Approaches to Scale Up Rural Sanitation May 29th, 2009 PACOSAN

1. Approaches to Scale Up Rural Sanitation May 29th, 2009 PACOSAN

2. Integrated Sanitation Approach Hygiene Foul Water/ Drainage Solid Waste INTERVENTIONS Excreta

3. Ladder Approach in Sanitation Address all elements of sanitation but target the highest risk first.

4. Total Sanitation Approach Total Sanitation means going beyond toilet construction and focuses on: • Safe confinement of excreta by the entire community by motivating communities to stop open defecation • Adopting improved and safe personal hygiene – safe handling of water, food. • Achieving environmentally safe environments – solid and liquid waste management

5. I. Hygiene Promotion • Adoption of improved and safe personal hygiene – safe handling of water, food by the community. • Involvement of Community Stakeholders: • Community Activists (social mobilization) • Religious leaders (talking CLTS in juma prayer) • Local traders (labor union involvement) • Teachers & School Children (Schools health and hygiene session) • Lady Health Workers (health sessions) • UC Councilors/ Nazims (reward, advocacy)

6. Flow Diagram Fingers In flow diagram community identify the ways though which human excreta come to their mouth Flies Fluid Fields

7. II. Safe Confinement of Excreta Has targeting toilet construction delivered sanitation outcomes? Increased coverage do not translate in increased usage Increased access also did not meet sanitation outcomes Programs failed to address the core problem ofsensitizing people on sanitation behavior and linking it with public health

8. Open Defecation Free Approach Approach emphasizes... • A TOTAL approach to sanitation – Making the whole community Open Defecation Free (ODF) and environmentally safe. • A Community led Approach – where the whole community takes a lead role in taking a collective decision to change their behavior and sustain it. • Collective action with 100% coverage ONLY leads to change in public health!

9. Community is making a social map showing houses with open pit latrines and defecation areas

10. In Kotli Sattian five religious leaders spoke on Sanitation in Juma sermon (August)

11. Cost Pour Flush Not Acceptable Improved Pit Simple Pit Open Defecation Fixed place Defecation Technology Choice as Means of Mobilization Informed choice on decisions on affordable technologies Local resources mobilization and local choice etc Part of the mobilization strategy

12. Collective Behavior Change Shift in focus from toilet construction to ‘Collective Behavior Change’ Total Sanitation focuses on final outcome, rather than inputs – inputs are means to achieve final outcome To achieve Total Sanitation, a Community approach is a faster, cheaper and sustainable way to achieve collective behavior change

13. Community members of Inzar Kalli village, of Seribehlol Union Council of Mardan district, NWFP describing the process of ODF status they have achieved (IRSP)

14. Achieving Environmentally Safe Environments – Solid & Liquid Waste Management • Community based solid waste managements initiatives; • Waste water management initiatives • Component sharing models (based on OPP and LPP)

15. Addressing Scale

16. Distinctive Elements of Delivery Mechanisms • Engaging Political Leadership: Focussing efforts on orienting political leadership to sanitation efforts and program • Multi-disciplinary Core Teams: managing communication and Training activities at all levels • Deepening Delivery Structure: Committees and members of local government become the frontline of mobilisation, motivation and achieving outcomes

17. Certain Enabling Factors…. To reach and sustain the program: • Political commitment Giving recognition to local leadership and enterprise Status/Prestige as motivational trigger Attention of District Administration to aspirant villages • Learning from each other – exposure visits, etc. • Demand generation has to be matched by effective supply • Continuous monitoring of process and sustainability

18. We can be there in 2015!!

20. Pakistan: • Diarrhea is the most common childhood disease in Pakistan; • Nearly half of all hospital admissions and one third of out patient visits comprises the patients of diarrhea less than five years of age; • It is estimated that 14 million episodes of diarrhea occur each year in Pakistan and that more than 100,000 pre-school children die as a result of the disease

21. The Way Forward with RSPs • 20 RSP senior staff visit arranged by RSPN to IRSP in Takht Bhai, Mardan in Nov 06

22. Social Mobilization Sensitization & Awareness Through: • Community Activists (social mobilization) • Religious leaders (talking CLTS in juma prayer) • Local traders (labor union involvement) • Teachers (Schools health and hygiene session) • Lady Health Workers (health sessions) • UC Councilors/ Nazims (reward, advocacy)

23. Community is making a social map showing houses with open pit latrines and defecation areas

24. Calculation of Faeces in Kotli Sattian

25. Flow Diagram Fingers In flow diagram community identify the ways though which human excreta come to their mouth Flies Fluid Fields

26. Willingness of the Community to take the Lead

27. Community members of Inzar Kalli village, of Seribehlol Union Council of Mardan district, NWFP describing the process of a Community Led Total Sanitation they have achieved recently

28. Local Innovations. Local decisions are crucial for the success of CLTS

29. Demonstrating the design of local latrine (Chukan) in Danyor - Gilgit

30. We can build toilet they we like. It is easy!

31. Use of ash after defecation in direct pit latrine is an innovation by the community. One gets potash rich manure at the end. Whose idea?

32. Local Innovations by rural community in Takth Bhai of Mardan district