From the case study we identified 20 Strengths, 11 Challenges, 3 Risks and 6 Opportunities
VWU = Vietnam Women’s Union; CHW=Community Health Worker; VH=Village Head.
FGD + Focus Group Discussion. The observations were done in the presence of the mason who had built the toilet, to discuss any observed issues.
The gap that occurred between Phase I and Phase II was introduced in slide 4 and could be seen to have led to an immediate drop in number of toilets built. It was therefore very challenging to know what had happened after the pilot project had ended.
The seven indicators given above resulted in the selection of two districts where progress and results had been better during the pilot project and two where the progress and results had been less positive. In each district we again selected purposively one better and one less good commune. This was to get the most balanced composition of the study sample, as we were also interested to see if we could identify why some communes stood out – the analysis of this will come in the final report.
Bullet 2: E.g. types of toilets FGD members had installed in relation to user satisfaction; Statistics: Some communes did not reply, others only could retrieve data for the last 2 years only. Statistics from Health Dept and Commune Stats Officer were not always consistent. Jaime Frias previous head of IDE VN now sent his files, but not yet all data have been analyzed.
Background: This photo is very typical for Vietnam. The Party makes an annual inventory of the promoters, looking at whether they perform their duties and have themselves met the criteria of a ‘cultural’= modern household. For the Party the promoters are the role models in the communes. The photo is also typical for the interview settings, with meetings with promoters in the People’s Committee halls.
DVPF = Double Vault Pour Flush composting toilet The lower installation of composting toilets is a missed opportunity for farmers especially, because costs of chemical fertilizers become ever higher and resources of nitrogen (only two in the world) are getting depleted. There is also the problem that septic tank toilets are not sanitary, unless they include regular emptying and safe end disposal. I shall give some information on economic gains from modern composting toilets based on agricultural research in Malawi and Nepal.
Although the focus was on household toilets, the study showed that omitting the toilets of the People’s Committee offices is an important gap, especially because the Party stresses role models of party cadres. This aspect came out in the interviews with the authorities – not yet in the preliminary report, but will be in the final report.
CLTS= Community Led Total Sanitation. CHCs=Community Health Clubs(now piloted by MoH). BoQs = Bills of Quantities (amounts of materials needed to construct a particular toilet). Having a BoQ makes it possible to save for the components and buy them straight away, then store them until the construction can start. This method avoids the effect of inflation, helping people to know what they can buy in advance. However, they need to know under what conditions to store, and which material looses quality when storing. Communes do not have to be 100% Open Defecation Free (ODF) to see public health improve. Steve Esrey of UNICEF already proved that a critical mass of 75% was enough to get a public health impact. The last quarter is however important for equity, dignity, social justice and personal health (health for all), rather than public health. Scaling out is that promoters and providers in pilot communes and districts train fellow promoters and providers in neighboring communes and districts. It is also called ‘horizontal learning’. By giving the workers a small honorary for visits, they become facilitators in other communes. Funding can in principle come from the own Depts., as very little money is involved – only cost of transport and daily allowance. The recipient communes can be asked to provide space, catering etc. The steps in the photos: 1. Classifying who are poor in commune (=not necessarily all or same who are on the official poverty list, according to the study team. This is same in India and Indonesia. From Indonesia I have hard evidence from a study I did in Flores for WSP. 2. Mapping sanitation conditions in commune (type of toilet - sanitary/non sanitary/none - per household per class). Local people know. Involvement is usually high and the subject ‘starts to live’. The result is often an eye opener for the community. Step 3 in next slide.
Close-up of a community sanitation map: rectangle = better off, triangle poor, circle in-between, red = unsanitary toilet, green = sanitary. Yellow= open defecation areas. Step 3: Make the commune sanitation matrix = baseline situation. Plan action and monitor action results, noting outcomes in the map and matrix. It is done by the people for the people. Local promoters are the facilitators.
R&D = Research and Development (as a project).
RSM= Rural Sanitation Marketing; VN = Viet Nam; CHW=Community Health Worker; VWU=Vietnam Women Union (leader); VH=Village Head. The combination of three local cadres working together for the same goal and cooperating with other unions (farmers, soldiers, youth, students, etc.) are strong points of RSM in Vietnam. Other countries may not have the same institutions. E.g. Indonesia has a national women’s organization and program (PKK), but discussions with my Indonesian colleagues confirmed that home visits by the lurahs (politically elected community heads, belonging to different parties, not a one party system as in Vietnam) are unlikely to work. They said that lurahs are unlikely to pay home visits to promote toilets and people would resent it if the lurah (village head) called on them for this kind of social pressure. I have of course no proof that it would not be possible and work, perhaps this can be tried out. In India, there is no national women’s union and the Sarpanch (village head) is a politically elected person, like in Indonesia. However, in the state program I worked in, good experiences were obtained with promotion by the members of local sanitation committees, chosen at the lowest admin level (ward=c. 500 households) with the ward MP as the .... how do you call that again (ex officio?) (someone who is automatically a member because of his/her position). I am adding this for you and the final report, not to present at the Hanoi workshop, that would go too far for the participants.
Participatory material needed for small group meetings of those without sanitary toilets: drawings of each model with various material options and bills of quantities per model, plus a tool to identify the different financing options and discuss the advantages and disadvantages of each option, before making decisions on which household will install what option, how they will install as a group and what financing mechanisms the households, or the group, will use.
VWU= Vietnam Women Union, MoH=Ministry of Health. RSM= Rural Sanitation Marketing; CLTS=Community Led Total Sanitation, CHC=Community Health Clubs. The providers already use peer learning. The promoters not yet and they do not go beyond own communes. MoH and VWU could stimulate that trained promoters train colleagues in neighboring communes and districts and offer a small incentive to them to do so, e.g. X days per year.
Final Stakeholders Meeting Hanoi, 8 September 2009
Outline: <ul><li>The pilot project (2003-2006) </li></ul><ul><li>The case study: Context, objectives, design </li></ul><ul><li>The findings: </li></ul><ul><ul><ul><li>Strengths </li></ul></ul></ul><ul><ul><ul><li>Challenges </li></ul></ul></ul><ul><ul><ul><li>Risks </li></ul></ul></ul><ul><ul><ul><li>Opportunities </li></ul></ul></ul><ul><li>Conclusions and next steps </li></ul>
<ul><li>Pilot project on rural sanitation marketing by IDE Vietnam, supported by DANIDA, </li></ul><ul><li>January 2003 – December 2006: </li></ul><ul><li>Rural sanitation market assessment; </li></ul><ul><li>Greater range of sanitary toilet technologies at lower, and indicative, construction costs, no toilet subsidies; </li></ul><ul><li>Training local providers suppliers, builders) on new models, service delivery, cooperation and management; </li></ul><ul><li>Training local promoters (VWU, CHW, VHs) to activate and raise sanitary toilet demand through women in households. </li></ul>100% self-financed! Subsidized toilet... Photo IDE <ul><li>The pilot project </li></ul>
<ul><li>The project stimulated the construction of 16, 261 sanitary toilets; </li></ul><ul><li>Average annual construction was 4,605 sanitary toilets/year; </li></ul><ul><li>This is 3 times the average under the government (2000-2002); </li></ul><ul><li>If the project gaps are excluded, the annual rate is even 4x higher; </li></ul><ul><li>For each US$ 1 the project invested, the households invested almost 3. </li></ul>Sanitary toilets construction over 3,5 years: <ul><ul><ul><ul><li>The pilot project </li></ul></ul></ul></ul>
<ul><li>Context of the Case Study: </li></ul><ul><li>Vietnam’s second National Target Policy (NTP2) ends in December 2010. Rural sanitation achievements are less good than for rural water supply. NTP3 will be formulated for 2011 - 2015. The case study results are relevant for the sanitation strategy of NTP3; </li></ul><ul><li>WSP is implementing a Global Project on Total Sanitation and Sanitation Marketing (TSSM) with its partners from November 2006 to 2010 in India, Indonesia and Tanzania. Lessons from Vietnam will be valuable; </li></ul><ul><li>Under the Sanitation and Water Partnership for the Mekong Region (SAWAP ) there should be lessons for Cambodia, Lao PDR and Southern China, where sanitation marketing is new. </li></ul><ul><li>The case study </li></ul>
<ul><li>Objectives - to assess the following: </li></ul><ul><li>Sustainability of the pilot approach and its results; </li></ul><ul><li>Spill-over effects in neighboring communes, districts; </li></ul><ul><li>‘ Parallel’ market developments in other areas; </li></ul><ul><li>Potential and implications for scaling up to national level; </li></ul><ul><li>Lessons learned for other areas: TSSM project areas (India, Indonesia, Tanzania) and SAWAP program (Cambodia, Lao PDR, southern China). </li></ul><ul><li>The case study </li></ul>
<ul><li>Methodology: </li></ul><ul><li>Desk study of relevant documents; </li></ul><ul><li>Collection of sanitation statistics from in principle 30 pilot communes and 4 comparable non-project communes; </li></ul><ul><li>Semi-structured interviews with functionaries: national (13), provincial (3), district (4), commune (10) levels; </li></ul><ul><li>In-depth study in a purposive sample of 8 communes with semi-structured interviews with promoters (24) and providers (21) and with 4 providers in non-project communes; </li></ul><ul><li>FGDs with 121 householders, 34 who built a toilet during the pilot, 27 who built afterwards and 60 who had not yet built; </li></ul><ul><li>Structured observations of 28 toilets (most & least satisfied in FGDs) and discussions with the owners. </li></ul><ul><li>The case study </li></ul>
<ul><li>Purposive Sample based on 7 indicators: </li></ul><ul><li>Rationale: to get a cross-section of good and less good environments for </li></ul><ul><li>sustained sanitation </li></ul><ul><li>Sanitation performance under the government (2000-2002) (absolute); </li></ul><ul><li>No. of sanitary toilets built/upgraded under the pilot (2003-2006) (absolute); </li></ul><ul><li>Relative growth in coverage under the pilot as compared to 3 previous years; </li></ul><ul><li>Self-sustained growth during the pilot’s gap between Phase I (Jan ‘03 – Dec ‘04) and Phase II (June ‘05-December ’06); </li></ul><ul><li>Speed in reducing the drop in construction after Phase I had ended; </li></ul><ul><li>% Relative increase in sanitary toilet coverage during the pilot (lowest of 8 communes = 100); </li></ul><ul><li>% Access for poor households. </li></ul><ul><li>The case study </li></ul>
Resulting purposive case study sample: <ul><li>The case study </li></ul>Province Thanh Hoa Quang Nam Project Districts Hau Loc District: ‘ better’ Hai Loc: ‘better’ Nui Thanh ‘ better’ Tam Anh Nam : ‘ better’ My Loc: ‘less’ Tam Hoa: ‘less’ Tinh Gia District: ‘ less’ Hai Thanh: ‘ better’ Thang Binh ‘ less’ Bin h Trieu: ‘better’ Tinh Hai: ‘less’ Binh Hai: ‘less’ Non - Project Communes Hau Loc Tinh Gia Minh Loc Binh Minh Nui Thanh Thang Binh Tam Hiep Binh Tu
<ul><li>Study Limitations : </li></ul><ul><li>Small and not representative sample, so indicative findings only; </li></ul><ul><li>Pre-testing and analysis would have brought out some gaps; </li></ul><ul><li>Recall period (6,5 years since start of pilot) might have had some effects </li></ul><ul><li>Informing leaders on purpose of study needed (no false expectations), but may have had effects; </li></ul><ul><li>No interviews with any providers that had stopped – none could be identified in the limited time; </li></ul><ul><li>Impossible to collect statistics on population and sanitation coverage from all 30 communes on sustainability over time; </li></ul><ul><li>No statistics on toilet ownership by the poor. IDE could collect this data because of their stay in all 30 communes; </li></ul><ul><li>Loss of IDE project and financial records due to a computer crash, but some back-up files received last week. </li></ul><ul><li>The case study </li></ul>
<ul><li>The trend of increase in sanitary toilets continued without any external support and no toilet subsidies after the pilot project had ended; </li></ul><ul><li>All study communes increased their coverage in 2007-08; </li></ul><ul><li>The findings: </li></ul>Source: Commune statistics, this study STRENGTHS
STRENGTHS <ul><li>Two slow performers during the pilot have since caught up; </li></ul><ul><li>The findings: </li></ul>Source: Commune statistics, this study
STRENGTHS <ul><li>Progress was much better in study sample than in 2 comparative communes in Thanh Hoa; </li></ul><ul><li>The findings: </li></ul>Source: Commune statistics, this study
STRENGTHS <ul><li>All promoters but one had continued promotion, be it with fewer activities (figure) and spending less time. In most communes, they held 1 ‘toilet/environment’ day per month with a local name ; </li></ul><ul><li>Emphasis on face-to-face and group meetings rather than just materials distribution (see Fig. below); </li></ul><ul><li>The findings: </li></ul>Source: Promoter interviews (N=24)
STRENGTHS <ul><li>VWU leaders, CHWs and VHs remained important as role models and as informants and motivators for households that wish to install sanitary toilets; </li></ul><ul><li>All providers interviewed, whether trained by IDE or not, sold materials and installed all 4 new toilet types; </li></ul><ul><li>As individuals, couples and groups they offered a range of services, from material supply and construction to tailoring designs, transport and financial services. 4/5 th adjusted products and services to new developments and demands. Two-third reported actively pursuing new trends through contacts with suppliers and city visits; </li></ul><ul><li>4/5 th reported that more customers now built toilets than in the past. 2/3 rd had seen their businesses, profits and incomes increase; </li></ul><ul><li>The findings: </li></ul>
STRENGTHS <ul><li>All networks established under IDE (18) were still functional and had grown in size and new ones were formed. Networks referred customers to its members and sold toilet installation as a package; </li></ul><ul><li>All but one gave credit services to households unable to pay all costs in one (about 1:3). Most common were interest-free loans without time limits, but with some down payment and payment after delivery. Informal arrangements, no collateral; </li></ul><ul><li>The findings: </li></ul>
<ul><li>Providers were conscious of gender differences in demand and adjusted to these. Five providers ran their business together with their spouse (husband or wife); </li></ul><ul><li>The quality of materials had gone up. They install bathrooms, hand washing basins, school and hospital toilets, introduced new materials and models; </li></ul><ul><li>Several providers could develop themselves from mason to contractor or producer. 15 of the 21 can live on their income from building; an estimated 10% of their income comes from toilets; </li></ul><ul><li>The findings: </li></ul>STRENGTHS
<ul><li>FGD participants (N=61) gave promoters and group-meetings as most important sources and mechanisms of information and promotion. Those who built after the pilot added commune radio; </li></ul><ul><li>Largest numbers of FGD participants gave health, national toilet standards, environment and community benefits as reasons for toilet construction; </li></ul><ul><li>The findings: </li></ul>Source: FGDs with toilet owners (N=60) STRENGTHS
<ul><li>Observed quality of construction in the small purposive sample was reasonable to good: Average scores of 80% - 95% adherence to MoH construction standards and 78% -100% on MoH standards on maintenance and hygiene - probably also depending on toilet age; </li></ul><ul><li>FGD participants reported a high satisfaction with the toilets, with a few exceptions; </li></ul><ul><li>The FGD participants without toilet were still motivated to have one. Main constraint was financial. Half knew what they wanted and at what price (septic tanks), almost 1/3 rd were saving money for construction, some had bought materials already. </li></ul><ul><li>The findings: </li></ul>STRENGTHS
<ul><li>Promoters have not produced/developed new promotion material and do not yet systematically plan, monitor and manage community toilet coverage; </li></ul><ul><li>There is no program and budget to introduce new staff to sanitation promotion – on average 2 of 3 workers are transferred after 3 years; </li></ul><ul><li>Statistics on sanitation were hard to get and were not always reliable; </li></ul><ul><li>Communes have statistics on no. of poor households and no. of households with types of toilets, but not on poor households with toilets; </li></ul><ul><li>Promoters and providers did not address specific information needs of household without toilets. There was only one type of (non-participatory, non-dynamic) information material; </li></ul>CHALLENGES <ul><li>The findings: </li></ul>
Unmet information needs of participants of FGDs without sanitary toilet (N=60) :
<ul><li>None of the study communes was as yet open defecation free; </li></ul><ul><li>No specific information strategies for poor. Only 9 of 21 providers actively promoted demand, mostly by talks at meetings & home visits, the latter presumably on invitation - to check. Information and tools not tailored to poor. Only 2 FGD participants without toilets mentioned masons as source of information on sanitary toilets ; </li></ul><ul><li>Both households and providers saw septic tanks as the most modern and hygienic technology; pit models “are for the poor”. The poor themselves also rather waited for a septic tank than install another, cheaper model; </li></ul>CHALLENGES Perception of interviewees: DVPF = Second class technology <ul><li>The findings: </li></ul>
<ul><li>Inflation may prevent those who save money from building their toilet.; </li></ul><ul><li>Observations showed that main reason for problems with toilet operation was cheap building; training for masons made no difference as they also learned otherwise; </li></ul><ul><li>The toilets at the 8 commune and 4 district headquarters were generally in a poor state – many lacked doors and were in an unhygienic state, yet had with evidence of being in use. Providers already built at schools, clinics , not yet for the commune office. </li></ul>CHALLENGES <ul><ul><li>The findings: </li></ul></ul>
<ul><li>In promotion, there has been no particular innovation (different for providers). Work had continued at a lower pace and promotion may loose its power : people have heard it all several times already; </li></ul><ul><li>Many poor people may not achieve the installation of a sanitary toilet, unless VN develops a clear strategy to meet their demand for better technical and financial information, incl. on financing options, and poor-inclusive monitoring & management; </li></ul><ul><li>All involved saw septic tanks as best. Without better information and services for sanitary emptying and end- disposal, this may create new sanitary problems in VN . </li></ul>RISKS <ul><ul><li>The findings: </li></ul></ul>
<ul><li>Promoters were willing and confident that they could build capacities of colleagues for sanitation promotion thru peer training for scaling out (expansion to neighboring sites); </li></ul><ul><li>Combining the strengths of Rural Sanitation Marketing with those of CLTS and CHCs may increase sanitary toilet coverage and use, at speed and at scale; </li></ul><ul><li>Methods and materials for people’s planning, monitoring and management of rural sanitation do not ask for expensive materials and techniques. Only needs are paper, felt-tipped pens and photocopied drawings of toilet technologies and materials with BoQs; </li></ul>OPPORTUNITIES <ul><ul><li>The findings: </li></ul></ul>
<ul><li>Technology and design of composting toilets can be modernized further (photo from South Africa) and especially farmers can be given information on the economic gains (free nitrogen & compost!). This may make the technology and its environmental benefits more attractive for certain groups; </li></ul><ul><li>Information on desludging should be part of information on septic tanks. One provider said he was interested in starting a sludge removal and recycling service – R&D/action research may teach us more; </li></ul><ul><li>Potential to expand sanitation marketing approach to Vietnam towns. </li></ul>OPPORTUNITIES Eco-Toilet <ul><ul><li>The findings: </li></ul></ul>
<ul><li>The combination of R&D (marketing, technology) and training of providers and promoters have made RSM a success and a model for other countries. Results were relatively fast (3 years, not 1) and have been sustained; Evidence of spill-over and parallel market development exists, comes in final report; </li></ul><ul><li>When demand and supply are developed concurrently, rural households can and do install and use sanitary toilets without subsidy ; </li></ul><ul><li>The interpersonal approach in meetings and home visits and the standard setting - modern toilets /households / communes - were very instrumental. They can be replicated in VN, partially applicable elsewhere; </li></ul><ul><li>The combination of 3 types of promoters (CHW,VWU,VH) and the cooperation with other unions may be typical for Vietnam; </li></ul><ul><li>Toilet types worked in coastal, non-ethnic areas and were still relatively costly. How in scaling-up? </li></ul>4. Conclusions and next steps
<ul><li>Self-sustained development esp. in supply & services, but promoters & providers need training for poor: </li></ul><ul><ul><li>Build toilet in stages – underground part first, even 1 pit now, 2 nd later is possible for some models; </li></ul></ul><ul><ul><li>Encourage FYPs : temporary outhouse first, then upgrade step-by-step, e.g. brick walls> full floor> door> roof> plaster inside>tiles >plaster outside; </li></ul></ul><ul><ul><li>Convert savings into materials based on BoQs; </li></ul></ul><ul><ul><li>Encourage household groups to buy and construct and save on costs (group discounts) & transport; </li></ul></ul><ul><ul><li>Groups invite mason/seller to explain cost savings (e.g. lower height, smaller dimensions, plastic pan or platform -NOT change essentials, e.g. Ø vent pipe; </li></ul></ul><ul><ul><li>Drawings of models + parts + BoQs to help make own household combinations </li></ul></ul>4. Conclusions and next steps
<ul><li>Promoters were ready to scale out to neighboring colleagues, but cannot do this alone. VWU and MoH can set up horizontal learning system (promoter -> promoter, provider -> provider) to scale out from one commune /district to next. Cost-effectiveness of peer training is better than cascade training ; </li></ul><ul><li>Provider training might also be integrated in short courses technical training centres </li></ul><ul><li>RSM, CLTS and CHC combined may unite “The best of both worlds”; </li></ul><ul><li>Donors can help finance testing a combined model district- and province –wide, on a demand basis and with TA from NGOs </li></ul>4. Conclusions and next steps