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CLTS Experience In Kilifi


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CLTS Experience In Kilifi

  1. 1. Local District Experience in Scaling up Community Led Total Sanitation in Kilifi. “ Usafi wa mudzini” Dr.B.K.Tsofa District Medical Officer of Health KILIFI
  2. 2. <ul><li>Outline of presentation </li></ul><ul><li>Background information </li></ul><ul><li>CLTS experience in Kilifi </li></ul><ul><li>- Initiation </li></ul><ul><li>- District scale up </li></ul><ul><li>- Achievements so far </li></ul><ul><li>- Stregnths and Challanges </li></ul><ul><li>- Lessons learnt </li></ul><ul><li>- Critical issues for consideration </li></ul>
  3. 3. <ul><li>Introduction </li></ul><ul><li>Kilifi District is one of the thirteen districts in coast province. </li></ul><ul><li>It covers an area of 3870.2km 2 </li></ul><ul><li>It has 6 administrative divisions </li></ul><ul><li>It has a population of approximately 450,000 people living in aprox 500 villages. </li></ul>
  4. 4. District Map
  5. 5. <ul><li>Background Information </li></ul><ul><li>Kenya's Latrine coverage is very low; with a National coverage of about 46%; and Coast provincial coverage of 51% </li></ul><ul><li>Pit latrine coverage in Kilifi is low standing at 33%; with a 46% access. (HMIS 2007) </li></ul><ul><li>75% of water sampled in 2007 from different sources in the district had E-coli contamination </li></ul><ul><li>There is a high prevalence of sanitation related diseases in the district </li></ul>
  6. 6. Top 10 OPD under 5 yrs morbidity 2008
  7. 7. <ul><li>Why CLTS in Kilifi Now? </li></ul><ul><li>Several other strategies, including use of Public Health Act Cap 242, Chiefs Act Cap 210,PHAST, PHC demonstration ; have been used before with little success at community level in many parts of the district. </li></ul><ul><li>Though poverty levels are high, every family builds a house, kitchen, store and shade for animals, WHY NOT A LATRINE?? </li></ul><ul><li>If your neighbors don’t have latrines/proper sanitation, does your house hold get affected….!!?? </li></ul>
  8. 8. <ul><li>CLTS in Kilifi District . </li></ul><ul><li>CLTS was started/piloted in Jaribuni village, Ganze Division in July 2007,as a collaborative effort between MoH ,Plan Kilifi and the community. </li></ul><ul><li>At triggering time, the village had 45 homesteads with only 3 pit latrine; and most of the villagers practiced open defecation. </li></ul><ul><li>After the triggering session, Jaribuni village finally celebrated open defecation free status in 19 th Nov 2007, and by then 42 pit latrine had been constructed and were in use. </li></ul><ul><li>The Latrine were constructed by the community members without any subsidies. </li></ul><ul><li>Lessons learnt provided a platform for a district scale up. </li></ul>
  9. 9. Sample latrines in Jaribuni....,,,,,
  10. 10. More latrine designs in Jaribuni….
  11. 11. <ul><li>CLTS Scale up </li></ul><ul><li>In May 2008, the DHMT, all PHOs & PHTs and some Plan Kilifi staff were trained on the CLTS concept with support and facilitation from Plan international Kilifi DA and Plan Kenya. </li></ul><ul><li>Mass triggering sessions were carried out in different villages all across the district, with different outcomes. </li></ul>
  12. 12. <ul><li>Spill over effect in neighboring villages started being experienced. </li></ul><ul><li>In July 2008, Kilifi hosted a Plan RESA training for CLTS, which was facilitated by Prof. Kamal Kar among others </li></ul><ul><li>Interacting with different CLTS champions provided us with an opportunity for exchange of ideas on the approach. </li></ul>
  13. 13. Prof Kamal Kar facilitating in the RESA training
  14. 14. Achievements so far DIVISION NO OF VILLAGES NO TRIGGERED EXIXTING PIT LATRINE NEW PIT CONSTRUCTED & IN USE UNDER CONSTRUCTION PIT LEVEL SLAB LEVEL SPS VITENGENI 80 11 63 720 30 6 3 KIKAMBALA 74 6 34 882 133 49 43 BAMBA 85 14 60 1026 147 130 32 GANZE 73 3 10 178 50 32 5 BAHARI 104 8 81 516 114 61 8 CHONYI 61 4 138 268 10 12 6 DISTRICT 477 46 386 3590 484 290 97
  15. 15. Achievements in the District
  16. 16. Achievement so far per division
  17. 17. Latrines under construction - District
  18. 18. <ul><li>Achievements Cont… </li></ul><ul><li>Two other villages ( Ngamani and Katsemerini ) have conducted an ODF status graduation celebration. </li></ul><ul><li>Five villages are btw 95% - 100% implementation level. </li></ul><ul><li>Majority of the triggered villages are over 50% implementation levels. </li></ul><ul><li>Spill over effect in neighboring villages is on the rise with good outcomes. </li></ul>
  19. 19. <ul><li>Ngamani Village Vitengeni Division </li></ul><ul><li>Was the venue for last years world toilet day celebration. </li></ul><ul><li>Triggered through spill over effect from neighboring Kahingoni village </li></ul><ul><li>Has 35 homesteads, and at triggering, (July 2008), only 6 homesteads had pit latrines. </li></ul><ul><li>29 Pit latrines were constructed and in use by end of October 2008. </li></ul><ul><li>Whole process was championed by two Community Health Workers in the village . </li></ul>
  20. 20. <ul><li>Katsemerini Village ODF Celebration </li></ul><ul><li>Was conducted last week. </li></ul><ul><li>Was entirely organized by the villagers themselves </li></ul><ul><li>Integrated sanitation issues with other community primary health issues </li></ul>
  21. 21. DMOH and DPHO led by Ngamani Village Sanitation Committee on an inspection tour of latrines in the village.
  22. 22. DMOH & DPHO inspecting latrines in Ngamani Village Vitenegeni Division....
  23. 23. World Toilet Day Celebrations in Ngamani in November 2008
  24. 24. <ul><li>Strengths </li></ul><ul><li>Stewardship from top DHMT management </li></ul><ul><li>Trained Public health staff took up the CLTS approach with a lot of enthusiasm. </li></ul><ul><li>Good reception and co-operation from local leaders and administrators </li></ul><ul><li>Good cooperation and partnership with local stakeholders </li></ul><ul><li>. Receptive community with active participation </li></ul>
  25. 25. Stewardship from core DHMT.....; DMOH,DPHO,DPHN KILIFI
  26. 26. <ul><li>Challenges </li></ul><ul><li>Hard rock in parts of the coastal line Bahari and Kikambala Division </li></ul><ul><li>High water table in Kikambala division. </li></ul><ul><li>Loose soils in several parts of the district </li></ul><ul><li>Shortage of PH staff and competing tasks has led to minimal post triggering support and supervision </li></ul><ul><li>??? Urban communities – Kilifi & MtwapaTowns; and institutions!!! </li></ul>
  27. 27. <ul><li>Challenges cont… </li></ul><ul><li>Rapid spread of spill over effects posing major challenges in tracking and monitoring progress </li></ul><ul><li>The recent drought and hunger in the district is now posing as one of the greatest challenges to most programmes, CLTS included. </li></ul><ul><li>??? Disease impact assessment </li></ul>
  28. 28. Rocky soils!!
  29. 29. <ul><li>Lessons Learnt </li></ul><ul><li>The approach works!; and communities should always take the lead role. </li></ul><ul><li>Start small, for easy tracking and monitoring </li></ul><ul><li>No blueprint design (only people’s designs, not engineers’) </li></ul><ul><li>Facilitate, don’t provide (zero subsidies) </li></ul>
  30. 30. <ul><li>Critical Emerging Issues </li></ul><ul><li>Neighboring districts through their DHMTs have shown interest but lack the support for training </li></ul><ul><li>There is need for “buying in” of the CLTS approach at higher level in the ministry, and explore possibility of entrenching it in the existing government community health strategy. </li></ul>
  31. 31. Conclusion We are quite determined to be declared the first ODF district in Kenya and probably in this region!!
  32. 32. I belive, …..” Yes We Can” ……!!! With determination, we can move from Kogelo to The Oval Office……!!
  33. 33. <ul><li>Acknowledgements </li></ul><ul><li>The Kilifi community for “doing it” </li></ul><ul><li>All Public health staff who have been overseeing the process in the district </li></ul><ul><li>Amos Ndenge the CLTS coordinator in the district </li></ul><ul><li>The DHMT Kilifi for the leadership and stewardship </li></ul><ul><li>Plan Kilifi for facilitation, support and true partnership </li></ul>
  34. 34. Namuvera zhomu Ero kamano Nimwega muno Asantenei sana Thank you very much!!