Assessment of the Sustainability of Sanitation Behaviors, Facilities and

Programs Using Community-wide Open Defecation Free Approaches

The Manoff GroupPlanning Alternatives for Change LLCPathways Consulting Services Ltd.[ROUGH DRAFT- FOR DISCUSSION -12 May 2010]

Summary of Study Findings

Goals of This Research

To document the present status of sanitation in unions that were officially declared to be “100%” open defecation free more than 4.5 years ago

To analyze the factors that challenge or contribute to continuation of the ODF achievement:

– Programs and institutions– People’s perceptions– Technical issues– Availability of supplies and services– Principal challenges– Main factors and forces contributing to sustainabilty

Topics covered in the study

Defecation practice only, not other aspects of sanitation (hand washing, environmental pollution, solid waste management):

– LATRINES & OPEN DEFECATION ONLY The context of latrine use: supply chain (latrine

selling businesses, free distribution, installation and pit cleaning services), UP activities, social norms

No direct assessment was done of intervention program impacts. No evaluation was done of any specific organization’s work.

Specific unions are not identified by name in this study.

Approach Used to Achieve “ODF/100%” in 50 Study Unions*

GOB-only approach: 23

CLTS approach: 10 (8 ASEH, 2 Dishari)

Non-CLTS/NGO approach: 9

GOB-donor: 8 (DPHE-Danida/UNICEF)

*3 additional: RRA/Reconnaissance only::GOB-only, GOB-Donor, & NGO

Follow-up ProgramsApproach Follow-up No Follow-up Total

CLTS 4 6 10

Non-CLTS 5 4 9

GOB-Donor 7 1 8

GOB-only 14 9 23

Total 30 20 50

Geographical Area

Total Arid/Plain Char Flood Coastal Hilly Mixed

CLTS 7 0 1 1 0 1 10

% within Approach 70.0% .0% 10.0% 10.0% .0% 10.0% 100.0%

Non-CLTS 2 0 4 1 0 2 9

% within Approach 22.2% .0% 44.4% 11.1% .0% 22.2% 100.0%

Gob-Donor 0 0 5 0 1 2 8

% within Approach .0% .0% 62.5% .0% 12.5% 25.0% 100.0%

GOB-only 4 3 4 1 2 9 23

% within Approach 17.4% 13.0% 17.4% 4.3% 8.7% 39.1% 100.0%

Total HH Counts 780 180 840 180 180 840 3000

% within Approach 26.0% 6.0% 28.0% 6.0% 6.0% 28.0% 100.0%

Methodology

Selected 50 unions out of 481 that met the selection criterion: “ODf/100%” declaration >4.5 years ago

Quantitative: Survey of 3000 households in 50 unions

Qualitative: RRA, reconnaissance, and/or in-depth team visits in 18 unions (15 covered by hh survey)

Summary of Study Findings

The Sanitation Campaign

UP leadership Numerous others: govt

officers, volunteers, women/men

School children active The campaign was

compared to national liberation movement (jagoron)

Faridpur District, Bhanga Uz., 2005 Rally for Safe Sanitation and Solving the Arsenic Problem

Different Approaches to the San. Campaign

All did: – surveys, – public notices, – general meetings, – religious leaders, – miking, – rallies

GOB areas: – strong threats, – some breaking and

burning of open/hang latrines,

– filing bogus “papers” warning people to stop OD,

– distribution of ring-slab sets

CLTS areas: – stressed

motivation & local donations;

– less use of violence and fear

Bhola 2002

Survey Responses

Punishment (or Fear of) Recalled

Approach Total

CLTS Non-CLTS

GOB-Donor

GOB Only

Jail/Confinement 29.6 40.8 49.2 43.3 40.7

Burning/Breaking 8.7 10.7 47.7 24.9 24.5

Monetary fine 48.3 21.4 12.5 24.9 28.4

Public humiliation 8.2 38.8 18.4 22.7 18.9

Physical punishment/Holding the ear 12.2 8.7 9.7 7.8 9.5

Chowkidar warning 3.0 0 5.9 1.7 2.9

Others 4.5

No. 402 103 321 630 1456

Percent of all respondents mentioning 67% 19% 67% 46% 48.5%

Have you heard about all using latrines here?

Yes 68.1

No 31.9

N= 3000

% 100

Perceived Benefits of Being ODF: Focus Groups and Key Informants

Less disease spread 29

Stopping water pollution/spread of water-borne diseases

5

Elimination of bad smells 12

Improves the environment 10

Village: honor, social dignity, peace, prestige 8

OD ‘not good’, causes ‘pollution’(Bengali dushon or noshto kora)

5

Other 20

Total 89

Current Views Regarding “ODF” or “100%”

Focus group participants in 13 out of 18 in-depth study unions were mostly enthusiastic about the idea about their villages being free of open defecation.

In five villages negativity was widespread. Reasons for this were:

– Some people are bypassed by development efforts– Insecure land tenure– Mistrust of local leaders– Low motivation to overcome practical problems: flooding,

water shortages, very hard soil, & others

Perceived Benefits of Latrine Use

Avoid ‘shame’ Convenient for women Essential to family status, respectability Improves marriage arrangement prospects Enhances spiritual life by ensuring

cleanliness and purity Negatives; Ghosts at night, snakes, bad

smells, and danger of injury

Institutional Supports

1. UP current activities 2. NGO/Other current program 3. Schools 4. Latrine parts & Installation services 5. Funding for latrine purchases 6. Pit cleaning services

Union Parishad: Current Efforts

Out of 53 UP Chairmen interviewed or observed, around 2/3 are still working to improve sanitation in their unions.

UP members also are active, more so than chairmen in some cases

No formal monitoring by UP, but some chowkidars (vill. police) & members check up

Out of 18 in-depth study unions, 10 using ADP funds for latrine distribution, 7 not, one information unclear.

Perceived “rules” against open defecation.

Supported by their UNOs Work well with NGOs

Who Comes to Discuss Sanitation, by Presence or Absence of Current Sanitation Program (multiple responses)

 Current Program   

Who Comes Yes No Total

Local Leaders 1 10 11

  0.2% 4.0% 1.5%

UP Chairman/Member 32 108 140

  6.5% 43.0% 18.8%

Health/NGO Worker 473 143 616

  95.7% 57.0% 82.7%

Student 0 1 1

    0.4% 0.1%

Total Respondents 494 251 745

  66.3% 33.7% 100.0%

The Role of Schools

Sanitation now established as part of the health & hygiene curriculum

Madrasas also teaching san. Students are actively interested in the

issue School latrines: problems exist, madrasas

better

Public Latrines

Observed: ____ Much money spent to

build some of them Bazaar latrines: - Only one had a paid

caretaker - None were clean - [OTHER INFO] Caretakers are very

difficult to hire. Many quit the job.

School and mosque latrines better maintained, but school latrines are over-used.

Latrine Parts Sellers

Mass production of latrine rings and slabs now well established, in response to sanitation campaign

Diversification of products is common

Some are former masons or “sanitation engineers”

Costs increasing more than prices

Give discounts to poor buyers

Pit Cleaners Pit cleaning is becoming a well-

paying occupation.

Some Muslims are taking up the profession (secretly or openly), competing with Hindu Sweeper caste people

Social stigma exists Charge by the ring: Cost is Tk. ___

to Tk. ___ & distance to dumping place

Frequency of pit cleaning depends on no. of latrine users and ability to pay.

Funding latrine purchases

[Survey data]

In some places micro-credit is not available for this purpose, although most micro-credit organizations did fund latrine purchases when they were starting up.

Open Defecation

Some open defecation (OD) persists

– OD mentioned in survey responses: 26 out of 50 unions

– High (5) / Moderate (6) levels of OD in 11 out of 18 in-depth study unions

Related to: weak enforcement of rules, extreme poverty & crowding

More in CLTS areas

Household Latrines

“Improved” Latrine

-Enclosed pit, confines contents

(not intentionally broken)

-Slab/Cover over pit, with or without water-seal or vent pipe

“Unimproved”

Uncovered pit Open/Hang latrine Other type:

intentionally drained out to open place

% of latrine use Total

Open/Hang latrine Improved latrine no covered/

water seal

Improved latrine with covered/

flap

Improved latrine with water seal

N %

CLTS 42.5 16.8 34.7 100.0 600

Non-CLTS 10.7 46.1 1.9 41.3 100.0 540

GoB-Donor 17.5 41.0 4.0 37.5 100.0 480

GoB only 9.9 47.5 3.0 39.6 100.0 1380

Not active 14.5 46.7 2.5 36.3 100.0 1140

Ultra Poor 15.4 58.3 7.0 19.3 100.0 602

Poor 13.9 52.0 8.5 25.6 100.0 598

Middle 10.3 47.3 7.5 34.8 100.0 600

Upper Middle 7.2 42.7 4.2 45.9 100.0 599

Highest 5.5 25.6 1.5 67.4 100.0 601

T (%) 10.5 45.2 5.7 38.6 100.0 3000

T (N) 314 1356 172 1158 3000

Superstructure

Approach Total

CLTS Non-CLTS GoB-Donor GoB only

Pucca (brick) with roof

23.8% 15.9% 11.5% 21.8% 19.6%

Tin/ bamboo walls with roof

30.3% 28.5% 40.6% 31.5% 32.1%

Tin/ bamboo walls without roof

13.4% 18.7% 11.3% 11.8% 13.3%

Walls made of jute, cloth, /polythene

12.7% 14.2% 18.0% 14.3% 14.5%

Walls made of jute sticks, straw, leaves

18.8% 22.4% 18.2% 20.0% 19.9%

Abandoned 1.0% .2% .5% .5% .6%

Total Count 575 508 434 1279 2796

% within Approach

100.0% 100.0% 100.0% 100.0% 100.0%

Superstructures

Superstructure Type

Wealth-ranking Total

LowestLow-

Middle MiddleHigh-

Middle Highest

Pucca with Roof 2.8% 4.6% 9.0% 20.6% 57.4% 19.6%

Tin/ bamboo fencing with roof25.3% 27.4% 34.6% 42.3% 30.2% 32.1%

Tin/ bamboo fencing without roof 15.5% 17.4% 15.5% 13.1% 5.6% 13.3%

Fencing with jute cloth/polythene 23.3% 19.4% 18.6% 9.4% 3.2% 14.5%

Fencing with jute stick/straw/leaf 31.9% 30.4% 21.6% 14.5% 3.2% 19.9%

Abandoned 1.1% .7% .7% .0% .3% .6%

Total Count 529 540 566 572 589 2796

% within Wealth-ranking100.0% 100.0% 100.0% 100.0% 100.0%

100.0%

Latrine Ownership

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lowest Mid-Low

Mid Mid-High

Highest

Ownership of Latrine, by Economic Status

Pct. Rent Hse

Pct. Oth.Own

Pct. Jt. Own

Pct. Own

Individual HH ownership percentage increases with economic level.

Alternative Technologies & Home-made Types

Clay Rings (paat)

Clay rings (paat), or clay + concrete [Kurigram, Bogra, Gopalganj, Naogaon]

GOB, Non-CLTS Low cost, no need for skilled

labor to install, very deep pits, less pit cleaning expense

Believed to last long when combined with one or two concrete rings at top of pit

Rodents & white ants go insideNaogaon District

Duli or dongi bamboo pit liner

Duli or dongi bamboo pit liner [four districts, Lalmonirhat, Chapai-N., Naogaon, Kurigram, all with some ASEH/CLTS program/follow-up]

Low cost No need to empty pit Does not last a long

time Rodents or tree roots

get inside

Others

Boitak offset model [Noakhali]

Pit (jar-shape) with narrow opening [Narsingdi & Lalmonirhat, Non-CL & CL)

Motka offset model [CLTS union, Naogaon]

Unlined pits in areas with hard earth [Narsingdi]

What is a ‘hygienic latrine’? FGD & Key Informants (104 comments)

No bad smell

Feces not visible

Clean

Ring-slab (concrete)

Water-seal

Expensive

No flies/mosquitoes

Covered

A whole system of good latrines

Pucca/Concrete parts or super-structure

Soap/Ash available for hand washing

No idea (4)

Other: Looks nice, lined pit, deep hole, has

vent pipe, has door/curtain, has walls, off-set tank, plenty of water used, footwear used, no disease spread

Maintenance Arrangements

[TO BE ADDED]

“Hygienic” vs. “Unhygienic”

Among the 50 unions, only 35% of “improved” HH latrines are “hygienic” in terms of maintenance:– No feces visible on the floor or pan;– No major leakage from the tank/pit;– Pit is not broken to let contents run out into

an open place; and/or– No strong, bad smell comes out

Sharing a Latrine

36% of improved latrine owners share with another HH

Sharing HH lower economic level than non-sharing HH

Many types of arrangements: regular share, temporary share, occasional, seasonal

Sharing (2)

Problems keeping them clean

Long queues Sharing pit cleaning

costs Can lead to open

defecation Cancellation of

sharing also can lead to OD

Latrine Shared, by HH Economic Status

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Share

No Share

The “Sanitation Ladder”

47% using the same latrine for the past five years; 41% two latrines during the 5-year period; and 10% had used three or more different latrines. Almost a half of the latrines used by the survey

households had been installed within the past four years, and 30 percent within the past 2 years.

Changes are mostly made within the same latrine type: for example, adding rings, changing location.

•Reasons for changing the latrine at any time during the past five year period:

-Latrine damage (39%), -Wanting or being pressured to install a latrine (39%), -Filling up of the pit (29.7%), and -Change of residence (11%).

•Latrine damage was the most frequently mentioned reason for first, second, and third latrine changes in GOB-only areas. •In CLTS areas it was filling up of the pit: 1st, 2nd, 3rd. •In GOB-Donor areas and Non-CLTS areas: filling-up of the pit and wanting or being pressured.

Unhygienic proportion of latrines in different main groups

Grouping

% Unhygienic by maintenance

% Hy-gienicOpen +

Hang

Improved, no covered/ water

seal

Improved with cover/

flap

Improved, Water seal

All

By Approach:

CLTS 100 71.0 68.3 39.4 61.3 38.7

Non-CLTS 100 78.7 90.0 54.3 71.1 28.9

GoB, Donor 100 71.6 63.2 56.7 70.6 29.4

GoB only 100 74.5 69.0 36.6 61.8 38.2

Wealth-ranking:

Ultra-Poor 100 79.2 69.0 64.7 78.9 21.1

Low-Middle 100 72.3 72.5 56.2 72.1 27.9

Middle 100 78.9 57.8 54.1 70.8 29.2

Upper-Middle 100 70.3 80.0 44.7 61.1 38.9

Highest 100 64.3 77.8 26.7 41.1 58.9

N 314 1356 172 1158 3000 3000

All 100 74.2 69.2 43.6 64.8 35.2

Shared vs. Not Shared (Improved Only)

  Hy-gienic

Unhy-gienic

Total

NotShared

45.2% (714)

54.8% (866)

100%(1580)

Shared 28.9% (245)

71.1%(602)

100% (847)

Total 39.5% (959)

60.5%(1468)

100%(2427)

Improved latrines only

Some comparisons relating to ‘hygienic’ latrine findings

GOB-only approach has been most effective in raising the over-all ‘hygienic’ status of latrines– But less effective in improving practices of poor

households relative to others in the union CLTS, Non-CLTS, and GOB-donor

approaches have had a greater impact on poor households’ latrine maintenance practices than GOB-only approaches.

G O B - D o n o r Unions : W e a l t h - r a n k i n g of Sample H H

01020304050607080

G-Do-9

G-Do-3

G-Do-7

G-Do-8

G-Do-6

G-Do-4

G-Do-5

G-Do-2

Poor

Middle

U-Middle

Not Poor

GOB-donor areas: percentages improved & hygienic latrines relative to union wealth-ranking (most- to least-poor)

0.010.020.030.040.050.060.070.080.090.0

100.0110.0

G-Do-9 G-Do-7 G-Do-3 G-Do-8 G-Do-5 G-Do-6 G-Do-4 G-Do-2 Total

Ultra PoorPoorMiddleUpper MiddleNot PoorImpromed latrineHygienice latrine

Wealth Ranking of Sample HHC L T S U n I o n s

0102030

40506070

CL-4/D CL-2 CL-3 CL-10 CL-1 CL-9 CL-8 CL-7 CL-6 CL-5/D

PoorMiddleU-MiddleNot Poor

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

110.0

CL-4/D CL-2 CL-1 CL-10 CL-8 CL-9 CL-3 CL-6 CL-7 CL-5/D Total

Ultra PoorPoorMiddleUpper MiddleNot PoorImpromed latrineHygienice latrine

Challenges and Positive Factors: Summary of Findings

Challenges to Sustainability (1)

Local Leadership-Weak commitment of 1/3 union chairmen-Hardware emphasis > Awareness raising or public

education. “Latrinization”-Building new houses, new settlements without

attention to sanitation: no local building codes or strong requirements

-None are formally monitoring; - No firm rules or regulations

-OTHERS-Some UP chairmen and members reluctant to pressure their people before election

Challenges to Sustainability (2)

Economic

-Extreme economic hardship in some parts of the population

-Concerns about pit cleaning costs

-Crowding, congested settlements

-Space for disposal of pit contents may be limited

-Large numbers of agricultural laborers or floating people

Challenges to Sustainability (3)

Social divisions and disparities

-Insecurity of land tenure (khaash land)

-Social exclusion: ethnic minorities (adivasi), new settlers, “colonies”

-Local class conflict

-Latrine sharing

Technical- Poor quality of concrete latrine parts, some not

using reinforced concrete- Self-installed latrines may not be technically sound- Superstructure – especially lack of a roof- Soil conditions: very hard earth, sandy soil- Floods (low-lands), Flash floods, cyclones & storms- Inconvenient water supply or seasonal water

shortage: low priority given to carrying water for cleaning

Challenges to Sustainability (4)

Positive Forces: Contributing to Sustainability (1)

Expansion of public programs in past 5 years to the full population

Public understanding of health benefits is nearly universal

Strong role of schools in building and maintaining awareness

Being ODF is perceived as a national priority, which helps to reduce divisions at local and regional levels

Positive Forces (2)

Institutional Ongoing efforts of UP (2/3 active) and inspired volunteers

-A few ‘rules’ & requirements (or perceived)-Good cooperation between GO & NGO-Chowkidars: some observing, reminding -Pit cleaners in one union remind and warn people too

Positive Forces (3)

Social Change in public ‘mind-set’ resulting from 5 – 30

years of sanitation promotion programs: ‘shame’ (lojja) assoc with OD

Local pride & public occasions – village festivals, cultural events

Family Social status needs: marriage arrangement, good relations with in-laws

Perceived spiritual/religious benefits of latrine use

Positive Forces (4)

Neighbors remind each other about problems: quarrels, even some salish – sign of social norms changing

Self-help mentality in some poor communities:– Install their own latrines– Maintain their latrines (at high rates in places)– Do their own pit cleaning

Positive Forces (5)

Enhanced economic capacity of households getting remittances from abroad

Adequate supply of latrine parts and pit cleaning services has developed in recent years

Conclusions

[TO BE ADDED]

THANK YOU

FOR YOUR PARTICIPATION