INTRODUCTION TO SANITATION CONCEPTS

AND APPROACHES WITHIN AN iWASH

FRAMEWORK

Module 2: Implementing iWASH Concepts,

Systems and Processes
Hotel H2O, Manila, September 18 to 21, 2017
What have achieved in the MDGs?

Source: WHO/UNICEF
Joint Monitoring
Programme on Water
and Sanitation, 2015
Moving from the MDGs to the SDGs:
What have we achieved and what is left to do?

Source: WHO/UNICEF Joint Monitoring Programme on Water and Sanitation, 2015

2.6 billion
With access to improved drinking water

96% urban
84% rural 8 of 10
people in rural areas still
Uses improved drinking water
without improved water

663 million
water people still without
improved water
Moving from the MDGs to the SDGs:
What have we achieved and what is left to do?

Source: WHO/UNICEF Joint Monitoring Programme on Water and Sanitation, 2015

2.1 billion
With access to improved sanitation facility

82% urban
51% rural 9 of 10
people still practicing open
Uses improved sanitation facilities
defecation, living in rural areas

2.4 billion
sanitation people still lack
improved sanitation facility
 Use of improved
drinking water
sources
Use of improved
84% in 1990 sanitation facility

92% in 2015 57% in 1990

74% in 2015
Philippines MDG Progress
Locating the poor and those without access to improved
sanitation: Leveraging on NHTS-PR and FIES

Households living in Red areas represent higher

Red areas circled in yellow
extreme poverty seem to concentrations of households in
represent higher concentrations
consistently reside in the lowest income quintile ($0-
of households without access to
geographic areas where $229 USD/capita/region). Yellow
improved sanitation
there is low access to circles represent areas with low
sanitation sanitation access.

Source: National Household Targeting System for Source: National Household Targeting System for
Poverty Reduction Poverty Reduction

Map showing Provinces without Map of high poverty areas overlaid

access to improved sanitation with areas without access to
improved sanitation.
Philippine Rural Sanitation access
by region

• FIES data show about 9.5 million without access to improved sanitation, slightly
higher than JMP estimates of 7.6 million (total rural pop = 47 million)
Sharpening the linkage between
poverty and sanitation access
Photos
GOAL 6: Ensure availability and sustainable
management of water and sanitation for all
 Goal 6: Ensure availability and sustainable
management of water and sanitation for all

6.1
Drinking
Means of Implementation
Water
6.6 6.2
Sanitation 6.A
Eco- and International
systems Hygiene cooperation
and capacity
Goal 6 development
6.5
Water 6.3
resource Water 6.B
manage quality Local
ment
6.4
Water- participation
use
Efficiency
 Translating
Translating thethe SDGs:
SDGs: Targets
Targets and Implications
and Implications
 SDG Indicator for Drinking Water
6.1.1: Percentage of population using safely managed
drinking water services

Definition: Population using an improved drinking water

source (MDG definition) which is:
• located on premises, Accessibility
• available when needed, and Availability
• free of faecal and priority chemical contamination Quality
Lead: WHO/UNICEF Joint Monitoring Programme

17
MDG/SDG Service ladder
SDG 6.1 Progressive realization

Safely managed Improved facility located on premises, available when needed,

Developed
drinking water and free from contamination

Basic water Improved facility within 30 minutes round trip collection time
MDG continuity

Developing
Unimproved water Unimproved facility does not protect against contamination

No service Surface water

18
Translating the SDGs: Targets and Implications
SDG Indicator for Sanitation and
Hygiene
6.2.1: Percentage of population using safely managed
sanitation services, including a handwashing facility with
soap and water

Definition: Population using an improved sanitation

facility (MDG definition) which is:
• not shared with other households Accessibility
• excreta are safely disposed in situ or transported
and treated off-site Quality

Plus a handwashing facility with soap and water 20

MDG/SDG Service ladder Progressive realization
SDG 6.2

Private improved facility where faecal

wastes are safely disposed on site or

Developed
Safely managed sanitation
transported and treated off-site; plus a
handwashing facility with soap and water

Private improved facility which separates

Basic sanitation
excreta from human contact
MDG continuity

Improved facility shared with other

Shared sanitation

Developing
households

Unimproved facility does not protect

Unimproved sanitation
against contamination

No service Open defecation

21
 SDG targets 'leave no one behind'
• SDG indicators to be
disaggregated where relevant
• income,
• sex,
• age,
• race,
• ethnicity,
• migratory status,
• disability and
• geographic location,
• or other characteristics

33
INTRODUCING THE SANITATION PILLARS
AND CROSS-CUTTING THEMES

Introduction to Sanitation Concepts and Approaches

Within an iWASH Framework
Workshop
(in 3 groups)
How do you understand:

• Participatory demand creation?

• Strengthening supplies and services?
• Enabling environment?

➢ Why do you think these are important to

consider for effective sanitation programming?

➢ What do you think are some activities under

each pillar?
Workshop
What do you mean by mainstreaming the
following in WASH/sanitation?
• Gender
• DRR (CCA)
• PPP

Give practical examples on mainstreaming

gender/ DRR/ PPP in sanitation.
 Participatory Demand Creation
• More than household-level behavior change
communication; it aims to strengthen a
community’s ability to: 1) identify risks to their
well-being; 2) address basic needs through
collective action; 3) make their needs known to
decision and policy-makers

• Effective demand creation programs need to

apply a range of different and complementary
methodologies to sanitation and hygiene at
community and household levels, as well as with
local government actors
Participatory Demand Creation
All about understanding behavior
Recognizing drivers of open defecation (OD) are
complex and multi-determined:
• Supply-side factors (e.g. access to latrines,
affordable building materials)
• Demand-side, or “user-centered”, factors
(e.g. cultural and religious practices, hygiene
beliefs, relative convenience and affordability
of OD).
Creating Demand
Pre- Post-
Triggering
triggering triggering
Sustaining Behavior Change
Sustaining Behavior Change
Strengthening Supplies & Services
Insights from a consumer research
Ability: affordability, perceived costs and preferences
• OD is a phenomenon among the poor
• high cost of sanitation is a main barrier to toilet adoption
• yet poor HHs own other durable goods of similar price range

Motivation: intention, competing priorities, beliefs & attitudes

• high level of intention to build (70%) but no commitment
when to build
Paradigm shift: Health messages no longer resonate well

Preferred behaviors to meet the ZOD

goal

Stop open defecation

Inquire about hygienic toilets
Buy a hygienic toilet
Use of toilet at home
Maintain the toilet
What is Sanitation Marketing?
Application of the best
social and commercial
practices to change
behavior and to scale up
the demand and supply
for improved sanitation,
particularly for the poor.
Focusing on households
as consumers
Marketing Mix – knowing the Four Ps

4Ps
Enabling environment
 Enabling environment
An enabling environment - a set of interrelated
conditions – such as legal, organizational, fiscal,
informational, political, and cultural – that impact
on the capacity of development actors to engage
in development processes in a sustained and
effective manner” - Thindwa, 2001

“The basic objective of development is to create an

enabling environment for people to enjoy long,
healthy and creative lives” -Mahbub ul Haq,
Pakistani Economist, 1990
Enabling Environment Framework
1. Policy

8. M & E 2.
Institutions

7. Cost- Enabling 3. Program

effectiveness Environment

6. Financing 4. Capacity

5. Products
 Enabling Environment Indicators
Policy
Shared vision, goals, and strategy among stakeholders
Secured political will at all levels
Laws, regulations, standards, guidelines

Institutions
Well-understood institutional mandates, roles, responsibilities
and accountabilities
Established mechanisms for partnership and coordination
among public, private, NGO, community, national, regional,
and LGU entities
Enabling Environment Indicators

Program methodologies
Mode of implementation (national, local)
Activities with budget and time frame

Capacity
Adequate human resources in terms of number and skills
at national and LGU levels
Sufficient facilities (tools, instruments, laboratories)
 Enabling Environment Indicators

Products and services

Available and affordable products and services
Appropriate, resilient, culturally acceptable, environment-
friendly, and gender-sensitive technologies

Financing
Source of financing (national, local, partners, community)
Modality ( microfinancing, incentives, subsidy, performance-
based)
Items for investment (products, services, capacity building,
promotion)
 Enabling Environment Indicators

Cost–effectiveness
Economies of scale
Shows impact (social, environment, economic)

Monitoring and evaluation

Delivery of outputs
Achievement of targets
Program effectiveness
Cost-efficiency
 WASH Framework

Communication for Development:

hygiene behavioral change to support increased use of basic sanitation

Enabling Environment Participatory Demand Creation Supply & Services

Basic
Basic Sanitation, Safe Water
Knowledge Sustaining
Sanitation, Hygiene and Supply, Solid &
Good Demand through
Governance
Management and Hygiene and Safe Water in Liquid Waste
Supply Side
Accountability Safe Water in Public Management,
Interventions
Communities Institutions (e.g. Drainage
schools, HCF)

Disaster Risk Reduction / Resilience

Mainstreaming gender
Practical gender needs are related to daily activities
and responsibilities; linked to helping women and men
with roles given by society.
Strategic needs are related to changing the
relationships, roles and responsibilities of women and
men in society; usually long-term and non-materials such
as increased participation in decision-making and
legislation for equal rights.
Why does gender matter?
❖ Specific to WASH, women are the primary
collectors, transporters, users, and managers of
domestic water, and promoters of home and
community-based sanitation activities

❖ Yet in many societies, women’s views are not

systematically represented in decision-making
bodies
 Gender Mainstreaming in WASH
WASH projects ‘mainstream’ gender through two
dimensions:
(1) the differences in needs and priorities of
women, men, girls and boys that arise from
their different activities and responsibilities;
and

(2) the inequalities in access to and control over

water resources and access to sanitation
services
Gender Mainstreaming in WASH
❖ Works to achieve gender balance, e.g., more
equitable task sharing

❖ Achieving gender balance often calls for meeting

the practical needs and interests of women and
girls more effectively, e.g. better access to water to
reduce their workload

❖ As well as meeting strategic gender needs and

interests, e.g., including women in community
decision-making
 A DRR Lens in WASH

Water,
Sanitation
&
Hygiene
Aims of DRR in WASH
To reduce the potential impact of hazard events on WASH
services (i.e. mitigation)

To Ensure rapid service level and structural recovery of WASH

services after hazard events (i.e. preparedness)

After damage by hazard events to ensure that the design of the

system addresses earlier vulnerabilities resulting in more
resilient services (i.e. build back better)

To ensure that WASH services have minimal negative effects on

the community (i.e. do no harm)
Aims of DRR in WASH

Mitigation

Risk Preparedness
DRR in & Response
Informed
WASH
Plans Build Back
Better
Do no Harm
Resilience in WASH- 5 PS

POLICY
PEOPLE

RESILIENCE
IN WASH PROVIDER

PRODUCT
PRODUCTION
 RIGHTS-BASED
PUBLIC-PRIVATE
PARTNERSHIP
UN Guiding Principles on Business and Human Rights
Pillar 1: The State Duty to Protect

States must protect against human

rights abuse within their territory and/or
jurisdiction by third parties, including
business enterprises
Pillar 2: The Corporate Responsibility to
Respect

Business enterprises should respect

human rights.
Responsibility vs Duty
Pillar 3: Access to Effective
Remedy

As part of their duty to protect against

business-related human rights abuse,
States must take appropriate steps to
ensure that when such abuses occur
those affected have access to effective
remedy
Rights-Based PPP in PRO-WATER
Three options that will be considered in collaborating with the
private sector:
▪ Engaging private water service providers and private
schools/academies in the conduct of technical and advisory assistance,
and to serve as mentors/coach in the development and sharing of
relevant tools, technologies and best practices in local water
governance;
▪ Mobilize resources and supplies from private sector to finance
investment requirement of the water and sanitation sector;
▪ Development of low cost technologies.
Some issues:
privatization of water and sanitation services, “elite capture,” higher
water pricing and tariffs, contractualization of labour, displacement of
workers especially women, alienation of community groups and CSOs,
e.g., consumer groups
PARTICIPATORY DEMAND CREATION

COMMUNITY-LED
TOTAL SANITATION
Where do we map Scaling up Rural
Sanitation?

NSSP Framework
Disease Prevention and Control
Program
• Food and Waterborne
Diseases
• parasitic diseases .e.g. STH
schistosomiasis, malnutrition
Zero Open Defecation Program
• CLTS
• Theory of Change
Rethinking what it takes to scale up Rural Sanitation
in the Philippines
▪ Giving toilets out for free is not an effective approach
▪ Era of supply driven programs in many contexts has proven not to work
▪ People have to demand sanitation
▪ Proper design and use of subsidies – targeting the remaining mile
Enabling Environment for Scaling Up Rural Sanitation
Demand Based Approach

POLICY,
STRATEGY &
DIRECTION
MONITORING & INSTITUTIONAL
EVALUATION ARRANGEMENTS

Programmatic
COST-EFFECTIVE PROGRAM
ENABLING
IMPLEMENTATION METHODOLOGY
ENVIRONMENT

IMPLEMENTATIO
FINANCING
N CAPACITY
AVAILABILITY OF
PRODUCTS AND
TOOLS
The challenge of rural sanitation programs…

• Large enough scale to make real

difference

• Sustainable behavior change,

facilities and programs

• Impact lives of the poor

CLTS SanMark, BCC

Scaling Up Two-Pronged Strategy

Sanitation
Marketing
Scaling-up
CLTS Rural
Sanitation

Community-Led Total Sanitation Sanitation Marketing

• changing behavior and stopping • creating demand and
open defecation strengthening supply for
improved sanitation at
individual and household level
• Raising collective awareness of • Strengthening of supply
the shit problem chain
What is ZODP?

• The ZODP is part of a broader intervention that includes other

sanitation related programs and activities initiated at the national and
municipal levels.

• Citing as an example, the LSSP incorporates strategic interventions

for a municipality-wide campaign to eliminate the practice of OD and
promote municipal wide access to sanitary toilets.

• To change the TRADITIONAL APPROACH, ZODP will utilize

community-led approaches which will maximize community
participation with the aim of empowering communities to make
decisions and to take actions in improving their sanitation conditions.
Objective of the ZODP

• The Zero Open Defecation Program aims to motivate those practicing

open defecation to abandon such practice and adopt sound sanitation
practices through community wide initiatives that emanate from the
grassroots level.

• Based on NSSP, it aim for zero OD by 2016 for priority areas.

Program Framework

• Community led approaches

• Builds upon social values of solidarity and cooperation
considering that sanitation is a shared concern
• Gender fair involvement
• Capacity building
• Community empowerment to make decisions and to
take action
• Public-Private partnership in extending support for
sanitation
Community-Led Total Sanitation

• Pioneered in Bangladesh sometime in

1999 by Prof. Chambers and Kamal Kar,
the approach’s innovator

• widely and correctly recognised as a

revolutionary participatory approach to
rural sanitation

• it is an innovative methodology for

mobilising communities to
completely eliminate open defecation
• Ignite change through social awakening
CLTS in the Philippines • CLTS was started in the
Philippines on July 2008 when
the WB-WSP formally facilitated
an exposure for the major
stakeholders of sanitation to
East Java, Indonesia

• Initial CLTS training was

conducted in Guiuan, Eastern
Samar

• CLTS was adopted by the DOH

and taught as an approach to
different parts of the country
CLTS Methodologies

• CLTS is a 5-day training course

• The training approach comprised

classroom sessions having lectures,
role playing, workshop, plenary,
active participatory discussions and
demonstrations.

• The classroom sessions covered the

basics of CLTS.

• The practical sessions involved

applying the training tools in real
community, purok or sitio.
ZODP and CLTS as an approach.....
• sanitation program can takes place without
hardware being provided or even financed
from the outside

• the KEY is facilitation, ask simple and

direct questions (?)

• “What word do you use for SHIT ?”

(in CLTS, the crude word is always used)

• “Where do you SHIT?”

• “What happens to it?

Objectives CLTS Training Course

• introduce CLTS for field workers, project facilitators and

health officers who are actively involved in community-
based water and sanitation activities

• enable them to implement, monitor and assess the CLTS

approach and its outcome in their respective areas
Specific Objectives
• Understand the concept, rationale, origin, development,
applicability and spread of CLTS approach.
• Gain knowledge on methodology, application and acquired skills of
facilitating CLTS with rural communities.
• Trigger CLTS in selected communities (sitios/puroks) thru hands-on
practice and shared experiences with the triggered communities and
interested institutions.
• Develop of plans of actions for introducing CLTS in their respective
institutions/areas of work in the next six months.
• Create a conducive institutional environment for scaling up sanitation
initiatives.
The CLTS sequence of steps
1. Pre-triggering
• Selecting a community

2. Triggering of the community

• Participatory sanitation
profile analysis, ignition moment, action planning

3. Post-triggering
• Follow-up and monitoring the progress, verification and
certification of ZOD status

4. Scaling up and going beyond CLTS

• Sanitation marketing, technology options, BCC,
PRE-TRIGGERING

▪ The conduct of activities to prepare a local community for the CLTS triggering
▪ Selecting a community assessment of the community (purok or sitio)
- courtesy call to local purok officials
- introducing the program and building rapport
- identify the ideal venue
- inform as many as members of the community
- inform that no subsidy will be provided at the onset
- doing a preliminary visit around the purok to be able to plan the transect walk
- Preparing the date/schedule for triggering activity
Community Selection Criteria

• Number of people in the community are practicing open defecation

• Status of morbidity/mortality due to sanitation-related diseases
• Preferably no history of sanitation hardware subsidy
• With strong leaders at the local level
• Demonstrated readiness to set up local organizations for follow-up activities
Data to be gathered during Community Assessment :
 Number of households with toilets, without toilets, sharing toilets, public or
communal toilets
 Gender disaggregated - Open defecation areas
 Defecation practices and after defecation cleansing practices
 Cultural beliefs on health and illness causation
 Secondary data on purok morbidity and mortality rates for STH and AGE
 Secondary data on water quality
 Other on-going sanitation programs in the purok
 Other salient characteristics of the community such as having congested or widely
spaced houses, original settlers or recent migrants, housing tenure status, coastal or
inland, IP or non-IP, Muslim or non-Muslim and other relevant data.
CLTSTriggering in communities

The process of facilitating a local community

to analyze of its own sanitation situation and
profile, using participatory exercises and
tools, with the objective eliciting a realization
of the adverse effects of open defecation and
a decision to stop the practice.
CLTSTriggering in communities
CLTS essentially is hinged on the premise that SHOCK, DISGUST , and
SHAME
will make the people act to address open defecation.
CLTSTriggering in communities

The facilitators shall utilize other motivational tools like :

• Aside from shame, shock and disgust, facilitators should also emphasize
pride and prestige during the triggering.
• While the notions of shame , shock and disgust are part of the original
CLTS strategy, pride and prestige has been determined from a previously
conducted study among IPs and Muslims in Polomolok
CLTSTriggering Process
1. Climate Setting

2. Defecation Area Mapping

3. Calculation of Shit and of Medical expenses

4. Defecation Area Transect

5. Faecal-Oral Transmission Mapping

6. Food and Shit demonstration

7. Glass of water and Shit demonstration

CLTSTriggering Process
CLTSTriggering Process
Sanitation Marketing
• Through the CLTS, it is expected that demand for sanitation technologies,
hardware and supplies will increase as people opt to build and use their own
latrine.
• Sanitation marketing component of the ZODP should be able to address the
supply side and ensure that appropriate and low cost technologies are
available (e.g. training for toilet and septic tank builders).
Sanitation Marketing:
• SaniFairs

• May be in the form of photo exhibits and actual display of hardware

showcasing simple low-cost technologies during the community action
plan presentations during post-triggering

• Technical advice on construction of toilets and septic tanks during the

presentation of community action plans during post-triggering
•
Declaring ZOD Status based on DOH Guidelines

• Declaring Zero Open Defecation status entails verification

works (ZOD)
- verification team should be established at the local level
• Declaration in a special local occasion
• Declaration can be accompanied by incentives and rewards
Program Structure (who will undertake)
• ZODP Local Action Committee

- LGU through the CHO/MHO and other LGU deparment/s

- Barangay Council

- PHO, DOH

- Other Partners – Interested entrepreneurs, lending institutions,

desludgers, masons
Needs Requirements

• LGUs to allot/allocate funds for sanitation activities through the CHO/MHO

• Costs shared by households, barangays (barangay sanitation fund), water
district, business sector, NGOs, and small and medium enterprises
• Micro-financing from lending institutions such as the Ormoc Credit
Cooperative, Inc, in Guiuan
• Corporate sponsorship or NGO partnership (e.g. DOLE Philippines,
Marinduque-Norwegian Mission Alliance)
How the DOH is rolling out of CLTS message
• Department of Health’s initiative and other partner agency collaborative
organized events like the conduct of symposium, summit and forum

• Dovetailing in the celebration of international events like Global

Handwashing Day served as venue in promoting the message of CLTS
to different stakeholders of sanitation program in the country.

• This has resulted in creating a favorable environment for CLTS as a

suitable approach in scaling up sanitation program in the country
LEARNINGS from CLTS

• It is important that an agency interested and capable of piloting

CLTS should act with urgency to pursue the introduction of CLTS
especially in areas where there is widespread OD

• Networking with support agencies and building momentum through

community visits, workshops, and publications are key elements to
the success of CLTS. The more people see CLTS working in real life
evidenced by ZOD conditions, the more they understand the
approach
LEARNINGS from CLTS
• It is important that an agency interested and capable of piloting
CLTS should act with urgency to pursue the introduction of CLTS
especially in areas where there is widespread OD.

• Networking with support agencies and building momentum through

community visits, workshops, and publications are key elements to
the success of CLTS. The more people see CLTS working in real life
evidenced by ZOD conditions, the more they understand the
approach.
ISSUES AND CHALLENGES
• Initial resistance to CLTS could be expected as it discourages traditional
sanitation hardware subsidy. Subsidy continues to be an issue.
Government and other major agencies commitment to shifting towards
a no subsidy approach will be a major determinant of the future of CLTS

• In areas where OD is still practiced, people in general have a notion that

construction of sanitary toilets is costly (CLTS under the concept SM and
STO, recognizes that there are low cost and easy-to-construct toilets
that could help address OD in communities)
ISSUES AND CHALLENGES
• CLTS challenges unacceptable defecation practices. The approach relies on
community members themselves to realize the need for changing sanitation
norms rather than relying on external influences.

• One big challenge is how to utilize the approach in more areas that are in need
of sanitation projects. Advocacy among political leaders and decision-makers
is necessary for adoption.

• CLTS is an approach that may trigger increased community demand for

improved sanitation facilities. Implementers will have to take advantage of
this demand and be ready to help address the supply side of affordable
sanitation technologies.
PHASED APPROACH TO TOTAL SANITATION
(PHATS)
Enabling Environment Study 2011
Recommendations

• Develop models of success

• Formulate local strategic plans
• Strengthen coordination, alignment and harmonization
• Improve monitoring and implementation capacity
• Raise awareness and generate political interest
Demand and Supply Research
Highlights
Drivers Barriers
• Not “Health” • Perception of high costs
• Weak relationships
• Pride between supply chain
actors
• Safety • Lack of suppliers
• Social mobility offering complete
sanitation solution
• Cleanliness • No mechanisms for
financing capital outlay
• Children’s welfare • Land tenure
Phased Approach to Total Sanitation (PhATS) Pillars

Communication for Development:

Households & School/Day Care Centers hygiene behavioral change and increased use of basic sanitation

Enabling Environment Participatory Demand Creation Supply and Services

Basic Safe Water

Basic
Good Sanitation, Sustaining Supply, Solid
Sanitation,
Governance Knowledge Hygiene and Demand through and Liquid
Hygiene and
and Management Safe Water in Supply Side Waste
Safe Water in
Accountability Public Interventions Management,
Communities
Institutions Drainage

Disaster Risk Reduction / Resilience

Phased Approach to Total Sanitation (PhATS)
G0 to G1: Behavior Change!
Sustaining Demand trough
Supply Side Interventions

G1 to G2
WASH in Learning Environments
G1 to G2
G1 to G2: WASH in Learning
Environments
DepEd’s Essential Health Care
Program
• Daily group handwashing
with soap
• Daily group toothbrushing
with fluoride
• Bi-annual deworming

Behaviour Change
• An initial study has found that daily group handwashing in school has increased the ability
and social norms among elementary school children to practice independent handwashing
with soap (IWC 2013)
Septage Management

G2 to G3
Phased Approach to Total Sanitation (PhATS)