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Extension Agent reorganization forCommunity Led Total Sanitation (CLTS)Implementation and MonitoringAshley Meek and Michael KennedyEngineers Without Borders CanadaMonitoring for sustainable open defecation free statusIbex Room, 09/04/2013
1. How is ODF defined – what indicators areused? ODF: Every household uses a latrine withprivacy, there is no shit in the bush(sharing isacceptable) ODF ++: Every household has and uses a latrinewith cover and hand washing facility; all primary andsecondary schools, CBCC’s, religiousinstitutions, market centres and health centres in thevillage have latrines with covers and hand washingfacilities
2. Who conducts the monitoring and whosupports them? Typical Health Centre Organization Block System OrganizationHSA: Health Surveillance AssistantAEHO: Assistant Environmental Health OfficerAEHOSr. HSAHSA HSA HSA HSA HSA HSA HSA HSA HSA HSAAEHOBlock 1(Sr. HSA; HSA; HSA)Block 2(HSA; HSA; HSA)Block 3(HSA;HSA;HSA;HSA)Block 4(HSA; HSA;HSA;HSA)Block 5(HSA; HSA; HSA;HSA)
3. How often is monitoring done? Expectation Setting Basic Calculation of CLTS activities as a group The purpose is to provide a simplified guideline to HSA blocks so that theycan track their CLTS activities. Unique cultural and topographic conditions within each Health Centre’scatchment area will impact the level of effort required for CLTS and blockformation. Extension staff are able to include CLTS in their regular planning and followup on the expectations they have set to determine how reasonable they are.
INumber of HSAsxDays in a weekxWeeks in a month=Workload Capacity5 5 4 100Mark With X Only complete for Category A activitiesTask/Activity AreasCategoryACategoryBCategoryCNumber of HSAsconducting Activity?Number ofLocation(s)?Frequency permonth (for oneHSA for onelocation)TotalHSAs x Locations xFrequency =Office Work:Nutrition; Malaria; Early InfantDiagnosis; Drug DistributionX 2 1 5 10Patient Follow-up:Palliative Care; Home-Based Care;TBX - - - -Outreach Clinic:Immunization; Growth Monitoring;Family Planning; IECX 4 1 4 16CLTSTriggering; Follow-upX 5 Number of OD Villages x 4.5 ÷ Number of months until target date10Monday MeetingX 5 1 4 20Data Collection/ Inspections:VHR; Institutional Inspections;Disease Surveillance; School HealthX 1 11 1 11Water TestingTesting; ChlorinationX 1 11 1/3 4VHC Activities:Training; MeetingsX 1 11 1 11Specialized Tasks:Larva Spraying; HTC (HIV); etcX - - - -Total Level of Effort CommitmentDetermine Workload CapacityDetermine Expectations826
4. What system / methodology do they useto collect and store data
5. Where is data stored and who analysesthe data?Local Health Center District / National
Group: One Two ThreeAveragePercentage (Add% of each groupthen divide bynumber of groups)Health Centre Monthly ActivitiesReportNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadNumberofOccurrencesPercentageofworkloadTask/Activity AreasOffice Work:Nutrition; Malaria; Early Infant Diagn6osis; Drug DistributionA15A ÷ Z19 12 15 14 15 16Patient Follow-up:Palliative Care; Home-Based Care; TBB4CB ÷ ZC 0C C 2C C COutreach Clinic:Immunization; Growth Monitoring; Family Planning; IECC16C ÷ Z20 16 20 18 19 20CLTSTriggering; Follow-upD5D ÷ Z7 10 12 12 13 11Monday Meeting E20E ÷ Z25 20 24 22 22 24Data Collection/ Inspections:VHR; Institutional Inspections; Disease Surveillance; SchoolHealthF9F ÷ Z11 10 12 12 13 12Water TestingTesting; ChlorinationG5G ÷ Z7 4 5 5 6 6VHC Activities:Training; MeetingsH9H ÷ Z11 10 12 12 13 12Specialized Tasks:Larva Spraying; HTC (HIV); etcI0I ÷ Z0 0 0 0 0 0TotalZ79 82 95 100TotalHSAs x Locations xFrequency =10-16102011411-8396. Are you monitoring progress against plans or targets, if so how isthis done and how does this impact on the progress or on the targets /plans?
District(e.g. AEHO)HCOther HC(e.g. HSA, sHSA)Other CatchmentArea(e.g. HSA)VHC(sHSA)HCTraditionalLeaderNGOrepresentative7. Who declares a community ODF? Whovalidates / certifies?• HSA block w/ 1-2 independent verifiers
Verification Process FlowStep 1:Self –Identification• All householdsStep 2:VerificationTeamFormationVerification In1 Village• Sample 10 % ofhouseholds in 1villageVerification InAn Area• Sample 5 % ofhouseholds in anarea
8. (How) is monitoring continued post-ODF? Extension Agents responsible for the communitymust do regular 6 month sanitation checks for theNational M&E framework. The HSAs plan monthly CLTS and Sanitationactivities with their Block
9. What feedback mechanisms /information sharing systems are in place?DistrictEnvironmentalHealth OfficerAssistantEnvironmentalHealth OfficerHSA Block
10. What are the key challenges with thisapproach to monitoring? Training and roll out – understanding benefits Lack of stationary / resources Lowest common denominator effect Negative competition between blocks and/orblock members Over simplified tools resulting inmisunderstandings or missed activities Lack of group management resulting in blocksnot creating their monthly plans or being heldaccountable to them
11. What have been its main successes? Streamlined training of HSAs Prioritizing CLTS Monitoring activities Understanding impact of CLTS activities onextension agent workload overall. Accountability Monitoring CLTS activities using the BlockSystem at the field and district level