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Beyond Scaling Up: Community Led Total Sanitation


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This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Mehta presented on the Community Led Total Sanitation (CLTS) project.

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Beyond Scaling Up: Community Led Total Sanitation

  1. 1. Going to Scale? The Potential of Community- Led Total Sanitation Lyla Mehta Institute of Development Studies
  2. 2. Shit happens and shit matters! • Around 4,000 people, mainly children under five, die every day due to poor sanitation, hygiene and water. • WHO estimate: health sector could save over US $11 billion in treatment costs; people could gain 5.5 billion productive days due to reduced diarrhoeal disease • Sanitation as neglected issue in development – main focus usually on water • Past interventions have tended to be technical, top-down paying scant attention to people’s actual needs and wants
  3. 3. Shit happens and shit matters! • Sanitation and the MDGs: Target 7 (watsan); MDG 4 (reduce child mortality); MDG 5 (maternal health); and MDG 6 (combat major illnesses – diarrhoea/ malaria etc.); • More recently receiving increasing attention - in 2007, the British Medical Journal voted for sanitation as the greatest medical advance in the last 166 years
  4. 4. What is CLTS • Pioneered by Kamal Kar, a development consultant working with the Village Education Resource Centre (VERC) , CLTS began as an experiment in Bangladesh in 1999. •Powerful participatory approach that analyses and unpacks the sanitation profile in a community and the spread of faecal-oral contamination •Strong emotions (disgust/ shame); humour and self analysis that everyone is ingesting each other’s ‘shit’ •Collective decision to stop open defecations, build and use toilets without upfront hardware subsidies
  5. 5. Transect walks Walking through the bush to find the stuff! Rural community near Awassa, Ethiopia leading a OD transect team. Slums in the outskirts of Ulaanbaatar in Mongolia – locations where sources of water get contaminated with human excreta are important points to stop during a defecation area transect and discuss with the community.
  6. 6. Mapping In a well facilitated CLTS triggering, villagers in Tanzania calculating household shit, the ignition point is often reached while they are doing this ‘Who shits where?’ Community members in Tororo, Uganda, map places used for open defecation. Photo: Philip Otieno, Plan Kenya.
  7. 7. Where is CLTS now ASIA • Bangladesh (WaterAid, VERC, Dhaka Asahnia Mission, PLAN, CARE, NGO Forum) • India (Government-driven) • Indonesia (government-driven) •Cambodia • Nepal • Pakistan • (introduced in China, Mongolia, Sri Lanka) AFRICA • Plan Regional East and Southern Africa is rolling out CLTS in Egypt, Kenya, Uganda, Sudan, Zambia, Zimbabwe; Ethiopia and Tanzania; •WaterAid in Ethiopia/ Nigeria •Sierra Leone LATIN AMERICA • Bolivia (UNICEF, Plan and WSP) • Brazil, Chile and Peru participated in workshop MIDDLE EAST •Yemen
  8. 8. Challenges around scaling up • Socio-technological dynamics • Quality v/s maximising impact • Impacts on poorest and women? • How sustainable? • Scaling up • Citizenship and rights
  9. 9. Social Technological Mindset Group characteristics Creativity Demographics Materials Power relations Supply networks Gender relations Maintenance Cultural practices Infrastructure Religious norms Cost Perceptions of shit Traditions for masonry Sentiments/needs/desires Availability Health problems Marketing Architechture Ecological Climate conditions Landscape changes Settlement patterns Wet/arid Floods/droughts Soil types Water/groundwater table Vegetation cover Presence of pathogens
  10. 10. Actors, institutions and processes • Kamal Kar, Pioneer; WSP; UNICEF: DFID; WaterAid; Plan • Learning and exchanges – 2002 BD workshop; exchange visits for officials • Regional processes (Sacosan; Africasan) • Research, Action learning and networking
  11. 11. Diverse pathways of spread and going to scale • Diverse experiences – BD, India, Indo • Role of trainers and facilitators • Role of champions • Different institutional homes (MoH v/s RD) • Different experiences with subsidies
  12. 12. Challenges of scaling up diversity v/s uniformity
  13. 13. Institutional challenges and scaling up
  14. 14. Inclusion/ exclusion
  15. 15. Sustainability issues
  16. 16. Gender, empowerment, rights
  17. 17. Technology matters
  18. 18. Conclusions • CLTS challenges conventional mindsets regarding financing/ help/ subsidies and the role of communities • People as agents of change, rather than institutions, things or bureaucracies • Scaling up through process and people • Challenges of sustainability and inclusion • the right to sanitation • Lessons from history (