrine materials and construction services, practice, the subsidies have been transferred activities in the locality. which undermines CLTS indicators. Regular updating of the SPT remains a challenge. targets and global sector Priority 1 WASH SIBs has only recently been established. improving resource allocation decisions. and is now being implemented nationally. (stated-verified-declared with celebration) Policy outcome: “an open defecation free environment” Policy outcome: “an where households are sanitation facilities can be subsidized the policy allows that household However, criteria that are yet to be set). disadvantaged (according to national vulnerability of four categories in the M&E framework of the National Under preparation: draft sets targets for each Basic Sanitation Policy: • • • • No direct finance of CLTS implementation, but significant national and local government support of implementation, but significant national and No direct finance of CLTS planning, implementation and monitoring. CLTS although little large-scale interventions are being linked with supply strengthening activities, 1. CLTS directed by the National Basic Sanitation Policy were to 2. The vulnerable household latrine subsidies approach. action planning into a localised CLTS integrates hygiene promotion and community 3. PAKSI the government, to report on progress towards National1. SPT is intended for use by 12 agencies, including (improved, basic and shared) and gaps with the aim of 2. SIBs provides data on sanitation coverage finalized by the sector working group, including three steps 3. An ODF verification process has been subsidy programme Reporting Tool Information System National Basic Sanitation Policy National Basic Sanitation National Strategic Sanitation Plan (draft, July 2012) Government programme support 1. Sanitation marketing household latrine 2. Vulnerable 3. PAKSI Sector Planning and 1. SPT: 2. SIBs: Rural Sanitation 3. ODF verification process Yes Yes Draft Maybe Indirect Policy policy in government CLTS Strategy targets in government CLTS strategies or development plans Finance financed by government CLTS Integration integrated with CLTS other approaches Monitoring Sustainable M&E of CLTS 102 CLTS impact on national sanitation coverage on national sanitation impact CLTS around 25,700 new suggest that Tool the Sector Planning Data from programmes in have been built through CLTS-based sanitation facilities per cent of all rural which means new latrines in 19 the last five years, found that Joint Sanitation Evaluation the 2009 households. However, total includes more than 130 communities triggered in 2012, of which only which 2012, of in triggered communities 130 more than includes total between rate ODF success average The ODF. yet been declared four have was 41 per cent. 2008-2011 CLTS Enabling Environment CLTS

PART II: Timor-Leste sanitation programoutcomes. Sources: BESIK(2012)CasestudyofPAKSI trainingTimor-Leste; GrumbleyA(2012)Lessons learnedfromCLTS; Shapiroetal(2010)Timor-Leste JointSanitationEvaluation:astudyof Community-Led Total Sanitation inEast Asia andPacific CLTS weaknessesandbottlenecks 2. ClearCLTS guidelinesrequired 1. RepackageandcontextualiseCLTS Lessons learned 4. Lackofcommunityfollow-up 3. HighunitcostsofCLTS inTimor-Leste 2. Insufficientresourcesallocatedto 1. Politicalsupportforlatrinesubsidies Constraints andbottlenecks? 4. Pigpenlatrines 3. Lowpriorityforsanitation 2. Limitedexperiencewithcommunity 1. Dependency:historyofgovernment Context issues? 3. Short-termNGOprojectsratherthan 2. Mixedmessages(onsubsidy) 1. LowdurabilityofCLTS latrines What’s notworking? triggering andfollowup facilitation andmobilization and donorsubsidyprogrammes sustainable long-termprogrammes 2. EachimplementerdevelopeditsownCLTS methodologyandmessaging,whichresultedinconfusionreducedunderstandingofthe 1. Seniorofficialsconcernedaboutanapproachthatmadecommunitiesfeelashamedorembarrassedtheirsanitation practices.Efforts 4. SignificantreversiontoODreported.MonitoringandfollowuprequiredsustainCLTS gains. 3. 2009JointSanitationEvaluationfoundthatCLTS projectcostsaveragedUS$60-160pertoilet.WhileCLTS remainslesscostlythanother 2. MostprogrammescontractpartnerNGOstoundertaketriggering,withgoodlocalimplementingmultiple simultaneously 1. PoliticalresistancetosimpleCLTS latrines(whichareseenasareturntoprimitiveways),resultinginincreasedsupportforsubsidized 4. Commonruralpracticeofallowingpigstoeatexcretadischargeddirectlyfromhanginglatrines. 3. Lackofawarenessbycommunitiesandgovernmentonbenefitsimprovedsanitationhygiene. 2. Mostsectorstakeholderslackedstaffthathadexperience,skillsandconfidenceincommunityfacilitation. 1. MajorityofCLTS communitiesevaluated(byBESIK)reportedthattheyhadcompliedbybuildingalatrine,andnowexpectedtheprogrammeto 3. CLTS processoftenimplementedasashort-termNGOproject,whichlimitedtheinvolvementofpotentialfieldworkers(e.g.healthcentreand 2. Communitymembersareoftenconfusedaboutthevariousprogrammesandapproachesbeingimplemented,leadingto distrustofprojects 1. Latrinesbuiltundernon-subsidizedapproachesareconsidered“generallyoflowerquality, unhygienic,andhave lastedlessthanayear”. but thesepartnersfeelthattheyhaveinsufficientcapacityorresourcestoconductthetriggering,follow-upandmonitoring adequately approach. Detailed,step-by-stepguidanceencouragesconsistent results,buildingconfidenceandunderstandingbeforegoingtoscale. approach (asPAKSI), increasefocusonthedisgusttrigger(ratherthan shame). were madetotacklethisissuebyraisingawarenessofCLTS benefits,butitprovedmoreproductive tocontextualizeandrepackagethe approaches, theaverageprojectcostsinTimor-Leste aresubstantiallyhigherthaninothercountriestheregion. construction ofpour-flush latrineswithconcretecomponents. provide themwithmaterialstoupgradetheirlatrines. community healthworkers,otherdistrictstaff). and reticencetoparticipateinunsubsidizedprogrammes. Significant slippageorreversiontoODreported. . 103 ,

PART II Timor-Leste Community-Led Total Sanitation in East Asia and Pacific Community-Led Total sustained monitoring of ODF status and phased sanitation development (as per the National Basic Sanitation (as per the National Basic Sanitation of ODF status and phased sanitation development sustained monitoring provides more structure and guidance of child and infant faeces. PAKSI Policy) including HWWS, and safe disposal control facilitation quality when going to scale; and is also more on facilitation skills in order to manage and to respond to different household needs and preferences. It built explicitly linked to supply strengthening measures used in water supply developed, therefore integrates well with other on the community action planning approach sector programmes and activities. motivational). and provide follow-up (both technical and of incentive rewards and objectives. subsidy eligibility rules; and be informed with easy access to affordable sanitation options and services, and in order to provide community members sustainable facilities. encourage upgrading to more durable and them to leverage available resources towards sanitation and hygiene improvement”. Where there was a lack of Where and hygiene improvement”. towards sanitation available resources them to leverage the interventions. not participate well in communities did engagement, than subsidy increase in coverage showed slightly higher sample CLTS households”; “the with CLTS was the case latrines. in similar rates of clean improved programmes”; and resulted to practice OD. and improve latrines. members with affordable options to build provided community than in comparable subsidy programmes. programmes cost-effective in CLTS also found to be more 1. District Health Services prefer an approach that provides greater structure to the follow up process to ensure structure to the follow up process to prefer an approach that provides greater 1. District Health Services (and partners) have sufficient staffing and resources to trigger communities 1. Ensure that programme implementers is provided and managed by the government; be aware of the 2. Communities need to understand that PAKSI to community engagement with sanitation interventions. 3. Local leaders are influential, thus critical interventions efforts need to be better linked to CLTS-based 4. Sanitation marketing and supply strengthening 1. BESIK reports that the addition of the incentive scheme “raised awareness amongst local leaders and galvanized and galvanized amongst local leaders “raised awareness of the incentive scheme that the addition 1. BESIK reports practiced OD than of subsidy households greater proportion found that “a Joint Sanitation Evaluation 2. The 2009 communities times more likely than those in CLTS in ‘subsidy communities’ were four 3. Disadvantaged households areas (e.g. Liquica) building latrines in some CLTS selling sanitation products and 1. Higher density of providers with software costs costs in latrine subsidy programmes, costs were 10% of total programme programme 2. CLTS subsidy communities (MoH) engagement improve government Lessons learned for follow-up 1. Improve program design to allow resources and strategy required 2. Better communication of government policy community participation 3. Engagement of local leaders is critical to options 4. Improve access to affordable sanitation 3. CLTS programs result in equitable sanitation outcomes in equitable sanitation programs result 3. CLTS What’s working? What’s scheme and incentive 1. CLTS outcomes than latrine have better sanitation communities 2. CLTS Success factors? of sanitation products and services 1. Availability approaches more cost-effective than existing substantially 2. CLTS Opportunities? and structured approach that will more programmatic 1. PAKSI: Sources: BESIK (2012) Case study of PAKSI training Timor-Leste; Grumbley A (2012) Lessons learned from CLTS; Shapiro et al (2010) Timor-Leste Joint Sanitation Evaluation: a study of Joint Sanitation Evaluation: al (2010) Timor-Leste Shapiro et learned from CLTS; Grumbley A (2012) Lessons Timor-Leste; training Sources: BESIK (2012) Case study of PAKSI sanitation program outcomes. 104 CLTS strengths and opportunities strengths CLTS

PART II: Timor-Leste Vanuatu

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation

CLTS date of introduction Not yet 13 0 100% 2 Status CLTS coverage: % of country 13 CLTS coverage: major organizations 13 OD population (2010, millions) 0.003m 2 29 Communities triggered (number) 13 80% Scale ODF communities (number) 13 Capacity developed (trained facilitators) 13 59 CLTS in government policy 13 15 CLTS targets in government plans 13 60% Enabling CLTS financed by government 13 CLTS integrated with other approaches 13 CLTS sustainable monitoring 13

ODF success rate 13 Coverage (%) 40% Effectiveness Triggered communities per facilitator 13 Performance 9

Summary CLTS potential maximized? No 13 High 1 54 Middle Low 20% 32

Scale of rural sanitation challenge 0% Rural sanitation coverage 1995 2010 Category Percent Households Population Improved sanitation Open defecation 2% 737 3,560 Shared sanitation Unimproved sanitation facilities 29% 10,700 51,600 Unimproved sanitation Shared sanitation facilities 15% 5,500 26,700 Open defecation Total without improved sanitation 46% 16,937 81,860

Source: 2012 JMP estimate; UN population forecast.

Community-Led Total Sanitation in East Asia and Pacific 105 Government Major Exceptions Subsidy programmes Red Cross Vision World ADRA Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Multi-lateral agencies AST and latrine subsidy approach latrine subsidy PHAST and to be using are reported in Vanuatu partners Most development key with the subsidy approach, PHAST and latrine a combined and ADRA. Vision, Cross, World being Red implementers Major exceptions Major 1. Bilateral programmes Swiss Red Cross International NGOs Learn Live & National NGOs 106

CLTS status CLTS developed an Live & Learn has been introduced. However, has not yet CLTS plans and sanitation marketing, and CLTS PHAST, approach that combines approach in its Pacific programmes. to implement this Rural: improved sanitation coverage sanitation improved Rural: sanitation in improved a recent increase estimate suggests The JMP cent in 1995 of 32 per from a baseline Vanuatu in rural areas of coverage use of the rural population further 44 per cent cent in 2010. A to 54 per The OD rate was facilities. or unimproved sanitation facilities either shared than 750 rural that fewer cent, which suggests to be only 2 per estimated sanitation facility. people) do not use any form of households (3,500 CLTS institutional coverage CLTS

PART II: Vanuatu Sources: ISF(2011)Vanuatu: WASH SectorBrief;personal communicationswithPaulLewthwaite&ChristianNielsen,LiveLearn. Community-Led Total Sanitation inEast Asia andPacific CLTS weaknessesandbottlenecks CLTS enablingenvironment 1. LowwillingnesstotrialCLTS Lessons learned 1. Noleadagencyforsanitation Constraints andbottlenecks? 1. Naturaldisasters Context issues? CLTS notyetimplemented What’s notworking? CLTS ingovernmentpolicy Policy strategies orplans CLTS targetsingovernment Strategy CLTS financedbygovernment Finance Integrated withotherapproaches CLTS integration Sustainable M&EofCLTS Monitoring No No No No No 1. Live&LearnhasdevelopedasetofCLTS andPHASTsanitationmarketingIECmaterialsdesignedforuseinPacificislandstates,butfaced 1. Nodesignatedleadagencyforruralsanitation.MunicipalandProvincialcouncilshaveresponsibilitieslocalhealth sanitation,and 1. SixnaturaldisastersaffectingPacificIslandsin2008-2010period:hurricanes,tsunami,floodsandvolcaniceruptions,all ofwhichhave significant obstaclesfromdecisionmakersandcommunityworkers thatwereconcernedaboutthesuitabilityofCLTS approachin Vanuatu. these reformsawaitapprovalofthenationalwaterstrategy. components inallruralwatersupplyprojects.ADepartmentof Water (DoW)isplanned,whichwillalsohaveresponsibilityforsanitation,but the RuralWater SupplySectionoftheDepartmentGeology, MinesandWater Resources(DGMWR)isnowreportedtoincludeasanitation damaged WASH facilities. No sanitationpolicy Vanuatu 2008-2018 National Water Strategyfor NoCLTS programmes No CLTS implementation No CLTS implementation sanitation. ThenationalwaterstrategyhasnotyetbeenapprovedbytheCouncilofMinisters. Follows theprinciplesofintegratedwaterresourcemanagement(IWRM),butfewreferencesto made byexternaldevelopmentpartners. Little WASH finance. WASH isnotmentionedinthe2011BudgetPriorities,andmostinvestments are fully implementedinVanuatu. Live &LearnapproachwillintegrateCLTS, PHASTandsanitationmarketing,buthasnotyetbeen No dataavailableonruralsanitationprogress. 107

PART II Vanuatu Community-Led Total Sanitation in East Asia and Pacific Community-Led Total the main WASH stakeholders in Vanuatu. The next stage will be to run some training using these materials to address barriers to these be to run some training using these materials The next stage will stakeholders in Vanuatu. the main WASH success stories. workers, and to start to build some local mindsets of local leaders and community new approaches in the is now an increased appetite for after only a few years. As a result, there latrines falling into disuse and disrepair majority of subsidized the Pacific context. that they can be shown to work in providing approaches like CLTS, behaviour change focused will require some adaptation to recognize the patient approach that seems to work, without losing its strengths or making it too passive. that seems to work, without losing its strengths to recognize the patient approach will require some adaptation 1. The Live & Learn CLTS and PHAST and sanitation marketing IEC materials have received positive and encouraging responses from all of and encouraging responses from all marketing IEC materials have received positive and PHAST and sanitation 1. The Live & Learn CLTS have not worked well, with the programmes in Pacific island states recognition that expensive latrine subsidy 2. There is widespread other Pacific island states, that the approach Vanuatu but, as in has great potential in practitioners suggest that CLTS 1. Experienced Pacific worked well What’s working? What’s not yet implemented CLTS Success factors? not yet implemented CLTS Opportunities? 1. Live & Learn IEC materials subsidies have not 2. Recognition that latrine Lessons learned approaches work better 1. Slow and sensitive Sources: ISF (2011) Vanuatu: WASH Sector Brief; personal communications with Paul Lewthwaite & Christian Nielsen, Live & Learn. with Paul Lewthwaite & Christian Sector Brief; personal communications WASH Sources: ISF (2011) Vanuatu: 108 CLTS strengths and opportunities strengths CLTS

PART II: Vanuatu Viet Nam

CLTS Summary Regional Ranking (14 countries) JMP estimate: Rural sanitation

CLTS date of introduction 2008 5 100% Status CLTS introduced: % of country 29% 6 6 CLTS coverage: major organizations 11 2 OD population (2010, millions) 3.7m 10 22 Communities triggered (number) 829 3 Scale 80% 43 ODF communities (number) 145 4

Capacity developed (trained facilitators) 1,132 1 4 CLTS in government policy Maybe 5=

CLTS targets in government plans No 8= 60% Enabling CLTS financed by government Maybe 5= CLTS integrated with other approaches Maybe 3=

CLTS sustainable monitoring No 8= 25

ODF success rate 17% 3 Coverage (%) Effectiveness 40% Triggered communities per facilitator 0.7 7 68 Summary CLTS potential maximized? Maybe 4 1 2

Performance 20% High 30 Middle Low

Scale of rural sanitation challenge 0% 1990 2010 Rural sanitation coverage Category Percent Households Population Improved sanitation Open defecation 6% 940,900 3,669,700 Shared sanitation Unimproved sanitation facilities 22% 3,450,100 13,455,400 Unimproved sanitation Shared sanitation facilities 4% 627,300 2,446,400 Open defecation Total without improved sanitation 32% 5,018,300 19,571,500

Source: 2012 JMP estimate; UN population forecast.

Community-Led Total Sanitation in East Asia and Pacific 109 MARD Health Government VIHEMA NTP-3 RWSS Community-Led Total Sanitation in East Asia and Pacific Community-Led Total Major Exceptions Subsidy programme Government: NTP-2, Poverty reduction programs (P135 and P134) NGOs: Save the Children (ermergency) Multi-lateral agencies UNICEF by the end of 2011. The government’s rural sanitation progress data, which which data, progress sanitation rural government’s 2011. The end of by the Third RWSS planning of the the basis for the as they form are important coverage sanitation suggest that improved Program, Target Phase National coverage cent rural sanitation lower than 68 per significantly in 2010 was probably lower coverage estimate The government’s by the JMP. estimated latrines. required for hygienic the higher criteria reflects status CLTS to 17 out of 58 provinces has since spread in 2008. CLTS Introduced by SNV nationally). Nam (29 per cent in Viet Bilateral programmes CWS Plan East West Meets SNV Fund Child International NGOs World Vision VWU National NGOs 110

The Government of Viet Nam has now adopted the Rural Water Supply and Water Nam has now adopted the Rural of Viet The Government by the and evaluation framework utilized monitoring Sanitation (RWSS) which reported and Rural Development (MARD), Ministry of Agriculture per cent in rural areas coverage had reached 55 that improved sanitation Rural: improved sanitation coverage sanitation improved Rural: coverage in improved sanitation a rapid increase estimate suggests The JMP cent in 2010. in 1990 to 68 per of 30 per cent from a baseline in rural areas 940,000 rural suggests that 6 per cent, which estimated to be only OD was sanitation facilities. do not use (3.7 million people) households CLTS institutional coverage CLTS

PART II: Viet Nam Community-Led Total Sanitation inEast Asia andPacific 3. 2. 1. CLTS variationsandpractice household sanitationusingahardwaresubsidyapproach. it remainsuncertainwhethertheseprogrammeswillcontinuetofinance government’s povertyreductionprogrammesisunderdevelopment,and and highwatertableareas.LiketheRWSS NTP-3, thenextphaseof Delta thatsubsidisessealedflushtoiletsforruralhouseholdsinflooded Children hasbeenimplementinganemergencyprogrammeintheMekong subsidies topromoteruralsanitationand,amongotherNGOs,Savethe major povertyreductionprogrammes(P135andP134)haveusedlatrine programmes continuetoprovidelatrinesubsidies.Thegovernment’s CLTS isgainingsupportandmomentuminViet Nam,butseverallarge Major exceptions approach tobeadoptedbytheprovincialauthorities. Program (NTP-3)withCLTS recognizedasakeycommunity-based rural sanitationactionplanaspartoftheThirdRWSS NationalTarget currently developinganationalcommunicationactionplanand The Viet NamHealth&Environment ManagementAgency(VIHEMA)is (Viet Nam,LaoPDR,Cambodia,NepalandBhutan). InViet Nam, SNV isimplementingthe SSH4Aprogrammeinfivecountries SNV: SS H4A financial supportforthe constructionofdoublevaultlatrines. Church World Service(CWS)hasusedCLTS intandemwithpartial CWS: CLTS andhardwaresubsidy to thelatrinesbuiltinordermakethemhygienic anddurable. motivate peopletotakethefirststep,andthensupport improvements knowledge gainedthroughPHASTtotakeaction, help,activateand Viet Nam.Theaimofthiscombinedapproachistomovebeyondthe ChildFund implementsacombinedCLTS and PHASTapproachin ChildFund: CLTS andPHAST triggering andODFprogress mayscaleuprapidlyoverthenextfiveyears. in Viet Namanditsfuturepromotionthroughthe NTP-3suggestthat proportion oftheruralpopulation, therecentuptakeandspreadofCLTS been reportedtoachieveODFstatus.Whilecurrently reachingasmall triggered usingtheCLTS approach,buttodate only145villageshave reported toliveinODFvillages.Morethan829villages havenowbeen Only 0.15percentoftheruralpopulationinViet Nam,89,000people,are CLTS scale communities perfacilitatoris0.7)remainslow. facilitators meansthatthefacilitatoreffectiveness (numberoftriggered from thesecapacitydevelopmentefforts,andthelargenumberoftrained were availableonthenumberofactiveCLTS facilitatorsthathaveresulted supported thetrainingofanother400CLTS facilitators.However, nodata been trainedunderitsprogrammes.TheMoHandUNICEFhavealso International reportsthat732CLTS facilitators,includingteachers,have Large numbersofCLTS facilitatorshavebeentrainedinViet Nam.Plan CLTS capacity 4. that thiscriticalfaecal-oraldiseasetransmissionrouteisblocked. sanitation demandtriggeredbyCLTS, andHWWSisincludedtoensure markets intheprojectareasarestrengthenedtomeetandmaintain SLTS, sanitationmarketingandHWWS.Supplychains In Viet Nam,CATS isbeingimplementedusinginterventionsonCLTS, MoH andUNICEF:CATS services, andimproveWASH governance. communication, increaseaccesstolow-costsanitationgoodsand information onsanitationoptions,promotebehaviourchange the Northwest,usingCLTS withadditionalcomponentstoprovide the SSH4Aprogrammetargetspoor, ethnicallydiversevillagesin 111

PART II Viet Nam Community-Led Total Sanitation in East Asia and Pacific Community-Led Total CLTS impact on national sanitation coverage sanitation national on impact CLTS on of CLTS the impact to determine data were available Insufficient sanitation coverage. national allowance for their impact on other approaches such as CLTS or sanitation marketing. or sanitation such as CLTS allowance for their impact on other approaches governance. including HWWS and WASH chain development and other components that users are responsible for capital investment for the construction of household latrines. However, for the construction of household latrines. However, that users are responsible for capital investment latrines in each programme commune. NTP-3 may finance a small number of demonstration environment for CLTS implementation. The technical regulations state the key principles required implementation. The technical regulations state the environment for CLTS protection, odour control, lids on dry latrines, water for hygienic latrines, including fly and animal no higher latrines, roofs for rain protection, and so on. However, seals in flush and pour-flush the achievement of OD free jurisdictions. level policy or guidelines exist to promote circulated for appraisal. The RWSS Partnership provided partial data on CLTS progress, but it appears that there is no Partnership provided partial data on CLTS The RWSS progress or performance. formal national system for tracking CLTS 1. Most latrine subsidy programs in Viet Nam are conventional programmes that make little Nam are 1. Most latrine subsidy programs in Viet supply (demand creation), CLTS SSH4A approaches combine and SNV’s CATS 2. Both UNICEF’s on the promotion Nam, and extensive work has been done in Viet Sanitation marketing predates CLTS is generally more of a challenge than the other components. of HWWS, thus the acceptability of CLTS NTP-3 contains no explicit budget lines to finance CLTS or other forms of sanitation demand or other forms of finance CLTS NTP-3 contains no explicit budget lines to a national rural sanitation action plan that will promote creation, although VIHEMA has developed promotion. date, few provinces have allocated finance to sanitation To CLTS. 1. NTP-3 will focus on increasing household latrine coverage rather than ODF targets, but assumes1. NTP-3 will focus on increasing household 1. Revised Ministry of Health technical regulations issued in 2011 provide a supportive policy 1. Revised Ministry of Health technical regulations Ministry of Health and implementation have been developed by the 2. Draft guidelines for CLTS riggered not ODF Rural population Living in ODF communities Living in ODF communities T Not triggered not ODF 344,948 hygiene promotion Phase 2012-2015 on hygienic conditions for latrines (QCVN 01: 2011/BYT) guidelines 60,727,369 RWSS Partnership RWSS 1. Subsidy programs and sanitation marketing and 2. CLTS National Target Program RWSS III Program RWSS National Target Phase 2012-2015 1. National Target Program RWSS III Program RWSS 1. National Target 1. 2011 National technical regulation implementation 2. Draft MoH CLTS 88,683 No No Maybe Maybe Maybe riggered not ODF Rural communities Living in ODF communities T Not triggered not ODF 684 99,171 145 Monitoring Sustainable M&E of CLTS Integration integrated with other CLTS approaches Finance financed by government CLTS Strategy targets in government CLTS strategies or development plans Policy in government policy CLTS 112 CLTS enabling environment CLTS ODF success rate success ODF cent of triggered rate: 17 per ODF success Nam has a moderate Viet by the RWSS to data provided ODF (according have been declared villages been villages have where ODF in the programmes However, Partnership). cent. higher at 29 per success rate was the average ODF achieved,

PART II: Viet Nam Community-Led Total Sanitation inEast Asia andPacific CLTS weaknessesandbottlenecks Sanitation profileof Vietnam andpossibilitiesforscalingupofCLTS. Sources: SNVVietnam (2010)Sanitationdemandcreation:strengths-basedreview;Jensen, Hang&Anh(2011)Genderandpro-poortargetinginRWSS-NTP –finalreport;KamalKar(2011) 2. Importanceoffollow-up 1. Limiteddemandforlow-costlatrines Lessons learned 4. LittlesystematicCLTS evaluation 3. Highstandardsforhygieniclatrines 2. Latrinecounting 1. Expensivesanitationproducts Constraints andbottlenecks? 4. Widespreadlatrinesubsidies 3. CLTS difficultinsteeplocations 2. FishpondlatrinesinMekongDelta 1. ExcretauseinnorthViet Nam Context issues? 3. Variations inODFcriteria 2. DurabilityofCLTS latrines 1. Demonstrationlatrines What’s notworking? 2. Continuousfollowupisrequiredduringthe6-12monthsafter triggeringtopromotesustainabilityandstrengthenmonitoringsystems.Inearly 1. Low-costmodelssuchastheVIPlatrineareoftenperceivedtobe‘temporaryandunhygienic’.Furthereffortswillrequired toconvinceboth 4. Afterfouryearsofpilots,therehasstillbeenlittlesystematicorcomprehensiveevaluationCLTS effectivenessandsustainability. 3. PlanKAPstudyfoundthatonly5%householdswereusing‘improvedhygienicfacilities’hadwalls,roofanddoor, mettheMoHtechnical 2. Mainindicatorforsanitationprogressremainsthenumberoflatrinesbuilt,thuslimitingfocusonbehaviourchangeor onthesustainability 1. Areviewoflocalsanitationmarketsfoundthatavailableproductsareexpensiveforthepoor, andthatlatrinebuildingservicesarenot 4. Transition toself-provisionofhouseholdlatrineswillbeaffectedbyhistory latrinesubsidies. 3. CLTS wasreportedtobechallengingwhenfewflatareasexistbuildlatrines. 2. MorechallengingtomakecommunitiesODFwherealargepercentageofthepopulationisusingfishpondlatrinesassociated withlivelihoods. 1. ThereisalonghistoryofexcretauseforagricultureinnorthernViet Nam,oftenwithlittleornocompostingbeforehandlingandapplicationto 3. ODFcriteriaandverificationprocessesvarysignificantlybyimplementingagency. Thereisneedtodevelop and harmoniseanationalODF 2. ThedurabilityofsimpleCLTS latrineshasbeenquestioned. 1. Demonstrationlatrineswerefoundtobuildlittlesanitationdemandamongthepoor, perhapsbecausethelatrineswereexpensive,and pilots, slowfollowupaftertriggeringlimitedtheimpact. rural householdsandlocalgovernmentsthatlow-costlatrinescanbepermanenthygienic. meet thecriteria. standards, andincludedahandwashingplacewithwaterhandcleaningagents.Another47%householdswereusingtoilets thatdidnot of sanitationimprovements. easily availableinethnicminoritygroupcommunities. fields andcrops. verification process. implementers didnotutilizeeffectiveIECapproaches. 113

PART II Viet Nam Community-Led Total Sanitation in East Asia and Pacific Community-Led Total resource persons. sanitation problems. interventions such as supply chain strengthening. struggle with the labour requirements of latrine construction. the labour requirements struggle with were provided for improved toilets. demonstration models 1. Government participation from provincial to village level resulted in an enthusiastic and proactive process, with good mobilization of village in an enthusiastic and proactive process, from provincial to village level resulted 1. Government participation district and province aided progress. and regular communication by commune, 2. Regular monitoring between sanitation, disease and good health. created a new awareness of the links effective in explaining the costs of OD, thus was 3. CLTS progress. and using latrines were key factors in regulations on building 4. Village experiences and lessons learned. 1. Important to share sustainability and scaling up. fund for community facilitators will encourage 2. Provision of a support spread and scaling up. into the NTP will encourage rapid 3. Integration of CLTS to tackle build toilets, good community spirit, and effective training resulted in a commitment 1. Mutual support between households to Viet Nam. in needs to be adapted to fit the diverse contexts and conditions found 2. CLTS including complementary and effective use of the sanitation demand created by CLTS, 3. Further efforts are required to ensure timely 1. CLTS was found to be more effective in creating demand for sanitation than other approaches. sanitation than other creating demand for be more effective in was found to 1. CLTS reported to households were and vulnerable although some marginalized other approaches, reaching the poor than was better at 2. CLTS and and design knowledge; shared construction latrine models; neighbours easy to build construction of low-cost encouraged the 3. CLTS Success factors? 1. Good leadership 2. Regular monitoring of benefits 3. Effective explanation sanitation rules established 4. Village Opportunities? 1. Knowledge management 2. Support fund for facilitators into NTP 3. Integrate CLTS Lessons learned 1. Mutual support works to different contexts 2. Adapt CLTS advantage of demand created 3. Take What’s working? What’s demand effective in creating 1. CLTS reaching the poor 2. Better at models easy to build latrine 3. Low-cost 114 Sources: SNV Vietnam (2010) Sanitation demand creation: strengths-based review; Jensen, Hang & Anh (2011) Gender and pro-poor targeting in RWSS-NTP – final report; Kamal Kar (2011) targeting in RWSS-NTP creation: strengths-based review; Jensen, Hang & Anh (2011) Gender and pro-poor (2010) Sanitation demand Sources: SNV Vietnam scaling up of CLTS. Vietnam and possibilities for Sanitation profile of CLTS strengths and opportunities strengths CLTS

PART II: Viet Nam ANNEX 1: Country Review Teams

List of the key stakeholders involved or consulted in the preparation of the DPR Korea country CLTS overviews. Name Organization Cambodia 1 Ramesh Bhusal UNICEF, Chief of WASH section Name Organization 2 Vinobajee Gautam UNICEF 1 Belinda Abraham UNICEF, Chief of WASH section 2 Dr. Nam Sieng UNICEF, WASH officer Lao PDR 3 Dr. Chea Samnang MRD, Director of Rural Health Care Name Organization 4 Chreay Pom MRD, Deputy Director RHC 1 John McGown Plan, WASH manager 5 Chhorn Chhoeurn MRD, CLTS focal person RHC 2 Mahboob Bajwa UNICEF Chief of WASH section 6 Syvibola Oun Plan, GSF programme manager 3 Southalack Sisaleumsak UNICEF, WASH officer 7 Davith Nong World Vision 4 Thea Bongertman SNV Lao PDR 5 Bounthavong Sourisak WSP Lao PDR China Name Organization Mongolia 1 Zhenbo Yang UNICEF, Chief of WASH section Name Organization 2 Dr. Kamal Kar CLTS Foundation 1 Bishnu Pokhrel UNICEF, WASH specialist 2 Dr. Kamal Kar CLTS Foundation Indonesia Name Organization Myanmar 1 Wahyu Triwahyudi Plan, WASH national advisor Name Organization 2 Nadarajah Moorthy UNICEF, Chief of WASH section 1 Dara Johnston UNICEF, Chief of WASH section 3 Kristin Darundyah Ministry of Health, Environmental Health 2 Mya Than Tun UNICEF, WASH officer 4 STBM Secretariat 3 Terence Kadoe UNICEF, WASH specialist 5 Amin Robiarto WSP Indonesia Philippines Kiribati Name Organization Name Organization 1 Tim Grieve UNICEF, Chief of WASH section 1 Marjolein Ooijevaar UNICEF, WASH specialist 2 Dr. Mike Gnilo UNICEF, WASH specialist 2 Beia Tim UNICEF, WASH mobilization officer 3 Karl Galing WSP Philippines 4 Rolando Santiago Ministry of Health, EOHO

Community-Led Total Sanitation in East Asia and Pacific 115 Papua New Guinea Viet Nam Name Organization Name Organization 1 Rick Steele WaterAID Papua New Guinea 1 Nguyen Quy Hoa Plan Viet Nam, WASH manager 2 Stuart Jordan EU-RWSSP 2 Nguyen Thanh Hien UNICEF, WASH specialist 3 Esther Silas Touching the Untouchables (NGO) 3 Tran Thu An UNICEF, WASH officer 4 Penny Dutton WASH consultant 4 Bich Ngoc RWSSP 5 Dr. Tran Dac Phu Ministry of Health Solomon Islands 6 Nguyen Bich Thuy Ministry of Health Name Organization 7 Tran Thi Kieu Hanh ChildFund 1 Tom Rankin Australian Volunteer in Development 8 Lene Jensen WASH consultant 2 Paul Lewthwaite Live & Learn 9 Jorge Alvarez-Sala Torreano SNV Viet Nam 3 Christian Nielsen Live & Learn 10 Dang Quoc Viet World Vision 4 Paul Tyndale-Biscoe WASH consultant Regional stakeholders Timor-Leste Name Organization Name Organization 1 Almud Weitz WSP-EAP Regional Team Leader 1 Dinesh Bajracharya WaterAid Timor-Leste 2 Dr. Kamal Kar CLTS Foundation 2 Alex Grumbley AusAID BESIK, Sanitation adviser 3 Peter Dwan WaterAid Australia, Head of International Programs 3 Caesar Hall UNICEF, Chief of WASH section 4 Christian Nielsen Live & Learn, Executive Director 4 Bruce Bailey AusAID BESIK, M&E adviser 5 Paul Tyndale-Biscoe WASH consultant 5 Keryn Clark AusAID BESIK, programme team leader 6 Susanna Smets WSP-EAP, Regional Water Supply and Sanitation Specialist 7 Dr. Robert Chambers IDS Vanuatu 8 Petra Bongartz IDS Name Organization 9 Hilda Winartasaputra Plan International, Regional WASH Specialist 1 Paul Lewthwaite Live & Learn 10 James Wicken WaterAID, Head of Policy and Campaigns 11 Chander Badloe UNICEF, East Asia and Pacific Regional Office, Regional WASH Adviser

116 Community-Led Total Sanitation in East Asia and Pacific ANNEX 2: Data from regional CLTS review

Table A2.1 Key indicators from country CLTS overviews Country Intro date % coverage Orgs OD popn Triggered ODF Capacity Cambodia 2004 48 16 8,132,400 1,998 717 214 China 2012 15 2 13,483,000 0 0 53 Indonesia 2005 97 9 48,115,400 7,325 1,279 530 Kiribati 2012 0 2 11,900 0 0 0 Lao PDR 2008 47 7 1,698,600 217 36 143 Mongolia 2011 0 3 272,200 10 1 15 Myanmar 2010 12 7 2,546,000 224 12 158 Papua New Guinea 2008 95 8 1,079,800 477 21 310 Philippines 2008 10 10 5,718,300 211 36 377 Solomon Islands 2012 10 2 143,700 2 0 40 Timor-Leste 2007 100 10 269,400 761 262 85 Viet Nam 2008 29 11 3,669,700 829 145 1,132

Table A2.2 Key indicators from country CLTS overviews Country Policy Plans Finance Integration Monitoring ODF success Triggered/fac Cambodia Yes No Indirect Maybe Maybe 35.9% 9.3 China No No No No No 0.0% - Indonesia Yes Yes Yes Yes Yes 17.5% 13.8 Kiribati No No No No No 0.0% - Lao PDR Maybe Yes Indirect Maybe Planned 16.6% 1.5 Mongolia No No No No No 10.0% 0.7 Myanmar Maybe No Indirect No No 5.4% 1.4 Papua New Guinea No No Indirect No No 4.4% 1.5 Philippines No Yes Indirect No No 17.1% 0.6 Solomon Islands No No Indirect No No 0.0% 0.1 Timor-Leste Yes Draft Indirect Maybe Yes 34.4% 9.0 Viet Nam Maybe No Planned Maybe No 17.5% 0.7

Community-Led Total Sanitation in East Asia and Pacific 117 ANNEX 3: Evidence: ODF Sustainability

This annex provides a summary of evidence on the sustainability of The author contends that the variation in performance, from high open defecation free (ODF) outcomes in rural communities both inside performing programmes, in which 90 per cent of households in ODF and outside of the East Asia and Pacific region. This summary has been communities were found still to be using hygienic latrines, to low compiled from research and evaluation materials that were readily performing projects, in which less than half of the households were still available to the review consultant and were thought to provide some using hygienic latrines, demonstrates that ODF sustainability is possible – insight into the topic in question. The summary is not intended to provide that CLTS interventions can produce effective and sustainable sanitation an exhaustive or definitive record of this topic. The main intention is to outcomes, and that the abandonment of non-durable latrines and reversion demonstrate the significant variation in ODF outcomes and sustainability to OD is not an inevitable consequence of the CLTS approach. found across the projects and programmes for which reliable evaluation material was available. However, the finding highlight the risk that less effective CLTS interventions can result in disappointing outcomes – widespread revision to OD, unused The information is provided three sections based on outcomes: or abandoned latrines, and the use of unhygienic latrines. Evaluators and analysts should attempt to distinguish between the effects of poorly A. High performing cases executed or ineffective implementation and the weaknesses of the 1. Bangladesh: multiple implementation approaches (including CLTS) approach, which influence results in even well executed and effective 2. Hamachal Pradesh, India: Total Sanitation Campaign programme (with CLTS interventions. support from WSP TSSM 3. Africa: Plan Pan African CLTS programme in Ethiopia, Kenya, Uganda The reasons for the wide variation in CLTS outcomes are complex. and Sierra Leone This review hints that high-quality facilitation, a comprehensive CLTS process, supportive contexts, and an enabling policy and programme B. Medium performing cases environment are all important factors in successful CLTS interventions. The 1. Nigeria: WaterAid CLTS programme absence of these factors is likely to result in less sustainable and effective 2. Indonesia: WSP TSSM East Java interventions. However, further research is required to understand better 3. Lao PDR: Concern Worldwide CLTS programme the factors that influence CLTS outcomes.

C. Low performing case 1. Cambodia: DPRD-UNICEF CLTS evaluation

118 Community-Led Total Sanitation in East Asia and Pacific A. High performing cases • 5.5 per cent use a hanging latrine or one that discharges into environment • 2.5 per cent use an open pit without a slab 1. Bangladesh: multiple implementation approaches • 2.5 per cent do not have any latrine (including CLTS) OD rates did not vary much across the four programme approaches, Country Bangladesh between 2.1-4.3 per cent, but were lowest in the CLTS (DISHARI & Date 2011 WaterAid) and Government of Bangladesh (Total Sanitation) programmes. Programme scale 481 Union Councils53 declared ODF before June 2005 Study scale 53 randomly sampled ODF Union Councils (3,000 households surveyed across 50 ODF Union Councils) More than 70 per cent of households had owned their current latrine for Study objective Determine the sustainability of sanitation behaviours and facilities in at least three years, suggesting that the majority of latrines were fairly communities declared ODF at least 4.5 years ago durable despite low expenditures on latrines – median latrine costs were Key findings 89.5% used a latrine ‘that safely confines faeces’ below US$ 22 in all but the highest wealth quintile, with 96 per cent of 7.9% households used an unimproved (hanging or open pit) latrine 2.6% practiced OD latrines financed by households themselves or through informal borrowing Source: Hanchett et al (2011) Long term sustainability of improved sanitation in rural from immediate family and friends. Bangladesh, Washington DC: The World Bank, Water and Sanitation Program, technical paper.53

Latrine technology Study overview While about 90 per cent of households were using or sharing latrines The WSP Bangladesh sustainability study examined current sanitation considered to safely confine faeces (latrine with squatting slabs, lined pits status in villages declared ODF before June 2005 (at least 4.5 years ago). but no drop-hole cover; latrines with squatting slabs, lined pits and drop- The study was well designed, large-scale and comprehensive, with the hole covers; or latrines with water sealed pans and non-leaking pits), the intention of providing definitive information on the sustainability of the low- household survey found that more than half (56 per cent) of these latrines cost approaches to sanitation improvement that had been implemented were found either to have faeces visible on the latrine floor or pan, or – in in Bangladesh. Four different implementation approaches were used in fewer cases – to have badly leaking latrine pits. It was also noted that 65 the areas studied, including CLTS and non-CLTS approaches. Hardware per cent of shared latrines were found to be ‘unclean’, compared to 49 per subsidies were provided to ‘hardcore poor; households by several of the cent among private latrines. local government programmes in line with central government policy. Key factors that contributed to reversion to OD were: Main findings • lack of space for new pits or disposal of pit contents Four and a half years after ODF declaration, all four implementation approaches • lack of a roof (affecting durability of slab and pit) were found to result in high rates of sustained latrine use and low rates of OD. • house and land rental Sample households were found to have the following sanitation practices: • poorly installed latrines (including tilted, cracked and broken slabs) 52.9 per cent own a latrine that safely confines faeces • • large numbers sharing a single latrine, which results in cleanliness problems 36.6 per cent share a latrine that safely confines faeces • • negative attitudes to local leaders or wealthier households (social rebellion) 53 There are 4,451 Union Councils in Bangladesh. Each Union is made up of nine wards, with • natural disasters damaging latrines (flooding, cyclones, landslides) one village is usually designated as a ward.

Community-Led Total Sanitation in East Asia and Pacific 119 Subsidy policy TSC was initiated to develop sanitation facilities in rural areas, with the goal Local governments provided some form of hardware subsidy – either free of eradicating OD. To support this goal, an incentive scheme, ‘Nirmal Gram latrine parts or latrine parts at subsidized prices – to 11 per cent of the Puraskar’ (NGP) was introduced to reward ODF blocks and districts (gram households surveyed. In general the standard subsidy amount, Tk. 450 panchayats). The assessment methodology involved randomly selecting 15 (US$ 6.50), was utilized to produce low-cost latrine slabs and concrete NGP winning gram panchayats and 15 non-NGP gram panchayats in each rings intended for ‘hardcore’ poor households in line with the central state, with 20 randomly selected households surveyed in each gram panchayat. government policy, but the study found that the subsidized latrine parts often went to non-poor households. Main findings In the NGP winning villages in Himachal Pradesh, which had been previously 2. Himachal Pradesh, India: Total Sanitation Campaign verified as having 100 per cent latrine usage, the assessment found that: programme (with support from WSP TSSM) • 80 per cent of households owned a functional latrine; • 10 per cent of households shared a functional latrine owned by others; and Country India • 10 per cent of households practiced OD. Date 2010 Programme scale State: Himachal Pradesh (5.5 million rural population) In total, 97 per cent of these latrines were in use – which meant that 87 per Study scale 30 Gram Panchayats (15 NGP and 15 non-NGP) (600 households surveyed across 30 GPs) cent of households were using or sharing functional, hygienic latrines. Study objective Analyse usage and construction quality of recently constructed toilets In the non-NGP villages: to understand NGP sustainability and intervention effectiveness • 54 per cent of households owned a functional latrine; Key findings 80% households in NGP villages owned functional toilets 10% households in NGP villages shared use of functional toilets • 5 per cent of households shared a functional latrine owned by others; and 10% households in NGP villages practiced OD • 41 per cent of households practiced OD. 97% functional toilets in NGP villages were in use

Source: Wilbur Smith Associates (2010) Rapid Assessment of Total Sanitation and Sanitation Marketing (TSSM) Project: Madhya Pradesh and Himachal Pradesh, The World Bank, Water Latrine technology and Sanitation Program, main report; Robinson A (2012) Enabling environment endline assessment: Himachal Pradesh and Madhya Pradesh, India The World Bank, Water and The Government of India TSC guidelines originally required that all dry Sanitation Program, working paper. latrines were converted to pour-flush latrines, but these guidelines were updated in 2007 to recognize the utility of dry latrines in cold and water- Study overview scarce areas. However, most district TSC projects continue to promote In early 2010, the lack of reliable or regular data on sanitation outcomes led pour-flush latrines as the standard level of service. WSP to contract an independent rapid assessment of the latrine usage rates and construction quality in Himachal Pradesh and Madhya Pradesh. At the time, the The rapid assessment in 30 villages found that: Total Sanitation Campaign (TSC) in Himachal Pradesh had been successful in • 100 per cent toilets were pour-flush latrines with water-sealed pans achieving 2,754 ODF communities, which meant that 85 per cent of the entire • 80 per cent toilets were ‘pucca’ (made from bricks, blocks, stone, concrete) State – a rural population of 4.6 million people – had been declared ODF. • 76 per cent toilets had vent pipes • 91 per cent toilets in NGP villages were clean (80 per cent in non-NGP villages)

120 Community-Led Total Sanitation in East Asia and Pacific The assessment also found an association between the proportion of Study overview households that practiced OD and the proportion that reported inadequate The Plan Australia ODF sustainability study was designed to examine access to water supply in the dry season. the sustainability of ODF outcomes in project villages from four of the countries involved in the Plan Pan African CLTS programme: Ethiopia, Subsidy policy Kenya, Uganda and Sierra Leone. In 2010, the national TSC guidelines allowed for the provision of a Rs 2,200 (US$ 48) incentive to below poverty line (BPL) households on completion The study has two phases – the ODF re-verification phase has already been and use of a sanitary latrine including a superstructure. The intention was completed in 116 villages; and the detailed research phase is currently on- that this post-construction incentive would encourage poor households to going in 40 villages (10 villages per country), which were selected based build sanitary latrines. on the data from the re-verification phase (three strongly ODF villages, four medium ODF villages and three weakly ODF villages). The study will be However, in 2005 the State Government of Himachal Pradesh issued a completed before the end of 2012. Strategy for Rural Sanitation in HP which stated that no latrine subsidies would be paid to BPL households, thus that the TSC incentives for BPL Main findings households would not be utilized. Fewer people had reverted to OD than anticipated: • Ethiopia (1,851 households in 57 villages): 90 per cent latrine coverage; The Government of Himachal Pradesh continued to practice this ‘no 9 per cent OD hardware subsidy’ policy at the time of the assessment, thus none of the • Uganda (1,860 households in 19 villlages): 81 per cent latrine coverage; households surveyed had received any hardware subsidy or other form of 1 per cent OD financial assistance to build their latrines. • Sierra Leone (512 households in 20 villages): 81 per cent latrine coverage, 1 per cent OD 3. Africa: Plan Pan African CLTS programme • Kenya (821 households in 20 villages): 78 per cent latrine coverage, 8 per cent OD Country Ethiopia, Kenya, Uganda and Sierra Leone Date 2012 The latrine coverage data were based on household observations, with Programme scale 2.3 million people targeted across eight African countries (Ethiopia, Uganda, Kenya, Zambia, Malawi, Ghana, Sierra Leone and Niger) OD rates based on household responses. The second phase research will Study scale Re-verification of ODF villages in four countries: 116 villages investigate the veracity of the claimed OD rates and the reasons for people (first phase of detailed ODF sustainability study) either reverting to OD or maintaining the use of hygienic latrines. Study objective Determine: i) proportion of households that are still ODF; ii) primary causes of households reverting to OD; Latrine technology iii) what motivates people to remain ODF. No data were available. Key findings After initial ODF re-verification phase: Ethiopia: 90% latrine coverage; 9% OD reported Uganda: 81% latrine coverage; 1% OD reported Sierra Leone: 81% latrine coverage; 1% OD reported Subsidy policy Kenya: 78% latrine coverage; 8% OD reported The programme did not provide latrine hardware subsidies. Source: personal communication with FH Designs study team in August 2012.

Community-Led Total Sanitation in East Asia and Pacific 121 B. Medium performing cases Little reversion to OD was found in two of the ODF communities: • 0 per cent OD in Igba, Benue State (100 per cent latrine use) 1. Nigeria: WaterAid CLTS programme • 1 per cent OD in Duhuwa, Jigawa State (excluding Fulani households – see below) Country Nigeria Date 2008 However, 18 per cent OD was found in the third ODF community, due Programme scale 98 communities in four States (Benue, Enugu, Ekiti and Jigawa) largely to the presence of temporary tenants that had not built toilets, Study scale Eight communities (three high performers, two median performers, three low performers) and had not been counted during the CLTS process. In addition, the study Study objective Examine the sustainability and equity of total sanitation programmes discovered that 71 semi-nomadic Fulani households had been excluded supported by WaterAid in Nigeria (part of a wider study that also from the CLTS process in Duhuwa. ODF status had been declared among examined WaterAid programs in Bangladesh and Nepal). the Hausa households, despite 76 per cent of the Fulani households Key findings Mixed outcomes in ODF communities: • 0%-18% OD found in three previously ODF communities continuing to practice OD. • Fulani exclusion in one ODF community (76% OD) Latrines were cleaner in communities with low OD rates. No difference in quality and hygiene of shared latrines. Latrine technology Source: Robinson A (2009) Sustainability and equity aspects of total sanitation programmes: a All of the latrines observed were pit latrines: study of recent WaterAid-supported programmes in Nigeria, WaterAid UK, report. • 5 per cent pour-flush pit latrines • 95 per cent dry pit latrines Study overview WaterAid introduced CLTS into its sanitation programmes in Nigeria in The majority of the dry pit latrines had mud-covered timber slabs; a 2005, and had implemented it in 98 rural communities at the time of the few concrete slabs were observed where WaterAid sani-centres had research in 2008. The sample frame for the 2008 study was the 44 project been established. In the five communities with low OD rates, only three communities where CLTS had been implemented during the 2005-2007 latrines (3 per cent) were found to be dirty; in the three communities with period. Eight of these communities were randomly selected for the study, higher OD rates, 47 per cent of latrines were found to be dirty but more with three selected from the high performing strata (defined as latrine than half of these ‘dirty’ latrines had been constructed prior to the CLTS coverage greater than 95 per cent), two from the median performers interventions (thus CLTS latrines were at least as clean and well-maintained (latrine coverage between 30 and 95 per cent), and another three from the as existing latrines). In general, there was little difference in the quality and low performing communities (latrine coverage below 30 per cent). hygiene of shared latrines, probably because the sharing households were usually part of an extended family. Main findings Prior to the CLTS interventions, latrine coverage was less than 20 per cent Subsidy policy in all but one of the communities. After the interventions, three of the WaterAid Nigeria has promoted the establishment of a sani-centre in each communities were declared ODF, and latrine coverage in the other five project community. The sani-centre approach was developed to tackle communities ranged from 11-86 per cent. transport and market access problems faced by remote rural communities, largely through the provision of seed money to buy and transport construction

122 Community-Led Total Sanitation in East Asia and Pacific materials, and the establishment of a production centre selling concrete latrine CLTS triggering to understand better the triggering processes, their slabs. The cost of establishing a sani-centre was estimated at US$ 450. consequences and the factors that influence these outcomes. The study communities were randomly selected from four strata: In practice, the sani-centre seed money provided a hardware subsidy to the • ‘Quickly ODF’ communities (self-declared ODF within two months); few people that received concrete latrine slabs, as few households repaid • ‘Late ODF’ communities (self-declared ODF after 7-12 months); the cost of the slabs. Only 30 sani-centre latrine slabs were found to be • ‘Not ODF high coverage’ communities (failed to become ODF but in use across the eight communities, with only three communities where achieved high sanitation coverage); and more than one slab was in use. As a result, the sani-centres proved to be • ‘Not ODF low coverage’ (failed to become ODF and had low an expensive feature of the programme – the study found that US$ 300 sanitation coverage). was spent for each sani-centre latrine slab in use – and had little impact on either sanitation coverage or the sustainability of outcomes. Main findings The action research found that the 20 ‘quickly ODF’ communities 2. Indonesia: WSP TSSM East Java performed well: • 18 ‘quickly ODF’ communities had 100 per cent use of individual Country Indonesia – East Java province improved latrines Date 2011 • 1 ‘quickly ODF’ community had 60 per cent latrine coverage but Programme scale All 29 districts in East Java province (target: improved sanitation for 1.4 million people in four years) remained ODF due to sharing by the other 40 per cent of households (in Study scale 80 rural communities across 20 districts groups of three to four households) Study objective Determine: • 1 ‘quickly ODF’ community was no longer ODF (80 per cent improved i) Principal factors influencing achievement and sustainability of collective behaviour change to become ODF; latrine use with broken pit covers responsible for abandonment in 20 ii) Links between influencing factors (to prioritize actions); per cent of the latrines) iii) Recommendations to accelerate achievement and improve sustainability. • 97 per cent use of improved latrines across the 20 ‘quickly ODF’ communities Key findings • 95% ‘quickly ODF’ communities remained ODF • 20% OD in ‘late ODF’ communities (despite 100% improved latrine coverage) The action research found that the 20 ‘late ODF’ communities also

Source: Mukherjee N (2012) Achieving and sustaining open defecation free communities: performed well: learning from East Java The World Bank, Water and Sanitation Program, action research report. • 20 ‘late ODF’ communities had 100 per cent improved latrine coverage • 20 per cent of the households practiced OD when washing at the river Study overview (despite having improved latrines at home) After three years of the TSSM project in East Java, 2,000 communities • 20 per cent river OD was present but not recognized when ODF status had been triggered with the CLTS approach, 700,000 people had gained was verified (i.e. no slippage since ODF declaration) access to improved sanitation, and about 35 per cent of these communities had become ODF. However, ODF success rates varied from 10-95 per In all 20 districts, communities located on riverbanks, beaches or lake cent across different districts. This research was designed to examine the shores tended to have low sanitation coverage rates and were significantly factors that influence the achievement and sustainability of ODF outcomes. less likely to achieve ODF status. The study suggested that this finding is Action research was conducted in 80 communities that had received

Community-Led Total Sanitation in East Asia and Pacific 123 due to a strong preference for defecation into water bodies among these 3. Lao PDR: Concern Worldwide CLTS programme communities – a practice recalled in focus group discussions as “clean, hygienic, pleasant, convenient and free of cost”. Country Lao PDR Date 2009 Programme scale Pilot CLTS project: 24 villages in Houaphan province Latrine technology Study scale 12 villages (470 household surveys) The STBM strategy and ODF verification criteria in Indonesia require that Study objective 1. Review CLTS pilot performance all latrines are fly proof, thus latrines without lids or water seals do not 2. Understand better whether CLTS is appropriate in the culturally meet the ODF criteria. As a result, 76 per cent of households were found to diverse context of Lao PDR be using pour-flush latrines and few unhygienic latrines were observed. Key findings • 2 villages sustained 100% latrine coverage and ODF status • 19% OD reversion in other previously ODF village The main sanitation technologies found (based on 574 latrine observations • 2-7% OD reversion in 3 other villages across the 80 study communities): • 17-25% OD reversion in 3 other villages

• 280 pour-flush latrines with septic tank and bathroom (49 per cent) Source: SNV (2009) Community-Led Total Sanitation: Pilot programme review, SNV and • 147 dry pit latrines with cover and direct pit (26 per cent) CONCERN Worldwide, report. • 106 pour-flush pit latrines with ceramic pan and one to two leach pits (18 per cent) Study overview • 49 pour-flush pit latrines with cement pan and leach pit (9 per cent) CONCERN Worldwide introduced CLTS into its Houaphan Health • 29 dry pit latrines with cement slab, cover and offset pit (5 per cent) Development Project in 2008, piloting the approach in 24 villages out of the • 6 dry pit latrines with direct pit and no cover (1 per cent) 162 villages covered by the project. Field surveys were undertaken in 12 of • 3 hanging latrines (0.5 per cent) the CLTS pilot villages, selected in clusters that were close to the road and easy to access in the rainy season.54 More than two-thirds (69 per cent) of Even poor households spent about IDR 300,000 (US$ 33) to build the households were surveyed in the 12 villages. cheapest improved pit latrine. In 9 per cent of the study communities, producers were offering simple upgradable pour-flush latrines for US$ 33, Seven of the 12 villages were reported to have 100 per cent latrine or basic pour-flush latrines with a single leach pit for US$ 82. coverage at the end of the CLTS interventions, with latrine coverage in the other five non-ODF villages ranging from 38-95 per cent. Subsidy policy Subsidies for household sanitation facilities have not been provided by Main findings the Ministry of Health since the STBM policy was approved in September The study found that CLTS had achieved a significant reduction in OD, 2008. However, other government programmes continue to provide latrine from a situation where 87 per cent of households practiced OD prior to the subsidies, and around 15-20 per cent of the ‘not ODF’ communities had intervention to 21 per cent OD when the review was undertaken more than received some form of hardware subsidy from the PNPM programme, a year later. Public Works Department or CSR funds provided by private companies. However, internal subsidies – from community leaders or members to other households – were found to be a factor contributing to ODF achievement. 54 The selection criteria are likely to have influenced the findings, as the more remote villages were excluded from the study.

124 Community-Led Total Sanitation in East Asia and Pacific The CLTS outcomes were found to be well sustained since the C. Low performing cases interventions were completed, with only 8 per cent of the households surveyed reverting to open defecation (from 86 per cent latrine use after 1. Cambodia: DPRD-UNICEF CLTS evaluation triggering to 79 per cent latrine use found by the review): • 100 per cent latrine use in two villages (previously ODF had 0 per cent Country Cambodia reversion) Date 2009 • 81-90 per cent latrine use in four villages (one ex-ODF, 3-6 per cent Programme scale 490 villages in nine provinces (150 declared ODF) Study scale 20 villages (10 ODF and 10 non-ODF) reversion in others) (160 households surveyed) • 68-74 per cent latrine use in four villages Study objective Assess CLTS performance by sustainability, equity, effectiveness • 47-55 per cent latrine use in two villages and efficiency. Key findings Low latrine coverage in ‘ODF’ villages: • 43% functional latrine coverage in ODF villages Other findings: • 29% practicing ‘dig and bury’ during rainy season • 28% OD or shared latrine use • CLTS appears to be cost-effective Source: Kunthy S and Catalla R (2009) Community-Led Total Sanitation (CLTS) in Cambodia: • CLTS working within government and local authority structures a formative evaluation report, UNICEF & Ministry of Rural Development, Department of Rural • CLTS effective in creating initial demand and uptake of sanitation facilities Health Care, report. • Post-triggering follow-up influences sustainability Study overview Latrine technology Twenty CLTS villages were purposively sampled (10 ODF villages and 10 Almost no innovation from the conventional latrine design. New latrines non-ODF villages) from the 61 village interventions initiated in 2006. In constructed after CLTS triggering were: each village, six households were randomly selected, and a further two • 88 per cent dry pit latrines built with locally available materials poor households were selected – in total, 160 households were surveyed. • 12 per cent pour flush latrines with imported ceramic pans and cement Main findings Some concerns were raised about the hygienic condition and durability of The household surveys found that only 43 per cent of households in the the latrines: previously ODF villages owned functional latrines, and that only 35 per cent • 22 per cent latrines did not adequately separate faeces from human or of households used latrines at all times (19 per cent of latrine owners in animal contact ODF villages practiced OD sometimes). • 59 per cent latrines were not fly proof (53 per cent dry latrines lacked hole covers) No detailed baseline monitoring data were available, but the CLTS records • 80 per cent latrines were reported to smell suggested that latrine coverage had been around 84 per cent at ODF • Some latrines already showed signs of ‘structural and material fatigue’ declaration, with 16 per cent assumed to be sharing other latrines. The focus group discussions confirmed that coverage had dropped to around Subsidy policy 46 per cent by the time the study was undertaken, which corresponds One of the 12 study villages had received some hardware subsidies prior to the reasonably well with the household survey findings. CLTS interventions. No hardware subsidies were utilized in the interventions.

Community-Led Total Sanitation in East Asia and Pacific 125 The study fieldwork was completed in the rainy season, when many of • 66 per cent thatch or bamboo walls (16 per cent brick walls) the villages in the areas studied experience flooding. Some low-cost and • 52 per cent thatch roof (24 per cent GI sheet roof) badly located latrines become unusable in the rainy season, which results in some reversion to OD. However, a significant proportion – 29 per cent Subsidy policy of households in ODF villages – reported that they practice chhik korb (dig The CLTS interventions did not involve any hardware subsidies for latrine and bury) when their latrines are unavailable, and the majority of these construction. However, a small proportion of households in the ODF households reported that they would rebuild and reuse their latrines when villages benefitted from latrine subsidies provided by NGOs either prior to the rainy season finished. the CLTS intervention or after the CLTS intervention: • 4 per cent households surveyed received concrete rings The sanitation data for the non-ODF villages highlighted some discrepancies • 8 per cent households surveyed received latrine pans in the study: the CLTS data and focus group discussions found that latrine coverage had been around 50 per cent in 2006 following the CLTS Interestingly, the proportion of latrine subsidies was found to be higher in interventions, but had dropped to 19 per cent when the study was undertaken; the non-ODF villages: whereas the household survey data collected by the study suggested 52 per • 26 per cent households surveyed received concrete rings cent latrine coverage. This discrepancy suggests that sampling errors may • 30 per cent households surveyed received latrine pans have had a significant effect on the household survey results. • 15 per cent households surveyed received wall materials • 10 per cent households surveyed received roof materials The household survey results suggested that latrine coverage was lower among poor households, at only 20 per cent in the ODF villages and 30 per The higher proportion of latrine subsidy among the households surveyed cent in the non-ODF, which implies that reversion to OD was higher among in the non-ODF villages may explain the higher than expected latrine poor households. coverage rates reported by the household survey in non-ODF villages.

Latrine technology The majority of the latrines built in ODF villages had simple wooden slabs, unlined latrine pits and superstructures made from local materials: • 85 per cent unlined latrine pits (15 per cent concrete rings) • 69 per cent wooden latrine platforms (12 per cent ceramic pans)

126 Community-Led Total Sanitation in East Asia and Pacific

UNICEF East Asia and Pacific Regional Office 19 Phra Atit Road Bangkok 10200 Thailand Tel: (66 2) 356-9499 Fax: (66 2) 280-3563 E-mail: [email protected] www.unicef.org/eapro