Synergies, trade-offs and support mechanisms at the boundaries of CLTS

CLTS Knowledge Hub, Institute of Development Studies, UNICEF, SNV, Institute of Sustainable Futures, University of Technology Sydney.

Facilitators: Robert Chambers, Jamie Myers

Case-Study Presenters: Georgia Davis, East Meets West, Silvia Devina, Plan Indonesia, Alex Grumbley, WaterAid Timor-Leste, Greg Lestikow, iDE, Nadira Khawaja, SNV and Mitsunori Odagiri, UNICEF Indonesia.

Setting the scene

The Community-Led Total Sanitation (CLTS) landscape has changed considerably. What were once thought of as non-negotiable principles are now being re-visited in Asia, as we work towards safely managed sustainable sanitation and the imperative to ‘leave no-one behind’. CLTS advocates have taken a strong position against placing hardware (and subsidy) first and focused on community mobilization, shifting the focus from toilet construction for individual households to the creation of open defecation free villages, districts and now countries and transformed the sanitation movement in the process. However, those most likely to practice (or revert back to) open defecation are often the poorest, marginalized and most disadvantaged. With the global commitments to the Sustainable Development Goals (SDGs), there is a need to revisit how support to the most vulnerable is mobilized internally, locally and externally (as illustrated in Figure 1 below).

Figure 1: Mapping support mechanisms used by SNV in their sanitation programming

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This session at WASH Futures 2018 Conference was attended by around 40 participants: internal and external support mechanisms were presented and scenarios were discussed in relation to how these interact with CLTS in practice.

Priority questions for discussion were: What other approaches are being used to strengthen CLTS programmes? Are they effective at supporting

the most vulnerable? How do you ensure that the introduction of other approaches, including those with external support

mechanisms, does not have a negative impact on the CLTS process? How best to identify the most disadvantaged? What systems are currently being used? Are they effective? What is a realistic balance between community-led approaches and national systems? What are the different types of support needed? What form should the support take? At what point in

time should it be introduced? Who should it be introduced by? What approaches are replicable at scale? Are they able to be implemented through government systems? What are the evidence and knowledge gaps?

Key issues and questions were addressed through Gallery Walks and small group work on where CLTS meets and merges with other approaches and how these can help to strengthen sustainable outcomes.

Key points from the Gallery Walk: Integration in local government systems: Cambodia has an ID Poor system that can be used to identify

vulnerable households. Indonesia has a government online STBM monitoring system. Latrine discounts and subsidies: iDE used targeted subsidies for poor households and increased latrine

purchases sufficiently to offset the additional programme costs imposed by subsidies. Partial latrine subsidies increase sanitation coverage more efficiently than unsubsidised efforts and do so without adversely affecting sales to non-poor customers. In Timor-Leste, WaterAid used vouchers for sanitation materials.

Context tailored approaches: In Indonesia a Fatwa was pronounced that allows Zakat to be used for sanitation. Zakat makes clear who is entitled to the money and there is no conflict over who is given support. Also in Indonesia, Plan International advocated for the use of village funds for sanitation purposes, particularly for people with disabilities (PWD) and poor households.

Local leadership: In Nepal, a change in the National Sanitation Master Plan built on the transition from subsidy to no-subsidy, but also ensured that no-one is left behind after mass demand creation through local government and Village Development Committee actions.

Evidence-based advocacy: In Indonesia, Plan International used formative market research on sanitation demand and supply chains; iDE and Causal Designs ran a RCT in Cambodia in which poor households in 83 treatment villages were offered smart subsidies; East Meets West and Thrive Networks had an Impact Evaluation in Lao PDR on sanitation incentives and awards.

Working with rights holder groups: WaterAid in Timor Leste is working with people with disabilities and their organisations.

Promotion of Inclusive technology: In Nepal, the focus for SNV is on improved latrines. The Master Plan refers to permanent structures to plinth levels so that everyone has a permanent toilet and the poorest have a minimum standard toilet. Attention is also given to the supply chain. In Timor-Leste, flip book for sanitation options + flip book for hygienic care for both care givers and people with disabilities have been developed. In Nepal, SNV has GESI Operational Guidelines (2013) that give priority to Village Development Committees (VDCs) with a high population of ultra-poor and poor by using a Disadvantaged Group (DAG) mapping tool.

Gallery Walk

Plan International: Community based Total Sanitation (STBM) in Nusa Tenggara Timur (NTT) Province, Indonesia, 2013-2017

Approaches: Securing provincial and district government commitment and resourcing for implementation of STBM

through socialisation. Memorandum of Understanding and the development of STBM Roadmaps. A cascading of training of trainers in STBM from provincial to district, sub-district and village level.

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Triggering, verification, follow-up and ongoing monitoring. Pilot and replication. Behaviour change communication training with local media. STBM training for schools, including MHM. Sanitation marketing training for local entrepreneurs. Formative market research on sanitation demand and supply chains. Advocacy in usage of village funds for sanitation purposes, particularly for PWD and poor HH.

Challenges: Water supply is limited and difficult to access in several villages. Lack of sanitarians (sub-district sanitation workers) in several villages. Governments’ online STBM monitoring system is limited to ODF pillar (1 of 5 pillars).

Achievements: Household access to sanitation services – 63% to 97%. Household ‘healthy toilet’: 25%-82%. 566,280 beneficiaries in 265 villages declared ODF. 80% of beneficiaries are satisfied with or ‘very satisfied’ with their household toilets. 27 local sanitation entrepreneurs have provided 10,000 units of products with cheaper prices than in stores

(and included modifications for people with disabilities). Village funds allocated for poor HH and PWD

iDE: Smart subsidies in Cambodia Increasing Latrine Purchases Among the Poor

Sanitation coverage rates in the seven provinces where iDE operates have risen from 29% to roughly 65%. However, an analysis of sales trends to poor households suggests that the market is not incentivised to reach the poor. MFIs are often reluctant to enter the sanitation space due to perceived risk, small loan sizes and relatively low returns.

The support mechanism: Smart subsidies: iDE is experimenting with a system of smart subsidies, defined as partial and targeted subsidies that cover a portion of the latrines market price for poor households. In this case, partial subsidies represent a discount between 25 and 50 per cent of a latrine’s market price. Importantly, iDE is piloting these subsidies in geographic areas where they already have a strong presence and where the ‘early adopter’ latrine market is established. Who is eligible: The Cambodian government at the local and national level has established a system for identifying poor households called the IDPoor system. Households are classified as Non-Poor, IDPoor1 (poor) or IDPoor2 (very poor). National and local governments partner to categorise households and provide poor households with an IDPoor card. Smart subsidies are available only to IDPoor households which can show these cards to latrine sales agents. Smart subsidy mechanics: Commission-based sales agents give sales presentations to individual households and large groups. During the presentation, the sales agent notifies customers of the smart subsidy. Poor households that purchase are given a voucher, which they present to the latrine producer at installation along with full payment on the discounted latrine price. The latrine producer presents the voucher to iDE to recover the subsidy amount.

Efficacy of smart subsidies: iDE and Causal Designs ran a RCT in which poor households in 83 treatment villages were offered smart subsidies. Poor households in a set of 83 control villages were offered no subsidy, while non-poor households in both groups paid full market price. Far more poor households purchased latrines when offered subsidies. At the same time, purchasing habits among non-poor households were nearly identical suggesting that the subsidies had little or no market distortionary effect. Statistical analysis shows that these results hold under a number of model specifications.

Cost effectiveness: Though smart subsidies add to program costs, they also result in more latrine sales. Because fixed costs are spread over a greater number of latrines sold, the total unit cost of selling a toilet in treatment villages was lower than in control villages where subsidies were not offered. The same story holds when projecting out to a programme-wide rollout of smart subsidies.

SNV: Nepal National Sanitation Hygiene Master Plan (2011) No subsidy: Locally managed financial support mechanism; incentives and rewards; support for poor,

disadvantaged and marginalised communities. Improved latrine = ‘any one of the locally appropriate improved toilet options with permanent structures at least

up to the plinth floor level for durability and sustainability of the structure’. GESI Operational Guidelines (2013) give priority to VDCs with a high population of ultra-poor and poor by using a

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Disadvantaged Group (DAG) mapping tool. Budget is given to address needs and aspirations of women, poor and socially excluded, build capacity of these groups to undertake skilled works within the sector and collect disaggregated data for monitoring

Strategies for targeting vulnerable groups District level: pro-poor mechanisms (using local support) defined in district strategy VDC community level: After a village reaches 80-85% sanitation access, local government and WASH

Coordination Committee: Identify poorest and vulnerable households: Identify barriers to access (labour, money, land, etc.): Agree on and implement support and financing mechanisms. Sustainable Sanitation and Hygiene for All (SSH4A) Programme: 2014-2017 achievements. 550,000 people with

access to improved sanitation; 730,000 people with access to handwashing with soap near the toilet; 8 districts declared ODF; 2 districts 100% coverage and pipeline for declaration.

UNICEF Piloting Islamic Charity Fund use for WASH The Government of Indonesia targets 2019 as the year to be free of open defecation. A Fatwa, or Islamic decree by the Council which stresses the importance of good sanitation facilities and hygiene

practices. The decree also allows the use of the Council’s charity funds (Zakat) to provide financial support to the poorest and most vulnerable families for better latrines.

Challenges: Cash vs. materials; timing ODF villages in high sanitation coverage versus low coverage; and coordination of stakeholders

Thrive networks – East Meets West (EMW) Water, Sanitation and Hygiene Output based Aid – Lao PDR – Impact Evaluation on Sanitation (Australian Aid and Palladium)

Worked in Sekong and Champassack – target is 2,100 latrines and 105 ODF villages. Households potentially eligible for a rebate according to a poverty score.

160 villages, 40 villages in each arm: Control CLTS and SanMark; Arm A is CLTS and SanMark + ODF Village Award Arm B+C CLTS + SanMark + OBA award + mobiliser incentive Arm A+B+C = CLTS + SanMark ODF Village Award + OBA award + mobilizer incentive

Impact evaluation questions: Do CLTS and SanMark improve access to improved sanitation and lead to faster ODF achievement compared

to villages without rural sanitation interventions? Does the addition of an output-based incentive targeted to poor households, combined with an incentive to

village sanitation mobilisers, lead to increased access of poor households to durable sanitation and to higher and faster achievement of ODF, than villages with only CLTS and SanMark and no incentives?

Does an output based incentive targeted to poor households lead to increased access of poor households to durable sanitation and to higher and faster achievement of ODF, than villages with only CLTS and SanMark and no incentives?

Does a collective cash incentive at the village level lead to higher and faster achievement of ODF, than villages with only CLTS and SanMark and no incentives?

Does a collective cash incentive at the village level lead to upgrading behaviour of households and higher level of access to durable sanitation at village level, than villages with only CLTS and SanMark and no incentives?

What intervention (financial incentive package) is the most cost-effective intervention in increasing access and how do costs compare with a full-subsidy approach?

Do increases in access to improved sanitation lead to reductions in reported child diarrhoea, stunting and wasting?

Number of ODF villages by treatment : 58% of villages with A+B+C intervention achieved ODF; 18% of the control villages achieved ODF; 7 control villages achieved ODF; 23 OBA+Mobilizer+ODF achieved ODF.

Treatment arms

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How are these households identified and targeted? Village Authority score all households and summarises into village list the households that score 50 or above and do not have a latrine are potentially eligible for the consumer rebate. Through village meeting, the list is agreed and confirmed as the ‘Village List’. Village List is sent to District NamSaat; District NamSaat enter into Excel and send to Provincial NamSaat and EMW. With the support of Village Sanitation Promoters, EMW verifies the Village List; Eligibility assessed through the Score Card and initial hygiene behaviours. Village sanitation promoters and authorities mobilise Potentially Eligible Households to construct the sanitary latrines.

Challenge and lessons learned: Needed to adjust poverty score in early stage of implementation; GoL cancelled/ran out of funding for CLTS part way through the programme; Believe scaling the poverty score card is possible but needs government commitment.

WaterAid: Supporting the most vulnerable in WaterAid’s CLTS programme in Timor-Leste

WaterAid Timor-Leste implemented a pilot project to target vulnerable household in 20 rural ODF communities with toilet upgrades, supporting the supply chain supporting mechanisms through voucher distributions.

Who is entitled to sanitation support and how are they targetedWaterAid programme components supporting the identification and targeting of vulnerable households in rural communities through awareness raising and wellbeing ranking processes include: Village leadership meeting on gender inequality and supporting people with disabilities (PWD). One hour participatory activity on making sanitation accessible for pregnant women and PWD. Flip book for sanitation options + flip book for hygienic care for PWD for both care givers and PWD. Vulnerable households identified with community through a Wellbeing Ranking exercise (the National Poverty

Profiling system is weak and currently insufficient). Post-ODF achievement, vulnerable households were identified through a participatory wellbeing ranking exercise.

This included: identifying the poorest barrios in a village with the village leadership, agreeing criteria, undertaking household interviews and then convening a community meeting to analyse the results and confirm the ranking of all households in a participatory 1-day process.

Wellbeing depends on: land area, type of house, type of toilet, animal ownership, income, household belongings, education, and the number of times a household cooks each day.

Support mechanisms: The support mechanism used in this pilot consisted of a voucher distributed to the households identified as vulnerable, with a focus on upgrading existing household toilets. In ODF communities, after the final wellbeing ranking community meeting, eligibility for a voucher was decided independently by the voucher scheme manager (in this case WaterAid) applying consistent criteria agreed with the community. Upon presentation of the voucher at a designated local shop, and purchase of sanitation products by the households worth at least $6, the voucher-holder would be eligible to receive bonus building materials (one sack of cement and one bar of reinforcing iron, with a value of US$10) which could be used to improve their existing toilet.

Programme scale and cost: This was a pilot project that targeted support to 100 vulnerable households from across 20 rural communities. It is hard to determine the exact costs of support at this stage however. 90 households invested US$985.25 in a matching hardware subsidy through a voucher scheme. A small relative contribution with the aim of tipping households into making the decision to invest in improving their toilet.

Lessons learned and the results: Vouchers for sanitation materials is an effective way of raising interest in hygienic sanitation facilities among rural communities. For vouchers, all shop owners and implementing staff, as well as recipients need to understand that there will rarely be a 100% redemption rate and that the limited redemption deadline exists for this reason. For vouchers, when planning the scheme and printing the vouchers, allow plenty of time

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between the completion of the well-being ranking process and the redemption deadline printed on the voucher, to allow participants to collect money. A clear and objective framework for identifying voucher recipients is needed at a national level, however, the wellbeing ranking process proved an effective and accepted process for identifying vulnerable households where the systems is not yet able to target households effectively. 90 vulnerable households had redeemed vouchers by the expiry date from a total of 119 distributed. 90% of toilets purchased had been installed, as observed in follow-up visits. Often people with disabilities and their families do not come forward until the end of a project, after building trust and understanding over time.

Scenario planning

Building on the learning from the Gallery Walk, participants were given the following four scenarios to discuss in small groups. They were asked to present back in plenary key points with respect to:

Scale: district-wide ODF strategy; Support mechanism; Trade-offs.

Scenario OD Rates Government policy

Poverty levels Sustainability challenges

Geography Social contexts

1 High levels of open defecation, 70-100 per cent across villages

CLTS policy in place. External support allowed for the poorest. Ineffective poverty identification system in place

High – limited difference between households and villages. Limited cash exchanges.

The small numbers of households who have toilets use them when they are at home.

Inaccessible – desert – sandy soils.

Mixed religious groups. Social capital strong within individual groups .

Summary of discussion

Scale: district-wide ODF strategy: District government ability depends on district capacity, technical design, household surveys and mapping. Formative research is needed on what has and has not worked in a low cash economy, and approaches need to avoid depending on and assuming a cash economy exists.Support mechanism: Rewarding collaboration in the process for community support e.g. providing tools to build the latrines that could also be used for other purposes. Work through existing organisations and institutions representing different groups (e.g religious etc.) to ensure support reaches those who need, since there is strong social capital within these groups,Trade-offs: Reaching scale given large numbers of OD whilst at same time devoting resources to provide support to those potentially disadvantaged (noting small differences in economic situation hence barriers to be addressed may not be financial).

2 Limited open defecation – approx. 20%. High levels of unimproved sanitation.

Strong no direct subsidy policy in place.

Mixed – high difference between top and bottom wealth quintile.

Those practicing open defecation are almost exclusively from bottom wealth quintile and mainly those who were previously using poorly built unimproved toilets.

Stable soils, easy to dig, occasional flooding.

Socially homogenous community.

Summary of discussion

Scale: district-wide ODF strategy: Link to the policy legal framework. Link to institutions, religious, business, schools, youth.Support mechanism: Community system of identification including verification of sub-groups. Cross-sectoral collaboration e.g. links to social welfare, health. Mobilise local support assuming high social capital.Trade-offs: Understanding the availability of options to upgrade. Challenge of going to scale with keeping it simple.

3 OD rates averages around 40-50%. High numbers of sharing but only between extended family.

Strong no direct subsidy policy in place.

High – limited difference between households and villages.

Those who have working latrines used them.

Coastal, some villages are built in rocky areas.

Outward migration high – especially 18-35-year-old men. Large communities.

Summary of discussion

Scale: district-wide ODF strategy: The need for very strong political will for the changes – advocacy at the national levelSupport mechanism: No direct subsidy – could use non-direct subsidies. Consider gender messaging that resonates with men, in creating savings or financing mechanism. Village can decide and help needed.Trade-offs: Coordination systems. Consider the decision-making power of the women left in the communities.

4 High levels of toilet use – mix of improved and unimproved. OD rates varies between 10-

No policy on subsidy. Target for ODF by end of 2019.

Mixed – high difference between top and bottom wealth quintile.

Found that some family members continue to openly defecate if reliant on unimproved latrine.

High ground water in some areas. Local materials available. Forested – lots

Low levels of social capital between and within villages.

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30%. of areas to OD.Summary

of discussion

Scale: district-wide ODF strategy: Final 10-30% haven’t got access yet – who are those people? Look at the policy context as well as external government support or partner support.Support mechanism: Given the context of low levels of social capital, baseline research is needed on what the barriers are for the most vulnerable people, what are their motivators? Consider a partial subsidy or a rebate to reach the final households. Incentive at the village level like an ODF award. Trade-offs: Sustainability challenge. The process of identifying the right mechanisms would be critical.

Future priorities

Participants had a number of topics for further attention, for example: How to move form pilots to scaling up, what would we do differently? Is it the right thing to trigger people if they don’t have the technical solutions (e.g. the experience with CLTS in Kiribas)? Sustainability. Gender and inclusion issues. Topics for further learning: the timing and phasing of support alongside CLTS; qualitative research with people who may be disadvantaged as well as working with people with a disability (or from a marginalised group) as co-researchers as part of the research team. Examples of where this has already been done include in Timor-Leste with DPO and staff members who have a disability working on the well-being index, Bhutan (formative research on disability with SNV with DPO and people with a disability in the research team) and MHM research; CMB (Christians Blind Mission) does disability inclusive participatory monitoring for WASH (e.g. in Zimbabwe).

Participants were also interested in whether we have the right learning culture and how to integrate learning into operations (trade-offs between research and action) rather than having learning as a standalone activity. IDS has experience with a number of different kinds of research that help us stay up to date such as immersive research (India) and the reality check approach (Nepal). The Hub has commissioned ad hoc rapid research: 4 studies with 15 day limit on particular topics (convincing men to stop OD; encouraging people to use twin-pits; stunting and OD). In India there is an example of crowd sourcing ideas through a Swatch-a-thon on 6 topics and thousands of ideas. Rapid Action Learning Workshops with district level staff have also been popular; these methods have their own rigour in timeliness and relevance than most academic research.

Potential issues of Frontiers of CLTS: An issue on disruption, the next game changer or ways of monitoring CLTS would be welcome. Participants would also be interested to have an issue on the evolution of CLTS. What is ‘the essence of CLTS’? What in the Manual still holds? Where has original thinking changed? Participants were also interested to know how CLTS works with other approaches: where CLTS stops being effective (i.e. the damp matchboxes), and what to do next. A Frontiers of CLTS on lining pits at low cost would also be useful.

Topics for further research/emerging topics

Ideas for future issues of Frontiers of CLTS

Priorities for the future

- Timing/phasing and contexts; support mechanisms and % towards ODF.

- Qualitative research with potentially disadvantaged households/people – including people as co-researchers.

- Integration of research and practice – how to establish a learning culture.

- Rapid rigour methods.- Essence of CLTS.- Evolution of CLTS and

change. - Systems to support

businesses. - Where CLTS is not effective

(damp matchboxes). - Technical low costs. - Incontinence.

- Frameworks, trade-offs. - Approaches from today. - Pilots to scale.- Sector strengthening – all levels. - Least able – maybe disadvantaged. - Participatory processes/ research. - Turning principles into practical guidance. - Ad hoc rapid topic research. - Crowd sourcing. - Rapid Action Learning Networks.

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