CYCLONE HAROLD RECOVERY & RESILIENCE

SANITATION PROJECT on VAO, MALEKULA

Final Report Cyclone Harold Recovery and Resilience WASH Project - Vao, North East Malekula

Background on TC Harold affected areas in North Malekula – Vao Island and Mainland

On Monday 6 April 2020, Category 5 Cyclone Harold (‘TC Harold’) cut a devastating path through the northern islands of Vanuatu. Parts of Santo, Pentecost, Malo, Ambrym and Malekula islands were among the worst affected.

On Malekula, consolidated assessment data from the Malampa Provincial Emergency Operations Centre documented that areas in the North, North West and North East were seriously impacted. While these communities were spared the worst of large-scale destruction of infrastructure, damage to food crops and clean water sources was substantial in the immediate aftermath of the disaster.

Over a 2-month period till the end of June, government coordinated food distributions and emergency water trucking to North Malekula communities took place with the assistance of the Red Cross.

Schematic provided by Vanuatu Health Cluster

Mainland Vao, and especially Vao Island in the North East of Malekula reported a surge in cases of waterborne diseases in the first 2 months following TC Harold.

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The Malampa Provincial Health Surveillance Unit reported a rapid rise in numbers of cases of diarrhoea, conjunctivitis and flu-like illnesses in cyclone affected communities. In particular, the communities of Vao in the northeastern corner reported the largest cluster of waterborne infections, especially in the 4 sectors of Vao Island.

Covid-19 related health awareness activities that began weeks before TC Harold refocused once again on disseminating basic handwashing and personal hygiene messages. According to the Malampa Provincial Health team, improved handwashing measures appeared to reduce the number of diarrhoeal cases. Rural communities without handwashing stations were encouraged to construct simple ‘tippy-taps’ made from bamboo or recycled plastic drink bottles.

As the emergency relief phase transitioned into recovery mode, communities considered more permanent ways to improve toileting and handwashing structures. Many people are aware of the connection between poor hygiene and heightened risks of contracting diseases, especially when natural disasters strike.

Population Statistics for Vao Mainland and Island

Vao Mainland Sector Number of Households Population Males Females Total Labung 25 41 39 80 Lawor 20 42 38 80 Tokvanuaute 57 117 124 241 St Joseph 32 64 77 141 Veturah 76 213 214 427 210 477 492 969

Vao Island Sector Number of Households Population Males Females Total Beteul 59 150 140 290 Tokvanu 40 84 96 180 Beterihivenu 56 105 125 230 Noroure-Sigone 63 147 179 326 218 486 540 1026

TOTAL 428 1995

Figures provided by Vao Dispensary (June 2020)

Strengthening hygiene and sanitation structures such as properly functioning toilets, handwashing stations and access to clean drinking water are ongoing challenges from the health education as well as implementation standpoints. Many households share toilets, some of which are poorly constructed, not well-maintained and are not cleaned regularly. Many toilets do not have proper handwashing facilities attached. The vast majority of toilets are not easily accessible by the elderly and disabled.

The health impact of the latest cyclone combined with the threat of Covid-19 has brought home the urgent message to strengthen the WASH needs of individuals and communities.

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The northern parts of Malekula experience sustained periods of low rainfall due to orographic effects. On mainland Vao, existing solar pump systems could benefit from upgrades and improvements, according to an independent survey recently commissioned by the Department of Water Services in May 2020. On Vao Island, 3 of the 4 sectors rely on wells as their primary source of water. Some households and communal areas have rainwater collection tanks as secondary sources for drinking and other uses. In the dry season, villagers from the small island frequently have to fetch water from the mainland when groundwater supplies turn brackish and tank water supplies are depleted.

Objectives

The core purpose of this project is to equip Vao communities on the mainland and small island with the necessary skills to construct a standard VIP (Ventilated Improved Pit) toilet that is affordable and accessible to everyone.

The activity is aligned with the Ministry of Health’s Sanitation Guidelines as well as its TC Harold Response Plan. The latest guidelines recommend that over 2000 household VIP toilets are built in North East Malekula alone.

• Objective #1: Recovery – to facilitate the reconstruction of properly functioning toilets for communities affected by TC Harold.

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• Objective #2: Health Education – to reinforce key messages around sanitation and hygiene, focusing on the transmission of diseases due to poor hygiene practices. Covid-19 awareness and preparedness activities will be integrated during community awareness sessions.

• Objective #3: Sustainable Development and Resilience –

1. Improvements to existing toilets according to Sanitation and Hygiene guidelines 2. Communities follow through by building their own toilets, including handwashing stations. 3. Communities gain the necessary skills to build their own improved toilets and knowledge on the importance of hygiene.

• Objective #4: Menstrual Hygiene – special focus will be placed on the needs of women and girls.

• Objective #5: Inclusiveness – modified design of VIP toilet that takes into account disability access.

Design

Refer to the Appendix A and B for design plans and sketches, and Bill of Quantities of Materials.

The proposed design of VIP toilet Photos courtesy of Keith Jacob Gasi Sanma Environmental Health Officer

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Implementation

A: Consultation stage

Who When Description

PORT VILA: 2 – 30 June ▪ Checks conducted to ensure proposed activity is aligned with the Ministry of Health’s TC Harold Environmental Health Unit Response Plan for Sanitation and Hygiene.

Sanitation Working Group ▪ Latest copy of Sanitation Guidelines obtained.

Neglected Tropical Diseases Unit ▪ Advice sought on toilet design plans, types of toilets and bills of quantities. WASH Cluster ▪ Explored potential opportunity to integrate this activity with Neglected Tropical Diseases Unit.

PORT VILA: 1 June ▪ Sought advice from WASH Cluster to coordinate activities with other agencies. Learned that Unicef is Unicef funding the training of 12 new Sanitation Officers who will be able to provide training to communities. Rota Mould Ltd. ▪ Consulted Rota Mould and Total Construction, both Total Construction Ltd. private businesses in Port Vila to find out about possible handwashing stations and alternative toilet designs.

MALEKULA (Norsup, Lakatoro): 25 May ▪ Held discussions with Public Health Manager and 15 June Health Promotions Officer to ascertain gaps and Malampa Provincial Health priorities in cyclone affected areas.

Department of Water Services ▪ Discussed the possibility of VIP toilets for various Aid Posts in the North, North East and North West Malekula.

▪ Obtained advice from Malampa Surveillance Officer on data relating to cyclone-related illnesses.

▪ Sought advice from Provincial Water Officer on proposed plans to improve water distribution systems to cyclone affected communities.

▪ Based on accumulated information above, provincial health authorities advised us to focus on the community of Vao.

MALEKULA (Vao): 17 June ▪ Discussed proposal with members of the Health Committee which included the nurse, school Vao Community Health 30 June - principal and paramount chief. Committee present

Malampa Disability Officer

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▪ Telephone consultations with Vao Dispensary Nurse in-charge to obtain population statistics and other data for planning purposes.

▪ Vao Health Committee team conducted awareness of the project in the various sectors.

▪ Nurse and Nurse Aid conducted a mini-survey of existing sanitation facilities in each sector – results currently being collated.

▪ Telephone consultation with Malampa Disability Officer to find out the details of specific individuals with disabilities on Vao. Learnt that there was a very recent survey conducted last month. Results will be published by mid-July and used to inform project planning.

SANTO: 22 June ▪ Several meetings took place in Luganville with the Sanma Environmental Health Officer and Malampa Sanma Provincial Health 26 June - Health Promotions Officer. Both these health officers Sanitation Officer present will be in charge of training the community in the construction of VIP toilets. Malampa Health Promotions Officer ▪ Gathered information on:

- Training material including practical steps for communities to prepare themselves for the hands-on component.

- Location of toilets taking into account environmental impact and appropriate distancing to avoid contaminating water sources.

- Design specifications including the riser moulds for the toilet seat.

- Schedules and Timeline.

- Possible integration of training and induction of newly appointed sanitation officers into this project.

Outcomes of consultations with National, Provincial and Vao Community stakeholders:

1. Approval by the Vao community leaders for the project and agreement that the community will contribute local timber, natangura thatch, bamboo and other natural materials available locally for the construction of the frame, walls and roof of each model toilet.

2. Approval by the Environmental Health Unit of the Ministry of Health (MOH) for the project to take place. Acknowledgement that the project aligns with MOH’s TC Harold Response Strategy for Sanitation and meets long term plans for development of proper sanitation facilities.

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3. Both National and Provincial Health managers agree that the training of new Sanitation Officers will be integrated into the practical component of the training on Vao.

B: Activity Plan

Stages of the project

What When

PREPARATION

▪ Finalise materials list and bill of quantities, obtaining quotes, requesting release 22 June – 13 July of funds. ▪ Ordering toilet riser moulds. ▪ Ordering washable sanitary pads. ▪ Preparing training material and resource packs for participants for first training workshop in mid-July. ▪ Health Promotions Officer to liase with Sanitation Officer for appropriate information to teach during the first training workshop. ▪ Logistics – procurements, shipping, delivery and storage of building materials and tools. ▪ Logistics – community mobilisation

INTRODUCTORY COMMUNITY WORKSHOP ON VAO 14 - 16 July

This workshop was conducted by the Malampa Health Promotions Officer, with the support of the Vao Community Nurse and with prior support by the Sanitation Officer.

Participants - community representatives from each of the 9 sectors including the primary school, church elders, chiefs, women’s representative and disability representative. Also included are 1 or 2 community builders from each sector.

Day 1 involved presenting health education topics on sanitation and hygiene, overview of the quick-survey of existing toilet facilities on Vao, transmission of diseases due to poor personal hygiene.

Day 2 was oriented towards the theory and specifications of toilet construction process including instructions on what each community needed to prepare for the practical training component. Each sector representative was expected to conduct further awareness in their respective sectors.

Day 3 allowed for further community consultation to take place, site visits of existing toilets and water sources, and to view proposed locations of communal VIP toilets.

COMMUNITY PREPARES FOR PRACTICAL TRAINING 20 July – 9 August

▪ Sector representatives hold awareness sessions. ▪ Harvesting of local materials for communal VIP toilet structures and pit linings. ▪ Weaving natangura thatch for the roofs of communal VIP toilets. ▪ Collecting sand and coral for the cement slabs ▪ Digging the pits for model toilets.

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NOTE: Vanuatu’s 40th Independence Day was celebrated on 30 July. The government announced an extended Public Holiday period from 23 July – 2 August. The start of the practical training was delayed for a week.

PROCUREMENT AND SHIPPING MATERIALS FROM SANTO AND PORT VILA TO VAO 20 – 23 July FINALISING SCHEDULE FOR SECOND TRAINING WORKSHOP WITH PROVINCIAL AND NATIONAL OFFICERS

PRACTICAL TRAINING IN VIP TOILET CONSTRUCTION 10 – 21 August ▪ Sanitation Officers from the Ministry of Health taught and supervised throughout the duration of this component. ▪ Sanitation officers-in-training were involved, providing additional personnel to supervise the construction of model toilets. ▪ Sanitation Officers directed how training took place at specific project sites on Vao Mainland and Island. This involved 3 sectors. ▪ Community builders participated in this training to pass on skills and knowledge learnt to other villagers at the conclusion of the training. ▪ Up to 20 model communal toilets were expected to be built. Additional time may be necessary to allow time for communities to complete constructing each toilet.

Additional activities being integrated during this 2-week component:

▪ Menstrual Hygiene education and introduction to use of washable sanitary pads. ▪ Women’s Health Education. ▪ Conducted by the Malampa Health Promotions Officer and Vao Dispensary Nurse.

DEBRIEFING WITH HEALTH COMMITTEE AND COMMUNITY LEADERS COMPLETE CONSTRUCTION OF MODEL TOILETS Debrief at the ▪ If necessary, allow time for communities to complete the building of model toilets. conclusion of the 2-week workshop. ▪ Allocation of remaining materials for further community public toilets, or to selected individual households as directed by the Vao Health Committee and Final inspection of community leaders. model toilets took place before the launching on 18 September.

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C: Community “Leaders and Builders” Session Report on Introductory Workshop and Community Preparatory Phase

This phase of the project took place from 14 – 16 July 2020. Procurement and delivery of purchased building materials, consumables and tools took place from 20 – 23 July 2020.

Refer to Appendix C for the programme outline consisting of 1-1/2-day’s theory session followed by 1- 1/2 day’s visit to each sector. Also included in Appendix C is a list of leaders and builders, task list for community contribution towards the toilet construction (handout), and key messages for building a proper VIP Toilet (handout).

Chiefs, Health and School officers, Women’s representatives, the Disability Officer and a group of community builders representing each of the sectors from Vao Mainland and Island gathered at the primary school in mid-July for an intensive health education session conducted by the Malampa Health Promotions Officer, Grennethy Tavunwo. At the same time, these community focal representatives were briefed on the details of the practical training in VIP Toilet construction. Training and construction of model toilets was scheduled to begin on 10 August. Each focal person will conduct further community awareness and request householders’ support with harvesting local building materials, preparing the sites where the toilets will be built and organising assistance with accommodation and catering for the visiting delegation of sanitation officers. A ‘Training-of-Trainer’ approach to this project is adopted so that knowledge and skills are passed on and embedded amongst key members of the community. Community builders from each sector have been appointed by respective sectoral chiefs. These builders will learn new techniques and build on existing skills so that members of each community will benefit from localised expertise in the future. It is hoped that gradually, the importance of practising proper hygiene and protecting drinking water sources will result in behavioural changes, thereby improving resilience in times of natural disasters.

The following components were covered during the preparatory session:

• Overview of the sanitation and water situation at the provincial level, for Malekula, and Vao. The Dispensary Nurse and Health Promotions Officer (HPO) urged community leaders to help promote and prioritise good hygiene practices, recommend that households build and maintain proper sanitation facilities, improve handwashing facilities as well as protect and maintain drinking water sources.

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• Awareness of how diseases can be spread through unsanitary practices and from drinking contaminated water. HPO presented using resources provided by MOH, WHO and Unicef.

• Covid-19 awareness and preparedness. Basic information was disseminated by the HPO using resources provided by WHO and MOH. This included an overview of the latest situation globally and in the South Pacific, current scientific knowledge on the virus’ transmission, and prevention focusing on hand hygiene. A Question-and-Answer session followed.

• Discussion on the challenges and gaps around sanitation facilities and clean drinking water experienced on Vao.

• Key points of the National Sanitation Guidelines and criteria for VIP toilets. HPO went through the Checklist for VIP toilets, presented as a handout to each participant. Short presentation on ‘building a VIP toilet’ which will be further discussed in the practical component.

Refer to Appendix C for the VIP Toilet checklist.

• Preparing for the practical training component:

▪ Reaffirming the main goal of the project with the emphasis on training/knowledge transfer. ▪ Introducing the recommended design plans for Standard and Inclusive VIP toilets. Copies of Standard and Inclusive plans were handed to each participant. ▪ Going through the list of tasks for communities to prepare before the practical training starts (Refer to Appendix C)

• Visits to each sector to view proposed locations of communal VIP toilets, drinking water sources and existing toilets.

• Logistics around procuring the building materials and tools, delivery to Vao and safe storage. Discussion on the list of supplementary tools required. Leaders were consulted as to how these communal tools will be shared at the conclusion of the training.

• Planning meeting with the Nurse and Village Health Worker who will provide assistance with further community health promotion in each sector while the practical training and toilet constructions are taking place. It is envisaged that a number of small-group health education sessions will take place targeting individual households so that important key messages are further disseminated.

Main issues identified by participants at the Leaders and Builders Session

▪ Challenges faced by communities over access and quality of water for drinking, washing and cooking.

▪ Rainwater collection tanks become contaminated during cyclones. Insufficient rain in the dry season to fill the tanks. Underground wells are brackish in prolonged dry periods.

▪ Insufficient number of toilets, with many households sharing a single toilet. -Challenges and gaps – provide summary based on the result ▪ Poorly constructed toilets, mainly ‘waterseal squat’ toilets. These requires water for manual flushing to function properly. Squatting is difficult for some people especially the elderly and those with disabilities.

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▪ Limited or no permanent handwashing facilities close to the toilets.

▪ Some communities have to travel long distances to fetch water.

▪ Unhygienic toilets due to lack of routine cleaning.

▪ Insufficient money to purchase building materials to build fully-functioning toilets.

▪ Poor understanding of the link between poor hygiene and diseases affecting health.

▪ Lack of motivation.

A more detailed look at the situation in each sector is covered under Section D below.

People with Disabilities

The Disability Officer from Vao and Malampa Disability Desk conducted a recent survey to ascertain details of people living with disabilities. Based on the latest statistics, there are at least 45 men, women and children with a range of disabilities on Vao.

Land Dispute in Lawor and Tokvanuaute

A current land dispute concerning the sector of Lawor and several villages in the sector of Tokvanuaute, both on Mainland Vao, was brought to our attention during the site visits in July. Those concerned request that no new structures be built in the areas under dispute while the issue is being resolved. There appears to be some disagreement amongst the affected villages as to whether communal public toilets, which some consider to be essential infrastructure, should be included in the temporary ban on new development.

The community builders and focal points for both sectors will continue to be involved in the project, assisting other sectors as necessary.

In the sector of Tokvanuaute where there is more than one village, two toilets will be built in the village of St Patricks where there is no land issue. Unfortunately, the secondary school is within the area in dispute and will therefore have to be excluded for VIP toilets, unless the issue is resolved.

As the matter is still under discussion, we will be guided by the community leaders on the best course of action. No timeframe for resolution of this dispute was given.

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Proposed location of Communal VIP Toilets

The following sites have been chosen by the focal points from each sector. The majority of these sites are community halls or churches where large numbers of people congregate regularly.

Sector or Institution Location of toilet

Betehul 1 toilet - community hall Tokvanu 2 toilets – community hall, kindergarten Beterihivenu 1 toilet – community meeting area Noroure Sigone 2 toilets – community stage, 1 inclusive Ambilak 1 toilet – community meeting area Primary School 2 toilets – primary classrooms, 1 inclusive 1 toilet – kindergarten classroom Catholic Mission 1 toilet - inclusive Veturah 5 toilets proposed as this is a large sector, 1 inclusive Toilets will be spread throughout the various villages – Donmeral, NTM Church, Presbyterian Church, SDA Church and Catholic Church meeting house

St Joseph 1 toilet – Women’s Centre Tokvanuaute Land dispute at the village of Hone * 2 toilets at the village of St Patrick’s – Kindergarten, Catholic Mission Labung 1 toilet - community meeting area close to the church. The focal point has suggested that the VIP toilet could be allocated exclusively for women.

Vao Aid Post 1 toilet - inclusive Lawor Land dispute throughout this sector – 1 toilet proposed once dispute is resolved.

Secondary School In the sector of Tokvanuaute where there is currently a land dispute. 2 toilets proposed once the dispute has been resolved.

*The President of the village of Hone (Sector Tokvanuaute) requested 2 public toilets in the communal meeting area. Due to the land dispute, construction has been placed on hold until the community can come to an agreement to allow unimpeded access to the facilities when completed.

Note: At the time of the official launching on 18 September, there was still no resolution of the land dispute. However, the Health Committee has already organised for some materials and consumables to be set aside for these toilets.

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Yannick Tevanu, Headmaster of Vao Primary School explaining how diseases spread through poor hygiene (above left). Community leaders and builders aired their views on some of the challenges experienced.

Jenny Malkali and Marie-Antine Telukluk (below left), both from St Joseph during a group activity. Health education sessions included Covid-19 awareness to update Vao leaders on prevention and preparedness.

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Field trips to villages on Vao mainland and island to prepare for practical training sessions

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Loading the MV Sheerwater with building materials at Melcoffee Wharf in Santo, and unloading with the assistance of local boats and community builders from Vao – Procurement took place from 20 – 23 July

Half the shipment of cement (2.5 tonnes) was purchased from Lakatoro on Malekula and delivered by truck to mainland Vao to minimise handling and transport issues on local boats.

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D: Training-of-Trainers (ToT) Workshop on the National Sanitation Guidelines

This theory and practical training session followed the introductory workshop outlined in Section C. This component built on the health education and WASH topics introduced by the Health Promotions Officer, with a more in-depth focus on the principles and technical skills behind the construction of hygienic, economically sustainable and environmentally sound VIP toilets.

The workshop consisted of 50% theory sessions presented by the Environmental Health Unit within the Ministry of Health, supported by the Sanma Environmental Health Officer and the Sanitation Engineer and Country Manager of Engineers Without Borders (EWB) Australia. The other 50% consisted of practical training involving 3 toilet construction sites, one of which was an inclusive toilet accessible by people with disabilities.

Once again, the model adopted was the ToT approach involving the same representatives from every sector in Vao who attended the first workshop held in July. In addition, newly appointed Provincial Sanitation Officers from 5 of the 6 provinces of Tafea, Shefa, Sanma, Malampa and Penama also attended this week-long training, enriching the mix of skills and ideas. All the sanitation officers have previous experience in building VIP toilets. The introduction of the national Sanitation Guidelines during this training therefore had a 2-fold impact. Firstly, it served to strengthen the capacity of the provincial sanitation officers in accordance with standardised guidelines and in particular, the inclusive VIP toilet. Secondly, it reinforced and in some cases, corrected the existing skills set of builders in the Vao community.

The list of participants and programme for the ToT workshop can be found in Appendix D.

The ToT workshop on the application the sanitation guidelines fell within key objectives #3 and #5

• Objective #3: Sustainable Development and Resilience

➢ Improvements to existing toilets according to Sanitation and Hygiene guidelines ➢ Communities follow through by building their own toilets, including handwashing stations. ➢ Communities gain the necessary skills to build their own improved toilets and knowledge on the importance of hygiene.

• Objective #5: Inclusiveness – modified design of VIP toilet that takes into account disability access.

Learning Outcomes, Practical Results and Recommendations for Improvement

1. Sanitation Guidelines principles

The presenters began with an overview of the objectives of the workshop followed by reiterating the importance of good sanitation and hygiene. Hard copies of the Sanitation Guidelines (English version) were handed to each participant.

Core focus:

• Participants learnt about different types of toilets and how to choose the most appropriate design with regard to the environment, cultural norms and cost. Attention was drawn to the toilet selection guide within the guidelines, emphasising the importance of location and water sources.

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• There was lively discussion about flush toilets with septic tanks. The audience was particularly interested in this design from an upgrade perspective. The presenters clarified that proper faecal management requires that septic tanks are constructed with certain features, and that they need to be emptied once full. There was some confusion about the definition and requirements of a septic tank versus a dual pit with pour-flush toilet.

Participants from Vao were advised against choosing to build septic tank toilets at this stage as there is no faecal management service available beyond Port Vila and Luganville. Existing pits thought to be septic tanks may in fact be contributing to environmental pollution and possible contamination of groundwater. There was insufficient capacity to properly inspect existing structures. This will be a useful exercise from the educational, environmental and health perspective.

• Minimum design standards, features and requirements of the VIP toilet was taught using the checklist of key points (Refer to Appendix C). Upon request, Bislama and French versions of the checklist were printed and distributed to the participants from Vao later. Use of this checklist is recommended for every household interested in constructing its own toilet. The checklist was used to monitor practical construction work during this training.

Choosing the best location for toilets, paying attention to distances to drinking water sources, shoreline or seafront, and neighbouring sleeping houses was discussed.

• Requirements and recommendations for gender and disability inclusive VIP toilets, with a focus on the additional features to ensure these toilets are safe and accessible. Menstrual Hygiene Management was introduced by the Health Promotions Officer to a predominantly male audience. There is more scope to increase awareness of disability and women’s health issues incrementally.

To encourage the women in the Vao Community to participate in the health activities, several discussions were organised over a week at all sectors. These sessions were presented by the Health Promotions Officer, Midwife, Nurse Aid and Village Health Worker from the Vao Dispensary and Aid Post. Discussions were designed to link up with the construction of VIP toilets taking place in each sector.

• Design plans for Standard and Inclusive VIP toilets. The plans were introduced in the classroom and applied on each training site.

ToT workshop on the Sanitation Guidelines

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Workshop involving group discussions, small group exercises and safety debriefings. Provincial Environmental Health Officers, Sanitation Officers and community builders from 9 sectors of Vao mainland and island attended.

Lessons Learnt and Recommendations:

Training Site 1: Tokvanu Community Hall

Location of Tokvanu Community VIP toilet should have been further away from the sea to minimise potential contamination of seawater. The site is also exposed to wind and waves in the event of a cyclone.

Note: Toilet pits for all 3 training sites were dug prior to the start of the workshop to help with time management.

Recommendations: • Before digging the pit, members of households should be advised to consult a trained community focal point or a sanitation officer for a pre-construction site visit. • Focal points should have sufficient knowledge to assess the suitability of proposed location of new toilets, taking into account potential impact to health and the environment.

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Training Site 2 for an Inclusive VIP Toilet at the Catholic Mission on Vao Island

Although the ground is relatively flat, the path to this inclusive toilet is narrow and uneven in parts. Wheelchair access could be improved by widening the area and smoothening the stony ground

Recommendations:

• As above, pre-construction site visits are recommended by a trained focal point.

• More in-depth awareness by the Malampa Disability Officer is highly recommended on general and specific disability issues.

The Disability Officer was invited to attend the launching celebration to make a special presentation. He cancelled at short notice due to transport and timetabling clashes.

Other recommendations:

• The Sanitation Guidelines are very comprehensive and ultimately beneficial – a great asset. From the perspective of community builders however, a simplified version of the key messages in a holistic, one-page poster with diagrams would make for easier referencing. Design plans and the checklist should also be incorporated. Bislama versions are highly recommended. Laminated, large-print posters will be useful for referencing in the field.

• A standardised training package for each provincial sanitation officer plus further ToT training so that the sanitation officers can train community focal points throughout the country. Build in follow-up monitoring and regular supervision as toilets are built.

On Vao, builders or carpenters were chosen with a certain level of building experience. This helped the supervising sanitation officers to identify those with particular strengths who, if they so choose, can be focal points for households. One builder already has extensive experience building concrete slabs for squat toilets.

2. Preparation of 2 types of pit linings

Depending on the type of ground, 2 methods were taught. The soil type on Vao is primarily sandy, hence the majority of dug pits had to be lined to prevent the sides from collapsing inwards. There are several ways to construct a pit lining using a variety of different materials. One of the most cost-effective ways using local bamboo was taught in this course, as bamboo is readily available on Vao. Builders were advised to choose the firmer, more robust variety of bamboo.

Where the ground is rocky or solid, the walls of the pit can be partially lined using timber. At least 2 of the toilet pits built during the course were of this sort.

The principles behind a raised pit was also discussed and demonstrated. Inadvertently, one of the toilets ended up being a ‘raised pit’ due to the height of the bamboo frame above the ground. Although this was unintentional, it nevertheless provided the opportunity for the sanitation officers to explain the circumstances where raised pit toilets are most appropriate.

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Participants were taught that the minimum depth of the pit had to be at least 1.5m, more if possible. In low-lying areas with a high water table, the raised pit toilet was taught to be more appropriate.

At least 50% of the communities had harvested the bamboo before the workshop while the remaining communities continued the process of collection during the construction phase.

Preparing the bamboo pit lining for sandy substrate

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Preparing partially lined pits – rocky ground

Lessons Learnt and Recommendations

Training Site 1: Tokvanu Community Hall

Trainees were advised to measure the height of the pit lining against the depth of the pit, then cut the bamboo strips to the right size. Otherwise, the pit protrudes above ground which has to be levelled, requiring more materials.

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Recommendation:

• The dimensions, especially the height of the bamboo frame should be carefully measured before installation. Otherwise the toilet will be raised too high, which uses up more cement for the foundation slab, as shown in the above pictures. Steps may also be required of the slab is too far off the ground, which uses up even more cement.

3. Ratios of cement, sand and coral for the top slab

The quantities of cement, sand and coral are crucial for the construction of the top slab where strength and integrity are key qualities. Although the majority of participants have inherent practical building skills, this point was emphasised due to questions raised during the early part of the practical training.

The community builders do not have accurate scales to measure quantities of each component. Using a standard shovel or spade as a measuring tool is a practical and sufficient method as long as there is consistency throughout. The sanitation officers discussed how much water to add to the dry mix, with some groups adding more than others to reach the right consistency.

Recommendations:

• It would be useful to include this ratio as part of the simplified key messages as a poster that can be referred to easily in the field, to remind householders building their own toilets. Diagrams would also be useful for this ‘recipe’.

• In addition to the ratio of cement, sand and coral, noting the quantity of water used was also discussed.

This team used more water with the dry mix

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Shovels or spades are used to measure quantities of sand, coral and cement for the top slab.

4. Making the seat riser

A total of 10 seat riser moulds were purchased to be shared between Vao Island and mainland sectors at the conclusion of the training to enable households to build their own toilets. Workshop participants were taught the basic steps of making toilet seat risers on the first day of the ToT workshop, focusing on the correct ratio (sand and cement) and thickness.

The mould is a relatively new design that has not been used previously so there was some trial-and-error involved, especially in releasing the seat riser without damaging the body once it has cured.

For the kindergartens, shorter seat risers were made by filling the mould with wet mix approximately halfway up the mould. This method worked well.

Recommendations: • Smearing the sides of the riser mould with used engine oil was found to help at the unmoulding stage, after the concrete cures.

• Sharing the use of riser moulds with the wider Malekula community was raised by provincial health officers. Vao Health Committee will be consulted on the best way to share this important resource with others.

Communities making the seat risers

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5. Making the top slab

The ratio of cement, sand and coral was emphasised throughout the training (point 3 above) to ensure that the slab is sufficiently strong. Sanitation officers taught the practical skills at each of the 3 training sites, followed by supervised construction in the few weeks after the workshop.

Participants grasped this skill quickly once reminded of the correct ratios, referring to the design plans as necessary. The Malampa Sanitation Officers and Environmental Health Officer provided valuable support during the construction phase, especially with techniques for markings and measurements.

Trainers suggested a minor change to the design plan during the practical, where the distance between the vent pipe and gap for the seat riser was altered to 350mm. So that the vent pipe and keyhole piece for the seat riser do not become stuck in cured concrete, builders were advised to rotate the fixtures regularly while the concrete was curing.

During the ToT, several community builders asked about using bamboo strips instead of wire mesh for structural strength, noting that this is common practice when building foundations for houses and other structures. This appears to be an alternative material when access to mesh wire is beyond easy reach.

Recommendation: • Further guidance on a possible alternative to wire mesh as a component of the top slab, being a departure to the sanitation guidelines.

Construction of the top slab at various sites

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6. Dimensions and key features for Inclusive Toilets

‘Inclusive’ in this context is defined in terms of access for people with disabilities. Also discussed was consideration of the specific needs around female menstrual hygiene. Both these areas were touched upon during the introductory workshop in July, ToT workshop in August and community health awareness sessions for women. 1 of the 3 training sites was designated to be inclusive. Following the training, another 4 inclusive toilets were constructed.

Conceptually, more in-depth, awareness about disability issues would be beneficial. The Malampa Disability Officer was consulted prior to the start of the project, and provided a list of potential recipients of inclusive VIP toilets. Ultimately, the community could not reach a consensus from the list provided, opting instead for public VIP inclusive toilets.

Core focus

• The Health Promotions Officer spoke about menstrual hygiene in the context of toilet facilities, drawing on content within the Sanitation Guidelines. This was a succinct introduction which can be elaborated further if the community desires, in a separate forum. Maintaining proper disposal bins for sanitary pads was highlighted. Internal washing facilities was outlined as a possible extra feature.

• The focus on access for people with disabilities highlighted key physical features – wider internal dimensions, ramp for wheelchairs, internal railings.

• 2 of the 3 practical training sites were supposed to feature inclusive toilets but only 1 was successfully completed in the end. This was not regarded as a failure, instead it presented a valuable learning opportunity for all participants. The third toilet was built as a standard VIP toilet.

• The focus was primarily around access for people with ‘physical’ disabilities, in particular those with mobility conditions who require wheelchair access.

Lessons Learnt and Recommendations:

Training Site 2 for an Inclusive VIP Toilet at the Catholic Mission on Vao Island

The pathway leading up to this inclusive toilet is not the easiest to manouvre around. As the site was chosen before the workshop, there was limited opportunity to negotiate an alternative location. In future, it was emphasised that pre-construction advice should be sought in advance. To improve access for wheelchairs, the surrounding area was cleared of bush and building materials.

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Training Site 1 at Tokvanu Community Hall

The ramp was built too steeply for people in wheelchairs. This toilet was completed as a standard-sized toilet and lessons learnt.

Recommendation: • Community builders are encouraged to consult a trained focal point and/or request a sanitation officer to make a site visit before building begins.

• Adequate supervision by community focal points and/or sanitation officers during the construction of inclusive toilets is important.

• Design plans and dimensions printed in a field format could be beneficial.

Veturah Catholic meeting house

Both these toilets were meant to be inclusive. However, the internal dimensions were too small to accommodate wheelchairs. As above, pre-construction advice, supervision, access to the plans on site and more practice building inclusive toilets will help improve the skills set of the community builders.

Tokvanu Kindergarten on Vao Island

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Completed VIP Inclusive Toilets

Catholic Mission on Vao Island

Vao Primary School

Noroure Community Meeting area

NTM Church

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Vao Aid Post

7. Handwashing

Handwashing was one of the key messages that was disseminated right throughout the project, from the time of the introductory workshop, to the ToT presentations and also during the practical construction and community awareness sessions. Hygiene and handwashing education have been around for a long time. Covid-19 and the impact of TC Harold simply provided greater impetus and urgency for ongoing health promotion to take place around handwashing and maintaining handwashing facilities.

The materials list for this project included 20L plastic jerry cans with taps. Alternatives using local materials such as bamboo have previously been taught and adopted to varying degrees of success. Site visits to all the sectors showed evidence of tippy-taps constructed from bamboo. Others used recycled plastic bottles. A system of refilling handwashing stations is an area that needs to be improved, and was discussed in the context of maintenance and management of the new toilets.

The majority of villages on Vao do not have access to a water distribution system (running water) so the distances between toilets and the water collection point was taken into account during the training. For instance, during a site visit to view the proposed location of the VIP toilet in the village of Beterihivenu, community focal points were advised to change the location of the toilet to an alternative site with a natural water source.

Sanma Environmental Health Officer with the focal point for Beterihivenu, inspecting the proposed location of the VIP toilet as part of the ToT training (left). Installing the rainwater collection system requires a relatively simple fix, but the process could take time and had stalled for years in this case. In the meantime, the community was encouraged to choose an alternative location closer to (but not too close) the well (above right). Jerry cans were included in the project funds (below).

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Covid-19 key messages and handwashing that were delivered by various provincial health teams working alongside other departments seem to be having an impact. Many households have adopted basic handwashing stations around their homes with soap.

8. Economising the use of materials

One of the objectives of the construction training was to demonstrate how to maximise the use of locally available natural materials such as bamboo, local timber, natangura thatch, sand and coral while optimising the use of imported building materials. The presenters of the ToT workshop and practical training managed to deliver this message to a reasonable degree. Almost all the toilets constructed were built from bamboo and thatch. Locally sawn timber supplemented purchased pine for the construction of the slab and structural framework.

The Bill of Quantities of materials was based on estimations provided by the Sanma Environmental Health Officer, who advocates the use local materials as much as possible to keep costs to a minimum while still maintaining the standard required by the guidelines.

The consumption of purchased timber could have been stretched out further if a greater quantity of local posts were used in the construction of the toilet structures. While this practice was actively encouraged, issues around time management, community coordination and logistical challenges had to be balanced out at the same time. On the whole, the community made a substantial contribution towards building materials, tools and labour despite hurdles around transport and systematic sharing of tools and other community resources.

It was also expected that more cement would be consumed during the training components. For instance, building of ramps for inclusive toilets, learning and/or construction errors (eg. incorrect ramps), and building raised pit toilets and toilets on a slope with steps. Following the completion of the model toilets, excess materials and

32 consumables will be distributed by the Health Committee. Discussions have either been held or are ongoing for further community public toilets and priorities given to vulnerable members of certain households.

E: Supervised Construction of Model Community VIP Toilets and Complementary Health Activities

Following focused training on construction of the slab, toilet riser, pit lining and features of an inclusive toilet at 3 separate training locations, participants completed the remaining toilets with the support of 2 sanitation officers and the Malampa Environmental Health Officer. The 3 health officers remained on site, dividing their time between various sectors.

Supervised construction provided the forum for sanitation officers and community builders to further embed skills learnt. Over the course of a month, several builders were identified with particular strengths who can potentially take on the roles of community advocates. At the launching event, the Health Committee publicly nominated 2 senior builders to lead and support the communities further.

St Joseph Veturah – Catholic Meeting House

Labung Community Meeting area

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St Patrick’s Kindergarten

Tokvanu Community Hall

Vao Aid Post (Labung) Betehul Community Hall

Veturah – SDA community St Joseph

Noroure Community Noroure Community

Betehul Community Hall

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Further selection of completed VIP toilets

Vao Kindergarten

Donmeral Community

Veturah - NTM Community

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Labung Community

Noroure Community – Inclusive and Standard Ablution Block

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Community WASH presentations for Women

Given the physical nature of the construction work, there were few female participants who were active on the building sites. However, several women attended the workshops from the beginning and more advocated for better toilets on behalf of their communities. The women were mostly in charge of weaving the natangura thatch, and some also prepared the bamboo for the pit linings.

In order to reach out to more women with the key messages around hygiene and sanitation, several presentations and discussions were organised at each sector. These sessions were driven by the Nurse/Midwife from Vao Dispensary with the support of the Malampa Health Promotions Officer, Nurse Aid and Village Health Worker. A special presentation was also presented to female students at Vao Secondary School.

Main topics included:

• Hygiene and Sanitation – the key messages on the transmission of diseases through poor hygiene.

• Menstrual Hygiene with a special focus on the use of washable, reusable sanitary pads designed and made by local Port Vila enterprise, Mamma’s Laef. One thousand pads of two varieties were purchased and shared amongst 165 women. With the current phasing out of disposable sanitary products, there was much interest in an alternative solution. This exercise on Vao is part of a trial with written feedback to be collected before the end of the year.

The programme, recipients of sanitary pads and attendees can be found in Appendix D.

Following this distribution, Butterfly Trust organised a sample pack with the full range of sizes and types, including incontinence pads, to be delivered to the nurse in charge. This will enable further awareness to take place in collaboration with Mamma’s Laef. Feedback from the survey will be shared with Mamma’s Laef in due course.

• Covid-19 awareness and key messages, including hand hygiene.

• Clean drinking water and water filtration – demonstration of the Sawyer bucket filter. 20 Sawyer filters complete with buckets were purchased with project funds to complement the five units provided through the Department of Water Resources.

Currently, these filters are being shared between households. An upcoming monitoring visit will be undertaken to ascertain how well the filters are being used and to encourage more focal points and/or advocates to be involved. A request was made to the Provincial Water Officer to deliver a presentation and further demonstrate the proper use and care of these filters, including backwashing. Unfortunately, this visit did not happen. A small number of users have since reported favourable results with the use of these filters.

Female students at Vao Secondary School 37

Community presentations on WASH with a special focus on women’s health issues

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Summary of recommendations for the consideration of all stakeholders and partners

Implementation of the Sanitation Guidelines by Sanitation Officers and Communities

The recent appointment of new sanitation officers in each province is much applauded. These officers are a valuable resource who can support communities and institutions further by ensuring that the different types of toilets are built to the required standards. Health and environmental concerns are key factors in building resilience and sustainability in the face of natural disasters.

• To maximise the available human resource and get the most benefit out of the sanitation guidelines, a system of community-based training of focal points, site surveys and inspections followed by supervised construction could be considered and developed using:

▪ Standardised training package with teaching materials for sanitation officers, Environmental Health Officers and Health Promotion Officers to train community representatives and advocates.

▪ Salient points and key messages within the guidelines in a field-friendly format for quick referencing by community builders and households.

• Build in monitoring visits to communities, and follow-up with community focal points who have received training to gauge how well lessons have been learnt.

WASH – Water Filtration

In addition to efforts to improve water distribution systems within communities, increasing usage of water filters as a preventative health mechanism in areas with poor quality water could be undertaken simultaneously.

• Focused education on the link between contaminated drinking water and disease to:

▪ Further the understanding of the key facts. ▪ Encourage households to get into the habit of filtering drinking water on a daily basis.

• Explore options to reduce the cost of water filtration systems available locally that are approved by MOH and DoWr. A subsidy system similar in principle to the Solar Subsidy led by the Department of Energy could be considered as one option, to encourage households to purchase their own systems.

Disability Awareness and Inclusive Toilets

Based on the experience on Vao, prior community engagement and further awareness on disability issues generally would enhance and complement the application to different scenarios, such as construction of inclusive toilets. Depth of input would vary between communities depending on how much prior awareness has already taken place.

Note: Follow-up action with the Malampa Disability Officer is on the agenda.

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Acknowledgements

Heartfelt thanks to YachtAid Global for the tremendous support in funding this cyclone recovery and resilience project for the people of Vao in Vanuatu.

Much appreciation to all stakeholders for the collaboration and teamwork.

This project is a partnership between Ministry of Health, Malampa Provincial Health, Butterfly Trust and YachtAid Global.

Special thanks to the following individuals from the Ministry of Health, Department of Water Services and Malampa Disability Office:

• Nellie Ham and Ratu Bani from the Environmental Health Unit, Ministry of Health • Salome Kenneth, Grennethy Tavunwo and Antoine Telukluk from Malampa Provincial Health • Keith Jacob Gasi, Sanma Environmental Health Officer • Xavier Watt, Malampa Environmental Health Officer • Stephanie Hamel from Engineers Without Borders Australia • Sylvester Harry and Andrian Melipsis, Malampa Sanitation Officers. • Sanitation Officers and Environmental Health Officer from Shefa, Penama and Tafea • Richard Tasi, Malampa Provincial Water Officer • Vijay Lele, Malampa Disability Officer

A huge effort by the Health Committee of Vao, Nurse Isabel Rory, the Chairman and Principal of Vao Primary School, Chiefs, community leaders and women from every sector who worked hard to mobilise all communities since the start of this engagement.

The community of Noroure Sigone hosted a very special celebration and launching on 18 September.

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APPENDICES A - E

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APPENDIX

A: VIP toilet design

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B: Bill of quantities of materials and tools

Quantities of materials have been estimated based on the advice of the Sanma Sanitation Officer who has supervised the training and construction of toilets in many rural communities in Vanuatu.

The amounts are for the construction of 20 VIP toilets that are large enough to accommodate people with disabilities. If a combination of standard and large toilets is the preferred choice of the community, any leftover materials and building consumables will be distributed to households in consultation with community leaders and the Health Committee.

A quantity of essential tools is included to supplement private tools owned by individuals. It is expected that some private tools will be available for loan.

The Health Committee and community leaders will be consulted on the communal ownership of supplementary tools to enable householders who require them to build their own toilets at the conclusion of the training.

Description Quantity Notes Cement 40kg bag 110 bags Amount of cement used per toilet slab will depend on size. Dimensions of the standard slab is 1m x 1.5m. However, the community may choose any number of larger slabs for disability access – 1.8m x 2.4m recommended, with extra cement for ramps if required.

Steel mesh (4.6 x 2.2) 15 pieces 1 piece of mesh for every 2 toilet slabs, again depending on 4.75 (F52) the size of slab. Extra built in for distribution to vulnerable households, if there is leftover.

NZ Pine 50 x 50 x 4.8m 140 pieces Boxing timber – can be reused and shared between sectors so households can build their own toilets.

NZ Pine 200 x 25 x 6m 30 pieces Used for lining the inside of the toilet pit

NZ Pine 100 x 50 x 6m 60 pieces Used for lining the outside of the toilet pit

Nails 2” Galvanised flat 70kg in 1kg For frame, roof and wall structure. Any access to be head packs distributed to vulnerable households and/or shared equitably Nails 3” Galvanised flat 100kg in 1kg for the construction of further communal VIP toilets in every sector. head packs Nails 4” Galvanised flat 70kg in 1kg head packs Nails 5” Galvanised flat 70kg in 1kg head packs Galvanised cyclone 100m (4 rolls) To supplement bush vine for stronger connections. strapping 25mm x 1mm (25m roll) Nails 25 – 30mm 50kg in 1kg To be used with cyclone strapping. Galvanised clout for packs cyclone strapping Black plastic 2m wide x 200m (4 rolls) Used by builders to mix cement manually in the absence of a 4m long x 50m concrete mixer.

PVC pipe 100mm 5.8m 15 pieces Vent for the toilet – 1 for every 2 toilets, with extra for distribution to vulnerable households.

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Fly screen 0.35mm 15 x 30m (1 roll) To be used with vent pipe. 14 mesh 30m Door hinges 100mm 80 Community will build the doors. pair Barrel or pad bolt 60 100mm Chicken wire 2” (50mm 60m (2 rolls) To be used to construct the toilet riser or seat. x 900mm) Galvanised 30m Toilet seats cover white 30 Type recommended by Sanma Sanitation Officer.

Toilet riser moulds 10 Special moulds that are necessary for the toilet seat. Can be reused. Each mould will be distributed to each sector so households can build their own toilets.

20L water containers 30 Tippy taps made from bamboo are an alternative as stocks with taps are low.

Sawyer bucket Filters 20 To filter drinking water from underground wells and other water sources that may be contaminated.

Bamboo, vines, local Varies To be provided by the community. timber, coral, sand, natangura thatch Sanitary pads washable 1000 pieces Menstrual hygiene component Handsaw 500mm 10 Hacksaw 2 Essential tools to support community builders with toilet Bucket with handles 20 construction. heavy duty 20L Steel claw hammer 16 - 20 20oz Spirit level 600mm 8 Tape measure 10m 10 Wooden float trowel 10 300mm Pointing trowel 25 Tin snips 4 Long handle shovel 10 Short handle shovel 10 Gardening spade 10 Crow bar 1.8m x 25mm 2 chisel end Construction gloves 50 pairs Wheelbarrow 4

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C: Programme for Introductory Workshop and Site Visits – 14 to 16 July 2020

14 July WHO WHAT Comments 0900 - 0915 Health Committee Opening prayer and welcome Opening address by the Chairman of the Health Committee and Nurse Dispensary Nurse Housekeeping matters 0915 - 0930 Health Promotions Officer Aims of the project (HPO) and Butterfly Trust Objectives of this workshop 0930 - 1015 Nurse and HPO Sanitation snapshot in Vao Nurse presented the results of a recent survey on the status of existing toilets on Vao and Sanitation statistics in Malampa background to the outbreak of diarrhoea following TC Harold. HPO presented the most Province and Malekula recent results of the sanitation data for the province and for Malekula. 1015 -1030 Break 1030 -1200 HPO and Nurse Disease transmission Health education presentation, focusing on the impact of poor hygiene and sanitation on health. 1200 -1300 Lunch Break 1300 – 1430 HPO COVID -19 awareness Background to global situation, cases in the Pacific, current understanding of the mechanism around its spread, prevention and community preparedness, Question and Answer session.

1430 - 1530 HPO and all participants Group activity Participants were divided into groups to identify and discuss issues and challenges around proper sanitation and hygiene. 1530 - 1630 HPO and all participants Presentations by each group 15 July 0830 - 0845 Nurse Morning prayer 0845 - 0915 HPO Sanitation Guidelines Presentation on the key points of the national guidelines 0915 - 1015 HPO Standard VIP Toilet What is a VIP toilet, checklist of essential components of what makes a VIP toilet, key points to note prior to construction, Q & A 1015 -1030 Break 1030 -1200 HPO, Butterfly Trust and Design plans, list of materials and Group discussion on the standard and inclusive design plans recommended by the all participants tools, and community Sanitation Guidelines, details of community contributions, logistics of delivery and storage preparation of building materials, essential tools required. 1200 – 1300 Lunch Break 1300 - 1600 All participants Site visits to each sector on Vao Island and Mainland. Further health education was carried out during these visits, including 16 July All participants discussions on location of toilets, proximity to water sources and challenges of access to clean drinking water.

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Introductory Workshop - Participants and Focal Points for each sector

# Name Sector Position 1 Isabel Rory Vao Dispensary, Labung (mainland) Nurse and Midwife 2 Rosaria Barthelemy Vao Dispensary Nurse Aid 3 Belda Malantugun Vao Aid Post, Labung (mainland) Village Health Worker 4 Rodrick Tebatune Tokvanu (island) Paramount Chief, Chair of Health Committee 5 Marie-Antine Telukluk St Joseph (mainland) Women’s Representative 6 Jenny Malkali St Joseph (mainland) Women’s Representative 7 Pierre Betsesai Beteul (island) Chair of Primary School Committee 8 Camillo Kota Tokvanu (island) Community Builder 9 Pierrot Melterougong Tokvanu (island) Community Builder 10 Emile Rory Labung (mainland) Chief, Community Builder 11 Ricky Maleb Lawor (mainland) Community Builder 12 Gerard Teilemb Tokvanuaute (mainland) Community Builder 13 Sergio Atpatun Tokvanuaute (mainland) Community Builder 14 Hippolyte Rory Labung (mainland) Teacher (retired) 15 James Antoine Veturah (mainland) Chief 16 Yannick Tevanu Vao Primary School, Beteul (island) Headmaster 17 Robin Nabor Noroure-Sigone (island) Community Builder 18 Ulric Meltevielser Noroure-Sigone (island) Community Builder 19 Jachias Belbong Beterihivenu (island) Community Builder 20 Sylvio Meltemal Beterihivenu (island) Community Builder 21 Isidore Teilemb Tokvanuaute (mainland) Disability Representative 22 Stephane Antoine Veturah (mainland) Community Builder

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Community Preparation List for VIP Toilet Construction Training in August 2020 TIME AVAILABLE: 20 July – 10 August (3 weeks)

WHAT to Prepare NOTES TO HELP YOU PREPARE Choose LOCATION of toilet Consider the important points presented at workshop

Prepare TOILET PIT • 1m x 0.8m • Depth 1.5m minimum or more • Cut bamboo for pit lining (or large lumps of coral)

Materials for CEMENT SLAB • Use 16 litre bucket (16,000 cubic cm)

Standard slab: 1.5m x 1m • For 1 slab – 4 buckets SAND, 1 bucket CORAL Inclusive: Can use larger slab • Collect EXTRA coral and sand for bigger slab and for the floor of inclusive toilet

Materials for TOILET HOUSE Cut enough BAMBOO, LOCAL TIMBER and BUSH ROPE Size: INCLUSIVE 2.4m x 1.8m for larger INCLUSIVE VIP toilet Height: 2m or more, steep roof

Natangura for ROOF Enough natangura thatch for INCLUSIVE VIP toilet

DOOR for INCLUSIVE size • Made from Bamboo and local timber 1.2m to 1.5m • Big enough for WHEELCHAIR access (1.2 – 1.5m)

HANDWASHING stand Timber or bamboo for 20 litre water container to sit on

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Key messages to consider when building a VIP Toilet

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D: Programme for Training-of-Trainers Workshop on Sanitation and Hygiene Guidelines – 10 to 14 August 2020

10 August -Day 1 (Practical) 0900 - 1030 Welcome ceremony and speeches on Vao Mainland. 1100 - 1130 Trainers and participants travel across to Vao Island. 1130 - 1200 Debriefing by Lead Sanitation Officer and Safety Officer. Participants and sanitation officers-in-training are divided into 3 teams. 1300 - 1700 Visits to 3 demonstration sites, practical training on construction of top slabs, risers and pit linings. 11 August – Day 2 (Theory) 0830 -0900 Opening prayer and introductions. GROUP DISCUSSION: All participants share their experiences of building sanitation facilities. 0900 - 1030 Why do we need Sanitation Guidelines and Standards? Training-of-Trainer (ToT) learning objectives. The important of sanitation and hygiene. What is the most suitable toilet and what is the cost? GROUP EXERCISE: Use of toilet selection guide. 1030 - 1230 Is the existing toilet adequate? Minimum design standards for each toilet type. GROUP EXERCISE: Use of the inspection checklist for VIP toilets. How to design an inclusive toilet. GROUP DISCUSSION: Appropriate toilets from the perspective of gender and people with disabilities. 1330 - 1630 Recommended designs and materials – Standard drawings and BoQ. GROUP DISCUSSION: Requirements for pit linings and high water table situations. How do I build a toilet? How to use and maintain the toilet? Safety protocols to follow when the toilet pit is full. 12 August – Day 3 (Theory ½ day, Practical ½ day) 0830 - 0930 Opening. Recap discussions from the previous day. 0930 - 1030 Continuation of presentation on recommended designs, with a focus on VIP toilets. Question and Answer session. 1045 - 1245 Inclusive toilets. Gender inclusiveness and toilet designs. Practical tips on constructing toilet slabs, toilet risers and pit linings. Ratios for concrete mix. Question and Answer session. 1400 - 1700 Travel to Vao Island. Continuation of practical training and construction at 3 demonstration sites. 13 August – Day 4 (Practical) 0830 - 1700 Continuation of practical training and construction at 3 demonstration sites. 14 August – Day 5 (Practical) 0830 - 1700 Continuation of practical training and construction at 3 demonstration sites.

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Training-of-Trainers Workshop on Sanitation and Hygiene Guidelines – presenters and participants during theory sessions on 11 and 12 August

# Name Sector, Province or Organisation Position Notes 1 Keith Gasi Jacob Sanma Province Environmental Health Officer 2 Abel Karai Sanma Province Sanitation Officer 3 Loli Kalo Tafui Sanma Province Sanitation Officer

4 Sackias Tabi Sanma Province Sanitation Officer EHOs and Sanitation Officers from 5 Joe Firiam Shefa Province Environmental Health Officer Sanma, Shefa, Tafea and Penama 6 Yann Johnny Shefa Province Environmental Health Officer provinces were present from 10 – 14 August to oversee practical training of 7 Joswa Warri Penama Province Sanitation Officer community builders. 8 Simon Saica Tafea Province Environmental Health Officer 9 Selwyn Siro Penama Province Sanitation Officer 10 Malkali Bule Penama Province Sanitation Officer 11 Xavier Watt Malampa Province Environmental Health Technical Officer Malampa EHO and 2 Sanitation Officers stayed for an additional week from 17 – 12 Sylvester Harry Malampa Province Sanitation Officer 21 August. 1 sanitation officer stayed 13 Andrian Melipsis Malampa Province Sanitation Officer on from 24 – 28 August. 14 Ratu Bani Shefa Province Environmental Health Unit, MOH Co-presenters at the ToT workshop on sanitation and hygiene from 10 – 14 15 Stephanie Hamel Engineers Without Borders Australia Country Programme Manager August. 16 Grennethy Tavunwo Malampa Province Health Promotions Officer 17 Isabel Rory Vao Dispensary, Labung Nurse and Midwife Presenters during Women’s Awareness discussions in the community. 18 Rosaria Barthelemy Vao Dispensary, Tokvanu Nurse Aid 19 Belda Malantugun Vao Aid Post, Labung Village Health Worker 20 Herne Malantugun Labung Community Builder Involved during construction stage. 21 Emile Rory Labung Chief, Community Builder 12 Aug, construction stage.

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# Name Sector, Province or Organisation Position Notes 22 Hippolyte Rory Labung Community Builder 11 August, construction stage. 23 Gerard Teilemb Tokvanuaute Community Builder 11 and 12 Aug, construction stage. 24 Arthur Atpatun Tokvanuaute Community Builder 11 and 12 Aug, construction stage. 25 Sergio Atpatun Tokvanuaute Community Builder 11 and 12 Aug, construction stage. 26 Georgie Telukluk St Joseph Community Builder 11 and 12 Aug, construction stage. 27 Marie-Antine Telukluk St Joseph Women’s representative 11 and 12 Aug 28 Jenny Malkali St Joseph Women’s representative 11 and 12 Aug 29 Antoine Romerito Veturah Carpenter 11 and 12 Aug, construction stage. 30 Stephane Antoine Veturah Community Builder 12 August, construction stage. 31 Julio Meltecon Donmeral Community Builder 12 August, construction stage. 32 Andrick Meltemal Veturah Pastor 11 August 33 Batick Corentin Betehul Community Builder 11 and 12 Aug, construction stage. 34 Batis Meltelili Betehul Community Builder 11 and 12 Aug, construction stage. 35 Yannick Tevanu Betehul, Primary School Head Teacher 11 and 12 August 36 Pierre Betsesai Betehul, Primary and Secondary School Chairman Primary and Secondary schools 11 and 12 Aug, construction stage. 37 Rodrick Tebatune Tokvanu, Health Committee Paramount Chief, 11 and 12 August Chairman Health Committee 38 Kota Kamilo Tokvanu Community Builder 11 and 12 Aug, construction stage. 39 Sylvio Meltemal Beterihi Community Builder 11 and 12 Aug, construction stage. 40 Ben Belbon Beterihi Community Builder 11 and 12 Aug, construction stage. 41 Gratien Neirove Ambilak, Noroure Sigone Community Builder 11 and 12 Aug, construction stage.

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Programme of Women’s community awareness sessions – 14 to 20 August

When Sector Topics 14 August Noroure Sigone Sanitation and Hygiene - VIP toilets, emphasis on handwashing. 16 August Tokvanu, Betehul and Clean drinking water and demonstration of Sawyer bucket filters. Beterihivenu Covid-19 awareness. 17 August Labung Reproductive health. Secondary School Menstrual hygiene. 18 August Lawor Introduction of reusable sanitary pads and trial packs distributed. 19 August Tokvanuaute Handwashing technique demonstration. All sectors on Vao island – Cervical Cancer awareness (Ikkana Foundation) Tokvanu, Betehul, Beterihivenu and Noroure Sigone 20 August Veturah Sanitation and Hygiene - VIP toilets, emphasis on handwashing. Clean drinking water, demonstration of Sawyer bucket filters. Covid-19 awareness. Reproductive health. Menstrual hygiene. Introduction of reusable sanitary pads and trial packs distributed. Handwashing technique demonstration. Cervical Cancer awarenss (Ikkana Foundation)

Number of participants at Women’s Community Awareness – 14 to 20 August

Village/Sector Number of participants Village/Sector Number of participants Hone/Tokvanuaute 16 St Joseph 22 Unnamed village/Tokvanuaute 5 Veturah 20 Laniguebor/Veturah 1 Saralivo/Veturah 1 Lawor 17 Labung 22 Betehul 33 Tokvanu 25 Beterihi 10 Venu 2 Ambilak/Noroure Sigone 1 Noroure Sigone 25 Secondary School 40 TOTAL 240

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Record of recipients of Mamma’s Laef Reusable Sanitary Pads

Recipient Village/Sector/School Age >18 Age < 18 Recipient Village/Sector/ School Age >18 Age < 18 Celine Maltause Hone ✓ Ninette St Joseph ✓ Jenny Teileb Hone ✓ TOTAL 18 0 Nadia Malcekane Hone ✓ Aniva Malcekane Hone ✓ Agnes Tokvanuaute ✓ Kaianna Malcekane Hone ✓ Beonga Kalkandy Tokvanuaute ✓ Rosita Maltause Hone ✓ TOTAL 2 0 Mariette Meltenoven Hone ✓ Egenie Teilemb Hone ✓ Anne-Lise Antoine Veturah ✓ Cidy Teilemb Hone ✓ Marie Jeanne Antoine Veturah ✓ Dorine Hone ✓ Jutite Antoine Veturah ✓ Sadrina Teilemb Hone ✓ Doriane Asaor Veturah ✓ Aunorine Teilemb Hone ✓ Lydia Meltevielser Veturah ✓ TOTAL 11 1 Claivicka Naror Veturah ✓ Melanie Antoine Veturah ✓ Carol Telukluk St Joseph ✓ Elsie Chalet Veturah ✓ Crina Telukluk St Joseph ✓ Katline Basilio Veturah ✓ Marina Telukluk St Joseph ✓ Fiona Chalet Veturah ✓ Makrina Telukluk St Joseph ✓ Janine Amet Veturah ✓ Marie-Antine St Joseph ✓ Zoraya Veturah ✓ Gina Betsai St Joseph ✓ Amila Antoine Veturah ✓ Ruth Atpatun St Joseph ✓ TOTAL 13 0 Jenny Malkali St Joseph ✓ Justiana Telukluk St Joseph ✓ Linda Maleb Lawor ✓ Regina Malkali St Joseph ✓ Joanita Maleb Lawor ✓ Rose Malkali St Joseph ✓ Rosie Maleb Lawor ✓ Lauth Malkali St Joseph ✓ Therese Maleb Lawor ✓ Asaor Somitila St Joseph ✓ Morema Maleb Lawor ✓ Vanessa Neimkone St Joseph ✓ Glorius Ruvun Lawor ✓ Marie Joseph Terong St Joseph ✓ Oneline Maleb Lawor ✓ Florentine Atpatun St Joseph ✓ Lina Maleb Lawor ✓ Doriane St Joseph ✓ Emeline Maleb Lawor ✓

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Recipient Village/Sector/School Age >18 Age < 18 Recipient Village/Sector/ School Age >18 Age < 18 Vanessa Maleb Lawor ✓ Coralie Betsesai Betehul ✓ Lindia Ruvun Lawor ✓ Chantal Asaor Betehul ✓ Aniva Ruvun Lawor ✓ France Betsesai Betehul ✓ Sylvana Maleb Lawor ✓ Moreia Batik Betehul ✓ TOTAL 11 2 Nadine Betsesai Betehul ✓ Sergine Tevanu Betehul ✓ Theresia Rory Labung ✓ Sonalise Betehul ✓ Shella Rory Labung ✓ Catherine Melteras Betehul ✓ Dolores Rory Labung ✓ Mere Betehul ✓ Sophie Rory Labung ✓ Hereline Batik Betehul ✓ Rita Rory Labung ✓ Louisina Tevanu Betehul ✓ Claudine Rory Labung ✓ Jessica Batik Betehul ✓ Stelline Rory Labung ✓ Rosaria Betsesai Betehul ✓ Appoline Rory Labung ✓ Sonia Tevanu Betehul ✓ Rosina Rory Labung ✓ Melinda Labamu Betehul ✓ Joella Rory Labung ✓ TOTAL 19 4 Rose Rory Labung ✓ Belda Malantugun Labung ✓ Rosaria Barthelemy Tokvanu ✓ Cyndia Labung ✓ Sabrina Teilemb Tokvanu ✓ Michelle Labung ✓ Antonia Virvir Tokvanu ✓ Christelle Rory Labung ✓ Emeliene Teilemb Tokvanu ✓ TOTAL 14 1 Marie Louise Tokvanu ✓ Lina Melteronrong Tokvanu ✓ Helene Rory Betehul ✓ Olga Melteronrong Tokvanu ✓ Viky Tevanu Betehul ✓ Augustine Melteronrong Tokvanu ✓ Olive Tevanu Betehul ✓ Lokatie Kota Tokvanu ✓ Amelia Betsesai Betehul ✓ Estha Labamo Tokvanu ✓ Fanny Charley Betehul ✓ Cwedeline Melteronrong Tokvanu ✓ Susane Tevanu Betehul ✓ Clairise Patunvanu Tokvanu ✓ Christie Melteror Betehul ✓ Andoinette Tokvanu ✓ Rosita Melteror Betehul ✓ Linda Melterovo Tokvanu ✓

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Recipient Village/Sector/School Age >18 Age < 18 Recipient Village/Sector/ School Age >18 Age < 18 Carla Liliore Tokvanu ✓ Justiana Meltevielser Year 9/Secondary ✓ Anne Marie Tokvanu ✓ Carmina Tebatun Year 9/Secondary ✓ Pascalina Melterovo Tokvanu ✓ Andriana Melteronrong Year 9/Secondary ✓ Rafaela Teilemb Tokvanu ✓ Anne-Cira Betsesai Year 9/Secondary ✓ Germaine Labamu Tokvanu ✓ Verose Year 9/Secondary ✓ Julliette Lilior Tokvanu ✓ Haviana Year 9/Secondary ✓ TOTAL 19 1 Onnelyse Rory Year 9/Secondary ✓ Liziella Belosat Year 9/Secondary ✓ Lisa Meltemal Beterihi ✓ Marie-Estelle Meltevieler Year 9/Secondary ✓ Elssi Samy Beterihi ✓ TOTAL 0 9 Zita Meltemal Beterihi ✓ TOTAL 3 0 Faina Malturneim Year 10/Secondary ✓ Tatiana Tatsupris Year 10/Secondary ✓ Rory Tiendra Year 7/Secondary ✓ Kathya Belbong Year 10/Secondary ✓ Francisca Melterou Year 7/Secondary ✓ Georgette Naror Year 10/Secondary ✓ Raphaella Batick Year 7/Secondary ✓ Claire Maltaus Year 10/Secondary ✓ Lavinia Melteror Year 7/Secondary ✓ Emelle Batik Year 10/Secondary ✓ TOTAL 0 4 Berthe Maleb Year 10/Secondary ✓ Pamina Maltourneim Year 10/Secondary ✓ Ciriane Asaor Year 8/Secondary ✓ Angelique Moulanrugaru Year 10/Secondary ✓ Florinda Tevanu Year 8/Secondary ✓ Marie-France Tevanu Year 10/Secondary ✓ Felomina Virvir Year 8/Secondary ✓ Monelise Malteck Year 10/Secondary ✓ Nilricha Maleb Year 8/Secondary ✓ TOTAL 0 11 Stephanie Rory Year 8/Secondary ✓ Oriana Bayeo Year 8/Secondary ✓ Roselina Maltaus Staff Secondary School ✓ Anne-Marie Malaskan Year 8/Secondary ✓ Giselda Basilio Staff Secondary School ✓ Linda Yavet Year 8/Secondary ✓ Justine Kuse Staff Secondary School ✓ Marie-Paule Neirove Year 8/Secondary ✓ Annicka Malkael Staff Secondary School ✓ Felory Sam Year 8/Secondary ✓ TOTAL 4 0 Fedra Meltemal Year 8/Secondary ✓ Agnes Vanu Year 8/Secondary ✓ Adelle Atoiti Atchin ✓ TOTAL 0 12 TOTAL 1 0

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Recipients of Mamma’s Laef Reusable Sanitary Pads – by sector/village

Sector/Village/School Total Age >18 Age < 18 Sector/Village/School Total Age >18 Age < 18 Hone (Tokvanuaute) 12 11 1 Tokvanuaute 2 2 0 St Joseph 18 18 0 Veturah 13 13 0 Lawor 13 11 2 Labung 15 14 1 Betehul 23 19 4 Tokvanu 20 19 1 Beterihi 3 3 0 Year 7 Secondary 4 0 4 Year 8 Secondary 12 0 12 Year 9 Secondary 9 0 9 Year 10 Secondary 11 0 11 Staff Secondary 4 4 0 Atchin 1 1 0 TOTAL 160 115 45

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E: Sector Overview – Images of selected water sources and toilets in every sector

Quantitative quick-survey of toilets and handwashing facilities conducted by Vao Dispensary in July 2020.

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BETEHUL Total # Households – 59 Includes the Catholic Mission, Primary School and feeder kindergarten Water sources

Various wells shared between a number of households can be found throughout Vao island.

These wells are used for drinking, washing and cooking. Some households walk long distances to fetch water. Issues with contamination and brackishness have been identified by community focal points.

Purpose built rainwater tank shared between households of an extended family.

When clean drinking water becomes scarce, villagers go across to mainland Vao to fetch water.

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Toilets - BETEHUL

Meeting hall where communal VIP toilet will be built.

The above pour flush toilet was built by a household with a physically disabled man. Bamboo railings were specially built to help the disabled family member find his way to the toilet. Tippy-tap made with recycled plastic drink bottle with soap for handwashing. Structure of the toilet house was damaged.

Squat toilets at the primary school but no handwashing station. Cleanliness is a problem. The school has a rainwater collection system that works well in the wet season but stocks run down during periods of low rainfall. Following recent Covid-19 awareness, 10L water containers with taps were purchased for each classroom so that students can from the habit of washing their hands regularly.

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BETERIHIVENU – 2 villages of Beterihi and Venu Total # Households – 56 Water sources

Wells servicing several households. There used to be a hand pump attached to an old borehole (far right) that became disused about 20 years ago.

To alleviate the drinking water challenges on Vao Island, a 10 000L rainwater tank was purchased. After 2 years, the project is still not complete.

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Toilets - BETERIHIVENU

Examples of a pour flush toilet (far left), an unhygienic bush toilet with a plethora of flies buzzing around (middle) and a squat toilet that was partially damaged during TC Harold (far right). The roof of this toilet and part of its walls were torn away (below).

Toilet with water for manual flushing (far left), tippy-tap for handwashing (middle). Animal enclosures (far right) are common throughout the villages.

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TOKVANU Total # Households – 40 Water sources

The majority of households from this sector benefits from having a piped water network drawn from an existing borehole pre-independence. Some years ago, a Peacecorps volunteer organised a solar pump, water tanks and pipes. Most of the households are able to access drinking water from this source. Secondary sources of water for washing including laundry are obtained from wells pictured below.

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Toilets - TOKVANU

Meeting area where the communal VIP toilet will be located (above). Partially damaged toilet (below left and middle) and an example of a tippy tap for handwashing made from bamboo.

Examples of pour flush toilets (far left and far right). The squat toilet in the middle picture belongs to a household with an elderly male who uses an old chair frame to support himself. Squat toilets are problematic for those with knee issues or who are disabled. Some villagers are interested in exploring the option of modifying existing squat toilets with a toilet riser and seat. Making these risers are part of the practical training in VIP toilet construction.

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NOROURE SIGONE AMBILAK – 3 villages Total # Households – 63 Water sources

Villagers from this sector experience the usual problems with brackishness and health risks associated with contaminated water from ground wells pictured above. During the field trip in July, participants questioned whether the drinking water well below is situated too close to the toilet.

< 15m Toilet

Well

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Toilets – NOROURE SIGONE

Meeting hall (above) where the communal VIP toilet will be located

Toilet structures (above right and below) rebuilt after the cyclone. Tippy taps made from recycled plastic drink bottles (circled yellow) are being encouraged for general hygiene and during Covid-19 awareness.

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VETURAH – > 5 villages Total # Households – 76 Water sources

This is the largest sector on Vao with ay least 5 villages that are spread across a relatively large area. Due to the distances to hand pumps attached to boreholes (see below), many households rely on easily accessible wells as a primary source of water for drinking, washing and cooking. If well water is too brackish for drinking, families use the water mainly for washing. TC Harold contaminated several drinking water wells.

Workshop participants inspecting a well in the village of St Paul with the nurse and Health Promotions Officer (below).

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One of a small number of rainwater collecting systems belonging to a household (above left). The picture on the right is a covered space for doing the dishes. Designated ‘clean areas’ for food preparation and storing utensils and crockery are actively encouraged during health promotion sessions.

There were several hand pumps attached to boreholes in the past but only 2 are currently operational. Both of these pumps can be found in this sector. Both pumps are situated on the outskirts requiring villagers to travel on foot each day, with wheelbarrows and buckets. Not all villages use these pumps due to the distances involved.

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Toilets - VETURAH

Pourflush toilets and squat toilets (above) are similar. Both require manual flushing to function properly. There is a local builder on Vao who acquired the mould for waterseal (squat) toilets previously. Hence these toilets are more commonplace here. This builder is a participant and is interested in learning how to build VIP toilets, which do not require water. Some toilets were damaged during the cyclone and have been partially repaired, others are not well-maintained and have become unhygienic. The pictures below show the ablution block of a well-maintained pourflush toilet and toilet house.

Presbyterian Church Catholic Church meeting hall

The chief chose the locations of 3 of the 5 communal VIP toilets (above and below) in places of worship due to the large numbers of people who will be using the facilities.

Neil Thomas Ministries

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ST JOSEPH Total # Households – 32 Water sources & Toilets

2 wells servicing the small community of St Joseph, and the structure of a toilet house (below right).

The Women’s Centre meeting hall (below) is the proposed site of the communal VIP toilet.

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TOKVANUAUTE – 2 villages of St Patrick’s and Hone Total # Households – 57 Water sources

A row of tippy-taps for children to practise handwashing at 1 of the 2 kindergartens in this sector. This one is in the village of Hone.

Tokvanuaute, along with the sectors of Lawor and Labung on the mainland benefit from at least 3 pumps operated by mains and solar power. One of these pumps and water distribution system (pictured below) are privately owned by a large extended family with several households. The head of the family is pictured below next to one of the taps in his compound. Wells are still used as secondary sources of water for washing, pictured above.

There is also a natural spring in this sector that services at least 100 people. Approximately half the population of this sector shares a water pump with the neighbouring sector of Lawor.

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Toilets - TOKVANUAUTE

The second kindergarten in this sector, at St Patrick’s Village, where a VIP toilet will be sited. Teacher Marie- Agnes showing the location where the pit will be dug, pictured below.

A second VIP toilet for this sector will be built at St Patrick’s Catholic Mission.

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LAWOR Total # Households – 20 Water sources and Toilets Primary water source that feeds into a distribution system for 1-1/2 sectors.

Primary water source

Along with half the population of Tokvanuaute, this small sector shares a water pump that is operated on mains power. The water source is pictured above left.

Some households have secondary water sources such as the well pictured above right, used mainly for washing.

A shared bush toilet, pictured left.

Lawor is one of the sectors where there is an ongoing land dispute preventing new structures from being built.

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LABUNG Total # Households – 25 Water sources and Toilets

Households in this sector have running water from a borehole with a generator-powered pump feeding water into a concrete tank.

Toilet

Fittings and the pipe that feed into the borehole (above left). Questions were raised by the focal point as to whether the bush toilet (circled yellow) is too close to the main water tank used for drinking purposes.

Secondary water source from an 8m well, the only well in Vao with a pulley and rope system to draw water.

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Water from this well (below) is used for washing only. Partially completed waterseal toilet (below right).

Vao Aid Post (below) where there will be a communal VIP toilet in its vicinity. The second VIP toilet will be built at the community meeting area close to the chapel.

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