An Assessment of CLTS Projects and
Formulation of the Strategy on
Sanitation Promotion
Final Report
Submitted to:
Nepal Water for Health (NEWAH)
Lohasal, Kathmandu
Nepal
Prepared by:
Centre for Economic and Technical Studies Pvt. Ltd.
Dhobighat, Lalitpur
Nepal
2007
ACKNOWLEDGEMENTS
In Nepal, sanitation is a major challenge. Only 39% of the population has access to
sanitation. A lot has to be done to meet the Millennium Development Goal (MDG) by
2015 and to achieve universal sanitation two years later by 2017. Many national and
international organizations, including the Government of Nepal (GON) have been trying
to increase coverage in sanitation sector. But to achieve the MDG or universal sanitation
within the stipulated time is a major challenge.
Over the years, NEWAH has developed strong network for promoting sanitation, apart
from providing drinking water facility to the needy people. Realizing the urgency to
achieve quick and yet more sustainable result, NEWAH piloted Community Let Total
Sanitation (CLTS) approach in Karkidada in Dhading in 2003 and in Dumre Ekata
Chowk of Morang in 2004. Subsequently, this approach was spread to over five districts
including in Dhading, Morang, Sunsari, Banke and Kailali. However, the non-CLTS
approach is also continuing.
We are pleased that the Centre for Economic and Technical Studies (CETS) was asked
to make assessment of the CLTS and give strategic recommendations. The CETS study
team members has been involved in the assessment of CLTS since 1 January 2007. In
conducting this work, we received major assistance particularly from NEWAH and other
concerned people and for this we are highly indebted to them.
More specifically, we are indebted to Mr. Umesh Pandey, Director, NEWAH and Sanjaya
Adhikary, Country Representative, Water Aid Nepal (WAN) for their guidance to the
assessment work. Our obligations are also due to Oliver Jones and Rabin Lal Shrestha
of WAN for their valuable inputs to the study.
Muhammod Abdus Sabur, Country Representative, Water Aid Bangladesh deserves
special thanks from us not only for giving distant input but working together with the
study team members in the field during the most turbulent period.
Our gratitude is due to Bipul Gyawali, Laxmi Paudyal and Ratan Budhathoki of NEWAH
headquarters for providing us valuable inputs and support at different stages of the
assessment. In the field, Himalaya Panthi, Regional Manager, NEWAH ERO, Kumar
Silwal, Regional Manager, NEWAH MWRO and Manoj Jung Rayamajhi, Regional
Manager, CRO provided all necessary cooperation to our study team members and for
this we would like to express our sincere thanks to them. We would also like to thank
Bharat Bhatt of NWEAH ERO for his briefing about the CLTS activities.
Our thanks are also due to Nawal Kishor Mishra, Chief, ESS, DWSS and Namaste Lal
Shrestha, UNICEF for sharing with us issues related to strategies for further growth of
CLTS in Nepal
2
We are obliged to Md. Zahid Parwez , sociologist for working so hard for the study. Our
thanks also go to Madhav Bhattarai, Hari Krishna Adhikari, Krishna Khanal and Shyam
Sundar Shah for conducting the field work in so adverse conditions.
Dhobighat, Lalitpur
30 March 2007
Hari Bansh Jha
Team Leader
3
CONTENTS
Page
ACKNOWLEDGEMENT
CONTENTS
LIST OF TABLES
LIST OF BOXES
ABBREVIATIONS
OVERALL ASSESSMENT, CHALLENGES AND STRATEGIC
RECOMMENDATIONS
i
iii
v
vi
vii
viii
Chapter One
INTRODUCTION
1-6
1.1
1.2
1.3
1.4
1.5
1.5.1
1.5.2
1
1
2
2
3
3
4
4
4
5
5
5
6
6
6
6
6
1.7
1.8
1.9
1.10
Sanitation Status
CLTS Approach
Objectives of the Assessment
Expected Major Outputs
Methodology
Secondary Source Information
Primary Source Information
1.5.2.1 Orientation Meeting
1.5.2.2 Site Selection and Survey
1.5.2.3 Interview
1.5.2.4 FGD
1.5.2.5 Checklist/Observation
1.6
Case Studies
Strategic Inputs
Data Processing
Draft Report
Final Report
Chapter Two
FIELD OBSERVATIONS
7-19
2.1
Background
2.2
Process
2.2.1 Knowledge about the Project
2.2.2 Ignition Process
2.2.3 Committee Formation
2.2.4 Social Mobilization
2.2.5 Tubewell/tap Functioning
2.2.6 Capacity Building Training
2.3
Reaching the poor and socially excluded
2.3.1 Dalits/Janajatis and Poor People in Programme
7
7
7
7
8
9
12
12
12
13
4
2.3.2
2.3.3
2.3.4
2.3.5
2.4
2.4.1
2.4.2
2.4.3
2.4.4
2.4.5
2.4.6
2.5
2.5.1
2.5.2
2.5.3
2.5.4
2.5.5
2.5.6
Women in Programme Implementation
Benefits
Support
Social Harmony
Sustainability
Cost Effectiveness
Technological Options
Hygienic Latrines
Hand washing Practices
Scalability
Impact on Disease Pattern
Major Challenges
Community or Committee Led
Geographical Consolidation
Too Hurry in Declaring NOD
NOD to Total Sanitation
Poor and socially excluded
Subsidy Approach
13
13
13
14
14
14
14
14
16
16
16
17
17
17
17
18
18
19
Chapter Three
CONCLUSION AND RECOMMENDATIONS
20-23
3.1
3.2
20
21
Conclusion
Recommendations
BIBLIOGRAPHY
24
Annex 1
Annex 2
25
26
Annex 3
Annex 4
Annex 5
Annex 6
Study Team Members
An Assessment of Community Led Total
Sanitation in Selected Districts in Nepal
(Questionnaire for Household Heads)
Guidelines for Interview with Resource Persons/
NEWAH Staff/Local Partner Staff/Health Post
Staff
Guidelines for Focus Group Discussion
Guidelines for Checklist/Observation of the
Households
Itinerary for Muhammod Abdus Sabur in Nepal
5
32
33
34
35
LIST OF TABLES
Page
Table 1:
Table 2:
Table 3:
Condition of the Tubewell/tap
Benefits to Socially Excluded Groups
Support for Poor and Excluded Groups
12
13
14
LIST OF BOXES
Box 1: Compelled by Grandchildren Dhan Bahadur Constructed Latrine
Box 2: Video Succeeded when social mobilization techniques failed
Box 3: "Khutruki" brings a change
Box 4: Hygienic latrine changes behaviour
`
6
9
10
11
15
ABBREVIATIONS
CETS
CHV
CLTS
CRO
DDC
DWSS
ERO
ESS
FGD
GON
MDG
MWRO
NEWAH
NGO
NOD
NSW
SACOSAN
SCNSA
UN
VDC
WAN
Centre for Economic and Technical Studies
Community Health Volunteer
Community Let Total Sanitation
Central Regional Office
District Development Committee
Department of Water Supply and Sewerage
Eastern Regional Office
Environmental Sanitation Section
Focus Group Discussion
Government of Nepal
Millennium Development Goal
Mid Western Regional Office
Nepal Water for Health
Non Governmental Organizations
No Open Defecation
National Sanitation Week
South Asian Conference on Sanitation
Steering Committee for National Sanitation Action
United Nations
Village Development Committee
Water Aid Nepal
7
OVERALL ASSESSMENT, MAJOR
CHALLENGES AND STRATEGIC
RECOMMENDATIONS
Overall Assessment








Sanitation coverage in the CLTS programme areas was 6% before the
declaration of NOD, which increased to nearly 100% after the declaration of
NOD.
Permanent latrines formed 96% in CRO, 80% in MWRO and 79% in ERO, which
averaged 85%.
94% of the latrines in the project areas were clean.
Latrines were largely upgraded in CRO and ERO, but they were hardly upgraded
in MWRO.
Hand washing practices with soap substantially improved during critical junctures
such as before eating, after defecation, after cleaning child's bottoms and before
child feeding.
Per household cost in CLTS amounted to NRs. 1,689; whereas it was NRs.
2,626 in non-CLTS project. CLTS project proved to be more cost effective than
the non-CLTS project.
CLTS was largely sustainable. It helped expand sanitation coverage within the
shortest period of time.
There was drastic reduction in the intensity of diseases like diarrhea, dysentery,
skin diseases, and fever due to CLTS project
Major Challenges









In CLTS project, the committee and not the community was the driving force.
CLTS was just an "island" of success as only "too small clusters" were selected
for the programme.
Too hurry in declaring NOD.
NOD and not hygiene and sanitation were the priority.
Lack of "no cost" or "cheaper cost" technological option for latrine construction for
the socially excluded groups.
Except a "few," all the family members used latrines. But even a "few" was a
threat to the rest as one fly is deadlier enough than 100 tigers.
Subsidy approach was treated as untouchable even for the poor and socially
excluded groups.
As certain pit latrines were damaged by rats and through rains in the Terai
region, people in certain clusters again resorted to the practice of open
defecation, which posed a major threat to the success of CLTS.
Virtually CLTS programme had hardly any linkage with local government bodies
such as VDCs and DDCs.
8

Complacency developed after a community was declared NOD. Least of efforts
were made to move a community from NOD status to totally sanitized one.
Strategic Recommendations
Ending Dual Approach

NEWAH should stop its dual approach of running both the CLTS and non-CLTS
projects at the same time. Of these two approaches, CLTS is a better option as it
is more cost-effective, sustainable and gives more of ownership feeling.
Therefore, in future NEWAH should "adopt" modified CLTS approach.
Priority to Hygiene Education

Hygiene has to come "first" and be given "top priority" while introducing CLTS
programme. NOD should come later. It should not be other way round.
Promotion of Hardware Subsidy

Subsidy should be provided to the disadvantaged groups in the form of sanitation
materials if that helps promote the purpose of CLTS. In this respect, wealth
ranking should be performed before CLTS activities begin so that economic
status of different groups of people is identified and necessary "subsidy" support
is extended to them.
Increase in Sanitation Coverage

There should be geographical consolidation of CLTS project for which the project
area coverage should be expanded to the entire VDC or a district and not just
selected clusters comprising only a "limited" number of households. In order to
increase this coverage, networking should be promoted with the government,
INGOs, bilateral and multilateral agencies working in sanitation field and
collaborate with them to use their resources and work together to give drive to
CLTS approach in far more effective way.
Further Motivation to use hygienic latrines

Even those "few" who avoid going to latrines for whatsoever reasons should be
further motivated to use hygienic latrines as they are threat to even those who
use hygienic latrines.
Adequate Technological Options

The poor people should be given adequate technological options for which R&D
activities should be promoted and the private sector entrepreneurs should be
encouraged to build and market "low cost" latrines. Among the landless groups,
the community latrine instead of individual latrine should be promoted such as in
Paribartan Tole of Urlabari VDC in Morang district or in Khatwe Tole of Babiya
VDC of Sunsari district.
9
Avoidance of Complacency in post-NOD stage

There should be no complacency even after achieving NOD status till the
community totally sanitized; for which monitoring and supervision activities
should be further intensified.
Total Sanitation

The community should be declared totally sanitized not haphazardly but based
on certain criteria like the presence and proper use of sanitary latrines on the one
hand and the change in behaviour of people in regard to personal, household
and environmental sanitation on the other.
Sustainability

Sustainability is guaranteed when a project is community led, not committee led.
The committee in a community should be formed in a way that it represents all
the groups of people and allows the "community" to be in the "driving seat." In the
place of a paid-facilitator, there should be a provision whereby the committee
performs its activities not through a single facilitator but through more effective
groups of extension and development workers including the CHVs for better
anchoring in total sanitation.
Scalability

For the scaling up of CLTS activities effectively, NEWAH should go for "joint
action plan" with all the organizations working or believing in CLTS model by
including governmental agency such as VDCs, DDCs, NGOs, INGOs, bilateral
and multilateral agencies. For this, what is also essential for NEWAH is to go for
frequent discussion meetings with such organizations and making advocacy for
joint action.
10
Chapter One
INTRODUCTION
1.1
Sanitation Status
In Nepal, the importance of sanitation was not well realized until 1970s. The traditional
and modern latrines until that time were mostly confined to the urban areas. Latrines
were almost non-existent in the rural areas. Even there was no national plan and
programme till that period to improve the sanitary condition.
It was first of all in 1981 that the GON intervened in the sanitation sector by launching
UN Declaration of International Drinking Water and Sanitation Decade. Accordingly, a
number of measures were announced in 1987 for the improvement of water supply and
sanitation situation in the country. Furthermore, in 1991 increased role of the NGOs and
other private sector agencies in sanitation sector was perceived. The Environmental
Sanitation Section (ESS) was established in Department of Water Supply and Sewerage
(DWSS) in 1992. Another major development in sanitation sector was the approval of
National Sanitation Policy in 1994. In order to plan and support sanitation promotion
programmes through the joint efforts of the stakeholders, the Steering Committee for
National Sanitation Action (SCNSA) was set up in 1998.
An era of observing National Sanitation Week (NSW) began in 2000, which is continuing
uninterruptedly each year. It has played key role in the promotion of sanitation both in
the rural and urban areas.
A number of provisions were made in the Eighth Plan (1992-97), Ninth Plan (1997-2002)
and the Tenth Plan (2002-2007) to increase the sanitation coverage in the country. The
Tenth Plan targeted to achieve 50% coverage in latrine coverage (Tenth Plan, 2002).
As a result of certain measures adopted by the GON and other agencies, the sanitary
condition in Nepal improved. Only 2% of the Nepalese had access to latrines till 1980,
which increased to 6% in 1990, 15% in 1997, 25% in 2001 and finally to 39% in 2004
(SACOSAN I).
Nepal's participation in SACOSAN I and SACOSAN II demonstrated the country's further
commitment to reduce the gap in sanitation by 50% to meet the Millennium Development
Goal (MDG) by 2015. The Rural Water Supply and Sanitation Policy 2004 further
committed to achieve universal sanitation coverage by 2017.
1.2
CLTS Approach
Despite Nepal's impressive score in sanitation coverage, significant gaps exist in water
and sanitation coverage. 82% of the Nepalese have access to drinking water; whereas
their access to sanitation is merely 39% (NLSS 2004). In view of this challenge, NEWAH
in recent years shifted its focus to increasing people's access to sanitation. There is a
11
growing realization in NEWAH that counting on number of communities declared No
Open Defecation (NOD) is much more important that the traditional practice of counting
on successes on the basis of number of latrines constructed in the community. This is so
because even those using a latrine are bound to live in a polluted environment due to
unhygienic practices of those who defecate openly.
Therefore, in June 2003 NEWAH sent a group of its staff on an observation visit to a few
Community Led Total Sanitation (CLTS) sites in Bangladesh. These staff members were
immensely impressed by the success of CLTS approach in Bangladesh. Following this
development, NEWAH piloted the CLTS in Karkidada in Dhading, which happened to be
the first pilot project of CLTS in Nepal. Subsequently, CLTS was introduced in Dumre
Ekata Chowk of Morang in 2004 after Kamal Kar, the pioneer of this approach, gave
certain orientation. So far 19 communities have been decelerated NOD and other 19
communities are awaiting for such a change. This approach is spread to five NEWAH
supported districts such as Dhading, Morang, Sunsari, Banke and Kailali. In order to
assess the sustainability and social inclusion aspects of CLTS approach, NEWAH
assigned an independent consultancy company, Centre for Economic and Technical
Studies (CETS), the responsibility to conduct an assessment of CLTS projects and
formulate the strategy for promotion of sanitation.
1.3
Objectives of the Assessment
The overall objective of the assessment study was to evaluate the effectiveness and
sustainability of CLTS approach and to provide the strategic inputs for the promotion of
NEWAH's sanitation programme.
1.4
Expected Major Outputs
The expected major outputs of the assessment were:
Process:




Are community mobilization methods inclusive, empowering and appropriate to
generate strong community institutions and a sense of community action needed
to achieve NOD communities?
To what extent are hygiene messages and other tools used in CLTS approach
relevant to communities needs and effective in influencing a collective change in
hygiene behaviour?
What social, financial or other barriers exit to successful implementation of the
CLTS approach at institutional and community level?
Does NEWAH’s CLTS approach provide sufficient support to communities in
regard to technological options, financing mechanisms and developing capacities
with communities to achieve Total Sanitation?
Reaching to poor and socially excluded:


Are women and other socially excluded groups playing a proportionate and
active role in implementation activities?
Are community mechanisms being established to support and/or cross subsidies
poorer households to achieve total sanitation?
12


Do socially excluded groups benefit equally from the CLTS interventions?
Does CLTS support the fostering of social harmony between different groups or
is it creating conflict?
Sustainability:










Technology:
To what extent have households built and maintained hygienic latrines?
What evidence is there that households have/will move up sanitation ladder?
Are materials available locally to maintain and upgrade latrines?
Behaviour Change:
Have communities declared as NOD maintained this status?
To what extent is improved hygiene practices being sustained e.g. hand
washing?
What community monitoring, reward or penal systems have been put in place to
maintain changes in behaviour?
Are communities moving from an NOD status to a Total Sanitized status?
Scalability:
Has CLTS approaches led to increased linkages with other programmes,
organizations and institutions e.g. local government?
To what extent does the CLTS approach cost effective compared to other
approaches?
Is CLTS an effective approach to take to scale and if so what might be the
barriers in achieving this?
NEWAH’s Sanitation Promotion Strategies:

1.5
Based on the assessment of CLTS, inputs received from few sample projects of
non CLTS, desk study and review of relevant documents, some key strategies
were suggested for promotion of sanitation programme in NEWAH.
Methodology
In order to fulfill the objectives and achieve the major outputs, the study drew upon
secondary and primary resource materials for data collection. Varieties of techniques
were developed for gathering such data.
1.5.1
Secondary Source Information
The secondary source information was collected and analyzed to reach the depths of the
issues related to the execution of CLTS. In this context, all relevant documents of
NEWAH internal and sectors policies, procedures and approaches related to sanitation
promotion, and costs of CLTS and non-CLTS projects were reviewed.
1.5.2
Primary Source Information
The primary source data for the study was collected largely through the interview of
household heads, Focus Group Discussions (FGDs), Checklists/observations, and case
13
studies. Appropriate tools and techniques were applied for collecting necessary
information for the study. The questionnaires and guidelines for some of those research
tools were prepared by the consultants by reviewing the relevant literature.
1.5.2.1 Orientation Meeting
An orientation meeting was conducted for the experienced research assistants to
familiarise them with the purpose of assessment so that they could collect data in the
field efficiently. In order to get reliable data, the research assistants were thoroughly
briefed about the objectives and the methodology of the study. The approach and
mechanism to conduct the survey was well explained to them. The following topics were
specially covered during the briefing:







Objectives and methodology of the assessment
Duties and responsibilities of the study team members
Interview techniques
Methods of filling questionnaires
Concepts and definitions of various terms and terminologies used in the
questionnaires
Art of building proper rapport with the respondents to get cooperation from them
during the field survey; and
Art of taking information through FGD.
1.5.2.2 Site Selection and Survey
The actual fieldwork of the study in NEWAH's CRO, MWRO and ERO started only after
the orientation to the field study team members between 18 January 2007 and 5
February 2007 (Annex 1 gives the list of Study Team Members, including the field staff).
The field staffs were well under the administrative and technical control of the study
Team Leader. NEWAH headquarters was informed of the dates of the field visit in
advance so that anybody interested to visit the field could do so.
The assessment covered both the hill and Terai regions. Dhading district represented
the hills; while Banke, Morang and Sunsari districts represented the Terai. While
assessing the CLTS projects of those districts, CETS study team members took into
consideration all CLTS projects supported by NEWAH in Dhading, Morang, Sunsari and
Banke districts.
Field survey of the household heads was conducted with the help of questionnaire in six
CLTS projects in Dhading, including in Halthum (Goganpani VDC), Karkidanda
(Bhumisthan VDC), Jugekuwa (Bhumisthan VDC), Devisthan (Bhumisthan VDC),
Deurali (Bhumisthan VDC) and Sudikhola (Bhumisthan VDC). In Morang, field survey of
households was conducted in Paribartan Tole, Prakriti Chowk and Ekata Chowk of
Urlabari VDC; whereas in Sunsari the survey was conducted in Khatwe Tole of Babiya
VDC. And in Banke district, field survey of the households was conducted in Bageshwori
(Bageshwori VDC) and Rai Tole (Sitapur VDC). Thus, field survey of the households
was conducted in altogether 12 CLTS clusters of Dhading, Morang, Sunsari and Banke
districts.
14
The consultants visited one non-CLTS project in Banke district and the other one in
municipality area of Biratnagar in order to ascertain effectiveness and sustainability of
CLTS project and determine the future strategies for sanitation promotion in NEWAH.
From each of the MWRO and CRO coverage areas, 10% of the households and
NEWAH staff were interviewed on the purposive sampling basis, which is a standard
norm. In ERO only 7% of the total households could be interviewed as the Terai unrest
did not allow the field staff to complete their assignment fully. However, this did not make
any difference in the expected outcome of the study. Altogether 51 households were
interviewed in CRO; 69 households in MWRO and 77 in ERO making the total number of
households interviewed as 197. The households were selected on the random sampling
basis and the household heads were interviewed by the field staff.
1.5.2.3 Interview
Interview with the questionnaires was directed to two groups of people – one to the
household heads in the CLTS project areas and the other to the resource persons,
NEWAH staff/Local Partner Staff and Health Post staff. The households covered in the
CLTS project areas, included those with latrine not upgraded, with latrine upgraded,
poorest/ultra poor and differently abled individuals.
The questionnaire for the interview of the households focused on such aspects as
process, poor and socially excluded groups, and sustainability (Annex 2). On the other
hand, the guidelines for the interview with the resource persons, NEWAH staff (Regional
Manager and supporting field staff)/Local Partner staff and Health Post staff focused on
aspects related to scalability, effectiveness and impact of the approach (Annex 3). The
questionnaires for interview were prepared in such a way that they enabled to produce
the future strategy for sanitation promotion.
1.5.2.4 FGD
FGDs were arranged in the sample areas with user committees, child group/child club,
women groups, P&E groups, community leaders such as teachers, local politician and
health post staff. One of the basic objectives of arranging the FGDs was to verify the
information collected from the questionnaires. In the FGDs, information was collected
from the discussants with the help of certain guidelines developed by the consultants
(Annex 4 ).
1.5.2.5 Checklist/Observation
Certain information not possible to be gathered either through the interviews or through
the FGDs were collected through checklist as per the guidelines developed by the
consultants (Annex 5), which primarily focused on:






Household observations on cleanliness
Latrine standard /hygienic condition
General hygiene condition of the community people
Evidence of improved hygiene behaviour
Triangulation and verification of NOD status
Assessment of collective action and community unity
15
1.6
Case studies
A few striking case studies were prepared to unveil certain social and cultural
dimensions inhibiting or promoting the implementation of CLTS approach.
1.7
Strategic Inputs
To capture the regional good practices on sanitation promotion and provide the inputs in
this assessment, Muhammod Abdus Sabur, Country Representative of Water Aid
Bangladesh visited a few CLTS projects along with the Team Leader in Morang and
Sunsari districts. Sabur's inputs proved valuable to produce the good report and to
provide the strategic input for sanitation promotion in NEWAH for future. In addition, an
interaction was made with the concerned resource persons of NEWAH, donor agencies,
Water Aid Nepal (WAN) and ESS/DWSS regarding different aspects of CLTS and nonCLTS approaches (Annex 6 presents Itinerary of Sabur and Jha's visit to Morang,
Sunsari and other places in Kathmandu).
1.8
Data Processing
In the process of data analysis, the consultants analysed the data collected from the
secondary and primary source materials. The secondary source data were reviewed and
wherever appropriate they were used to supplement the primary source information in
areas related to process, accessibility to poor and socially excluded communities,
sustainability, and scalability. The raw data collected in the field through the structured
questionnaires, FGD and checklist/observation were initially tabulated, compiled and
processed by the data processor and then they were arranged in a tabular and graphical
form to present the result in a qualitative way. Data were collected in a way that they
covered all major achievements and strategies for the promotion of sanitation
programme in NEWAH.
1.9
Draft Report
The draft report of the assessment as presented to NEWAH for comments contained the
methodology of the study, analysis of the field data and strategies suggested for
promotion of sanitation programme in NEWAH.
1.10
Final Report
Useful comments and suggestions were made by NEWAH on the draft report, which
were duly considered while finalizing it.
Reference:
CBS. 2004. Nepal Living Standard Survey (NLSS). Kathmandu
NPC. 1998. The Ninth Plan. Kathmandu
NPC. 2002. The Tenth Plan. Kathmandu
SACOSAN I & SACOSAN II Reports
16
Chapter Two
FIELD OBSERVATIONS
2.1
Background
NEWAH introduced CLTS pilot projects in communities with very low coverage of latrine
and sanitary condition in 2003-2004. The projects aimed at achieving universal
sanitation by motivating people to construct latrines on their own. Under the existing
arrangement, there was no provision of hardware subsidy. The field result showed that
the CLTS piloted projects in all the three regions of the country i.e. CRO, MWRO and
ERO not only helped increase sanitation coverage but also changed hygienic behaviour
of the targeted population. However, there are still many challenges that need to be
addressed to make the CLTS projects more efficient and effective in future. The field
observations carried out by the study team members came out with the following details:
2.2
Process
NEWAH's staff initially developed certain criteria for the selection of project areas. As per
the first criteria, the project area should be located at a place where no other
organization worked before. The second criteria was that there should be poor and
mixed groups in a community from social, cultural and economic perspectives. And the
third criteria was that the area should have accessibility to local materials. Once the area
was selected, the staff built rapport with the community where intervention had to be
made through CLTS piloted projects. In this process, they acquainted the people with
the objectives of CLTS programme. Besides, they also tried to convince them about the
need to lead and implement the programme without any subsidy.
2.2.1
Knowledge about the Project
Field observations showed that all the household heads interviewed in CRO, MWRO
and ERO were aware of CLTS project. It was mainly from the NEWAH's staff that they
learnt about this project. They had a feeling that the project as designed by NEWAH was
useful to them and so they needed it. However, 21% of the interviewed household heads
in MWRO did not feel any need of CLTS project as they were not much aware of its
activities.
2.2.2
Ignition Process
Before the intervention was made in the project areas through Ignition tools, the
households in general lacked latrines. Many people did not even wash hands with soaps
after defecation. The schools lacked latrines. The environment in and around the villages
were polluted because of haphazard excreta disposal along the roadsides, streets and
17
other public places and so it was difficult to walk there. In several places, the human
excreta and animal dung used to get mixed together and create serious environmental
problem.
During the process of intervention, an effort was made to assess the local situation
through Ignition Participatory Rural Appraisal (PRA) process with a view to bringing
change in people's thinking and their behaviour. The communities with the help of the
facilitators identified the main sites of defecation in the villages. On all such sites, flags
were installed by the community members to create awareness in the community about
the need to stop open defecation. And then, the communities calculated the total amount
of faeces collected due to open defecation. Such exercise was made to bring awareness
among the people as to how the open faeces transmitted into human mouths affected
their health. It helped motivate the people to construct latrines – be it temporary or
permanent – as per their economic conditions and get rid of open defecation.
In order to ignite the communities, all such motivational tools as walk the same, social
mapping of village, defecation mapping, faeces calculation, faeces mobility and group
discussions on diseases (caused by open defecation) and the costs involved in
treatment were used. All the interviewed households in CRO and ERO reported that
Ignition PRA tools like faeces mapping, faeces calculation, faeces flagging and faeces
mobility chart were used as intervention strategies in the communities to trigger change.
However, in MWRO 58% of the respondents denied of Ignition PRA tools ever used in
their communities.
2.2.3
Committee Formation
After the Ignition tools were performed, the communities formed representative
committees to enable them to take a lead in planning and mobilizing people's support in
latrine construction. Children's clubs were formed to monitor and prevent people from
open defecation. Women were also involved in the process of maintaining cleanliness in
their houses, yards and surrounding environment. In several communities, women clubs
were formed and the members regularly cleaned their houses, yards and the
roads/streets and performed continuous monitoring of such activities.
A number of reward and punishment mechanisms were introduced in various CLTS
programme areas. In MWRO, 98% of the respondents found the reward and punishment
mechanisms useful in the implementation of CLTS programme. On the contrary, in CRO
88% of the respondents denied of having any such reward and punishment system.
Such a person who played an important role in maintaining sanitary environment or the
one who built latrine in a community first was awarded. Marking was made on the social
maps of the households who constructed latrines. A household was also awarded for
keeping one's latrine clean.
But at the same time a person was fined any amount varying from NRs. 10 to 51 if found
defecating openly. The child committee members were made to chase a person while
defecating openly. For this, they kept patrolling the open defecating spots since the early
morning and shouted loudly, blew whistles, made cartoons and even wrote the names of
persons defecating openly on the notice board. In Rai Tole of Sitapur VDC in MWRO,
the Child club members fined a person NRs. 10 while found defecating openly and in
this process they were able to mobilise NRs. 1,700 for the club. Box 1 below presents
18
the case of Dhan Bahadur Rai who constructed latrine when he was not allowed by his
own grandchildren to defecate openly.
Box 1:
Compelled by Grandchildren Dhan Bahadur Constructed Latrine
Dhan Bahadur Rai (63) is an inhabitant of Rai Tole of Sitapur VDC in Banke district. Before the
CLTS programme was introduced, all the community members including him used to go to open
field and forest for defecation. But at the advent of CLTS programme, everybody in the
community had to make commitment for making their area NOD. The Child club was also formed
to monitor open defecation activities.
Despite the fact that Rai had made commitment for NOD, he himself took a water bottle in one
fine morning and proceeded towards the field for open defecation. But the members of the Child
club including his own grandchildren blew whistles and did not allow him to defecate. He was too
angry and so he murmured for some time. But he could not do anything as he was also one to
make commitment for NOD.
Rai then had no option left but to walk for half-an-hour with the water bottle in his hand towards
Man Khola. He defecated there. But he returned home throwing the water bottle in Khola itself.
Soon he started digging at his home compound and constructed a latrine. He would not have
constructed the latrine so soon if he were not compelled by his own grandchildren. Now he is
member of the Committee formed to promote CLTS. He actively monitors sanitary activities and
does not allow people around to go for OD. He has realization of the mistake that he made
initially and now he gladly shares this feeling with others.
Source: Madhav Bhattarai
In CRO, all the respondents found the representative committees as active. On the other
hand, in ERO 95% of the respondents held the committees to be active. In MWRO, only
58% of the respondents regarded such committees as active. These committees played
key role in creating awareness in the communities for constructing and promoting the
use of latrines and maintaining environmental sanitation. In order to give vigorous drive
to some of those activities, the paid-facilitators were appointed.
2.2.4
Social Mobilization
During the process of social mobilization, the local communities were asked to make
proper use latrines and cover food and drinking water. Relations between faecal-oral
diseases were explained to them. All the respondents in CRO and ERO told that
different social mobilization techniques such as rallies and street plays were launched to
achieve NOD status. In MWRO, however, 39% respondents reported that social
mobilization techniques were not initiated.
All the respondents in CRO reported that the social mobilization techniques were
effective in bringing change in the attitude and behaviour of people. In ERO, 86% of the
respondents found the social mobilization techniques to be effective; whereas in MWRO
only 57% of the respondents held such techniques as effective. In Simarbona Tole of
19
Tanmuna VDC in Sunsari, the social mobilization techniques in the initial stage could not
prove effective as people did not change their habit of open defecation and they did not
keep their surrounding environment clean. But when they had an occasion to see the
results of CLTS programme of Dumre, Urlabari VDC through the video, their life and
behaviour significantly changed (Box 2).
Box 2:
Video Succeeded when social mobilization techniques failed
In Simarbona Tole of Tanmuna VDC in Sunsari, none of the social mobilization techniques
proved effective in motivating the local Madheshi (Tharu) community to construct latrines. They
used to buy land and construct houses, but latrine construction was far from their thinking. It was
too difficult to motivate them to construct latrines. In such a situation, the people were shown a
video, which gave details of success of CLTS project in Dumre of Urlabari VDC in Morang. It also
mentioned how the people benefited from the programme. It was then that the people of
Simarbona Tole became motivated and they constructed latrines. If drainage were made in this
cluster, it could have emerged as a most successful model of CLTS.
Source: Hari Bansh Jha
As a result of social mobilization techniques, the households began to cover food and
drinking water. They kept their utensils clean. They began to construct and use latrines.
They also started washing their hands after defecation, before taking food and after
cleaning the bottom of the child. At certain places such as in Paribartan Tole of Urlabari
VDC (ERO), the households began to put wastes in the garbage pit. Utensils were
washed properly and put on racks. Environmental sanitation was maintained on the
roads, streets and other public places, which earlier used to be polluted due to open
defecation. Box 3 presents a story of Gyana Devi who brought substantial change in
Rajbanshi community by saving money in "khutruki" to construct latrine in one non-CLTS
project at Bakhari tole of Biratnagar Sub-Metropolitan City. Even the community people
were motivated to abstain from smoking and drinking and as a result quarrelling largely
stopped in the project area.
20
Box 3:
"Khutruki" brings a Change
NEWAH has its non-CLTS project at Bakhari tole in Biratnagar Sub-metropolitan city. In the initial
stage, Bal Samaj Nepal, a local NGO, was selected for implementing the project. In this process,
the families at Bakhari tole were classified into Ka, Kha and Ga groups. As per the requirement,
all the household heads at Bakhari tole were asked by Bal Samaj Nepal to make the required
contributions to receive rings and pans for latrine construction from NEWAH.
Being a resident of Bakhari tole, it became obligatory for Gyana Devi Rajbanshi to make
contributions amounting to NRs. 800 to receive rings and pan for latrine construction. But she had
no money to pay for. At that time, even other household heads at Bakhari tole did not come
forward to make contributions and receive rings and pan for latrine construction, though the
situation of that place was worse in terms of latrines and sanitary conditions. The roads and
streets of the tole were all polluted due to open defecation. Even a cycle passing through the
roads and streets used to get contaminated. Haphazard disposal of human excreta along the
roads and streets created many diseases and made the surrounding areas most polluted.
It was not solely due to poverty but also due to lack of trust that the people did not like to make
contributions to Bal Samaj Nepal. There was a rumor that the NGO would collect money from the
residents of Bakhari and then vanish altogether from the scene. So the non-CLTS programme
was not making any progress.
Even in such an embarrassing situation, Gyana Devi Rajbanshi was fully determined to make
contribution for rings and pan so as to make latrine. She had also certain compulsion to stay in
the programme as she was in the committee.
So without telling anybody about her plan, she began to deposit coins in her small "khutruki" i.e.
saving box made up of clay. Since she was from an ordinary family, it was too difficult for her to
make savings. Somehow, she began to put coin of 25 paise, 50 paise and 1 rupee denominations
in the "khutruki."
One day she went straight to Bal Samaj Nepal taking "khutruki" in her hand and gave it to the
staff of Bal Samaj Nepal. The total savings made in the "khutruki" was found to be NRs. 28,000.
A good amount of money indeed! Of this amount, she immediately gave NRs. 8,000 to Bal Samaj
Nepal as her contribution to receive rings and pan for latrines. With the rest of the money, she
made house. Once she constructed latrine, it had a big demonstration effect in the society.
Immediately, other households also started making contributions for rings and pan for latrine
construction. Now the open defecation in the area stopped as each household has a latrine. The
roads and streets all look clean.
Even the 3-year grandson of Gyana Devi Rajbanshi does not go to his maternal uncle's house
fearing that he will have to go for open defecation. I was told the little boy had gone to his
maternal uncle's house, but he found no latrine. He felt tortured when he was made to defecate
openly. He then compelled his mother to return home. After this incident, the boy flatly refused to
go to his maternal uncle's home. When I asked the little boy if he would like to go to his maternal
uncle's house, he said na jaibe meaning "I will not go."
Gyana Devi Rajbanshi recalls that there has been drastic reduction in diseases in her area as a
result of improved sanitary environment. Earlier she had to go to hospitals quite frequently as
diarrhea and dysentery were common. But now these diseases are rare phenomenon. She is
now the treasurer of Bakhari Drinking Water Supply Committee under the NEWAH non-CLTS
project.
Source: Hari Bansh Jha
21
2.2.5
Tubewell/tap Functioning
There is co-relation between tubewell/tap condition and sanitation. The better the
condition of tubewell/tap, the higher is the chance of sanitary condition. Table 1 shows
that 86% of the tubewells/taps in the CLTS projects was well-functional. However, the
fact that 14% of the tubewells/taps were either non-functional or partially functional
shows a greater need to improve their conditions.
Table 1
Condition of the Tubewells/taps (In Percentage)
---------------------------------------------------------------------------------------------------------Regions
Well-functional
Non-functional
Partially functional
---------------------------------------------------------------------------------------------------------CRO
86
4
10
MWRO
89
7
4
ERO
83
4
13
---------------------------------------------------------------------------------------------------------Total Average
86
5
9
----------------------------------------------------------------------------------------------------------Source: Field Survey 2007
Note: The well-functional tubewells/taps are those which supply adequate water; whereas the
non-functional tubewells/taps hardly supply water. On the other hand, the partially functional
tubewells/taps supply water, but less than the required level.
In order to ensure sanitary condition around the tubewells/taps, it is essential that there
should be proper platforms. However, in CRO none of the taps had any platform. In
MWRO, 83% of the tubewells had platforms against 95% in ERO. Furthermore, 87% of
the respondents in ERO and 94% in MWRO found the surrounding condition of the
tubewells clean. Similarly, 90% of the tubewells in ERO and 71% in MWRO had
provisions of proper use of waste water.
2.2.6
Capacity Building Training
Capacity building training was most widespread in the CLTS programme. In CRO, all the
respondents told that they had received one or the other training related to construction
of hygienic latrine, management training, gender training, kitchen gardening training, etc.
In ERO, 96% of the respondents received such training. But in MWRO, 61% of the
respondents denied of having received any such training.
2.3
Reaching the poor and socially excluded
Under the CLTS programme, the poor and socially excluded groups like the Dalits,
Janajatis and women mostly living below the poverty line need to have proportionate and
active role in the implementation activities. This programme cannot be successful until
these groups of people are effectively targeted. These are the people who are most
vulnerable and exposed to all sorts of health risks emerging from open defecation and
other unhygienic practices. Therefore, the success of CLTS largely depends on the
extent they construct latrines and practice different hygienic practices.
22
2.3.1
Dalits/Janajatis and Poor People in Programme
All the respondents in CRO told that the socially excluded groups like the Dalits/Janajatis
were represented in the implementation activities. In ERO, 97% of the respondents had
the same feelings about the representation of these socially excluded groups in the
implementation activities. Similarly, in MWRO 77% of the respondents told that the
socially excluded groups were represented in the implementation process. In CRO,
mostly the educated families (84%) from the excluded groups were involved in
implementation activities; whereas in ERO and MWRO 63% and 43% of the poor from
excluded groups were represented in such a process respectively.
2.3.2
Women in Programme Implementation
All the respondents in CRO and ERO reported that the women had proportionate and
active role in implementation of CLTS programme. In MWRO, 78% of the respondents
told that the women had certain role in implementation activities. 82% of the women
involved in CLTS implementation activities in CRO came from educated families;
whereas in ERO and MWRO 62% and 43% of the women represented in
implementation activities came from poor families.
2.3.3
Benefits
As the table 2 shows, 98% of the respondents in CRO and 95% in ERO believed that the
socially excluded groups were benefited equally from CLTS interventions. 77% of the
respondents in MWRO had a feeling that such groups benefited from CLTS
interventions. In MWRO, with the support of District Development Committee (DDC)
subsidies to the extent of 50% were given to the poor in the form of rings and pans for
latrine construction in CLTS project area. The Bageshwari Purn Sarsafai Samiti in
MWRO itself approached the DDC of Banke and managed to receive hardwares for
latrine construction for 25 households.
Table 2
Benefits to Socially Excluded Groups (In Percentage)
---------------------------------------------------------------------------------------------------------Regions
Yes
No
---------------------------------------------------------------------------------------------------------CRO
98
2
MWRO
77
23
ERO
95
5
---------------------------------------------------------------------------------------------------------Source: Field Survey 2007
2.3.4
Support
The following table demonstrates the respondents' perception in regard to the support
extended to the poor and excluded groups under the CLTS project. In ERO, all the
households reported that due support was extended to poor and excluded people and
that they benefited from the programme. In CRO, too, 96% of the respondents had
similar views. Similarly, in MWRO 61% of the respondents accepted that such support
was extended to poor and excluded groups. All the respondents in ERO and 61% and
49% of the respondents in CRO and MWRO revealed that such a support was made
available to the poor and excluded groups in the form of technology.
23
Table 3
Support for Poor and Excluded Groups (In Percentage)
---------------------------------------------------------------------------------------------------------Regions
Yes
No
---------------------------------------------------------------------------------------------------------CRO
96
4
MWRO
61
39
ERO
100
---------------------------------------------------------------------------------------------------------Source: Field Survey 2007
2.3.5
Social Harmony
The general perception of the respondents was that the CLTS project created social
harmony. None of the respondent told that it ever created conflict. However, 57% of the
respondents in CRO and 16% in MWRO reported that the CLTS rogramme neither
resulted into social harmony nor conflict.
2.4
Sustainability
The sustainability of the CLTS projects largely depends on the effectiveness of hygiene
and sanitation messages. Major highlights of these messages were related to
"construction and proper use of hygienic latrines," "building village on one's own efforts,"
and "maintaining environmental sanitation." The messages were given due publicity to
achieve NOD. Besides, hygiene and sanitation education programmes were also
launched.
2.4.1
Cost Effectiveness
An analysis of tables on Kotpokharachour Health and Sanitation Project (Damek 4 5,
Baglung) clearly indicates that NEWAH's support per household in CLTS project
amounted to NRs. 1,689; whereas it was NRs. 2,626 in non-CLTS project (Annex 7).
The CLTS programme, thus, appeared to be more cost-effective than the non-CLTS
project.
2.4.2
Technological Options
NEWAH could hardly provide "no cost" or "cheaper cost" option for latrines in the CLTS
projects. In most of these project areas, the latrines had only ceramic pans and rings.
There could have been even cheaper options of those hardware parts in the form of
plastic pans and pans/rings made up of other locally available materials, but they were
least promoted. In Bangladesh, some 10,000 industries prepare only hardwares for the
latrines; whereas in Nepal this sector is least promoted.
2.4.3
Hygienic Latrines
Before the CLTS programme was introduced, only 6% of the households had latrines in
the project areas of CRO, MWRO and ERO. 94% of the people in various communities
used to defecate mainly in the open field and also along the road side and their home
surroundings. In Khatwe Tole of Babiya VDC, only one or two houses had latrines before
the programme. But now there is no house where there is no latrine. So the latrines were
constructed mostly after the implementation of CLTS programme.
24
The households constructed latrines for a variety of push and pull factors. The fear of
penalty for open defecation, possibility of quarrel in going for defecation in others' land
and fear from snake bite were some of the push factors for latrine construction; while
growing awareness of the people for the construction of latrines for comfort and health
was the major pull factors. In CRO, there was a general tendency on the part of the
people to spend one-tenth of the cost of house-making for latrine construction.
After the declaration of the communities as NOD, almost all the households had latrines
and the family members regularly used latrines. Yet old people above 60 mostly found it
difficult to use latrines. This was partly due to the habit and partly due to unsanitary
condition of the latrines. Box 4 presents the story of an old woman who avoided the use
of latrine mainly because it was unhygienic and due to bad odor. Once an improvement
was made in the latrine, she began to use it. However, there were also "small" number
of people who were not prepared to change and they went for open defecation.
Box 4:
Hygienic Latrine changes behaviour
Khajura is situated 7 km from Nepalgunj on the way to Gularia. A 75-year old woman belonging to
Gurung family lives there. Except this woman, all the Gurung family members in this village used
latrines. She was reluctant to use latrine and, therefore, she always went outside for open
defecation. She was feeling tortured and wept if someone forced her to go to latrine. Her
daughter-in-law often grudged against the mother-in-law for her behaviour.
Once the old woman revealed it to her relatives that she avoided the latrine because it gave bad
odor. She even complained of bad odor of latrine in Nepalgunj where her daughter lived. It was
later on confirmed that her complain was not all invalid. The latrine at her house was joined with
Gobar Gas plant and there was no siphon attached to it. So bad odor was coming and that was
the root irritation for the old woman. Once the siphon was attached to the pan and it was made
hygienic, the old woman began to use the latrine. Now she feels proud of avoiding open
defecation and is comfortable enough in going to the latrine.
Source: Madhav Bhattarai
Pans and cement rings were mostly available in the local or nearby market. Local raw
materials such as bamboo, wood and straws were widely used to make the
superstructure. Households made latrines as per their economic conditions. In
Bhumisthan VDC in CRO, the expenditure made on latrine construction by individual
household varied from minimum NRs. 3,500 to NRs. 16,000. The wealthier people
commonly made permanent superstructure; while the poor used temporary
superstructure made up of locally available raw materials. In most of the CLTS projects,
the beneficiaries experienced least of problems in latrine construction and their
maintenance. It was only for making superstructure of the latrines that they had certain
problems.
Most of the latrines constructed in CLTS projects appeared to be well maintained as they
were having ceramic pans, rings and offsets with ventilation pipes. Field observation
showed that many of the latrines which initially were having pit structure were later on
upgraded to offset latrines. Altogether, 78% of the respondents upgraded their latrines in
25
CRO and 52% in ERO. However, in MWRO none of the respondents took any interest
in upgrading their latrines due to the financial problem.
Permanent latrines constituted 85% in total. At the regional level, permanent latrines
constituted 96% in CRO, 80% in MWRO and 79% in ERO. Similarly, 94% of the latrines
in total were found clean. At the regional level, 98% of the latrines were clean in CRO,
93% in MWRO and 93% in ERO. In all the CLTS programme areas, most of the family
members used such materials as cleaning brush, finial and Harpic to clean their latrines.
In ERO, all the SaniMart products such as pan, cleaning brush, bathroom cleaning
detergent including Harpic and other construction materials like HDPE pipe and cement
were available nearby for the construction, operation and maintenance of latrines. 67%
of the families received such products in nearby market in MWRO. But in CRO only 20%
of the families received those products in the local market.
2.4.4
Handwashing Practices
All the respondents in CRO, MWRO and ERO reported that they washed their hands
after critical junctures such as before eating, after defecation, after cleaning child's
bottoms and before child feeding. In MWRO, all the people washed their hands with
soap and water; whereas in ERO 74% of the people washed their hands with soap and
water and the remaining 26% washed their hands with ash and water. Moreover, in CRO
the number of people washing their hands with soap and water constituted 33% followed
by those who washed their hands with mud and water (22%), ash and water (16%) and
water only (4%).
2.4.5
Scalability
The CLTS projects were not all selected on the supply driven concept, but at places
there was also a demand for them. For example, the households of Prakriti Chowk in
Urlabari VDC asked for the CLTS project when they were impressed with its
development in Dumre Ekata Chowk. Likewise, the people of neighbouring Majh Tole
and Babsthan Tole initiated the CLTS programme in their areas as a result of the
demonstration effect of the programme in Rai Tole of Sitapur VDC in MWRO. In the
same region, people of Ailani Tole, Barmeli Tole, Elgaon, Basantpur, etc. also asked
NEWAH office in MWRO to introduce the CLTS project in their respective Toles.
However, the CLTS programme lacked linkage with VDC or DDC. The VDC is the lowest
unit of the government at the village level; while the DDC is the district level government
body responsible for the development of a district. Both the VDC and DDC have certain
human and other resources and they are also authorized to divert part of its budget for
sanitation activities.
2.4.6
Impact on Disease Pattern
CLTS programme made important contributions towards the reduction in the disease
pattern. Wherever this programme was launched, the beneficiaries largely became free
from diseases like diarrhea, dysentery, scabies, intensity of worms (roundworms,
whipworm, tapeworm and guinea worm), intensity of fever (typhoid, malaria, yellow fever
and kalazar), etc. In CRO, MWRO and ERO, the people reported of reduction in some of
these diseases after the introduction of CLTS programme. In Rai Tole of Sitapur VDC of
MWRO, the people reported of reduction in some of these diseases including gastritis
and eye diseases to the extent of 70 to 80%. The Sub-Health Post of that VDC revealed
26
that the diarroheal and dysentery cases in the community reduced by 60%. As a result,
the expenditure on the treatment of some of those diseases declined.
2.5 Major Challenges
Significant achievements have been made by CLTS projects in hygiene and sanitation
sectors. The poor and socially excluded groups were benefited from them. Yet there are
challenges, which cannot be overlooked. NEWAH needs to address them to improve the
effectiveness of the projects. Some of those challenges are:
2.5.1
Community or Committee Led
There is no adequate involvement of the entire community members in the process of
forming representative committee. Women, children, Dalits and other disadvantaged
groups are represented in the committee, but in many cases they do not have active
participation in program activities. Of course, there is a provision for facilitator in the
committee, who works part time for the promotion of sanitation. But the question is
whether the facilitator's role is really supportive? How would it have been if in the place
of facilitator the project could have engaged in one or the other way the extension
workers such as the Community Health Volunteers (CHVs) or the NGOs? As an
individual, a facilitator has limitations to expand the area of her activities – be it related to
the development of drainage, solid waste management, waste water management or
promotion of sanitary menstruation. A facilitator, of course, could facilitate the sanitation
activities and behaviour in a community to a certain level. But does it allow a community
to take the "driving seat." Some of these questions compel one to think if the CLTS
approach is really community laid. If the project is not community led, sustainability of
the programme is questionable.
2.5.2
Geographical Consolidation
CLTS is implemented as pilot project in only a few clusters of some districts. There is
hardly any coverage of even entire ward or VDC in the existing CLTS approach. Only
certain households in a ward represent a cluster. The VDC or the district is too big unit
as compared to a cluster. In this perspective, even if a CLTS project becomes
successful, it is just an "island" of success.
2.5.3
Too Hurry in Declaring NOD
There is a set time line for the completion of any project. Certain longer process has to
be followed to make the people understand about the importance of hygiene and also to
generate demand for latrine construction. In fact, hygiene and sanitation messages are
meant for behaviour change and it takes quite a longer period of time for motivational
and promotional measures to become effective before a community makes a change in
household and environmental behaviour.
In CLTS projects, the people hardly have time to understand why they need to have
latrines, wash their hands before eating or after defecation, use separate slippers for
latrines and maintain cleanliness during menstruation. Changes in such activities are not
possible in short period. But there was too much hurry in declaring NOD in CLTS
projects. Some projects were declared NOD even within 2 months from the date of start.
Others were declared NOD in time varying between 3 and 7 months.
27
There were clusters that declared themselves NOD even though they did not comply
with the requirement of sanitary latrine or safe drinking water. In Paribartan Tole of
Urlabari VDC, for example, there was hardly any provision of ventilation pipe in the
latrines. Bad odor still came through the pans. Similarly, in Dumre Ekata Chowk, almost
all the latrines and tubewells existed at too close proximity (within 30 ft. distance). Since
the residue of latrine mixed with catchments area of tubewell water at certain level, the
source water was contaminated. However, some of these factors were not duly
considered while declaring the communities NOD.
Mostly coercive methods such as whistling and fining were largely promoted to declare a
community NOD, but they did not always bring out tangible results. Therefore, except a
few cases, there was no system even in communities declaring themselves NOD of
sparing slippers for latrine purposes. There were some individuals who still practiced
OD. In Ward No. 8 and 9 of Debasthan VDC or in ward 7 of Jungekuwa of Bhumisthan
VDC in Dhading, there were certain households who could not construct latrines due to
poverty, illiteracy and lack of awareness. In ward no. 5 of Goganpani in Bhumisthan
VDC, NEWAH had promised to make latrines in school, but such a promise was not
fulfilled.
In non-CLTS project at Bakhari Tole of Biratnagar municipality, 50% of the beneficiaries
particularly from Musahar community did not use latrines. They even demanded further
subsidy in the form of bricks to construct the superstructure of the latrines and also some
additional tubewells in their areas. At Bakhari Primary School, the latrines existed but
they were closed fearing that the 600 children studying in the school would pollute them.
The children had no choice but to go for OD. OD even by one person is most dangerous
as one fly is deadlier than 100 tigers.
NOD was declared in Nyauli Danda Radhapur (MWRO) just within 4 months of
introduction of CLTS programme. But the result was that the temporary latrines turned to
be dysfunctional soon afterwards and then the people again had to go for open
defecation.
2.5.4
NOD to Total Sanitation
After a CLTS project was declared NOD, not much attempt was attached to achieving
total sanitation. To be declared total sanitation, the major focus needed to be given to
the use of hygienic latrines by all and behavioural change among the community people
in regard to household sanitation, menstruation sanitation and environmental sanitation.
People also needed to cover food and protect drinking water source from contamination.
Additionally, the project area needed to have drainage system, solid waste management
system and waste water management system. Such requirements seemed to be only
partially fulfilled even in projects which were completed or declared NOD.
2.5.5
Poor and socially excluded
The poor and socially excluded groups cannot easily afford to pay for ceramic pan and
rings for the construction of latrines. Usually, they used bamboo-made rings and above
the foundation they used the locally available materials like bamboo, wood and grass for
the superstructure. But normally such a system collapsed due to the attack from rats and
28
also due to rains. So there were cases in which some of those people stopped using
latrines.
In Babiya Khatwe Tole in Sunsari district, for example, nearly 20 households who
constructed pit latrines in the implementation phase of CLTS abandoned their use and
went outside for open defecation. There was a grudge among those people that NEWAH
office in Biratnagar had promised to them to extend support in the form of rings and
drinking water supply line, but such a promise remained belied. NEWAH office rarely
monitored this community. Such a tendency is a threat to the sustainability of the project.
Availability of "no cost" or "cheaper cost" option for latrine construction in the CLTS
project could have encouraged poor and socially excluded groups to construct latrines.
These people might also have been encouraged to construct latrines if financial
mechanism in the form of "revolving fund" were made available to them.
Similarly, there are many landless people, particularly in Terai CLTS projects such as in
Khatwe Tole of Babiya VDC in Sunsari district. If these people were encouraged to
construct "Joint Latrine" instead of "Individual Latrine" and provided adequate drinking
water supply, they would have benefited more. This system of "joint use" of latrines
might not only have reduced cost but also provide added advantage particularly to the
landless people towards the achievement of total sanitation.
2.5.6
Subsidy Approach
In CLTS approach, subsidy is treated more "untouchable," which, in fact, is misnomer.
Globally, subsidy is accepted, particularly in the public health programmes. Such
programmes can hardly sustain in the absence of subsidy. Even in CLTS projects, it is
not that subsidy does not exist. It exists in the form of software support. So there is no
truth that CLTS is totally immune from subsidy.
Even in MWRO, when the people felt that there was no hardware subsidy in NEWAH
programme, they themselves approached other organization for such a subsidy. For
example, the Bageshwori Purn Sarsafai Samiti approached Banke DDC for support for
hardwares for latrine construction for 25 poor households. This support component was
obviously subsidy. Besides, in Dumre Ekata Chowk, subsidy seemed to have been given
to the people in the form of improved stove to the households.
In some clusters, NEWAH introduced CLTS modality (though as pilot projects); whereas
in others it is still practicing non-CLTS modality. In the CLTS modality, subsidy for the
hardware like rings and ceramic pan is lacking, but it is available in the software form. In
the non-CLTS modality, such a support is available at highly subsidized rate for the
hardwares and also to a certain extent for softwares. NEWAH's dual approach in
sanitation sector has even trickled to community. Hence, even in CLTS projects, there is
certain demand for subsidy in the form of hardware support.
Despite the fact that the subsidy component is common in both CLTS and non-CLTS
projects, the subsidy is higher by 64% in non-CLTS project (NRs. 2,626) as compared to
CLTS project (NRs. 1,689) (Annex 7). Besides community contribution is 38% in CLTS
project against only 4% in non-CLTS project. Thus, the cost of the project appears to be
substantially lower in CLTS project as compared to the non-CLTS due to lower subsidy
component.
29
Chapter Three
CONCLUSION
AND
RECOMMENDATIONS
3.1
Conclusion
In general, the households were made aware of CLTS programme activities by
NEWAH's staff. Ignition Participatory Rural Appraisal (PRA) tools like faeces mapping,
faeces calculation, faeces flagging and faeces mobility chart were used as intervention
strategies in the communities to trigger change. In order to give boost to some of those
activities, the representative committees were formed, which further appointed paidfacilitators. Most of those committees were active as they formed child clubs and women
clubs and contributed significantly in controlling open defecation and maintaining
sanitary environment through social mobilization techniques, which included certain
reward and punishment mechanisms as well.
Capacity building training was widespread in CLTS programme as the targeted
population received certain training related to hygienic latrine construction, management
training, gender training and kitchen gardening training. Most of the people largely
benefited from technological options, which allowed the different strata of society to
construct latrines as per their economic conditions. CLTS also helped create social
harmony. The socially excluded groups like the Dalits and the women were represented
in the implementation activities of CLTS programme.
Certain sanitation messages were given due publicity to achieve NOD and total
sanitation. This encouraged targeted population to construct and maintain latrines. As a
result, the sanitation coverage in the CLTS programme areas increased from 6% before
the declaration of NOD to nearly 100% after the declaration of NOD. Of those latrines,
permanent latrines formed 96% in CRO, 80% in MRO and 79% in CRO. 78% of the
latrines were upgraded in CRO and 52% in ERO, but there was no case of upgradation
of latrines in MWRO. Except a "few", all the family members used latrines. The latrines
were largely clean in all the three regions varying from 91% to 98% as people cleaned
them with brush, finial and Harpic. There was also an improvement in hand washing
practices after defecation.
The per household cost in CLTS project amounted to NRs. 1,689; whereas it was NRs.
2,626 in non-CLTS project. The CLTS programme, thus, was more cost-effective and
sustainable than the non-CLTS project.
30
There had been drastic reduction in diarrhoeal and dysentery cases, skin diseases
(scabies), worms (roundworms, whipworm, tapeworm and guinea worm), and fever
(typhoid, malaria, yellow fever and kalazar) in CLTS programme areas. This to some
extent increased scalability of the programme in neighbouring communities.
However, major challenges remain, which needs to be addressed with urgency. In
MWRO 61% of the households did not receive any training – be it related to hygienic
latrine construction, management training, gender training and kitchen gardening
training. In the same region, 91% of the respondents also denied of having access to
any "no cost" or "cheaper cost" option for latrines for the poor and landless people.
There is certain sense of "complacency" in CLTS approach as programmes meant for
moving the communities from NOD status to totally sanitized status is weak.
There is hardly any effort in CLTS project to form any linkage with the local government
such as the VDC having pool of extension workers, NGOs, INGOs and other
international agencies.
There is a question if the CLTS is committee or community led. Its basic characteristics
give an impression as if the programme is committee led rather than community led,
which poses threat to its sustainability.
The selection of only a few clusters in the CLTS project is just an "island" of success.
Besides, there is too much emphasis on NOD and, therefore, all such activities as
whistle blowing, fine, etc. are promoted. Sanitation and hygiene promotion activities are
secondary. It is not well explained as to why the NOD is necessary. The target
population fails to internalize the hygiene and sanitary message such as the latrines are
meant for dignity, convenience, and to remain disease free (breaking disease cycle).
There are cases in which even basic criteria of declaring NOD was overlooked. People
in certain communities resorted to open defecation when their pit latrines were damaged
by rats or due to rains in the post-NOD stage.
3.2
Recommendations
Dual Approach

NEWAH should stop its dual approach of running both the CLTS and non-CLTS
projects at the same time. Of these two projects, CLTS seems to be more costeffective, sustainable and gives more of ownership feeling. Therefore, in all the
NEWAH programmes only CLTS projects should be followed.
Hygiene Education

Hygiene has to come "first" and be given top priority while introducing CLTS
programme and NOD should come later. It should not be other way round.
Hardware Subsidy
31

Subsidy should be provided to the poor in the form of sanitation materials if that
helps promote the purpose of CLTS.
Coverage

There should be geographical consolidation of CLTS project for which the project
area coverage should be extended to the entire VDC or a district and not just
selected clusters comprising limited number of households. In order to increase
such coverage, networking should be done with government, INGOs, bilateral
and multilateral agencies working in sanitation field and collaborate with them to
work together to give drive to CLTS approach under uniform policy.
Poor and socially excluded

Wealth ranking should be performed before CLTS activities begin so that
economic status of different groups of people is identified and necessary
"subsidy" support is extended to them in hygiene and sanitation sector.
Total Sanitation

The community should be given total sanitation status not haphazardly but based
on certain scientific criteria like the presence and proper use of sanitary latrines
on the one hand and the change in behaviour of people in regard to personal,
household and environmental sanitation on the other.
Complacency in post-NOD

Complacency in the implementation of programmes aimed at moving the
communities from NOD status to totally sanitized status should be removed and
for this monitoring and supervision activities should be further intensified. Even
those "few" who avoid going to latrines for whatsoever reasons should be further
motivated to use hygienic latrines as they are threat to even those who use
hygienic latrines.
Sustainability

Sustainability is guaranteed when a project is community led, not committee led.
The committee in a community should be formed in a way that it represents all
the groups of people and allows the "community" to be in the "driving seat." In the
place of a paid-facilitator, there should be a provision whereby the committee
performs its activities not through a single facilitator but through more effective
groups of extension and development workers including the CHVs for better
anchoring in total sanitation.
Scalability

For the scaling up of CLTS activities effectively, NEWAH should go for "joint
action plan" with all the organizations working or believing in CLTS model by
including governmental agency such as VDCs, NGOs, INGOs, bilateral and
multilateral agencies. For this, what is also essential is to go for frequent
32
discussion meetings with such organizations and making advocacy for joint
action.
Technological Options

The target population should be given adequate technological options. The poor
should be given option for cheaper quality of pan. In the community of landless
groups, the community latrine instead to individual latrine should be promoted
such as in Paribartan Tole of Urlabari VDC in Morang district or in Khatwe Tole of
Babiya VDC of Sunsari district. R&D should also be promoted in a way that the
private sector entrepreneurs are encouraged to construct "low cost" latrines for
those poor people.
Training & Others

Those community people who could not be involved in the initial training
programmes related to the construction of hygienic latrine, management training,
gender training and kitchen gardening training should be given fresh opportunity
for such involvement even after a community is declared NOD. Besides, the
tubewells and latrines should be placed at the minimum distance of 10 metres
and construction of drainage should be given priority in the CLTS programme.
Also, tubewellsl/tapes should be made fully functional to facilitate sanitary
activities.
33
BIBLIOGRAPHY
CBS. 2004. Nepal Living Standard Survey (NLSS). Kathmandu
CBS, 2002. Census Report 2001. Kathmandu
DWSS and WHO. 2005. Report of the Visit Programme on South Asian Conference on
Sanitation (SACOSAN). Kathmandu
DWSS and WHO. 2003. Report of the Visit Programme on South Asian Conference on
Sanitation (SACOSAN). Kathmandu
DWSS/WHO. 2003. Participatory Approach for Behavioral Change towards Improved
Personal Hygiene and Safe Disposal of Waste. Kathmandu.
ESP/DWSS. 1994. Nepal National Sanitation Policy & Guidelines for Planning &
Implementation of Sanitation Programme. Kathmandu: 1994.
ESS/DWSS. 2005. Assessment of National Sanitation Weeks (2000-2004). Kathmandu.
GON/Nepal, 2005. Nepal Millennium Development Goals Progress Report 2005.
Kathmandu: National Planning Commission
MoPPW. 2004. National Hygiene and Sanitation Guidelines – 2004. Kathmandu
NEWAH. 2005. Community Led Total Sanitation: NEWAH's Experience of Piloting the
Approach in Nepal. Kathmandu
NPC. 1998. The Ninth Plan. Kathmandu
NPC. 2002. The Tenth Plan. Kathmandu
Plan Nepal. 2006. Evaluation of Country Led Total Sanitation (CLTS). Kathmandu
Various Issues of Pani Ra Sarsafai
Water Aid Nepal. 2006. Community led total sanitation in Nepal. (Discussion papers).
Kathmandu
34
Annex 1
Study Team Members
Consultants
Prof. Hari Bansh Jha
Mr. Md. Zahid Parwez
Mr. Rajesh Kumar Jha
Economist and Team Leader
Sociologist
Data Processor
Field Staff
Mr. Madhav Bhattarai
Mr. Hari Adhikary
Mr. Shyam Sundar Shah
Mr. Krishna Khanal
35
Annex 2
An Assessment of Community Led
Total Sanitation in Selected Districts in Nepal
(Questionnaire for Household Heads)
(A) District:……………………………
(B) VDC:………………….Ward No:……………………….
(C) Name of the Project:…………………….
(D) Name of the Respondent:
(a) Sex………….(b) Age…………(c) Occupation………..
(d) Caste………..(e) Education:…….
1.
Do you know about CLTS project?
(a)
Yes
[
]
(b)
No
[
]
(c )
If yes, who made aware of this project?
(i)
NEWAH Staff
[
]
(ii)
Local Partner Staff
[
]
(iii)
User Committee
[
]
(iv )
School Teachers
[
]
(v)
Political Leaders
[
]
(vi)
If any other, please explain:………………
2.
Do you feel the need of CLTS project?
(a)
Yes
[
]
(b)
No
[
]
( c)
If no, why?
………………………………………………………………………
………………………………………………………………………
3.
Who designed the CLTS Programmes in your village?
(a) NEWAH
[
]
(b) Partner Organizations
[
]
(c) Community Members
[
]
4.
Have the Ignition PRA tools been used as intervention strategy in your
community?
(A)
Yes
[
]
(B)
No
[
]
(C )
If yes, had the following tools been applied?
(a)
Faeces Mapping
(i) Yes [
]
(ii) No [ ]
(b)
Faeces Calculation
(i) Yes [
]
(ii) No [ ]
(c )
Faeces Flagging
(i) Yes [
]
(ii) No [ ]
(d)
Faeces Mobility Chart
(i) Yes [
]
(ii) No [ ]
(D)
If yes, what was the situation of your community before ignition PRA
activities?
36
(i) At HH:
……………………………………………………………..
(ii) Personal:
……………….……………………………………………..
(iii) School ( If )
………………………………………………………………
(iv) Environmental:
……………………………………………………………….
5.
Have the social mobilization programmes been launched to achieve NOD
communities?
(a)
Yes [
]
(b)
No
[
]
(c )
If yes, please explain the different techniques:
(i)
…………………………………………….
(ii)
…………………………………………….
(iii)
…………………………………………….
6.
Are the social mobilization techniques effective in bringing change in the
attitude and practice of the people in sanitation sector?
(a) Yes
[
]
(b) No [
] (c) Don't know [
]
(d) If yes, what are the changes?
……………………………………………………………….
……………………………………………………………….
7.
Has the community appointed a health motivator to mobilize the
community to maintain household and environmental sanitation and to construct
latrine and make its proper use?
(a)
Yes [
]
(b)
No
[
]
(c )
If yes, what techniques they adopt to mobilize the people:
(i)
…………………………………………….
(ii)
…………………………………………….
(iii)
…………………………………………….
8.
Have the users' committees been formed in CLTS communities and whether they
have played an active role in the project?
(a)
Yes [
]
(b)
No
[
]
(c )
If yes, what are their activities:
(i)
…………………………………………….
(ii)
…………………………………………….
(iii)
…………………………………………….
(iv)
……………………………………………….
9.
What are the major sanitation messages in CLTS programme? Please explain:
…………………………………………………………………………
…………………………………………………………………………
…………………………………………………………………………
37
10.
Is there platform in the tube well?
(A) Yes
[
]
(B) No
[
]
(C ) If yes, is the surrounding condition?
(a) Clean
[
]
(b) Not Clean [
]
(D) If yes, is the waste water used properly?
(a) Yes
[
]
(b)
No
[
]
(e ) If yes, how:……………………………………….
(E) What is the condition of the tube well?
(a) Well functioning
[
]
(b) Not functioning
[
]
(c) Partially functioning [
]
11.
Has there been any training in CLTS project for the capacity building of the
community?
(a) Yes
[
]
(b) No
[
]
(c )
If yes, are those training programmes related to?
(i)
Construction of hygienic latrine
[
]
(ii)
Management training
[
]
(iii)
Gender training
[
]
(iv)
Kitchen gardening training
[
]
(v)
Improved cooking stove use training [
]
(vi)
All of the above
[
]
12.
Do the socially excluded members from deprived families, like Dalits have
proportionate and active role in implementation activities?
(a)
Yes
[
] (b) No
[
]
©
If yes, are they from:
(i)
Rich families
[
]
(ii)
Poor families
[
]
(iii)
Educated families
[
]
13.
Do the women have proportionate and active role in implementation activities?
(a)
Yes
[
] (b) No
[
]
(c )
If yes, are they from?
(i)
Rich families
[
]
(ii)
Poor families
[
]
(iii)
Educated families
[
]
14.
Do you feel that the socially excluded people are benefited equally from
CLTS interventions?
(a)
Yes
[
]
(b)
No
[
]
(c )
If no, please explain how they will be benefited:
……………………………………………………………
……………………………………………………………
38
15.
Are there adequate technological options for the construction of cheap
latrine to suit the economic conditions of poor and landless households?
(a)
Yes
[
]
(b)
No
[
]
(c )
If yes, what are the options? Please explain.
…………………………………………………………
………………………………………………………….
16.
Was there any support for poor and excluded people?
(a)
Yes
[
]
(b)
No
[
(c )
If yes, was it in the form of:
(i)
Material Support
[
(ii)
Financial Support
[
(iii)
Technical Support
[
(iv)
All of the above
[
]
]
]
]
]
17.
Does the CLTS programme create?
(a)
Social harmony
[
]
(b)
Conflict
[
]
(c )
None of the above
[
]
18.
Is there a system of assessment by the community in regard to achieving the
goals of CLTS at different stages of the project?
(a) Yes [
]
(b) No [
] (c) Don't know [
]
(d) If yes, how?
……………………………………………………………………..
…………………………………………………………………….
19.
Do you have latrine?
(A)
Yes
[
]
(B) No
[
]
(C)
If yes, what type of latrine you have?
(a)
Temporary
[
]
(b)
Permanent
[
]
(c)
Since how long have you been using latrine?
(i)
Before CLTS Project
[
]
(ii)
After CLTS Project
[
]
(D)
If yes, have you upgraded the latrine since construction?
(a)
Yes
[
]
(b)
No
[
]
(E
If no, what are the problems?
(i)
Financial
[
]
(ii)
Landlessness [
]
(iii)
Cultural
[
]
(iv)
Unawareness [
]
(v)
If others, please explain:
…………………………….……………………
20.
What factors compelled you to construct latrine?
(a)
……………………………………………………………
(b)
……………………………………………………………
(c )
…………………………………………………………..
39
21.
Where did you defecate before CLTS Project?
(a)
Along road side
[
]
(b)
Home surrounding
[
]
(c )
Open field
[
]
(d)
All of the above
[
]
22.
What problems did you face when you had no latrine?
(a)
…………………………………………………………………
(b)
…………………………………………………………………
(c )
………………………………………………………………..
23.
Are all the family members regularly using latrine constructed in your
house?
(a)
Yes
[
]
(b)
No
[
]
(c )
If no, who don't use the latrine?
………………………………………………………..
………………………………………………………..
(d)
What are the reasons?
………………………………………………………..
………………………………………………………..
24.
Have you maintained cleanliness of your latrine?
(a) Yes
[
] (b) No
[
]
(c ) If yes, how? Please explain…………………………………….
…………………………………………………………………
……………………………………………………………………
25.
Do you wash your hands after defecation?
(a) Yes [
] (b) No [
]
(c ) If yes, how?
(i)
Water only
[
(ii)
Ash and water
[
(iii)
Soap and water
[
(iv)
Mud and Water
[
(iv)
All of the above
[
]
]
]
]
]
26.
What have you used in construction of your latrine?
(a)
At Pit level:………………………………………………….
(b)
Superstructure:………………………………………………
27.
Are the SaniMart products like pan, cleaning brush, bathroom cleaning detergent
like Harpic and other construction materials like HDPE pipe and cement available
nearby for the construction, operation and maintenance of latrine ?
(a) Yes [
] (b) No [
]
(c )
If yes,
(i)
Before the Intervention
[
]
(ii)
After the Intervention
[
]
40
28.
Is there any system of reward and punishment to maintain the NOD status?
(a) Yes [
] (b) No [
]
(c ) If yes, what are they?
………………………………………………………………….
………………………………………………………………….
29.
Do you have the system of orgainising coordination meetings/mass
gatherings, in your cluster/community to build latrines and promote good hygiene
practices?
(a) Yes [
] (b) No [
]
(c ) If yes, how effective are they?
(i)
Most effective [
]
(ii)
Effective
(iii)
Not so effective
[
]
30.
If you have any idea for the success of the programme, please explain:
………………………………………………………………….
……………………………………………………………….
………………………………………………………………….
41
Annex 3
Guidelines for Interview with Resource Persons/
NEWAH Staff/Local Partner Staff/Health Post Staff
1.
Has CLTS approaches led to increased linkages with other programmes,
organizations and institutions e.g. local government?
2.
To what extent is the CLTS approach been cost effective as compared to
other approaches in terms of cost per beneficiary and funds spent on
hardware and software?
3.
How far are CLTS tools applied by NEWAH been more effective than the
traditional practices?
4.
Is CLTS an effective approach to take to scale and if so what are the barriers
in achieving this?
5.
Is there Detailed Action Plan with adequate provision of capacity building of
the community to make the CLTS successful?
6.
Have the programme targets been adequately achieved?
7.
Please give your observations on:
(A) Reeducation in the number of diarrhoeal and dysentery cases
(a)
Yes
[
]
(b)
[
]
(B) Reduction in the number of skin diseases, like scabies
(a)
Yes
[
]
(b)
[
]
(C) Reduction in the intensity of worms (roundworms, whipworm,
tapeworm, guinea worm, etc.
(a)
Yes
[
]
(b)
[
]
(D) Reeducation in the intensity of fever, including typhoid, malaria,
yellow fever, kalazar, etc.
(a)
Yes
[
]
(b)
[
]
(E) Reduction in the filarial cases
(a)
Yes
[
]
(b)
[
]
(F) Reeducation in the mortality rates
(a)
Yes
[
]
(b)
[
]
42
Annex 4
Guidelines for
Focus Group Discussion
(User committees, child group/child club, women groups, P&E groups, Community
leaders such as teachers, local politician, and health post staff)
1. Do every community members have commitment to declare NOD community?
2. Is there political commitment for the programme from VDCs and other local
leaders?
3. What has been the role of women and children in achieving NOD community?
4. Did you consider such factor as the operability of the latrines especially for
children, elderly and disabled members of your families?
5. Are there barriers in achieving NOD community?
6. Do you think your community to be capable enough to sustain CLTS?
7. Have poor and Dalit families equally participated and benefited from this
programme? In your feeling what needs to be done for poor and landless people
in your community?
8. Do you feel OD as problematic causing epidemic and several other diseases?
How do you think those diseases could be controlled and who should play key
role in this effort?
9. Are the gastro-intestinal and other diseases reduced in your community?
10. Do you feel that the community is saving money as the expenditure on medicines
has reduced due to the decline in the diseases in the recent years?
11. What changes have perceived in health and sanitation after the launching of
CLTS programme?
12. Is there any impact of the project beyond the project areas – e.g. in neighbouring
communities?
43
Annex 5
Guidelines for
Checklist/Observation
of the Households
(a) Increased use of Per Capita Water Consumption
(b) Proper cleanliness of hands and utensils:
(c) Proper handling of water
(d) Adequate cleanliness of latrine
(e) Increased percentage of latrine users
(f) Adequate cleanliness of household yard
(g) Adequate measures adopted for food covers and fly nuisance
(h) Adequate measures for proper management of solid waste, household
wastewater and storm water
(i) Puting utensils after cleaning:
- Anywhere
- Certain Places
- Drying Racks
(j)
Use of different slippers for latrine?
44
Annex 6
Itinerary for
Muhammod Abdus Sabur
in Nepal
19 January, 2007
Kathmandu
 Meeting with the consultants at NEWAH office in Kathmandu
 Discussion on the methodology of the study
 Appraisal of the progress made in the study
 Discussion on activities to be covered during the field visit

Dr. Jha coordinated this meeting with Dr. Sabur in which Oliver John, Umesh Pandey,
Bipul Gyawali and Laxmi Paudyal were invited.
20 January 2007
Biratnagar (Morang District)
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
Departure from Kathmandu to Biratnagar (Morang)
Visited ERO and had detailed discussion on the status of CLTS projects in
Morang and Sunsari with the ERO staff
21 January 2007
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Visited CLTS communities /observation (Simarbona Tole (Ward No. 8) of
Tanmuna VDC)
Interaction with beneficiary groups
FGD with mixed groups
22 January 2007
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
Interaction with staff members of Child Society Nepal, Biratnagar
Visited Malahanuwa, Ward No. 16 of Biratnagar Sub Municipality for non-CLTS
project
Interaction with beneficiary groups
FGD with mixed groups
23 January 2007
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Visited Dumre Ekata Chowk, Urlabari
Interaction with beneficiary groups
FGD with mixed groups
Visited Paribartan Tole, Urlabari
Interaction with beneficiary groups
45
24 January 2007

Return to Kathmandu
25 January 2007
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

Debriefing at Water Aid Nepal about the preliminary experiences in the field,
views of sector organizations and potential strategy to be recommended to
NEWAH. Present in this meeting were NEWAH and WAN staff.
Interaction with Nawal Kishor Mishra, Chief, ESS, DWSS and Namaste Lal
Shrestha, UNICEF on CLTS project and strategies for its further growth in Nepal
Return to Dhaka
46