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Es 8 2-2013


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  • 1. Dr. Than Win Deputy Director Environmental Sanitation Division Department of Health
  • 2. Total Population India China Thailand Bay of Bengle Area Growth rate States & Regions Districts Townships Wards Villages U5 Mortality Infant mortality Life expectancy 60 million 676.578 Sq km 1.75% 14 66 330 2,786 64,910 46.1 37.5 64.5 2
  • 3. • Sanitation Programme began in 1982 • Changed to Demand driven approach in 1996 • Annual National Sanitation Week from 1998 until 2011 • Accelerated progress in access to improved sanitation • Diarrhoea rates in under five children indicate slippage • Low maintenance • Low use • Lack of awareness • 2011 introduction of Community Led Total Sanitation (CLTS) • National Sanitation Campaign launched in 2012 to accelerate progress, includes CLTS
  • 4. Timeline of Sanitation Progress in Myanmar Demand Driven Sanitation Approach Supply Driven Sanitation Approach National Sanitation Week Movement 2011 Ends Community Based Health Education 1986 Sanitation Programme 1982 1985 National Sanitation Week Movement 1998 3 Cleans - Hands, Toilet & Water - 1996 1990 1995 National Sanitation Campaign 2012 Introduction of 4 Cleans - Food - CLTS 2010 2001 2000 2005 2010
  • 5. 76% coverage, 83% urban, 73% rural (JMP 2012)  60% increase in diarrhoea between 2003 and 2010 (MICS 2003 and MICS 2010)  Most of the Township health profiles indicate high levels of under five mortality from diarrhoea and dysentery  Open defecation:    1 % Urban, 8% Rural - JMP 2012- whole country average 3% Urban, 19% Rural - KAP 2011 - areas with high prevalence of infant mortality, poverty, etc.
  • 6. 16% 100% Myanmars Sanitation Progres: 1995 - 2010 90% 80% 70% Open Defecation 50% Unimproved latrine 40% 30% 20% Excreta Disposal Method 60% 12% 10% 8% Improved latrine 6% Piped/Septic Tank U5 Diarrhoea 4% 2% 10% 0% 0% 1995 Under 5 Diarrhoea 14% 2000 Year 2003 2010
  • 7. 17% 83% Improved Latrine 6% Unimproved Latrine 30% 65% Functional Not functional Partially functional
  • 8.  To advocate high political commitment  To raise community awareness on importance of safe water supply and proper excreta disposal,  To involve various sectors including NGOs, enhance implementation and support monitoring and management in various States/Regions.  Special emphasis on Community-Led Total Sanitation(CLTS) to meet MDG goal (7)
  • 9. Community-Led Total Sanitation in Myanmar      Community participatory appraisal on Behavior Change Communication (BCC) Community empowerment Development of sustainable environment by Community Primarily stressed on to develop Open Defecation Free (ODF) community No subsidy
  • 10.  Yes for community subsidy  No top-down  No teaching, learning from community  Sanitation Marketing  Triggering the Solidarity spirit among the villages  Continued to total sanitation ( drainage, wastewater disposal, solid waste disposal)  Continued to development tasks of villages, township, States and Regions
  • 11. Pre-triggering Selecting a community Introduction and building rapport Triggering Participatory sanitation profile analysis Ignition moment Post-triggering Action planning by the community Follow up Scaling up and going beyond CLTS ( including monitoring, supervision and evaluation on previous ones)
  • 12.          Advocacy meeting Pre-triggering Triggering Post-triggering Monitoring Declaration of ODF Scaling-up of CLTS Sanitation marketing Developing of solidarity sprit
  • 13.  Capacity improvement and empowerment of community  Developing of solidarity sprit  Leading role carrying-out for all sanitation activities  Leadership of development tasks for village and township  Scaling-up from villages to Townships, States and Regions
  • 14. Calculating amount of faeces produced Households can use their own methods and measures for calculating how much human excreta they are generating each day. Multiplication can be used to find a figure for the whole community, and to calculate the amount of faeces produced each week, month or year. The quantities usually surprise the community. The calculations lead into further discussion about where the faeces go and the effects of having faeces on the ground. The key point in the process is reached when the community realizes that open defecation needs to stop- a juncture known as ‘triggering’.
  • 15. Transect walk The process often starts with an informal talk with a few community members during a walk through the village. During the walk, areas of OD are pointed out, as well as different types of latrines currently in use. It is important to stop in the areas of OD and spend time there asking questions. Having their attention drawn to the unpleasant sight and smell by a visitor to the community is a key factor in triggering mobilization. Once the interest of a few community members has been captured, the process continues to trigger CLTS.
  • 16. Children’ activities Children can be very strong advocates against open defecation. For example, they might lead procession where they shout slogans or sings about the need to stop open defecation.
  • 17. Natural Leaders
  • 18. Activities that communities might decide to carry out include: *forming a sanitation action group with representatives from every neighborhood in the community *making a list or map of households and their access to sanitation *digging pits and using them as temporary latrines until others are constructed *getting wealthy households to start constructing latrines immediately; these households could donate wood or bamboo for constructing latrines, allow poor families to use their latrine in the short term
  • 19. Action planning
  • 20.      CLTS TOT training course was conducted at (2) times in Myanmar during 2011 and trained by with sponsorship of UNICEF Government staffs from Department of Health, Department of Development Affairs, Department of Education and personnel from NGOs, INGOs Field implementation at Two Townships Achieved the active participation in both trainings New approach was very interesting for all participants
  • 21.       Pilot CLTS IN Tatkon Township nearer to Nay Pyi Taw, new capital of Myanmar Implemented by means of no subsidy and no topdown Active participation of Tatkon community Able to trigger to community and BHS staff Five villages became CLTS village Monitoring, supervision and evaluation Superior Requirement in CLTS approach
  • 22.       1 % Urban, 8% Rural (JMP 2012) 3% Urban, 19% Rural (KAP 2011) MICS is whole country average KAP study looks a areas with high prevalence of infant mortality, poverty, etc. 62% of households had family members working in the field and 69% defecate openly while working in the field (KAP 2011) Extent of practice of open defecation is a threat to health
  • 23.      CLTS Pilot project implementation in Tatkone township in Nay Pyi Taw CLTS implementation in (10) townships Kawa , Tanutbin, Waw and Paungde townships in Bago Region Nyaungdon, Kyaunggon , Hintada, Kyaiklat, Bogalay and Ngaputaw townships in Ayeyawady Region Successful implementation in above (11) townships including pilot township Tatkone
  • 24.  Through the developing of many OD Free villages  Scaling-up is under piping  Monitoring, supervision and evaluation Superior Requirement in on-going Sustainability is Still problematic in some flooded villages due very recent flood of heavy rain
  • 25. 4 5
  • 26.  Convert knowledge of good hygiene into practice  Concerted and coordinated efforts of the Government, Local NGOs , INGOs and People  Acceptable and functioning community latrine designs.  CLTS results in maintainable latrines, within community's budget  Donors and other stakeholders desire to subsidize latrine construction  Get accurate sanitation indicators in 2014 census
  • 27.  Dramatically increased the Sanitation Coverage from 45% in 1995 to 84.6% in 2010  Successful 4 Cleans Campaign since 1996 has improved peoples knowledge of hygiene and sanitation  "Sanitation for all by year 2015" Guideline based on National Health Policy - High level political commitment down to grass-root level - National Sanitation Campaign (NSC) through CLTS
  • 28. Act now! CLTS, to achieving Millennium Development Goal. Thank you