Learning brief: Achieving District Wide Sanitation – lessons from Banteay Meas,

Introduction Sustainable Sanitation and Access to improved sanitation is a basic human Hygiene for All (SSH4A) is SNV’s right, yet more than 60% of the rural population in Cambodia still live without a safe, comprehensive approach to sanitary toilet.1 ensuring equitable and sustainable Operating district-wide, compared to supporting access to improved sanitation and only selected communes or villages, achieves hygiene by supporting the delivery economies of scale and is more effective in of district-wide rural sanitation and building momentum and achieving sustainable results. The commitment and leadership of the hygiene services. local authorities is essential, and greater Developed since 2008, the SSH4A buy-in can be achieved when working area-wide. This does not mean that the entire approach is now implemented district will immediately become Open Defecation by SNV in 15 countries and 75 Free (ODF), but works towards changing the districts in Asia and Africa. More dynamics and mindset of the stakeholders, which is the key to reaching full coverage.2 than 2.7 million additional people now have access to improved Through capacity building, learning and sharing, the building blocks for a scalable district-wide sanitation and more than 9 million approach have been established in Cambodia. have benefitted. This brief provides highlights of the SSH4A approaches implemented to support further district-wide progress.

1. The 2015 Update and MDG Assessment of the Joint Monitoring Programme (WHO and UNICEF, 2015).

2. When working at a village level the tendency is to go for the easier villages without addressing the bigger institutional picture that is essential for sustaining behaviour change. The SSH4A approach recognises the SSH4A in Cambodia need to: SNV, in collaboration with the Ministry of Rural • understand that sustainable sanitation Development (MRD) and Provincial Department and hygiene is first and foremost about of Rural Development (PDRD), is implementing behavioural change. However, whilst demand SSH4A in Cambodia. The SSH4A model is creation should come first, affordable recognised as an innovative and integrated hardware solutions also need to be in place approach to scaling up access to sanitation so that people are able to act upon their in the rural areas of Cambodia and supports newly defined priorities4 the objectives of the Royal Government of Cambodia’s National Strategy for Rural Water • reach all by making explicit inclusive Supply, Sanitation and Hygiene 2011-2025. strategies with local stakeholders that aim to ensure that the needs of women and In 2012, SSH4A was implemented district- men from a range of social groups are taken wide in Banteay Meas, with a focus on into account, that effective participation is building the capacity of the partner agencies at achieved at all levels and that gender equality provincial, district, commune and village level to is advanced plan, implement and monitor the sanitation and hygiene interventions. In 2016, Banteay Meas • develop capacities and approaches that was declared the first ODF district in Cambodia. can be scalable, through a government-led approach, as opposed to focusing exclusively The leadership and commitment of local on individual communities authorities is key to this success. Utilising learnings from Bantey Meas, in 2015 SSH4A was • innovate in hygiene promotion practice, scaled-up in Basedth district, Kampong Speu and linking this to the sanitation drive, but also Chum Kiri district, Kampot. The 2016 mid-term embedding this practice in long-term health results showed that in both districts access to promotion; and a long-term strategy is sanitation had more than doubled since the required to sustain sanitation and hygiene 2015 baseline.3 behaviour change, beyond one-off triggering and ODF-focused programmes • measure progress in small steps (moving up SSH4A Integrated Approach the sanitation ladder) and to measure access as well as the use and maintenance of toilets In order to ensure equitable and sustainable and handwashing with soap. access to sanitation, a comprehensive and integrated approach is needed. Strategies such Highlights of the key activities that have as demand creation and sanitation marketing supported the government-led district-wide need to be embedded in longer-term processes SSH4A approach are as follows: that develop sustainable service delivery models at scale. Capacity for steering and implementation of Designed to address this need SSH4A is sanitation demand creation essentially a capacity building approach, To build capacity for implementing demand supporting local government to lead and creation activities at scale that create accelerate progress towards district-wide momentum, SSH4A focuses on building sanitation coverage with a focus on institutional the skills of individual community led total sustainability and learning. SNV, through SSH4A, sanitation (CLTS) facilitators to implement focuses on strengthening local stakeholders to effective triggering and follow-up activities plan, implement, monitor, and sustain sanitation that take into account differences between and hygiene interventions. The SSH4A approach communities. SSH4A also works towards building integrates best practices in sanitation demand organisational capacity of the local authorities creation, sanitation supply chain strengthening, across different levels (province, district, hygiene behaviour change communication, and commune and village) to organise and steer governance, including gender and demand creation activities, with attention social inclusion. to quality. As a result of the capacity and technical support, PDRD/DoRD has led the planning, implementation and monitoring of the WASH governance demand creation activities and local sanitation committees have been established and regularly review progress. In addition, regular and frequent follow up and sanitation promotion has Sanitation Sanitation supply been conducted by commune focal points and demand chains & nance mainstreamed through key local stakeholders creation Sustainable sanitation including health centres, schools and pagodas. & hygiene for all Capacity for sanitation supply chains and finance Hygiene behavioural change communication Based on SNV’s experience in value chain development and sanitation marketing, SSH4A Specic institutional and cultural context works towards realising market-based solutions

3. Details at .

4. For affordable supply to be available to households at the moment of triggering, work to improve the supply side should start well before. that meet a range of consumer needs and reach different geographical areas and poorer preferences. They must also be responsive to households, including prioritising use of the changing demands, as communities progress commune fund, and sets clearer standards that beyond ODF. Consumer studies, supply chain can reduce contradictions between analysis and business modelling are used to the approaches. understand sanitation demand and identify supply constraints. The experience in Banteay The planned sanitation and hygiene needs are Meas highlighted the need to target different now integrated into the commune development consumer segments5 - adjusted or alternative and investment plans and regular village, products are needed for lower-income groups. commune and district meetings are held to Analysis is developed in partnership with MRD review results and share experiences and and local government agencies; this increases solutions for addressing difficult issues. local capacity to undertake this work in future Close monitoring of sanitation progress has and understand potential barriers to private strengthened local commitment to sector engagement and financing mechanisms. achieving results. Through SSH4A, local suppliers have been SNV engages both locally - local government, supported to engage or expand their businesses the private sector and civil society - and at into rural sanitation, including through training national level: working with MRD, national on marketing and business management, and agencies and development partners to support strong cooperation and coordination among sector reform. Many barriers for accelerating supply chain actors has been established. PDRDs progress and effective up-scaling are found now provide technical support to suppliers and in having competing or contradictory WASH commune and village sanitation focal point are approaches implemented within the same area. directly coordinating with them. Presence at the different levels of government not only creates synergies, but also facilitates Capacity for behavioural change learning with the ultimate aim of improving the communication (BCC) overall performance of the sector. Recognising the need for local innovation in hygiene promotion practices and translating international insights into local understanding to achieve better quality results, SSH4A works to introduce and build capacity in BCC methodologies at the local level with the active involvement of MRD and PDRD. The approach consists of a participatory review of existing information, education and communication (IEC) or hygiene promotion work, definition of priority behaviours, building skills in formative research, development of BCC strategies, design of messages and campaigns and, finally, monitoring effectiveness. Outreach includes radio and TV spots, pagodas, schools and health centres along with community campaigns using parades, special sanitation school events and National Sanitation Day. Strategies are being adjusted in response to evolving priorities, including additional focus on promoting menstrual hygiene management and safe emptying practices.

Capacity for WASH governance SNV’s experience has shown that building capacity and leadership from the start is essential to delivering sustainable and scalable WASH interventions. SSH4A works to build the capacity of local authorities to promote and achieve district-wide coverage, which requires addressing equity through targeting both the poorest communities and households. Through SSH4A, local leaders and sanitation focal points now work together in setting goals to improve sanitation in their area. The development of sanitation and hygiene plans with clearly defined objectives, annual targets and action plans has been fundamental to building commitment and collective understanding of issues and actions required. The district-level focus incentivises stakeholders to discuss the needs and approaches to Second ODF commune: Sdach Kong Khang Leck

5. It was found that while the “Easy Latrine” would boost sales, it closer met the needs of middle to lower-middle class customers. Key Learnings from SSH4A What Next? The emphasis of the current phase of the in Cambodia SSH4A programme is on quality, equity and Achieving sustainable district-wide improvements sustainability. Commitment and leadership of in the sanitation situation and hygiene practices the local authorities has been shown to be the takes time as well as tailoring of messages and key to building momentum and sustaining ODF approaches so as to reach all communities and status, however, while ODF provides a milestone households, including for leaders to mobilise around, it is not the the poorest. end-point. The challenge is looking beyond ODF towards the vision of the Sustainable • To ensure institutional sustainability it is Development Goals and universal access. important to embed sanitation and hygiene requirements within established local The lessons learnt from the SSH4A approach in government administration processes. Banteay Meas, which has been demonstrated to be effective in achieving accelerated impact in • Local leadership commitment to sanitation is rural sanitation and hygiene, will continue to be key to success. Supporting local leaders and used to support the government to scale up the sanitation committees to take ownership and comprehensive approach in Cambodia. be accountable for the results and progress in their areas also encourages them to identify local solutions and incentives. • Supporting the capacity of the district authorities to lead consultation and development of sanitation and hygiene plans with clearly defined objectives, annual targets and action plans has been fundamental to building commitment and collective understanding of issues and actions required. • Working collectively helps build and accelerate momentum. A multi-stakeholder approach helps harmonize competing or contradictory approaches within the same area, as well as strengthening and expanding Review of sanitation progress data the reach of the key messages. • Knowledge sharing, exchange visits, learning and reflection of successes and lessons learnt among stakeholders and sanitation focal points locally and internationally have been seen as important in motivating and strengthening commitment of local leaders working to improve sanitation and hygiene.

Author Jenni Lillingston February 2017

Further information To learn more about SNV and our work in Cambodia, visit our website at www.snvworld.org/en/cambodia SNV is a not-for-profit international development organisation. Founded in the Netherlands nearly SNV Cambodia 50 years ago, we have built a long-term, local P.O. Box 2590 presence in 38 of the poorest countries in Asia, #184 (2nd Floor), Street 217 (Monireth) Africa and Latin America. Our global team of , Cambodia local and international advisors work with local Tel: +855 23 994562 partners to equip communities, businesses and Fax: +855 23 994563 organisations with the tools, knowledge and connections they need to increase their incomes Contact: Sunetra Lala and gain access to basic services – empowering WASH Sector Leader them to break the cycle of poverty and guide their Email: [email protected] own development. All photos by SNV staff