Thanks a lot, Roland for the comments. I got a bit lost on the ministry/department ownership bit - are you suggesting that MoH should be in charge? If not, will another inter-departmental coordinating body be able to play an effective role? I am not sure I would blindly recommend that the MoH take the lead, since it depends on mandate, capacity constraints, etc - but I would caution against leaving water and sanitation in the hands of engineers (again, not sure that is what you have in mind!)

Great to see also, the focus on financing for equity. The danger of advocating a zero-subsidy approach is that equity might be sacrificed when people are satisfied with incremental coverage (that may be stalled indefinitely, at times).

Also, I am based in Nairobi - would be great to catch up any time!

Hi,
I am working Urban Management centre where we surveyed slums and schools for improving the infrastructural conditions. During the visit of slums we observe that the value of this sanitation facility is very less. Even the government construct the toilet,they hardly use it.On other hand some of them are using it for storage facility.Due to cultural habits, they prefer defecating in open which is one time job with use of little amount of water.they prefer electricity and water and other services over toilet.As there no demand from them, government also work causal, in some slums they just provide superstructure. their mindsets are like government to provide everything, they don't know it is their necessity to have a healthy life.
it is very sad to see even government is constructing toilet, with water facility,still open defecation is not stopping because users are not willing to use the service.

Dear Suvojits, Dear Tracey, I find you contribution very interesting.

Let me start with my contribution with the bigger picture which is the sector development for water and sanitation. I particularly refer to urban water and sanitation as this has started to be the real challenge not only because of the rampant urbanisation but also because of population density in settlements. Density is the key factor for prioritisation of areas for sanitation interventions. Therefore, we need to acknowledge the different realities and therefore make a difference between urban and rural water and sanitation with our actions.

The overall sector development goal is access and that means foremost physical access to infrastructure, including the sanitation chain. Up-scaling access needs therefore up-scaling of infrastructure and with it the sanitation chain. Hygiene sensitisation / behaviour change is important but it does not lead to access! It can be therefore considered an (important) accompanying measure. How useful is up-scaling of hygiene sensitisation without being part of up-scaling facilities and the sanitation chain? Up-scaling infrastructure includes also the up-scaling of sustainable operation of the chain. Therefore, the driver for up-scaling infrastructure should ideally be the same which is responsible for sustainable operation of the sanitation chain.

Up-scaling of access need an enabling framework (policy, legal, institution) and funds channelled through a professional financing mechanism to put infrastructure in place and to ensure professional operation of the sanitation chain (all of it with national ownership). It also needs national standard setting and pro-poor orientation, as well as, must be a comprehensive concept (oriented on household demand, acceptability, etc.) to avoid a narrow focus on hardware which is as little helpful as a narrow focus on software. This are the basics!

Now to your questions: Successful models are to be found in Burkina Faso (ONEA) and now coming up in Kenya (WSTF) which you should visit if you are based in Kenya. Both offer subsidies and serve exclusively the dwellers in the low-income areas (equity).

Kenya combines now the promotion of household facilities with investments in the sanitation chain. Implementation is done by professionals from the water sector (utilities receiving funds through calls / competition from the autonomous WSTF run by professionals and not civil servant, NGOs or project structure established by donors) in cooperation with NGOs supporting the utilities. Thus, there is national ownership from top to the bottom and national standards are established and country wide applied. With the fund disbursement a capacity development program for the utilities, NGOs and small scale private actors is provided. The same is the case in Burkina Faso. For the construction of facilities and involved in the sanitation chain local private small scale actors are involved and trained. Channelling fuds through a national, professional and autonomous national financing mechanism also offers the opportunity to practice good governance.

Other basics: 1) We have learned that Ministries should not be involved in implementation because there is a limit civil servants can do. Does this not also apply to municipality employees? What should be their role in water and sanitation development and service provision? Don?t we need (like for water supply) more involvement of professionals instead of civil servant from national and local level? In the urban setting these are the utilities! They should be in the driving seat coordinating with local authorities, civil societies, community representatives, small scale private sector, donors, etc. None of these latter should be in the lead!

2) There is no doubt that sanitation is very much linked to health but also to non-health factors. Water and sanitation (considering the sanitation chain) is foremost a matter of infrastructure development and operation by professionals. What arguments are there to convince me that the health sector must be in the lead for sanitation? In Burkina Faso the Government Cabinet adopted the sanitation policy describing the roles of all the many players. It was not one of the line ministries. This seems to be the key to success. Who has to report on access to sanitation? In Kenya it is the MWI and not the MoH! With the public utilities on hand the water sector (responsibility of counties and overseen by the MWI and the national regulator) has a professional water and sanitation structure in place. This is not the case in the health sector! And can one ministry coordinate other ministries? Especially, if it is not the key player in creating access?

Sorry that I replied so late but I was out of the country on a mission. With best regards

Roland GIZ from Kenya

Depinder Kapur added these fascinating comments to the WSSCC CoP forum:

Experience from Maharashtra village leaders who have successfully championed community wide sanitation coverage using a mix of individual subsidy incentives and social coercion was that some villages may achieve ODF withing a week or two and some take long. In most villages, there is a last mile challenge of getting the stubborn resisters to buld and use toilets and that may take even a year to achieve.

In Jharkhand tribal villages where Global Sanitation Fund is working since 2011, my understanding is that the predominantly tribal community is more hygiene and cleanliness conscious than caste based communities of India. However their adoption of toilets is a challenge given the water scarcity and the risk of unsanitary dry toilets creating a health problem closer home. They are easily motivated by the triggering approach of creating disgust to shit through the role play and community mobilisation. They build temporary toilets on their own with the motivation given but do not have the resources to either make a pucca toilet and also the time and water to maintain and keep it clean. Hence sanitation promotion works well initially but without water and financial support for pucca toilets - usage drops soon thereafter when temporary toilets start crumbling in the rains.

We need to learn from direct experience. Document the reasons for failures, and not immediately jump to analysing the results. Unfortunately in the WASH sector we have a tendency for fanatical adherence to one sanitation and hygiene promotion approach and any failure is blindly assessed and defended from the perspective of how that approach was applied, and no effort is made to understand reasons for failure from the perspective of the community. The issue of threshold levels is a misnomer - since it depends on context and conditions.

Experience from rural Maharashtra or Jharkhand may not be applicable everywhere in India and to the rest of the world. For example in India we see that where the need is more and where open defecation places are few, where religious and cultural factors prevail in positively influencing sanitation behaviours - any promotional approach that is well executed, will take a relatively shorter time.

The important thing to note is that achieving ODF status in a rural community may take up to a year or even 2 years where you have a local NGO or a government programme pushing them to change. And in some instances where there is no external pressure, even much longer. To achieve and cannot be expected as an automatic instantaneous behaviour change realisation of one sanitation promotion approach. A lesson of massive slippage in CLTS promoted villages, that is almost the same slippage as other promotion approaches.

Behaviour change is important, also important are material living conditions and livelihoods. If people are giving more priority for say their livelihoods eg. where there is migration for long periods in a year, and where water availability is an issue, then we cannot expect behaviour change and maintenance and use of toilets in their villages. In caste based communities, that are hierarchical and social and economic status is intertwined, the self perception of low caste people is often a manifestation of their livelihood status and the work they do. For example a manual scavenger who collects shit in the urban areas and a low caste villager in rural area who may be a manual labourer - their self perception of what they are and what they should be, is often determined by their occupation and the social structures imposed from centuries. They may perceive open defecation and not washing hands with soap as a natural result of their low social and economic status.

In Bihar were we did a Formative Research on Hygiene and Sanitation - the low caste men told us that their social status will come into conflict with higher caste and landlords, if they started washing hands and wearing clean clothes. They told us that they are well aware of benefits of hygiene and hand washing but then that is not their prerogative that they are better off looking unclean and some of them do not even bathe everyday. Hence your personal sanitation and hygiene standards are not an outcome of lack of knowledge and awareness, or a result of failure of "a correctly administered CLTS approach", but as an indirect reflection of your social and economic status. At least this is true in most parts of India.

Hope this direct response helps. Since we deal with shit, we should not be afraid of facing it!!

Thanks Sujoy! And good to get in touch. Do post some information on how we can get updates on the progress you make. I am sure there will plenty of important lessons for everyone in there.

Thanks for your comment, Depinder. I was hoping to hear from you! Fortunately, I have heard of the Maharashtra story through the newsletter. I agree that setting out a model where one says Triggering +n days, there is 100% ODF is aiming for the impossible, purely theoretical, and therefore, the wrong approach. But also interested in hearing from you, and others possibly, on what a practical time horizon is...So I have heard from the field that if all HHs dont adopt/change behaviour within six months, the chances of slippage, or leaving the community with partial coverage is high. Is there any experience that suggests what that threshold is?

Hi Suvojit.
The question is well presented.
Scaling up in sanitation can never be 100% ODF as CLTS and other approaches declare. It has to be incremental because human beings are not machines or stupid people who can suddenly be "triggered" into changing behaviours.
A short answer to what works - a mix of approaches(incentives, awareness, political will, campaign and some disincentive based pressure), works the best in scaling up sanitation. This is expemplified in the Maharashtra state of India where a rural sanitation programme was scaled up by the state government from 2000 to 2007 to cover approx 25% of the districts. This experience is the most successful scaling up experience in India and the most under reported. We had documented it in our WASH Forum Newsletter recently.

Hi Shubojit

What prompted me to reply, was your opening line- fortunately the need to go to scale is no longer a discussion.

This is a serious challenge- how do we change the behavior of entire populations in countries that have open defecation. Entire populations, because the socially accepted practice of OD has to be rejected by all. OD has existed and continues to exist because our societies accept it.

Going to scale is about reaching out to communities in the village / para / tola level simultaneously in a district / state. This can be achieved if the focus is on construction as there are enough people in the system to deliver construction. But the focus has to be on sustainable behavior change and herein lies the problem,the system does not have the number of people required to affect sanitation behavior change at the community level. Community facilitators deployed to facilitate community ( not individual) behavior change will require specialized training and mentoring.The key questions here is whether there is adequate capacity and resources available to provide training on community behavior change in large numbers as also the capacity and resources to mentor trained community facilitators.

As the Team leader, i am currently engaged in a project supported by unicef, to develop the implementation framework for using the CLTS approach at scale. Scale here is the district of Malda in West Bengal. Successful implementation of the framework is likely to influence the state policy which still proposes construction delivery through Rural Sanitary Marts and behavior change through community mobilization and extensive use of IEC. Readers will be aware of the CLTS approach and I will not mention how it differs from the IHHL construction approach.

The project is currently being rolled out in phases across the 15 blocks of the district and the focus is on creating the institutional capacity of the district and block administration to implement the national rural sanitation programme using the CLTS approach.

I am hopeful that a viable model of implementation can be demonstrated over the next few months to add to the basket of solutions required to address the magnitude of the problem.

Would be glad to receive queries if any.

Regards

Sujoy Chaudhury

Thank you Suvojit for stimulating our conversations throughout the last week. Thanks too for this thought-provoking six step formula!

I will post the summary in the coming days - so please continue to watch this space...

Thanks all, for this great discussion. Its been a great week, with plenty of new learning. Tracey will be posting a summary of the discussion, but to sign off, I will leave you with my six step formula to a successful sanitation campaign - I know not all will agree, but hopefully this will contribute to the debate in the next two weeks!

First, do not approach communities with a single message (build and use toilets), but with a comprehensive health and hygiene intervention.
Second, instead of being subsidy-averse, be ready to experiment until you get the design right.
Third, play on local power relations.
Fourth, allow communities to evolve their own norms around individual and collective rights and responsibilities.
Fifth, do not hurry into scaling up.
Sixth, and perhaps most important, be conscientious about quality.

Thanks Suvojit for the prompt about the role of the private sector. On the WSSCC CoP, Lalita Pulavarti has added some suggested leads for us to follow:

Suvojit, Re Private sector and other innovative experiments, one private sector initiative we have come across is parishudh.sedam.org/ funded by Infosys in Karnataka.

On behavior change, Final Mile has done some work on figuring out how to nudge behavior change: : finalmile.in/behaviourarchitecture/category/social-behaviour

Thanks for the summary, Tracey.

One subject we did not touch on adequately during this week's discussion is the role of the private sector. As sector practitioners have seen, the private sector has a prominent role to play in the promotion of hygiene and sanitation campaigns and expansion of programmes. Whether in the form of innovative communication campaigns, or financing through CSR, private sector resources need to be harnessed through mutually fruitful collaborations. Again, if there are any instructive experiences of this kind, please do share.

I am sure this will come up in next week's discussion too, on 'Sustainability for behaviour change'.