By
Odhiambo M. Edwins
Regional CLTS Coordinator/National CLTS Trainer
Ministry of Health
Kenya
Previous CLTS Trigger
In June 2008- PPHO,Western province wrote to DPHO,Busia on failure to achieve 50% district latrine coverage target at mid term and was compelled to write to CPHO to explain and give the way forward. This was based on the Ministry of Public Health and Sanitation previous policy on counting number of latrines to signify improvement of sanitation which has since then changed to ODF communities.
In response to the order, the DPHO decided to try the CLTS approach using the two officers (PHO’s) who were trained on the approach in September 2008. The two,Edwin Odhiambo & Charles Ngira, who have since then turned National/Master Trainers.
Community Led Total Sanitation (CLTS) is an innovative methodology for mobilizing communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free). At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease. In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilization instead of hardware, and shifting the focus from toilet construction for individual households to the creation of “open defecation-free” villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for change, propels them into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability
July 2009-DPHO, Busia charged Mr. Charles Ngira with the responsibility to trigger 3 villages, of which one village (Mlimani)succeeded to go ODF and the other two villages failed.
In September2009CPHO became curious and anxious of the Mlimani success. December 2009, CPHO and PPHO,Western led a team of DPHOs to Mlimani village and recognized the achievements made, thereby giving a motorcycle to scale up CLTS activities. In February 2010 Job Meiger,WASH advisor, Royal Dutch Embassy visited Mlimani village and confirmed the achievements.
PREVIOUS CLTS PERFORMANCE
In October2009, Mlimani village became 1st ODF in Busia county, western province. This success elicited a lot of interest both at the National level and partners in WASH interventions. In August 2010, the Ministry of Public Health and sanitation and UNICEF embarked on a pilot program in 6 districts (5 in Nyanza province – Nyando, Siaya, Bondo, Kisumu West & Rachuonyo and 1 in Western - Busia) due to their poor sanitation indicators especially being cholera hot spot. Under the GoK/UNICEF program Phase 1, the Greater Busia District was targeted, which comprised Nambale, Butula, Samia, Busia and Bunyala districts. In this Phase, October 2010, the Greater Busia delivered 287 villages ODF. Out 287 villages 79 were from Nambale district which represented 83.6% of the district coverage (Nambale) which were certified in August 2011.Meanwhile 23 villages and 3 sub locations (Sikinga, Lwanyange andKisoko) had attained ODF status in early 2011. About 10 Natural Leaders emerged in the process and 10 villages marked celebrations and erected billboards.
Emasinde Declaration
May 2011 Dr. Kamal Kar on a visit during National ODF celebration at Emasinde village, Kamal asked the community whether they could use their success to stir the district ODF.Emasinde community unanimously declared to stop Open Defecation in the entire district.
Dr. Kamal with Mr. J. Kariuki- DCPHO, Mr. Farooq Khan UNICEF/WASH Consultant, Mr. Odhiambo Edwin, Mr. A Fwamba DPHO & Mr. Charles Ngira engaging Local / natural leaders on way forward in making Nambale the first ODF district in Kenya
PHASE 2:
NAMBALE DISTRICTCLTS
Implementation
In Jan 2012, Nambale district rural populationwas targeted ODF Status. The district CLTS stakeholders committee chaired by the area DC wasconstituted. The District was zoned into regions as north, central and eastern.Respective regional CLTS committees managed their areas and reported to the DC.
A stakeholders meeting at Nambale chaired by the DC
STRATEGIES
A total number of 12 Competent PHO/PHTs were deployed to handle 5 villages each and 10 Competent Natural leaders to handle 4 villages each while 15 urban villages were deferred. Local Administration /Provincial Administration was involved at locational level andcreatedan awardsystem for competition to facilitate results. The committee set specific timeline of one month from trigger to ODF status. The area DC and DPHO ConductedBi- weekly assessment and gave direction.The DPHO sourced for funds from UNICEF through the support of the CPHO. The district constituted CLTS stakeholders forum to harmonise and synergize the intervention. Schools and school children participation was listed and enhanced the success faster.
CLTS NAMBALE IMPLEMENTATION TIMELINE – January to march 2012
Stakeholders
The district stakeholders ODF Committee was constituted chaired by area DC. The team established sub committees (Northern, Eastern and Central) which were managed by area chiefs and reporting to area DC.The sub-Committees were chaired by the area chief while the PHO’s/PHT’s coordinated the field activities.
Trigger session
The DC Nambale arriving for a triggering session at Namisi village
The District Commissioner, Nambale District chairing a triggering session in Namisi West of Bukhayo central in Nambale . Ms. Rebecca Matalanga led the community through the steps of the session.
Follow –up
Maseno university students undertaking environmental Health Sciences on field practical were key component in village ODF follow ups.The PHOs/PHTs /NL were actively involved in this exercise. The District team led by DPHO-Busia oversaw follow up in the whole CLTS processes.
Follow up in Nangeni west village by Natural leader; Lillian Wanguria
Community investment in Sanitation
Latrine cost
1. Finance:
• Excavation – (4x2) sq. Ft -@200/= per foot.
• Minimum 10ft = 2000/=
• Timber slab =500/=
• Super structure =1500/=
• Grass thatching = 300/=
• Mudding = 300/=
• Shutters =400/=
• Cost per latrine =5000/=
•
• Total Cost = 5,000 X 1817 = 9,085,000
•
2. Labour:
• No. of days for latrine construction
•
• No. of persons deployed for one toilet -2 people.
- Digging -3 days
- Construction - 2 days
- Thatching/mudding -2 days
• TOTAL DAYS 7
3. Time:
• No. Of hours used for construction - 4 hours per day
• 7days X 4hours = 28 hours per latrine
• Cumulative time = 28 days (4 wks) X 24 hrs = 672 hrs
Way forward
The district has been certified by 3rd party and is awaiting a National Declaration and celebrations. The community has embarked on the upgrading process along the sanitation ladder and sustain the health gains. So far already 98 households have upgraded their latrines to VIP latrines.
Impact of CLTS intervention
Diarrhoea Prevalence among the under 5s before and after CLTS intervention
JAN / FEB / MAR / APR / MAY / JUN / JUL / AUG / SEP / OCT / NOV / DEC2008 / 43 / 92 / 22 / 16 / 89 / 105 / 83 / 24 / 51 / 52 / 29 / 20
2009 / 63 / 75 / 30 / 40 / 43 / 114 / 36 / 18 / 30 / 8 / 23 / 40
2010 / 25 / 16 / 17 / 14 / 24 / 32 / 15 / 22 / 22 / 33 / 46 / 32
2011 / 43 / 19 / 19 / 6 / 41 / 23 / 15 / 11 / 18 / 13 / 14 / 12
Data for the Under 5