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AN EVALUATION OF THE COMMUNITY LED TOTAL
SANITATION PROGRAMME (CLTS) PROGRAMME IN SIERRA
LEONE
21 April 2011
Report Prepared By: Dalan Development Consultants
12A King Street, The Maze Wilberforce
Freetown Tel (Landline) +232-22-227347 Tel (Landline) +232-22-236207
Tel (Cell) +232-33-851-405 Tel (Cell) +232-76-627-878
Email – [email protected] Email – [email protected]
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TABLE OF CONTENTS PAGE
Contents ACRONYMS ..................................................................................................................... vi
CLTS Community Led Total Sanitation ............................................................ vi
MDG Millennium Development Goals ................................................................. vi
LIST OF TABLES, FIGURES, AND APPENDICES .................................................... vii
EXECUTIVE SUMMARY ................................................................................................ 9
1. Background and Context........................................................................................... 13
1.1 Global Context ........................................................................................................ 13
1.2 Health, Sanitation and Hygiene in Sierra Leone ..................................................... 13
1.3 Status with Meeting National and Global Sanitation Goals ................................... 13
1.4 About the CLTS programme in Sierra Leone ......................................................... 14
2. Rationale, Purpose, Research Objectives and Criteria for Evaluation ...................... 14
2.1 Rationale for the Evaluation ................................................................................... 14
2.2 Purpose for the Evaluation ...................................................................................... 14
2.3 Research Objectives ................................................................................................ 15
2.4 Criteria for Evaluation ............................................................................................ 15
Methodology ..................................................................................................................... 16
3.1 Sample Frame and Determination of Sample Size............................................. 16
3.2 Data Gathering Methods .................................................................................... 16
3.2.1 Qualitative Data Gathering methods ................................................................ 16
3.3 Quantitative Data Gathering Methods................................................................ 16
3.4 Data Collection Instruments .................................................................................. 17
3.4.1 Tools administered at National and District Level .......................................... 17
3.4.2 Tools administered at Community/Site Level ................................................. 17
3.5 Preparation for Field Work and Field work ............................................................ 18
3.5.1 Preparation for Field Work .............................................................................. 18
3.5.2 Data collection at Site Level ............................................................................ 18
3.5.3 Data Collection at National and District levels................................................ 18
3.6 Coordination Arrangements .................................................................................... 18
3.7 Data Management ................................................................................................... 18
3.7.1 Quantitative Data ............................................................................................. 18
3.7.2 Qualitative Data ............................................................................................... 19
3.8 Limitations Encountered ......................................................................................... 19
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3.8.1 Technical Related Challenges .......................................................................... 20
4. Findings............................................................................................................... 20
4.1. Site and Beneficiary Profile ............................................................................... 20
4.1.1 Coverage of CLTS Sites Surveyed ............................................................. 20
4.1.2 Beneficiary Profile ...................................................................................... 21
4.2 Assessment of the CLTS Implementation Approach .............................................. 21
4.2.1 Partner NGOs ................................................................................................... 21
4.2.2 Community Selection Approach ................................................................. 22
4.2.3 Coherence of Implementation Approach ......................................................... 24
4.2.4 The Natural Leader .......................................................................................... 28
4.2.5 Coordination and Monitoring Mechanism for CLTS ................................. 30
4.2.6 Systems of Reward for Achievement of ODF Status ...................................... 31
4.3 Programme Effectiveness ....................................................................................... 31
4.3.1 Increases in Latrine Availability: ..................................................................... 31
4.3.2 Average Duration between Triggering and ODF........................................ 34
4.3.3 Evidence of Continued Drive to Dig Latrines ................................................. 35
4.3.4 Increase in latrine usage: .................................................................................. 36
4.3.5 Further progress in the sanitation profile of communities ......................... 37
4.3.6 Hand Washing Practices in ODF and Non ODF Communities .................. 40
4.3.7 Hindering Factors to Programme Effectiveness ......................................... 43
4.4 Programme Impact .................................................................................................. 44
4.4.1 The Mean Number of Children Reported Ill with Diarrhoea and Malaria Two Weeks
Prior to the Survey at ODF and Non ODF sites........................................................ 45
5. PROSPECTS FOR SUSTAINING PROGRAMME BENEFITS ............................ 46
5.1 Enabling Factors of ODF Sustainability ................................................................. 46
5.1.1 Favourable Policy Environment and Active MOHS Leadership ................ 47
5.1.2 Community Acceptance of Relevance of CLTS Programme ..................... 49
5.1.3 Beneficiary Willingness to Rebuild Damaged Latrines and Move up the Sanitation
50
Ladder ....................................................................................................................... 50
5.1.4 Laws and Fines introduced against Open Defecation in ODF Communities50
5.1.5 Committed Natural Leaders ............................................................................. 51
5.1.6 Availability of Local Materials ................................................................... 51
5.2 Threats to Sustainability of Programme Achievements .......................................... 51
5.2.1 Socioeconomic and Cultural Factors ............................................................... 52
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5.2.2 Environmental Factors ................................................................................ 54
5.2.2 Structural Factors ............................................................................................. 56
5.2.3 Implementation Related Factors ...................................................................... 56
5.3 Equity Issues ...................................................................................................... 56
5.3.2 Hindering Factors............................................................................................. 57
6. PROSPECTS FOR SCALING-UP CLTS ................................................................ 58
6.1 Opportunities for Scaling-Up ............................................................................. 58
6.2 Challenges to Scaling-Up ................................................................................... 59
7. RECOMMENDATIONS .......................................................................................... 62
7.1 Recommendations to Improve Programme Implementation .................................. 62
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ACRONYMS
CLTS Community Led Total Sanitation DFID United Kingdom Department for International Development DHMT District Health Management Teams DMO District Medical Officer DHS Demographic and Health survey FGD Focus Group Discussions IDI In-Depth Interview IP Implementing Partner IR Immediate Results MOHS Ministry of Health and Sanitation MDG Millennium Development Goals NGO Non Governmental Organization OD Open Defecation ODF Open Defecation Free UKAid United Kingdom Aid Agency VDC Village Development Committee WASH Water, Sanitation and Hygiene
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LIST OF TABLES, FIGURES, AND APPENDICES
List of Tables Table 4.1 Profile of CLTS Sites Table 4.2 Profile of Household Heads, by Sex, Education and Main Occupation Table 4.3 CLTS IPs, by Operational Districts Table 4.4 Latrine Status Before and After CLTS, by District Table 4.5 Mean Conversion Period between Triggering and ODF Status Table 4.6 Number of Houses that Started Latrine Construction after CLTS, by
OD Status Table 4.7 Mean Number of Latrine Users per Household, by OD status and
District List of Figures Figure 4.1A Proportion of Sampled Households with Latrines in ODF Sites Before
and After CLTS, by District Figure 4.1B Proportion of Sampled Households With Latrines In NON ODF Sites
Before and After CLTS, by District Figure 4.2 Percentage of Households that have Started Latrine Construction
after Triggering by OD status Figure 4.3 Percentage of Households with Plate Racks, by OD status Figure 4.4 Percentage of Households with Clothes Line, by District and OD
Status Figure 4.5 Percentage of Households with Compost Fences, by OD Status Figure 4.6 Percentage of Households with Water near Latrines, by OD Status Figure 4.7 Percentage of Households with Soap near Latrines by OD status and
by District Figure 4.8 Percentage of Households with Ash near Latrines, by OD Status and
by District Figure 4.9 Reported Diarrhoea Episodes among Under-fives, by OD Status and
by District Figure 4.10 Reported Malaria Episodes among Under-Fives, by OD Status and by
District Figure 5.1 Factors Contributing to the Sustainability of ODF Status Figure 5.2 Threats to the Sustainability of ODF Status Figure 6.1 Opportunities for Scaling-Up Figure 6.2 Challenges to Scaling-Up List of Pictures Picture 1 Plate Rack with Cooking Utensils and Latrine Kettle Kept Together Picture 2 CLTS Latrine Damaged by Bug Infestation ANNEX Annex 1 Terms of References Annex 2 Tool Set (Provided as a Separate Document)
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EXECUTIVE SUMMARY The MOHS, UNICEF Sierra Leone, Plan International and partners formally initiated the Community Led Total Sanitation (CLTS) in 2008 as part of the Water, Sanitation and Hygiene (WASH) Programme. The United Kingdom government through UKAid (formerly DFID) has been the major funder for the CLTS component. CLTS is a community empowerment approach that ignites a change in sanitation behaviour through the construction and use of latrines. CLTS contributes to the WASH policy aiming for 50% of households to achieve sustainable sanitised status by the end of 2012. The scale up of CLTS in Sierra Leone has been rapid since its inception in 2008. By June 2010, over 2000 villages had been triggered and over one third verified as Open Defecation Free (ODF)1. The MOHS, UNICEF and partners deemed it necessary to evaluate the approach at this stage to find out how well the processes have worked, what the immediate results were and what challenges were encountered in order to examine further the prospects for the horizontal spread of CLTS to cover all areas in the country. For this evaluation, a total of 2022 CLTS sites formed the sample frame, of which 58 percent (1167 sites) were triggered communities and the remaining (853) were sites already declared open defecation free. The evaluation was conducted in 20 percent (408 sites - 171 ODF and 237 Non ODF), taking into account the distribution of sites by district, IP and open defecation status. The evaluation - which was carried out from November 2010 to January 2011 - made use of both secondary and primary data sources, although the bulk of the data was collected through primary data sources using both quantitative and qualitative data gathering methods. 44 trained enumerators collected the data at site, district and national levels using a mix of tool types. Over 5000 houses were assessed across the 408 sites in all 13 districts, to find out primarily about latrine status, latrine use, other sanitation measures, and illness episodes among children under five years. KEY FINDINGS Implementation Approach
Community Selection and Mobilisation
The CLTS IPs used a mixture of methods to decide which community to trigger. The evaluation found no direct relationship between the method used to select communities and the pace of conversion from triggered to ODF status.
The mobilisation approach for triggering meetings was largely uniform across all districts. IPs (described as “outsiders” by communities) made initial contact with chiefs who in turn mobilised communities to convene at a convenient venue for triggering meetings. In Kailahun, Bo, Moyamba and Pujehun districts, town criers and/or bells were used to draw the attention of community members and encourage them to attend triggering meetings.
However, respondents surveyed in two communities sampled in Kono district and four
communities in Moyamba district - which were listed as triggered communities - maintained that
they have never taken part in any activity to trigger action against open defecation.
Facilitation and Community Participation
Overall, the IPs made use of three methods to organise triggering meetings - i) one meeting
organised for all - i.e. males, females and children; ii) two separate meetings, one for adults, the
other for children; and iii) three separate meetings held for adult males, adult females and
children respectively.
The level of women’s participation in triggering meetings was low. Women remained silent for
two reasons and stated that: a) nobody asked them to speak or to ask questions; and b) they
would rather not speak up at meetings where their husbands or other male participants were
also present, as the latter were expected to speak on the former’s behalf.
It would appear that the most convenient time for the IPs to facilitate triggering activities was
during the morning hours which also coincided with the school going hours. Children who missed
participating in triggering activities were more likely to continue open defecation practices.
1 Quarterly WASH Report UNICEF Sierra Leone, April- June 2010
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Motivating Factors for the Success of the Triggering and Post Triggering Processes
Going by the emphasis placed by adult participants in focus group discussion (FGD) sessions, the
flow of shit demonstration and transect walk were the most powerful tools that the CLTS IPs used
because they triggered shame and disgust and prompted action to construct latrines.
Respondents across all groups held the firm belief that involving committed Natural Leaders in
the CLTS process was the most effective strategy for attaining ODF status and the most efficient
way of spreading the concept to other communities.
Programme Effectiveness and Impact
The evaluation revealed that the proportion of households with latrines, before and after CLTS
was altered dramatically. Over 70% (76% - 4274 of 5597) of houses surveyed now have toilets
compared to 19% (1080 of 5597) before CLTS. Not surprisingly, the change was more marked for
ODF sites. Among ODF communities in Kenema district, the number of households with latrines
increased from 17% before CLTS to 83% after CLTS intervention, which accounts for a 66%
expansion in latrine ownership (and this can be directly attributed to the CLTS programme).
Even in communities that have been triggered and are gradually on their way to attaining ODF
status, there is growth in the proportion of households with latrines. Only 22% of households in
Non ODF communities had latrines before they were triggered. At the time of data collection for
this evaluation, this had increased to 44%, which accounts for a 28.8% increase in the number of
households with latrines.
In addition to the 4274 houses assessed with completed toilets, another 663 (12%) of all houses
surveyed across all districts were in the process of constructing new latrines.
The pace of conversion from triggered to ODF status varies by district. The mean number of
months for converting to ODF status ranged from 3.3 months (Bombali district) to 10.4 months
(Koinadugu district).
The mean of latrine users (9.3 persons for Non ODF and 8.0 persons for ODF sites) in 12 districts,
with the exception of the Western Area, was found to be higher than the average household size
for Sierra Leone (5.9 persons). The results confirm that latrine sharing arrangements are taking
place as a result of CLTS.
Water was not readily available near latrines, regardless of whether the latrine was built before
or after CLTS. Latrine users carried water in kettles from water reserved inside the house.
Communities have been innovative in washing hands with ashes, which is locally available, in
circumstances where they cannot afford soap.
The majority of households in ODF and triggered communities have clothes lines which are
shared by households. With the exception of Bombali and Koinadugu districts, there was no real
difference in the availability of plate racks by ODF status.
In the majority of districts, the mean number of children under five years who were reported ill
from diarrhoea and malaria two weeks prior to the survey was consistently lower in ODF sites
compared to Non ODF sites.
Prospects for Sustaining Programme Benefits Relevance of CLTS
There is overwhelming evidence supporting hygiene transformation behaviour and the relevance
of CLTS. Before triggering meetings, adults as well as children were defecating openly in the bush,
backyards, streams, rubbish heaps and coffee and cacao/cocoa farms. Even though most
recognised “run belleh” (diarrhoea), vomiting and malaria as serious health consequences, very
few made the link between open defecation and these health consequences.
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Through CLTS, communities came to learn and understand more about practices relating to
personal hygiene management. They learned about washing hands and the safe disposal of
babies’ faeces.
Enabling Factors
The policy environment is favourable to CLTS, with the Ministry of Health and Sanitation gradually
making efforts to develop structures (such as the CLTS Task Force) to coordinate implementation at
both national and district levels.
Most of the Natural Leaders across all districts were appointed by community people and enjoyed
high acceptance. The show of appreciation for Natural Leaders was particularly encouraging because
Natural Leaders are the de facto successors of the IPs.
In attempts to maintain shit/kaka free communities, respondents reported “cleaning and repair of
latrines”, “bought chambers for children” and “enforcing bye laws” to reduce the risk of slippage back
into improper sanitation and hygienic behaviour.
Even though keeping a kettle with water or alternative water storage facility was not widely practiced,
there was evidence that water was readily available at household level for use after defecation.
Challenges for Sustainability
Although communities expressed a willingness to repair or build better latrines, intentions did
not always translate into action. For instance, there were several broken plate racks that needed
repairs, yet communities did not replace them. The reasons may be linked to a combination of
factors: a) low motivation to commit funds to replace the damaged racks; and b) lack of follow-up
on the part of IPs to monitor and support communities in order to sustain sanitation gains.
Even though most districts have a somewhat functioning CLTS Task Force, coordinating all the
CLTS IPs became a challenge.
The Natural Leaders who are the default successors of the IPs are hardly supported in any way.
Few were trained or remunerated. Even though they expressed willingness to stay in their
positions, it is unlikely that their efficiency will be sustained.
Materials used to construct latrines are not durable. The message from the southern province is
that the latrines are not durable beyond two years.
Children across districts revealed that although communities have been triggered, and latrines
are now readily accessible, there is still a tendency for children to go to nearby bushes or streams
to defecate.
Latrines at school sites do not have stools for use by children under five years. As a result younger
children use nearby surroundings to defecate during school hours.
There is evidence of open defecation at farm sites, despite latrine construction at home.
Some agencies continue to support parallel subsidy-led sanitation projects that are in conflict
with the CLTS approach.
Some IPs may not have fully grasped the importance of promoting CLTS as a community driven
approach. Some IPs made empty promises to entice communities to construct latrines- promising
food supplies and adding the caveat that only people who built latrines were eligible to receive
them. In other communities, household heads were promised building materials on completion
of latrines.
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Main Recommendations: A) Recommendations for Programme Implementation
IPs should align CLTS activities, especially triggering and latrine construction, to slacks in the farming calendar. This will create the environment for communities to be more committed to the programme.
Communities should be encouraged to use collective action for CLTS. For example, a group-based approach to dig latrines will yield more and better quality latrines at a faster pace.
IPs should be empowered to address socio-cultural factors, so as to create an environment for women and children to express their opinions and concerns about the CLTS approach.
IPs should encourage communities to also build temporary latrines at farm sites.
School latrines should have stools for children that are too short to use the latrines.
District Sanitation Task Force to develop guidelines that will govern the selection decisions of IPs. B) Recommendations to Enhance Sustainability
There is need to review the role of District Health Management Teams (DHMTs) in favour of a more active role in monitoring and coordination and less so as implementers.
IPs need to now strengthen the capacity of Natural Leaders in community mobilisation and sanitation promotion methodologies.
A Chiefdom Sanitation Forum to be established comprising of District Medical Officers (DMOs), Paramount Chiefs, Sub Chiefs and Natural Leaders so as to contribute to maintaining ODF status and help communities progress up the sanitation ladder.
IPs should continue to monitor the ODF status of communities at post-ODF periods, for at least a year.
C) Recommendations for Scaling-Up CLTS
1 The Local Councils also need to be more visible at the scaling-up phase. 2 IPs would need to consider developing a sanitation market and products that are affordable to
communities as a way of supporting communities to climb up the sanitation ladder. IPs may consider two possibilities as a first investment: a) provide communities with sanitation platform patterns and cement etc; and b) support communities to develop revolving funds to support the scaling-up of CLTS.
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1. Background and Context
1.1 Global Context Sanitation is vital for health. About 2.6 billion people (almost 40%) of the global population lack
access to basic sanitation2. Poor sanitation is becoming a global threat to human civilisation. It is
estimated that diseases linked to poor water and sanitation account for 6.3% of all global deaths,
while 88% of all diarrhoeal deaths are related to unsafe water, sanitation and hygiene3.
Furthermore, in the developing world, poor environmental conditions and the lack of appropriate
hygienic and environmental practices seriously undermine governments’ efforts to reduce child
morbidity and mortality from water and sanitation related diseases.
1.2 Health, Sanitation and Hygiene in Sierra Leone Sierra Leone still has one of the highest infant and under-five mortality and morbidity ratios in the
world. Diarrhoea is among the top three killer diseases among children under five years old.
Diarrhoeal diseases rooted in inadequate water and sanitation, account for 20%4 of all deaths
among children under five years.
Coverage statistics related to water and sanitation reveal equity issues. Access to safe water ranges
from 84% for urban areas to 32% for rural areas. Only a meagre 13% of the population have access
to improved sanitation facilities, with wide urban/rural differentials. The 2008 Demographic and
Health survey (DHS) estimates sanitation coverage as 6% and 26% in rural and urban areas
respectively. The situation for the poor is even more worrisome. Only 11 % of the poor have access
to safe water, compared to 91% for those in the richest quartile5, while sanitation is 1% versus 79%
for the poorest and richest respectively6. One in five persons (21%) relies on the use of nearby bush,
fields, streams or rivers as toilet facilities. Open defecation is prolific - practiced by 36% of the rural
population7.
1.3 Status with Meeting National and Global Sanitation Goals UNICEF Sierra Leone, as part of its contribution to the reduction of maternal and under-five
mortality, has a child survival and development programme, which has a Water, Sanitation and
Hygiene (WASH) component. The WASH component sets an expectation for 50% of households in 5
districts to achieve sustainable sanitised status by the end of 2012 as its Immediate Result (IR) 1.3.28.
UNICEF’s IR 1.3.2 contributes to the Millennium Development Goal (MDG) sanitation target of
reducing the percentage of people who do not have basic sanitation by half between 1990 and
20159. At the current rate of progress, Sierra Leone is not on track to meet its national targets and
2 Tearfund - Demand Led Approaches to Sanitation, International Year of Sanitation 2008 3 Terms of Reference – UNICEF Call for Proposal For the Evaluation of Community Led Total Sanitation.
August 2010 4 Child Health: Countdown to 2015 - WHO 2008 report for Sierra Leone 5 Sierra Leone - Poverty Reduction Strategy Paper, 2009 6 Sierra Leone Poverty Reduction Strategy Paper, 2009 7 DHS 2008 Report 8 UNICEF Sierra Leone WASH results framework 9 Multiple Indicator Cluster Survey (MICS) 2005
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the MDG. The lag in achieving the sanitation target has implications for achieving other related
targets for education, health and poverty, given sanitation is inextricably linked to these other
development goals. Even though efforts have been made in the past to improve the sanitation status
of the country, there is little evidence of sanitation programmes that have delivered sustainable
improvements at a scale required to meet the MDG sanitation target.
1.4 About the CLTS programme in Sierra Leone In 2008, the UNICEF WASH component formally initiated the Community Led Total Sanitation (CLTS)
programme in Sierra Leone, in collaboration with the MOHS, Plan International and other partners.
The United Kingdom Government through UKAID (formerly DFID) has been a major funder of CLTS.
CLTS is a community empowerment approach for the construction and use of latrines by
communities themselves, by relying on local resources and without any subsidies for the
construction of latrines. The CLTS approach focuses on igniting a change in sanitation behaviour
rather than constructing toilets, achieved through a social awakening stimulated by facilitators.
Sustained practices of washing hands with soap following contact with human or animal excreta and
before and after handling food is also an integral part of the CLTS approach.
The CLTS strategy for Sierra Leone has three phases: inception, development and scale-up. The
programme is now in its development phase. In this phase, the focus is to create an enabling policy
as well as the social and political environment necessary for CLTS implementation and strengthening
of the capacity of implementers. Other key components of this phase include strengthening the
social structure and expanding the human resource base to fast track the scaling-up of CLTS. CLTS
Task Forces set up at district and national levels provide oversight of implementation, while the
responsibility of coordination lies with the CLTS National Coordinator who is based in the Ministry of
Health and Sanitation. The CLTS partnership network routinely undertakes systematic reviews, to
gauge progress, share lessons and reach agreement regarding ways to adapt the CLTS approach to
suit different contexts.
2. Rationale, Purpose, Research Objectives and Criteria for Evaluation
2.1 Rationale for the Evaluation The scale-up of CLTS in Sierra Leone has been rapid since its inception in 2008. By June 2010, 2108
villages were triggered and 779 verified as Open Defecation Free (ODF)10. UNICEF and partners
deemed it necessary to evaluate the approach at this stage to find out how well the processes have
worked, what the immediate results were and what challenges were encountered in order to
examine further prospects for the horizontal spread of CLTS to cover all areas in the country.
2.2 Purpose for the Evaluation 1. To evaluate CLTS with respect to its relevance, effectiveness, impact and sustainability whilst
taking into account equity issues.
10 Quarterly WASH Report, UNICEF Sierra Leone, April – June 2010
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2. Identify opportunities and constraints to scale-up CLTS.
2.3 Research Objectives 1. To assess and document the implementation approach of CLTS for communities triggered for
CLTS as well as communities declared free of open defecation.
2. To investigate the extent to which CLTS has been effective, using verifiable sanitation related
indicators as performance measures.
3. To analyse the changes in peoples’ lives since the inception of the CLTS programme including
changes in childhood morbidity from diarrhoea and malaria at household and facility levels.
4. To examine the prospects and challenges for sustaining CLTS programme benefits, taking into
account policy, social, cultural, economic, technical related factors and equity issues.
5. To offer recommendations for scaling-up and replicating CLTS in other geographic areas, for
improving the CLTS approach and for improving policy and action at local and national levels.
2.4 Criteria for Evaluation Programme Relevance: Do beneficiary communities recognise the key issues and problems
associated with poor sanitation? What was the level of acceptance of CLTS by beneficiary
communities? Does the government view CLTS as relevant? How does CLTS relate to government
development priorities?
Programme Effectiveness: What proportion of houses that were motivated to start the construction
of a latrine have completed a new latrine since CLTS was introduced? How many members in the
house are using latrines? How many houses have put up compost fences, clothes lines, plate racks
and installed accessible hand washing facilities for use by house members, as a result of CLTS?
Programme Impact: What changes are we seeing in people’s lives - especially in terms of episodes of
malaria and diarrhoea among under-fives, at house and facility levels since the inception of CLTS?
What kind of behaviour change in peoples’ lives (children, families and communities) was brought
about by the CLTS programme? What other social change (example community cohesiveness) is
taking place as a result of CLTS?
Programme Sustainability: To what extent will the objectives of the CLTS programme continue to be
met without IP support? What are the risks of ODF communities slipping back to Non ODF status?
Equity: How and to what extent has equity, especially for women and socially excluded members
(e.g. children, physically challenged etc.), been addressed by CLTS? How have communities in hard
to reach areas been affected by CLTS?
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Methodology
3.1 Sample Frame and Determination of Sample Size A comprehensive database listing all CLTS communities by name, chiefdom, district and by IP was
created with support from the UNICEF country office, the National CLTS Coordinator and IPs. A total
of 2022 sites were captured in the database, of which 58 percent (1167 sites) were triggered
communities and the remaining (853) were sites already declared open defecation free. A sample
size of 20 percent (404 sites- 171 ODF and 233 Non ODF) was established using appropriate
statistical methods. The sampling process took into account the distribution of sites by district, IP
and ODF status.
3.2 Data Gathering Methods The study made use of both secondary and primary data sources, although the bulk of the data was
collected through primary data sources using both quantitative and qualitative data gathering
methods. Multiple methods were used to collect data for critical pieces of information so as to
triangulate and validate the information collected.
3.2.1 Qualitative Data Gathering methods Site Level – in-depth interviews and focus group discussions were conducted at CLTS site level to
understand beneficiaries’ experiences regarding the implementation of CLTS, and the extent of
community involvement and engagement in the CLTS process. Natural and community leaders were
the target groups for in-depth interviews. The categories engaged for focus group sessions were:
Adult men, including male village health committee members
Adult female, including females with young children, and female village health committee
members
Children 7-15 years
The child group was an important respondent category for this evaluation, because children are
more likely to disclose their past and current defecation practices. A deliberate attempt was made to
recruit mothers with children less than five years and care givers to take part in the adult women
focus group sessions, in order to get more reliable responses about how they dispose faeces for
children under five years old. Village Development Committee (VDC) members available at the time
of the survey were also earmarked to join the appropriate gender focus group. All focus group
discussions and in-depth interview sessions were tape recorded.
In each sampled CLTS community, a transect work was done to observe the sanitation and hygiene
situation and findings were documented using an observation checklist.
National and District Level - Other relevant stakeholders including IPs, representatives of the CLTS
Task Force and senior officials of the Ministry of Health and Sanitation were also survey
respondents. They also provided information for the evaluation through individual interviews and/or
focus group discussions.
3.3 Quantitative Data Gathering Methods – To fully address the evaluation criteria
relevant to effectiveness and impact, it was important to complement qualitative data from in-
depth interviews and focus group discussions with more verifiable quantitative data. An attempt
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was made to survey at least 50 percent of houses in each CLTS site sampled, to collect
quantitative data through the use of a checklist that allowed for documenting quantitative
information through interview and direct observation. The aspects assessed were: availability of
latrines before and after CLTS, latrine use, availability of hand-washing facilities, availability of
other sanitation and hygiene facilities, and childhood illness episodes with specific reference to
malaria and diarrhoea. The data gathered from the house assessment made it possible to
analyse the following indicators by Open Defecation (OD) status (ODF versus triggered/NON
ODF)11, by District and by IP CLTS sites.
Proportion of houses with latrines before and after the introduction of CLTS
Proportion of houses in the process of constructing a new latrine
The mean number of household members using latrines
Proportion of houses with compost fences, clothes line, plate racks and accessible hand-washing
facilities
3.4 Data Collection Instruments
3.4.1 Tools administered at National and District Level
In-depth Interview Guide for Senior Ministry of Health Officials
In-depth Interview Guide for IPs (UNICEF and Non-UNICEF funded NGOs)
Checklist for the Inventory of IP CLTS activities
In-depth Interview Guide For Task Force Members
3.4.2 Tools administered at Community/Site Level
In-depth Interview Guide for Community leaders Including Community leaders who are care
takers of children under 5 years
In-depth Interview Guide for Natural Leaders
Focus Group Discussion Guide For Adult Males and Females
Focus Group Discussion Guide For Children 7-15 years
Household Observation and Interview checklist
Transect Walk Observation checklist
11 For this report, triggered communities are referred to as NON ODF communities
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3.5 Preparation for Field Work and Field work
3.5.1 Preparation for Field Work
Forty four experienced enumerators were recruited using a competitive process. A five-day intensive
training programme was organised for enumerators, to ensure understanding of: a) the CLTS
process; b) quantitative and qualitative data gathering methods; and c) purpose and use of the data
collection instruments. As part of the training exercise, site level instruments were pre-tested at
three CLTS in the Western Area which were not sampled for the survey.
Enumerators were organised into seven district teams, each team with a designated supervisor.
Three teams covered more than one district to achieve a balanced workload.
The number of enumerators in each team varied from 4-10, depending on the number of sites to be
covered by each team. Kenema District had the largest team size (10 team members) because of the
relatively large number of sites (101) CLTS sites earmarked to be surveyed there.
3.5.2 Data collection at Site Level
Team members assigned to gather data in a specific district worked in pairs at site level. Teams
reconvened at the end of each day to review achievements in each site, to solve problems and plan
for the following day. For quality control, the evaluation technical team members (4) provided
oversight to a cluster of district teams. The arrangement was for technical team members to
dedicate at least one full day with each pair/sub team of data collectors to provide hands on support
and clarify issues.
3.5.3 Data Collection at National and District levels
The Evaluation Technical Team also had the added responsibility to gather all required data at
national, district and facility levels.
The entire data collection process lasted for approximately one month (November 21st – December
22nd).
3.6 Coordination Arrangements The national coverage of this evaluation calls for an effective mechanism to coordinate all stages of
the exercise from the training of enumerators through to the data management phase. A Project
Coordinator was hired to work with the Technical team leader to ensure the smooth implementation
of each phase of the evaluation exercise stages of this study.
3.7 Data Management
3.7.1 Quantitative Data The quantitative data management process was supervised by a qualified and experienced
Statistician. Data capture started after the completion of field work. Data entry was preceded by
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designing relevant database structures using EPI INFO soft ware package followed by training of five
data entry operators. The data was exported into SPSS and cleaned before data analysis.
3.7.2 Qualitative Data At the end of the field work most enumerators were re-engaged to transcribe all recorded focus
group discussion and in-depth interview sessions.
Following transcription, the analysis process involved:
(1) Thorough the review of transcripts and identifying relevant themes and sub themes
(2) Developing a framework that allows for mapping out the frequency of responses, by different
respondent groups, according to themes
(3) Organising quotations with accompanying respondent information into a chart
3.8 Limitations Encountered Substantial effort went into planning the evaluation exercise to ensure that data collection, data
management and analysis progressed smoothly. Dalan thought through and put strategies in place
to respond to the most anticipated challenges - however, hardly any level of planning was sufficient
to spot and eliminate every challenge at the various stages of this study. Challenges encountered
which had a bearing on the technical aspect of the evaluation are listed in the main body of the
report (section 3.8.1).
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3.8.1 Technical Related Challenges
Incomplete CLTS Database - Although an attempt was made to create a comprehensive database of
CLTS activity by IP, the database was not entirely complete. A few IPs did not meet the deadline for
submitting data relevant to CLTS activities. This means the 2022 sites captured in the database,
which formed the sample frame does not represent the complete CLTS coverage in the country.
Incomplete Information on CLTS IP Activities – As part of the field work, each CLTS IP was contacted
at their district based offices to provide more detailed information for each CLTS site, including: the
date each CLTS site was triggered (month and year), date sites converted to ODF status and the
number of houses in each CLTS site. Not every IP was able to provide the required data for each site.
The information gaps had implications for computing reliable estimates on the average duration
since triggering, average duration to convert from a triggered to ODF community and the proportion
of houses surveyed to assess latrine construction coverage.
4. Findings
4.1. Site and Beneficiary Profile
4.1.1 Coverage of CLTS Sites Surveyed
In all, field enumerators gathered data in 408 CLTS sites. Forty two % (171 sites) are ODF and the
remaining sites (237 sites) are NON ODF. Over 5000 (5597) houses were assessed across all 408 sites,
in all 13 districts to find out primarily about latrine status, latrine use, other sanitation measures
and illness patterns among children under five years.
Table 4.1 - Profile of CLTS Sites
COVERAGE PROFILE
DISTRICT Total Number of
Target CLTS
Communities/Sites
Actual
Number of
CLTS Sites
surveyed
Overall Site Coverage (%)
House
Coverage
ODF Non
ODF ODF Non
ODF
NORTHERN
PROVINCE
BOMBALI 11 9 11 10 105% 293 KAMBIA 1 1 100% 13
PORT LOKO 19 45 18 43 95% 982 TONKOLILI 14 19 15 17 97% 451 KOINADUGU 15 18 120% 219
SOUTHERN
PROVINCE
BO 1 11 10 83% 162
PUJEHUN 18 52 22 55 110% 951 MOYAMBA 21 40 17 41 95% 858 BONTHE 2 2 100% 24
EASTERN
PROVINCE
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KENEMA 86 17 87 17 101% 1326 KAILAHUN 17 18 106% 260
KONO 1 3 1 3 100% 37 WESTERN AREA 2 2 100% 21
TOTAL 171 233 172 233 101% 5597
4.1.2 Beneficiary Profile Table 4.2 shows the profile of the heads of the households covered as part of the household
assessment. The majority of households surveyed - at least two-thirds - were reportedly headed by
males. Most household heads never attended school and were engaged in farming as a means of
livelihood (See Table 4.2).
Table 4.2 - Profile of Household Heads by Sex, Education and Main Occupation
N=5597 Households
District
Profile of Household Head
Sex Education Main
Occupation
%
Male
%
Female
% Never
Attended
Schooling
% Attained
Primary
Education
% Attained
Secondary
Education
% of HH
Heads who are
Farmers
BO 75.0 25.0 91.3 5.6 3.1 69.8
BOMBALI 91.8 8.2 100.0 0.0 0.0 87.4
BONTHE 70.8 29.2 79.2 8.3 12.5 87.5
KAILAHUN 75.4 24.6 79.2 13.5 7.3 92.3
KAMBIA 61.5 38.5 100.0 0.0 0.0 92.3
KENEMA 72.9 27.1 84.1 8.0 7.9 87.3
KOINADUGU 89.5 10.5 99.1 0.0 0.9 77.2
KONO 75.7 24.3 75.7 16.2 8.1 73.0
MOYAMBA 80.7 19.3 84.8 5.6 9.7 88.8
PORT LOKO 88.2 11.8 85.9 8.7 5.4 91.5
PUJEHUN 77.3 22.7 80.3 11.6 8.1 93.8
TONKOLILI 69.6 30.4 94.7 1.6 3.7 94.1
WESTERN AREA
RURAL
78.6 21.4 60.0 10.0 30.0 35.7
4.2 Assessment of the CLTS Implementation Approach
4.2.1 Partner NGOs
CLTS is implemented in partnership with 27 Non Governmental Organizations (NGOs) and with the District Health Management Teams (DHMT) of the Ministry of Health - (UNICEF
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provided funding and technical support to some IPs including the DHMT). Most NGOs support one or two districts. IPs with relatively more CLTS operational districts are DHMT (7 districts), Plan International (3 districts) and Pekin To Pekin (3 districts). Although Kailahun has Oxfam as its Implementing Agency funded by the European Commission, Oxfam itself does not implement at the field level. OXFAM engages three sub IPs: Counterparts in Rural Development-Sierra Leone (CORD-SL), Bo Pujehun Development Associates (BPDA) and Community Agricultural and Skills Training Institute (CASTI). At least one CLTS site supported by each of the 28 IPs was sampled for the evaluation.
Table 4.3 - CLTS IPs, by Operational Districts
DISTRICT Name of Implementing Partner
NORTHERN PROVINCE
Bombali CTF, PACT, PLAN-SL, DHMT Kambia CAWEC Port Loko PLAN-SL, SAFER FUTURE, PEKIN TO PEKIN, DIP,ORIENT Tonkolili CHIDO, CIP,PEKIN TO PEKIN, ORIENT,CADA,CONCERN WORLDWIDE,PACT Koinadugu DHMT,MDM,CRS SOUTHERN PROVINCE
Bo FOWED,MOVE-SL-SLRC Pujehun ACCEPT,HELP-SL PACE,WATERAID,FOWED Moyamba PLAN-SL,DHMT,CIP,CORD-SL,SAFER FUTURE,PEKIN TO PEKIN Bonthe DHMT EASTERN PROVINCE
Kenema DHMT,CORD-SL,GOAL,MOWUDA,IRACODE Kailahun DHMT,OXFAM ( Through CORD –SL- BPDA and CASTI) Kono DHMT,OXFAM,SILPA and WSD WESTERN AREA DHMT
Source: Database created for this evaluation with support from MOHS, UNICEF and Selected IPs to Inform Evaluation Design
4.2.2 Community Selection Approach
CLTS IPs are currently using multiple models to decide on which communities to trigger or not. There are at least six approaches in use and the strengths and weaknesses of each are highlighted. However, this evaluation was not able to establish a direct correlation between the community selection approach and attainment of ODF status. I) Selection based on favourability criteria- some agencies targeted communities for the triggering process based on how far their characteristics matched the description conditions considered favourable for triggering, as outlined in the CLTS handbook12. In other words, an IP, such as MUWODA in Kenema District is more inclined to select small communities with few latrines (if any); priority was also given to hard to reach communities. This approach was also used by IPs like PACE and ACCEPT in the South with the exception of Bonthe District. Overall, about one fifth of sites surveyed were selected based on this criterion. The main advantage of this approach is the chances
12 Handbook on Community Led Total Sanitation, Kamal Kar with Robert Chambers - 2008
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of success with triggering and subsequently attaining ODF status for communities with this profile is much better than going for localities that are fairly large and that perhaps find themselves located along a major travelling route. The disadvantage, however, comes with the fact that only small localities (in some cases with pockets of populations) get to benefit from CLTS when in fact large and populated communities with much higher needs for sanitation and cases of sanitation related illnesses are neglected.
II) Selection based on assessment of sanitation needs of community – An IP, such as the Water Supply Division of the Ministry of Energy, Power and Water Resources, undertakes an assessment of latrine availability in the village. To put this in perspective, facilitators will go to any number of communities and work out the proportion of houses with latrines in each village. Based on this proportion, communities with lower proportional values of latrine receive priority over communities with relatively higher proportion of latrines. This approach was used by most of the IPs in the Northern Province, and overall, about one third of sites visited were selected in this way. Its major advantage is that, somehow, communities with much higher sanitation needs get selected at the end of the day. But it also means that nothing is done to improve the sanitation situation of communities that are not selected. Even though FOWED used this approach in both the Bo and Pujehun Districts, there are ODF communities in the latter but there are none in the former, especially among the communities that were selected for evaluation. The community selection model therefore does not necessarily explain why one community attains ODF status earlier than others. III) Chiefdom-wide approach to community selection – at least one agency in Kenema District, GOAL, has adopted a targeted approach which attempts triggering every community in the chiefdom. GOAL works in a couple of chiefdoms in a typical year, but then rolls out CLTS like a wave that (possibly) leaves the entire chiefdom ODF in the wake of its path. PLAN SIERRA LEONE and PIKIN TO PIKIN adopt the chiefdom wide approach and the former has the second highest ODF communities in the southern region. However, even though CORD-SL adopts this approach and most of their communities in the Kenema District have attained ODF status, none of CORD-SL communities in Moyamba district had attained ODF status. There are several positive points to this approach, including the fact that the chance of achieving total sanitation at chiefdom level is much more feasible. An additional advantage, at least in principle, should be savings in programme operational cost, as the agency will spend less on monitoring communities in a single chiefdom as compared to monitoring communities that are scattered across several chiefdoms. One downside to this approach could be the IP commits itself to the difficult task of triggering less favourable communities with the chiefdom, such as chiefdom headquarters in towns.
IV) Selection based on proximity to IP district office – at least the DHMT in Kailahun said its main criteria for selecting CLTS operational communities was based on how close a community is to the DHMT district office, based in Kailahun Town. For this reason, DHMT had only worked with communities in Luawa Chiefdom, for which Kailahun Town is the chiefdom headquarters. A similar pattern of community selection was observed for DHMTs in other districts, such as Kenema, Kono and Bonthe. The advantage in this targeting approach is perhaps the possibility that this decision is based on prudence. DHMTs have their core functions which are to manage and deliver public healthcare services in the district, and as such, they probably do not have the human and other resources to effectively monitor operations at distant communities. The disadvantage could also be that DHMTs, by default, find themselves targeting communities based on convenience, and less so on other factors.
V) Selection based on population size – an IP, such as Community Agricultural and Skills Training Institute (CASTI), selects communities on population size. The agency selects communities with 250
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and more people, and not only facilitates CLTS but also provides the community with a water well. The key strength of this approach is that it targets reasonably populated communities, which some other IPs may shy away from triggering, for the simple fact that it is much more difficult to achieve ODF status with populated communities. However, the challenge comes with the fact that smaller communities are excluded, regardless of the need for sanitation improvement. This approach is also not working at some other level. Already, CASTI has learnt that in many communities, the enthusiasm to complete latrines evaporates as soon as the water well is completed and goes into use. It appears the strategy to provide communities with water wells as incentives to dig latrines may not be that effective. If the water wells are constructed as rewards for building latrines, then the situation will be positively different.
VI) Selection based on a combination of two or more models— MOVE-SL in the Bo District considered triggering communities based on their sanitation needs and inaccessibility coupled with the fact that these communities were un-serviced by other IPs especially in the areas of water and sanitation. This approach is more context-friendly in that the IP would decide to adopt two or more models depending on the sanitation and other relevant factors. The dynamic nature of this approach makes it a lot more favourable in that it is flexible and can therefore be adjusted to meet the demands of the prevailing circumstances.
4.2.3 Coherence of Implementation Approach
Community Led Total Sanitation CLTS) has an implementation framework that directs
implementation process. It is organised into four stages- i) pre-triggering; ii) triggering; iii) post-
triggering; and iv) scaling-up and going beyond. There is a dependency relationship between stages,
with each stage defined by a set of discrete activities and deliverables. NGOs and other agencies that
take on CLTS implementation are guided by these process stages.
On the whole, CLTS activities in Sierra Leone since 2008 have focused on pre-triggering, triggering
and post-triggering. This is because the programme design is yet to make the transition from the
development phase to the scale-up phase. Findings relevant to these stages are discussed:
Pre-Triggering Approach: This stage requires the implementing agency to make initial contact with
community authorities, establish a rapport with them and set a date when facilitators will come back
with the intent of triggering the community. Facilitators are not expected to raise sanitation
discussions with the community at this point; this has to be delayed for the triggering session that
comes later. The evaluation found from chiefs, other community leaders but also from FGD
participants that most NGO and DHMT facilitators did make pre-triggering visits to their respective
communities. Facilitators asked for chiefs during the first visit and they were led to them. After the
first visit from visitors13, word went around the community that the visitors were coming back to
speak to the community on a date that had been agreed with community elders. Because
communities knew in advance that visitors were coming on another date, facilitators had more
people waiting to attend the triggering meeting. The chances of attracting more community
members to attend triggering meetings are better when they are informed in advance, which
justifies the need to undertake pre-triggering, as a forerunner to triggering.
13 The visitors in this context refer to CLTS facilitators that visited the community
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Triggering Approach:
Important activities and processes that happened at this stage are discussed, thus:
I) Mobilising Communities for Triggering Meetings
The mobilisation approach for triggering meetings was largely uniform across all districts. Upon
arrival at a site, IPs made contact with chiefs, who in turn mobilised communities to convene at a
convenient venue for triggering meetings. In some instances, town criers or bells were used to draw
community members’ attention to respond to the call to attend triggering meetings. By working with
the local leadership structures - i.e. chiefs and other community leaders - triggering sessions were
often well attended. This was to ensure that decisions that were made (i.e. to dig or not dig latrines)
were reached through a consensus mechanism.
CLTS beneficiaries in the Southern districts demonstrated clear understanding of the identity of IPs
who came to trigger their communities and how they were mobilised for the meeting. The same was
not found for districts in the North and also for Kenema. Most CLTS beneficiaries who took part in in-
depth interviews (IDIs) and focus group discussions (FGDs) could hardly recall the names of the
specific IPs that triggered their communities, although they knew the names of the individuals that
came to trigger their communities.
II) Organising Triggering Meetings
CLTS Facilitators are expected to adopt a multi-tier approach to organising triggering meetings, with
separate meetings for adults and children. The way triggering meetings were organised in many
communities may not have necessarily facilitated the full participation of some stakeholders. The
evaluation revealed three approaches:
A combined meeting for adult men and women: Here, the men and women were grouped
together in the same meeting while the children were either in a separate meeting or excluded
from the activities.
The downside of this approach is that it limits women’s participation. Women found it difficult to
participate in the presence of their husbands or other men. Many said they did not actively
participate in triggering meetings because they were not asked questions. The expectation is
that with men in a meeting, women should only respond to questions that are directed to them.
Box 4.1
“M: Did women and children contribute actively in the meeting?
R: They never asked females to contribute in the meeting” FGD Women, Fandu
“M: Those four communities that you triggered, how did you do it? Did you trigger them in separate groups: women, children or you combined them in one group?
R: We combined the adults and separated them from the children. We did that in all the communities. We’ll put them and draw the map of the communities, asked where they would shit, when and in emergency cases—that transect walk, we did all of those.
M: That is in two groups: children and adults?
R: Yes, they would be in separate groups.” IDI DHMT, Kailahun
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A combined general meeting for everybody regardless of gender and age: Implies that men,
women and children were triggered in the same meeting. There was no separation of groups,
either by age or sex. At more than 70% of the FGD sessions held in Kenema district, researchers
were told that a single meeting was organised for adults as well as children. The challenge with
this approach is that both the women and the children were restricted, in that children hardly
said anything while their parents were in the meeting. The only time children participated fully
was when (at the end of the meeting) they would take the children and teach them the shit song
and they would go round singing and dancing.
Separate meetings for children, women and men: Other communities reported that
triggering meetings were held in the three groups. However, even in these communities, it
was reported that initially a general meeting was convened before participants were
separated into three groups. At the end of the activities, these groups would again converge
at a general meeting for the closing courtesies. This was the most effective of approaches as
it gave equal opportunities to participants of all ages and gender dimensions to contribute in
a meeting that would eventually lead to the improved health status of their community.
Although children are valuable agents of change, in some communities, they were either
selectively excluded from the triggering or inevitably absent as triggering was done during
school hours.
III) Use of Ignition Tools
CLTS facilitators are expected to conduct triggering, using the tools and processes set out for this
purpose. For example, transects walks, defecation mapping, calculation of shit and medical expenses
and other tools are recommended for triggering.
The account of facilitators and communities does indicate these tools were used. CLTS facilitators
that were interviewed appear quite familiar with triggering tools and the effect they have on igniting
communities into action. Facilitators have been also successful in adapting tools to the needs of the
local context, without necessarily deviating from the core principles and processes proposed by the
pioneer of the methodology.
Box 4.2
“Do you hold separate meetings during triggering for children,
women and men or you just assemble everybody at one location?
R: Well during the triggering process, we address all of them in a combined meeting
M: How about the children?
R: We address all of them, including the adults, in a combined meeting.” IDI-IP, CASTI, KAILAHUN
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Most respondents in CLTS sites surveyed recalled that transect walk, defecation mapping, shit song
and shit flow route were done to illustrate hazards of open defecation. In one CLTS site in Kailahun
district, community members were impressed with the use of a ready-made picture on a big hard
card depicting the faeco-oral transmission routes. One female participant at an FGD recalled the
process, thus: “they asked us to bring ashes and map out the town. After that, they asked us to mark
the kaka sites with the ashes” (FGD Women, Motorma, Kandu Lekpiama Chiefdom, Kenema
District).
Going by the emphasis placed by FGD adult participants, the flow of shit demonstration and transect
walk, were the most powerful tools that CLTS which triggered shame and disgust, and prompted
action to construct latrines. Adults participating in focus group discussion sessions in the Northern
districts revealed that they felt truly embarrassed by the “kaka songs sung by their own children”.
IV) Conflicting views - Triggered or Not Triggered
The evaluation team did come across conflicting cases regarding the actual CLTS status of some
communities. Members in some communities that were listed as triggered could not recall any
attempt being made in the past to trigger them. Communities in Sambaru and Kundorwahun in the
Luawa Chiefdom, Kailahun District, and Bikondu and Boroma in the Gbense Chiefdom, Kono district
could not recall being triggered by the DHMT team. These communities were however listed as
being triggered by DHMT in the two districts.
Box 4.3
“M: So, as I had asked, people said they came here to talk to you about
the shit issue, how not to shit in the bush and...; has such a thing happened in this town for the last two years since 2008?
R1: No, we have not seen that.
M: Did they not come here?
R1: No
M: Nobody ever came here? I am not talking about NaCSA. Nobody ever came here to talk to you about people to stop defecating in the bush, or to build latrines?
R6: Nobody came here. You are the first people.
M: We are the first people to come?
R6: You are the first people to come here.
M: Wait, let me ask again, those people when they reach a town, sometimes they take the women or the men to the bush to show them where they shit in the bush, in the town and explain to you its effect. How flies sit on them... do you want to tell me those people never came here?
R4: Never.
R2: We have not seen them here. You are the first people to come here.
M: So nobody ever came here, and this town is Bikondu right?
R1: Yes.” FGD Women, Bikondu, Kono.
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Likewise respondents surveyed in two communities in the Pujehun district, Konovulahun, Galiness
Peri Chiefdom and Fanima village, Soro gbema Chiefdom, also maintained that no official from either
an NGO nor the Ministry of Health visited their community to trigger action against open defecation.
Post-Triggering Approach:
CLTS facilitating agencies in Kenema district appear to have taken steps to support immediate
follow-up on decisions reached on latrine construction at triggering, and also to deepen its
engagement with communities through ongoing monitoring. Arguably, the fundamental milestone
at post-triggering is that of identifying a member of the community who effectively becomes the
agent and advocate of CLTS at the community level. NGO representatives with responsibilities for
facilitating CLTS worked very closely with Natural Leaders. Facilitators are expected to make regular
visits to sites to oversee progress and resolve bottlenecks preventing triggered communities from
moving forward to achieve ODF status. Many IPs are not able to meet monitoring targets for lack of
funds.
4.2.4 The Natural Leader Profile
The profiles of Natural Leaders vary from one CLTS community to another. The majority (98%) are
men. In Pujehun district for example, out of the 41 Natural Leaders who took part in the evaluation
exercise all but one were men. Most Natural Leaders are youths. In Kailahun District in the Eastern
Region, most Natural Leaders already held the position of “Town Sanitary”. In Pujehun and
Moyamba, districts, there are indications of involvement of Community Health Officers (CHOs) as
Natural Leaders, or complementing the efforts of Natural Leaders within some Chiefdoms.
Selection process
The evaluation found several approaches through which Natural Leaders came into being.
i) Natural leader emerged at triggering meeting: individuals who felt deeply moved by the effect of
the triggering process declared their unwavering commitment to lead the campaign against open
Box 4.4
M: did anybody visit this village to talk to you about cleanliness and hygiene? R: No visitor ever came to this community
M: You mean nobody ever, not even sanitary inspectors in this area?
R: Only the sanitary inspector from Bumpeh village visited us some time ago but did
not tell us anything about kaka.
M: So, you mean nobody came here before to talk to you about this kaka project ?
R : Ehe, no.
M: Ok, thank you very much for this .” FGD, Male, Konovulahun
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defecation in their communities. Most of these people went on to become Natural Leaders, and in
most cases were the first to construct a latrine in the community.
ii) Natural Leaders appointed by community: it was reported at the majority of the sites visited that it
was community folks that appointed one or more of its member to serve in the capacity of Natural
Leader. The decision to appoint them was often based on the fact that the community already knew
the Natural Leader was active in mobilising cleaning activities in the community. Appointees are
usually highly respected and accepted in the community. This practice was much more common in
Kenema district.
iii) Chiefs appoint Natural Leaders in consensus with community: at a few sites, the evaluation team
learned that village heads often nominated someone to become Natural Leader, and later asked
community members present at triggering meetings to endorse appointees. This trend was more
common in Kailahun district, where chiefs often appointed village sanitary officers as Natural
Leaders. It was learnt that IPs would first ask for the village sanitary and automatically made that
person Natural Leader. Somebody different was only appointed to this post in a situation where the
village did not have a sanitary officer.
iv) IPs appoint natural leader: facilitators of some IPs also selected Natural Leaders in some of the
communities, such as sites in the Southern Region. There are always going to be concerns when an
IP takes on such a role, especially if the community is suspicious of the appointee. The Natural
Leader for Mowagor, Bonthe District is a public health worker of the MOHS and at the same time
member of the Mattru (Bonthe) DHMT. As far as the community is concerned, the Natural Leader is
answerable to the Ministry of Health and Sanitation, and not to the community. The practice of
agencies appointing Natural Leaders also undermines ownership, which lies at the heart of CLTS. The
truth is, when an IP selects someone to be the natural leader, it creates an opportunity for that
person to demand financial incentives in return for the functions they perform. The Water AID
representative in Pujehun district said that already some Natural Leaders were requesting to
become employees of IPs that appointed them while others were requesting identification cards and
salary. In a way, CORD-SL (Kailahun District) adopts this approach in that they recommend a member
from the triggering meeting to the Chief for the latter’s appointment of the nominee to become a
Natural Leader.
“M: Do you appoint Natural leaders or do you allow community leaders to
appoint Natural Leaders?
R: We identify Natural Leaders and recommend them to the chiefs for
appointment. We say Chief, this particular person is capable of doing the
job of Natural Leader. Later we begin to work closely with them.”
IDI, CORD-SL, KAILAHUN
Perspectives about the role of Natural Leaders
Communities clearly articulated in different ways what they perceived as the role of Natural Leaders.
Most people in the community described them as inspirational to championing CLTS and mobilising
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other members of the community to dig latrines. In addition, communities also see them as
monitors of community sanitation, including enforcement of sanitation bye-laws and monitoring
ODF status in the community.
Across all districts, communities were appreciative of the role played by Natural Leaders, whom
most people refer to in communities as “kaka chief”. This view is also shared by CLTS Task Force
members, who firmly hold to the belief that involving Natural Leaders in the CLTS process is the
most effective strategy for attaining ODF status and also for spreading the concept to neighbouring
communities. The CLTS Task Force in Moyamba cited “the involvement of Natural Leaders in the
CLTS process” as a success factor at implementation level. But even so, some district Task Forces
have stressed the importance of providing Natural Leaders with more logistical support to enable
them to perform their role more effectively.
4.2.5 Coordination and Monitoring Mechanism for CLTS
District Level
Responsibility for monitoring CLTS at district level starts with the Task Force. The CLTS Task Force
comprises representatives of the DHMT, the Council and all NGOs implementing CLTS, with the
District Medical Officer as the Chair. The main work of the Task Force is “to monitor the activities of
IPs”. The Task Forces in Pujehun and Moyamba districts are fairly active. The Task Force meets
regularly and minutes of previous meetings were available for inspection at the time of the
evaluation. The Task Force also enjoys cooperation from all IPs as well as the district council and
DHMT.
In Bo and Bonthe district, the Chair of the CLTS Task Force could do more in terms of convening
meetings on more regular bases, and also ensuring that important stakeholders, such as IPs and local
council authorities are actively involved in Task Force activities. The challenge was highlighted by
CLTS Task Force member in Bonthe: “when we started we were coordinating well, but of late we had
some challenges such as the lack of refreshment at meetings, which has made some agencies to back
out”. As long as CLTS Task Force structure remains weak, monitoring and coordinating CLTS activities
will continue to be slow and less effective.
Kailahun District has no functioning CLTS Task Force. Therefore, all CLTS activities are either poorly
coordinated or not coordinated at all. The DHMT (with only one CLTS-trained staff) is therefore
poorly prepared to monitor other IPs operating in the district.
Site Level
At the community level, Natural Leaders work closely with IPs to monitor the sanitation behaviour of
households with regards to constructing latrines in their operational areas. IPs often use monitoring
tools to document progress and in turn report on these activities to the Task Force. The presence of
an effective Task Force, such as in Pujehun and Moyamba, is putting IPs in check and getting other
partners like the local council and Chiefdom Health Overseers (CHOs) interested in the CLTS concept
and activities.
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In Pujehun and Moyamba, mention of the involvement of CHOs as Natural Leaders, or
complementing the efforts of Natural Leaders within some chiefdoms is an indication of the growing
interest of the local council in the process. However, the majority of FGD adult respondents across
districts reported the marginal involvement of Council representatives in CLTS activities.
4.2.6 Systems of Reward for Achievement of ODF Status
In order that community people speedily attain open defecation free (ODF) status, IPs generally
organise a celebration/ceremony for ODF communities, otherwise known as “kaka dance”. During
this occasion, representatives from the DHMT, Local Council Authorities, other CLTS IPs and opinion
leaders from neighbouring communities are invited to witness the event that has become festive.
On this occasion, the celebrant community is openly recognised as a model of good health and
sanitation practices. Plan Sierra Leone in the Port Loko District, for example, supports the celebrant
community to erect billboards as a way of publicly recognising their new status. This adds to
community pride and provokes other communities to want to be like their neighbours.
FOWED, an IP supporting CLTS in Bo District, advocates for more tangible rewards such as providing
water wells to communities who have attained ODF status. Other stakeholders including Natural
Leaders themselves call for more training of Natural Leaders as CLTS facilitators, and for the
provision of bicycles for Natural Leaders to ease of movement to trigger other communities.
4.3 Programme Effectiveness
4.3.1 Increases in Latrine Availability:
Table 4.4 and Figures 4.1 display the proportion of houses with latrines before and after CLTS was
introduced by district and open defecation (OD) status. The evaluation reveals that the proportion of
households with latrines, before and after CLTS has changed dramatically. More than two-thirds
(76%- 4274 of 5597) of the houses surveyed now have toilets compared to 19% (1080 of 5597)
before CLTS. Not surprisingly, much of the increase occurred in ODF communities, where the
number of latrines increased by nearly five times (4.9) the pre-CLTS numbers while in Non ODF
communities, the growth in number of latrines available to households was about two times the pre-
CLTS level.
Kenema District is the most successful in terms of the number of communities that have converted
to ODF. The number of households with latrines in sites that have been declared ODF increased from
17% before CLTS to 83% after CLTS, for the households that were assessed in ODF communities - this
indicates a 66% expansion in household latrine ownership which can be directly attributed to the
programme. Pujehun district presents an unusual case. Only 36% of houses surveyed in ODF sites
had constructed latrines at the time of the evaluation. This raises the question of how and why did
sites earn ODF status. One explanation would have been that latrine sharing across houses was a
more common phenomenon for Pujehun district compared to other districts. But this was not found
to be the case. From table 4.8 in section 4.3.4, the mean number of latrine users for ODF sites
sampled in Pujehun district, was 7.5, compared to 11.2 for ODF sites sampled in Port Loko district.
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All the same, there is growth in the percentage of households with latrines, even in communities
that have been triggered and gradually on their way to attaining ODF status. Only 21% of households
in non-ODF communities had latrines at the time they were triggered. At the time of data collection
for this evaluation, this had increased to 44%, representing a 28.8% increase in households with
latrines. Non-ODF communities in Port Loko and Moyamba districts are making good progress to the
attainment of ODF status.
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Table 4.4 – Latrine Status Before and After CLTS by District
District
No of Sites Assessed
No of houses Assessed Latrine Status
ODF Non-ODF ODF Non-ODF
Before CLTS After CLTS
Before CLTS After CLTS
KAILAHUN 17 - 260 - - 15(6%) 63(24%)
KENEMA 101 1,132 194 194(17%) 936(83%) 26(13%) 92(47%)
KONO 4 10 27 4(40) 10(100%) 11(41%) 12(44%) BOMBALI 21 50 243 13(26%) 43(86%) 106(44%) 123(51%) KAMBIA 1 - 13 - - 6(46%) 9(69%) KOINADUGU 15 22 197 14(64%) 19(86%) 135(69%) 144(73%) PORT LOKO 59 260 722 56(22%) 206(79%) 180(25%) 395(55%) TONKOLILI 32 168 283 19(11%) 144(86%) 104(37%) 170(60%) BO 10 - 162 - - 30(19%) 60(37%) BONTHE 2 - 24 - - 8(33%) 16(67%) MOYAMBA 59 258 600 23(9%) 224(87%) 57(10%) 294(49%) PUJEHUN 76 245 706 19(8%) 88(36%) 56(8%) 135(19%) WESTERN AREA RURAL 2 - 21 - - 4(19%) 11(52%)
Total 399 2145 3452 342(16%) 1670(78%) 738(21%) 1524(44%)
Fig 4.1A - Proportion of Households with Latrines Before and After CLTS, by District
Proportion of Sampled Households with Latrines in ODF Sites Before and After CLTS, by District
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Fig 4.1B - Proportion of Sampled Households with Latrines In Non ODF Sites Before and After CLTS,
by District
4.3.2 Average Duration between Triggering and ODF
The sample for ODF communities was drawn from eight of the thirteen districts in the country. No
ODF sites were sampled for the remaining five districts, because the five districts did not fulfil the
minimum number of ODF sites required to include them in the sample selected for ODF sites. IPs
within the eight districts from which ODF sites were selected did provide data on the period
between triggering and attainment of ODF status for their respective ODF sites sampled. The data
shows variation in the average conversion period across districts. Table 4.6 below shows mean
conversion period between triggering and ODF status by district. The mean itself has been weighted
to adjust for the fact that some districts were over represented while others were under
represented in the sample for ODF communities.
Table 4.6: Mean Conversion Period between Triggering and ODF Status among ODF Communities,
by District
District Observations Total Mean
(Months)
Variance Standard
Deviation
BOMBALI 50 165.0000 3.3000 3.3163 1.8211
KENEMA 1206 7205.0000 5.9743 42.6558 6.5311
KOINADUGU 22 228.0000 10.3636 26.9091 5.1874
KONO 10 40.0000 4.0000 .0000 .0000
MOYAMBA 200 1569.0000 7.8450 78.8754 8.8812
PORT LOKO 274 1206.0000 4.4015 30.7906 5.5489
PUJEHUN 260 2369.0000 9.1115 43.0416 6.5606
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TONKOLILI 191 892.0000 4.6702 11.8117 3.4368
Overall, the performance of Bombali was better than the other districts when it came to triggering
communities and then facilitating the process to attain ODF status. It took 3.3 months - roughly
speaking 100 days14, to successfully trigger a community in Bombali and attain open defecation free
status. The performance of Kenema district is perhaps of some interest, considering the fact that the
district had the most number of ODF communities, at least up to the period leading to the
evaluation. The mean conversion period for a community in Kenema was close to six months (5.9
months), which was almost twice the average period it took to convert a triggered community in
Bombali to ODF. For other districts, such as Koinadugu and Pujehun, it took much longer for
triggered communities to attain ODF status.
4.3.3 Evidence of Continued Drive to Dig Latrines
Out of the 4,274 households with latrines - in both ODF and Non-ODF communities - 3,194 of them
started and completed latrines during the CLTS implementation period (that is, 76.3% all latrines at
the sites assessed were CLTS latrines). Even with this progress, many other households had also
started building their own latrines by the time field data was collected. Across all sites, 663 (50%) of
the 1,323 houses that did not have latrines had started digging. With this development, it is looking
promising that over time many more households will construct latrines, thus expanding the
population of ODF communities in each district.
From Table (4.7), Moyamba District is making important strides in the direction of attaining universal
ODF status, at least for the communities that were sampled for the evaluation. Of the 858 houses
assessed, 598 houses (69.7%) had latrines which were complete; another 181 (21%) houses had also
commenced latrine construction. This progress however needs to be contextualised, so that it does
not appear that Moyamba is necessarily ahead of all the other districts in terms of the district with
the most ODF communities. In fact the distribution of sites sampled for the evaluation seems to
suggest that Kenema and Pujehun districts have triggered more communities than Moyamba (see
table 4.7).
Table 4.7 - Number of Houses that Started Constructing Latrines after CLTS, bY OD Status
District
No of Sites Assessed (Valid N)
No of Houses Assessed Started Latrine After CLTS
ODF Non ODF ODF Non ODF
Kailahun 17 - 260 - 21(8%) Kenema 101 1,132 194 111(10%) 27(14%) Kono 4 10 27 - 3(11%) Bombali 21 50 243 7(14%) 38(16%) Kambia 1 - 13 - 2(15%) Koinadugu 15 22 197 1(5%) 6(3%)
Port Loko 59 260 722 27(10%) 49(7%) Tonkolili 32 168 283 16(10%) 54(19%) Bo 10 - 162 - 2(1%) Bonthe 2 - 24 - 11(46%) Moyamba 59 258 600 35(14%) 146(24%)
14 On the assumption that the average days in the month is 30
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Pujehun 76 245 706 51(21%) 47(7%) Western Rural 2 - 21 - 9(43%) Total 399 2145 3452 248(12%) 415(12%)
Figure 4.2: Percentage of Households that have started Latrine Construction After Triggering by
ODF Status, by District
4.3.4 Increase in latrine usage: It is not only the case that more latrines have been built, but it is also true that marked changes have occurred in latrine usage. In ODF communities, adults told researchers that they no longer defecated in the open. Adults and children above the age of five years use latrines while children below the age of five use stools, which are then emptied into latrines. Not every household has completed a latrine; yet, communities have found ways of accommodating families that do not have latrines, mainly through sharing. Table 4.8 displays the mean number of persons using latrines in ODF and Non ODF communities. The mean has been weighted to adjust for the uneven representation of sampled sites between the various districts, with the weighting criteria being the number of households.
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Table 4.8: Mean Number of Latrine Users per Household Compared for ODF Status, by District
District Mean Users/Latrine in Non-ODF Communities
Mean Users/Latrine in ODF Communities
BO 12.9214 - BOMBALI 14.3798 9.3794 BONTHE 1.5424 - KAILAHUN 5.8944 - KAMBIA 11.2000 - KENEMA 10.3765 8.0653 KOINADUGU 9.5686 8.5909 KONO 9.8209 6.2222 MOYAMBA 6.6894 4.3517 PORT LOKO 12.7483 11.1694 PUJEHUN 6.4636 7.4712 TONKOLILI 9.3185 8.6545 WESTERN AREA RURAL .3667 -
Overall, the mean number of latrine users is higher in Non ODF communities. Not surprisingly, there is also variation between districts. Non ODF sites in Bombali district reported the highest average in the persons that used the household latrine - about 14 persons. Among ODF communities, it was Port Loko district that reported the highest mean users per household latrine, which was 11 persons. Considering that the average household size in Sierra Leone, of 5.9 persons, is lower15 than the reported mean for persons using individual household latrines, it is reasonable to draw the inference that latrine sharing is taking place in the various communities. This was widely confirmed during interviews as well as informal discussions with community members at the time of data collection. Members of the community often said to researchers that they will rather share their latrine with a neighbour than watch that neighbour defecate in the bush, when at the end of the day they will eat the shit.
4.3.5 Further progress in the sanitation profile of communities
CLTS has not only been limited to the construction of latrines. Households have also adopted additional hygiene measures, as part of the CLTS campaign, including hand-washing after defecation. Figures 4.3, 4.4 and 4.5 show the proportion of households with plate racks, clothes line and compost fences. Findings for hand-washing practices are discussed separately in section 4.3.6. In Figure 4.3 below, the data does indicate that overall, many households have taken steps to build plate racks since CLTS facilitators triggered their respective communities. However, it has to be acknowledged though that progress in getting communities to adopt the use of plate racks is not as impressive as the achievements in building latrines. With the exception of Bombali and Koinadugu districts, it would seem that the difference between the 15 See data on household size in the 2004 Sierra Leone Housing and Population Census Report
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percentage of households in ODF and that of households in Non ODF communities that have plate racks is marginal. It is likely that plate racks may be the first set of activities that communities seem to undertake or at least complete, once they have been triggered.
Figure 4.3 - Percentage of Households with Plate Racks, by District and by OD Status
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Figure 4.4 - Percentage of Households with Clothes Lines, by District and by OD Status
Unlike for plate racks, the percentage of households that were found to have lines to dry clothes mostly exceeded 60% in ODF and Non ODF communities, with the notable exception of communities in Bonthe and Western Area Rural (see Figure 4.4 above). Again, the performance observed at ODF sites does not significantly exceed achievements in Non ODF communities. In most cases the difference is about 10 percentage points. The explanation might as well as be that practice of rural households having clothes lines was already there before CLTS, even though CLTS may have given impetus for more households to have one. Based on district performance in Figure 4.5, it seems that the construction of compost fence is lagging behind in most of the districts. Even in a district such as Kenema which is clearly leading in CLTS (i.e. latrine construction), it has been less successful in facilitating households to build compost fences. According to the field data, only about one in five households were found to have built a compost fence in Kenema District. In Pujehun, the performance is far less encouraging, about 97% of households sampled in the district did not have a compost fence. Based on field observations, the real challenge across districts is not that households had nowhere to deposit domestic waste, and that rubbish was indiscriminately scattered in the community. The problem is that the majority of households had demarcated somewhere at the back of their houses where rubbish was emptied, but that these places were simply unfenced.
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Figure 4.5 - Percentage of Households with Compost Fences, by District by OD Status
4.3.6 Hand Washing Practices in ODF and Non ODF Communities
One of the characteristics that make the CLTS approach unique and widely aspired to is its holistic view regarding sanitation improvement. Talking to most programme facilitators, they seem to make the point that facilitating communities to reach the ODF status does necessarily guarantee them from consuming human faeces. The absence of good hygiene practices after defecation, such as the use of water and soap to wash the hands, clearly puts people at risk of eating shit when eventually the hand is used to feed the mouth. For this reason, an almost equal degree of effort goes into educating and sensitising communities about hand washing, as a core CLTS activity. The figures below report household observations on key inputs for hand washing at the time of data collection. Water Availability near Latrines: Data collectors physically checked latrines of the 4,274 households with latrines to establish whether water was available within the immediate vicinity for washing hands. The percentage of households in ODF as well as Non ODF which had water next to the latrine is presented in Figure 4.6.
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Figure 4.6: Households with Water near Latrines, by OD Status and by District
It was generally observed that the majority of households did not have water close to latrines, except in Bombali district, where more than 70% of households observed in ODF communities had water within the vicinity of the latrines. Even though the data underscores an overall challenge in hand washing, it seems that the practice of keeping a kettle or alternative water storage facility within the latrine was more successful in ODF than Non ODF communities. Other observations strongly indicate though that many more households were using water than the data suggested in Figure 4.6. Most community members mentioned that households actually had a kettle. However, it was much safer to keep the water storage containers (including kettles) in the veranda and the frontage of households so that children and animals did not spill or damage the containers. This account was also confirmed by data collectors, who reported that most of the households kept water for hand washing in a container at the back or front of the home, which users easily took with them to the latrine. Availability of Soap near Latrines: Data was further collected on the availability of soap for hand washing, through observation. Figure 4.7 shows that in most of the districts, data collectors did not see soap for the majority of household latrines seen in ODF and Non ODF communities. This does not necessarily imply that most people did not use soap to wash their hands after using the toilet. Members of the communities visited explained that they did not also leave soap behind in their latrines for fear that somebody might take it away and use it for some other purpose. This explanation may be credible, especially in contexts where members from different families make use of a single latrine. In spite of whatever reasons advanced for not storing soap within the building of latrines, it does not diminish the preference of storing soap next to the latrine, after all, the nearer the soap, the more likely the chances that people will use it. The chances of not using soap because it is not readily available in the latrine is possibly higher with children, who may
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often have the tendency of just running to the latrine without particularly paying adequate attention to the practice.
Figure 4.7: Households with Soap near Latrines, by OD Status by District
Availability of Ash Near Latrines: Ash is used as substitute to soap in most communities. However, observations also indicate that communities in most districts neither store soap in the latrine, nor do they substitute it with ash. While the performance for ODF communities is slightly better than Non ODF communities, the fact remains that ash is not often stored in latrines. Many focus group discussants said they substituted ash for soap in the place of soap, but again, the evaluation team did not find significant evidence to support the practice.
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Figure 4.8: Households with Ash near Latrines, by OD Status by District
4.3.7 Hindering Factors to Programme Effectiveness It is recognised among IPs as well as CLTS communities that several factors have challenged the effectiveness of the CLTS process, especially in terms of promoting holistic sanitation. Below are some of these factors that were either reported or observed in the field both in terms of latrine construction and of getting every community to monitor programme effectiveness:
Some communities reported that digging coincided with a period of high labour demand in the
farming calendar. This meant digging had to be abandoned for several weeks and months in
such cases.
Latrine construction commenced in the rainy season in some communities. As a result, rains
interrupted digging and latrine holes were often filled with surface flow, especially when left
uncovered. To avoid this situation, some households delayed digging until the dry season.
Some communities also reported that the more durable wood that is often used as slab in the
absence of concrete slabs was not available in their communities. This put additional demands
on them to search for wooden slabs from other communities.
Some villages reported having a high concentration of bugs that fed on thatch and other local
materials used to build latrines. Some latrines and plate racks had already collapsed as a result
of termite activity.
Open defecation was still happening in varied ways – i) most people said they used the bush for
defecation when working at the farm; ii) some people still used the stream or nearby bush to
defecate when they go to fetch water or launder at the stream; iii) schools do not have stools,
which left pupils in lower classes, especially Class 1, to defecate on the latrine floor or at the
back of the school latrine.
Few communities considered CLTS latrines as native, even though they built them. They
compared CLTS to the previous latrines they had, which were roofed with corrugated iron sheets
and had concrete slabs.
Many plate racks have collapsed in some villages and have not been rebuilt; and while compost
sites were demarcated, most of them were not fenced off. This seems to suggest that IPs may
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not be making sufficient follow-up visits to ODF communities, which should ideally provide the
opportunity to work with Natural Leaders and the relevant community authorities to address
such situations.
There was evidence of the inappropriate use of plate racks at a few sites. For instances, kettles
used to wash hands after latrine use were kept on plate racks, just next to cooking utensils. This
practice is not hygienic as there is the possibility that kettles brought back from latrines may be
contaminated and it is also likely that flies might transfer contaminants to utensils (See example
in Picture 1).
Picture 1: Plate Rack with Cooking Utensils and Latrine Kettle Kept Together
At a few sites, it was reported that the number of latrines were not enough and as a result, some
residents were still defecating in the bush even though the sites had been declared ODF.
By and large, local politicians (whether counsellors or parliamentarians) have not come forward
to join hands with village chiefs to show leadership/take ownership of the process. Chiefs are
prominently identified with triggering communities into action, and the people they lead
welcome this sort of leadership. It is important that the local politicians including local council
authorities show interest in the programme and complement the leadership role being
demonstrated by local chiefs.
4.4 Programme Impact This evaluation was done two years after initiation of the CLTS approach in Sierra Leone, and it may be too early to begin to see the true health impact of the programme. Still, an attempt was made to measure the mean number of children reported ill with diarrhoea and malaria two weeks prior to the survey at ODF and Non ODF sites as a test run in order to begin to detect signs of health benefit as a result of CLTS.
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4.4.1 The Mean Number of Children Reported Ill with Diarrhoea and Malaria Two Weeks Prior to the Survey at ODF and Non ODF sites
The underlying assumption is that the prevalence of diarrhoea and malaria - especially among children under five years - should drop as sanitation practices improve in CLTS communities. If the assumption is correct we expect to record fewer cases of diarrhoea and malaria at ODF sites compared to non ODF sites. From Figures 4.9 and 4.10, there are initial indications that across all districts, the weighted mean16 number of children under five years who were reported ill from diarrhoea and malaria at ODF sites was consistently lower compared to Non ODF sites. The exception is Port Loko district which did not show any difference in the number of diarrhoea case episodes by ODF status.
Figure 4.9 - Reported Diarrhoea Episodes among <5s, by OD Status by District
16 The number of households was used as the weighting criteria for estimating the mean
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Mean # <5s (Non-ODFCommunities)
Mean # <5s (ODFCommunities)
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Figure 4.10 - Reported Malaria Episodes among <5s, by OD Status and by District
The same trend was observed for reported malaria episodes among children under five years. There
were fewer malaria cases reported for ODF sites compared to NON ODF sites.
5. PROSPECTS FOR SUSTAINING PROGRAMME BENEFITS The merit of a development programme is judged by its ability to sustain the change it delivers on a
lasting basis or at least, for a long period of time. This section of the report will therefore discuss
opportunities and threats to maintaining the ODF status achieved by communities over the long
term. The discussion is primarily informed by field data, as well as existing national policies and
strategies relevant to sanitation.
5.1 Enabling Factors of ODF Sustainability Several factors, both within and outside the control of ODF communities, appear to be promoting
the likelihood that communities that have reached ODF will maintain this status over the long term.
If similar factors also emerge and are sustained in other communities that convert to ODF in the post
evaluation period, then the prediction is that they will also stand better chances of maintaining ODF
status. Figure 5.1 highlights enabling factors that sustain CLTS benefits.
00.20.40.60.8
11.21.41.61.8
Mean # <5s (Non-ODFCommunities)
Mean # <5s (ODFCommunities)
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Figure 5.1: Factors Contributing to the Sustainability of ODF Status
5.1.1 Favourable Policy Environment and Active MOHS Leadership
Existing policies and strategic plans broadly accommodate the approach; this makes CLTS consistent
with national priorities for improving sanitation, especially rural sanitation. The Government of
Sierra Leone has specifically committed itself to promoting the adoption and scaling up of the CLTS
concept in the Poverty Reduction Strategy Paper (PRSP) II, covering the period 2008 to 2012. The
Water Supply and Sanitation Policy17 also identifies participatory methods and the use of low-cost
technical options as key principles that will guide the promotion of rural sanitation; both principles
in fact form the pillar of the CLTS concept. The MOHS published the National Environmental Health
Policy (NEHP) in 2000, which outlines sanitation priorities for rural and urban communities. NEHP
does require every rural household to have “proper toilet facilities and be encouraged to manage
and dispose of refuse properly”18. While policies are and plans only become effective when they are
converted to programmes, the fact that the CLTS concept does have a place and special recognition
(in the case of the PRSP II) in key sanitation service delivery strategy marks an important step in
institutionalising the approach.
At an operational level, the MOHS bears overall responsibility for sanitation services while Local
Councils manage aspects of sanitation functions devolved to them under the Decentralisation Act of
17 This policy was published in 2007 by the United Nations Economic Commission for Africa 18 NEHP, Addendum to National Health Policy (2000), Pg.38
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2002. It is a truly positive development that MOHS is demonstrating leadership and ownership of the
CLTS process, especially in terms of coordinating the activities of NGOs implementing CLTS at district
level. Officials in the MOHS do genuinely recognise that CLTS is groundbreaking and a more effective
way of improving sanitation, especially for rural communities. From the point of view of ministry
officials, subsidy-led latrine construction, which used to be the predominant model of improving
rural sanitation, was less successful in addressing open defecation in communities. The problem was
simple, the emphasis was on financing latrine construction for communities, with very little or no
effort was channelled into influencing positive sanitation behaviour change. Consequently, most of
the subsidy driven latrines built by the numerous NGOs were barely used by the community and in
some cases community elders used them more as storage facilities than sanitation facilities. CLTS on
the other hand, is considered as an empowering approach by ministry officials, in the sense that it is
the community that organises itself and decides on what latrine design to build. CLTS actively
promotes latrine use and hand-washing practices, which is a key strategy used by government to
minimise sanitation related illnesses.
While the MOHS is enthusiastic about working towards a policy framework that mainstreams the
CLTS, it does appear that officials need to start addressing a number of critical issues that may stand
in the way of popularising the approach. For instance, some NGOs continue to subsidise latrine
construction in many parts of the country, and in a few places do the two intervention models go
side by side.
In a district like Kailahun, CLTS and subsidy-led latrine construction are locked in a quiet rivalry,
which leaves communities less enthusiastic about building latrines with their labour and resources
when they know that the Local Council NGO is building latrines in neighbouring communities at
absolutely no financial cost to users. This underscores the need for government to facilitate the
development of a strategy to harmonise both approaches to guide NGOs that work in the sanitation
sub-sector. It appears at this stage, the preference of MOHS officials is to move away from subsidies
and institutionalise CLTS and get NGOs to operate within this framework.
As much as MOHS officials favour this, the point is made by some officials (even within MOHS) that
communities that become open defecation free need to be compensated for their effort. This
argument is justified on the basis that it is appropriate to reward communities for adopting positive
behaviour change. It could mean, for instance, that a rural community that does not have safe
drinking water is provided with one as a reward for attaining ODF status. It could also be that other
forms of assistance that tackle the wider subject of income poverty, such as income generating
activities could be provided to communities or specific groups as incentives for reaching ODF. In
principle, this proposal should be feasible; however, there might be some questions regarding the
extent to which such an incentive scheme should become a standard practice in CLTS
implementation without necessarily undermining the core principles of the approach. In essence,
CLTS is driven by the need to facilitate the empowerment of communities to take positive actions for
sanitation improvement without making promises or linking any form of material or financial reward
to communities. While the need for water improvement services is undisputable in any community
that rely on open sources, it is important that the distinction is made between the two needs, and as
such intervention design has to be informed with this philosophy.
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5.1.2 Community Acceptance of Relevance of CLTS Programme
The pre-CLTS sanitation profile of communities targeted for the intervention was deplorable in many
ways. Most communities had no more than a handful of latrines, often poorly kept and in many
cases, in a virtual state of collapse. There were in fact some communities that virtually had no latrine
prior to CLTS. For these reasons, much of the population residing in these communities defecated
indiscriminately in nearby bushes in the village and farm sites, as well as in nearby streams that were
used as drinking sources by some of those communities. Children were particularly known to
defecate behind dwelling houses and sites used for dumping domestic waste. Besides the health
hazards that came with such open defecation habits, the sight of human faeces was unsightly, and
many communities said the pungent smell of shit usually hung in and around particular sites in the
village neighbourhood.
Residents at evaluation sites indicated that the impetus for accepting CLTS and the interest in
maintaining the ODF status was driven by the need to deal with the health hazards and the shame
that they were exposed to during the days when open defecation was widely practiced in their
respective communities. From all indications, it was clear that most communities were seriously
committed to sustaining their ODF status. During village transect walks conducted by researchers,
there was little evidence of human faeces in most villages that have been declared open defecation
free. Community people were proud to take researchers to the back of their houses and other sites
that were previously used for defecation, as evidence that open defecation was no longer happening
in their communities.
In addition to facilitating latrine construction, CLTS has also promoted hygiene education in
communities, with the result that communities are now better informed of the health hazards of
poor sanitation practices (including open defecation) and the necessary actions to deal with them.
For instance, people now know the pathways of faecal contamination. At many FGDs, flies were
identified as the major means through which shit was transported to human food. Diarrhoea,
dysentery and cholera were diseases that were linked to human faeces. Facilitators also educated
mothers with under-five children on how to wash hands each time they came in contact with the
faeces of their children; caretakers were also educated on how to separate faeces from the napkins
of children before they took them to the stream for laundry. Hand washing practices, with water and
soap (or ashes if soap was not present) is a message that has spread. While a practice, such as hand
washing may sound very simple and basic, some people did not fully appreciate the essence of
maintaining this practice on daily basis, as expressed by a male participant at an FGD: “... Before they
came, we were not using water and soap because we were normally in haste” (FGD Male, Geima,
Koya Chiefdom, Kenema District).
While knowledge of the health risks of open defecation has improved, it is also true that many
participants hold some misconceptions about illnesses caused by shit. Some people said that coming
into contact with human faeces can lead to malaria. In one community, Lassa fever was attributed to
human faeces, as reported by this participant- “they said shit will give sickness and even Lassa fever
is caused by shit” (FGD Men, Gandohun, Lower Bambara Chiefdom).
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5.1.3 Beneficiary Willingness to Rebuild Damaged Latrines and Move up the Sanitation
Ladder
The evaluation team asked one simple question to every focus group and in-depth interviewee- “are
you willing to rebuild or repair your latrine if your latrine is damaged”? The immediate direct
response was “we would rebuild damaged latrines because we do not want to go back to open
defecation or start eating our shit again”. The response to this question is relevant for the purpose
of sustaining the change from open defecation to the ODF status that communities are so proud
and, in most cases, boastful of. Communities expressed willingness to rebuild/repair in the event
that current latrines became unusable at some point. There is even the desire among the majority of
households to install improved latrine types at their homes, depending on whether they could afford
the cost of such latrines. For example, there was popular desire among households to replace
existing latrines roofed with thatch and wattle walls with latrines that have concrete slabs and
roofed with corrugated iron sheets (CI Sheets), if it were not for the high cost of acquiring these
improved materials.
5.1.4 Laws and Fines introduced against Open Defecation in ODF Communities
Arrangements have been made at different levels to ensure that communities do not relapse back
into open defecation. It may seem that communities are taking a lead in this area, by drawing on the
local power structures that are available to them. ODF communities in Kenema and other districts
have bye-laws in place, part of which levy fines on any person caught openly defecating in
communities and the nearby bushes. Fines range from a minimum of Le.5, 000 to a maximum of
Le.25, 000, depending on the community. They cover every adult. The fines also apply to children,
and in the majority of communities it is the parent of the child that is required to pay, while in a
handful of communities children receive a beating when caught defecating in the open. Natural
Leaders and the village sanitary officers monitor and alert chiefs if there is a breach; in some
communities the natural leader also doubles up as the sanitary officer. The community leadership
structure for Fandu, in Kono District has also imposed a fine of: palm oil, two cups of rice, a fowl and
Ten Thousand Leones, for defaulters caught practising open defecation.
This has sent a strong message that local authorities and Natural Leaders have a non compromising
stance on the issue, as illustrated in the dialogue in box 5.1 with a Natural Leader in Tonkolili District.
In Kenema District, a few persons have already been caught violating the defecation ban, and they
have paid the appropriate fine. Enquiries were not made about what/how the fine is utilised at the
time of data collection. Based on local knowledge, it is likely that a fine of this nature is shared
between elders who summon the accused, rather than it being saved for other purposes.
Box 5.1 M – What have you done to make sure that people do not go the bush again to kaka? R – “Well I have decided that if anybody kaka outside, even if it is a child or adult, if you kaka in the bush and we get hold of you we fine you. That is what I said; that is how I pass the order. When your little child shit outside, dispose of it quickly into the latrine and then cover it.” IDI NL _ Moria _ Sambaya Bendugu _ Tonkolili
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The viewpoint of implementing agencies appears to be consistent with the actions Chiefs and
Natural Leaders have taken. The emphasis is on behaviour change, and they argue that if
communities adopt mechanisms that discourage people from drifting back into open defecation,
then every household will make latrines as an essential facility that cannot be neglected while
dwelling at a house. For this reason, agencies believe they have given fairly adequate preparation to
Natural Leaders so they can always influence authorities and ordinary households to keep latrine
ownership as a fundamental requirement by the community.
5.1.5 Committed Natural Leaders Responses from CLTS beneficiaries across communities left little doubt that most Natural Leaders
were appointed by community people themselves. There was overwhelming consensus not only in
the community but even among NGOs about the critical role Natural Leaders are playing to ensure
that their respective communities do not slip back into open defecation. Natural Leaders have
continued to monitor and mobilise communities to take necessary actions that promote better
sanitation practices. In this way, they have become the de facto successors of the IPs. They are at
the forefront of monitoring and enforcing sanitation byelaws.
As a matter of fact, most Natural Leaders have broadened the scope of their work from merely
monitoring open defecation and mobilising households that have not completed their latrines to do
so. They are at the centre of organising the cleaning of the village, so that the village environment
looks decent. This development is positive, especially at a time when communities spoke quite
favourably about their Natural Leaders and when in fact the Natural Leaders themselves are
confident and feel appreciated for the role they perform. This said, the evaluation team did come
across isolated cases of communities that were not satisfied with the performance of their Natural
Leaders. In Kailahun district, for instance, communities like the Bandajuma and Sandia were less
impressed with the role played by their Natural Leaders.
5.1.6 Availability of Local Materials
CLTS latrines rely on indigenous construction materials and unskilled labour to build project assets.
This is perhaps the greatest attraction and appeal of the approach to providers of sanitation services
and communities. Households build latrines by gathering bush sticks, thatch and mud. Latrine
designs are basic and simple and adult males do have the expertise to build them. The materials that
go into building concrete slabs are usually expensive (i.e. cement and iron rods) and as such used to
hold back most rural households from building latrines. Wooden slabs are widely used to build CLTS
latrines.
5.2 Threats to Sustainability of Programme Achievements There is clearly no doubt that communities that have made the transition from open defecation to
ODF remain enthusiastic about maintaining this status. This determination is self driven and to a
large extent rooted in the pride that communities have attached to the popular expression “we have
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stopped eating our shit, and we no longer want to return to eating shit”. At the same time, the
challenges of living this dream, especially over the long term cannot be ignored. Based on
conversation with population samples at ODF communities, as well as field observations by data
collectors, there are many threats to hanging over the widely cherished ODF status attained by
several communities. It should never come as surprise if a couple of ODF communities revert to
open defecation if actions to address these challenges are delayed or ignored. Broadly speaking,
these challenges can be grouped into three categories: a) socioeconomic and cultural factors; b)
environmental factors; and c) implementation challenges (See Figure 4.12).
Figure 5.2 - Threats to the Sustainability of ODF Status
5.2.1 Socioeconomic and Cultural Factors
1) Children Do Not Fully Appreciate The Need To Stop Open Defecation – Children in many
communities were quite open about the continued practice of open defecation in communities
that have been declared ODF. The resistance to behaviour change by children may be partly
linked to the fact that many of them were absent for triggering meetings. In many instances, the
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schedule of triggering meetings coincided with the period when children were in school. It would
appear that those who were absent were not properly briefed about triggering activities
afterwards. As a result, many children have not fully grasped the consequences of open
defecation, and continue to defecate in bushes close to dwelling houses.
Box 5.2 “
M: What are your defecation sites?
R5: Yes, we have been ‘kaka’ in the bush, in the stream and sometimes in the latrine. Yes, people came and spoke to us about OD but we are still doing it.
R: Before the people came, we used to kaka in the bush, on the beach and behind our houses. Even after they came and left we still kaka in those places because we do not have enough latrines.
R3: Sometimes in the night we use black plastic and kaka in it and throw it in the bush.
R9: Our younger ones kaka on the ground and a shovel is used to throw it in the bush...”
FGD CHILDREN, MILE 13.
2) Constraints in Household Income to Purchase More Durable Construction Materials- CLTS, being
a locally owned initiative does expect rural communities to make use of local materials to
construct latrines. Communities do not necessarily object to the use of bush sticks, mud and
wooden slabs and thatch/palm fronds to build a latrine. Even though house owners use local
materials (such as sticks and mud for the slabs and the superstructure as well as thatch/palm
fronds for roofing material), some house owners could still not afford to construct latrines.
However, the concern was raised in the communities visited that local materials do not last for
long, and that the imported construction materials were much more durable, yet they were very
expensive to be within the reach of the average rural household.
However, in other communities the construction of CLTS latrines came at reasonable financial
cost. This difference may be due to factors such as difficult terrain and the unavailability of
critical construction materials locally, such as durable wood to be used as the wooden slab. The
cost of building a latrine in Koinadugu District, for example, could be as high as One Million
Leones (250 USD) due to the rocky nature of the landscape in this part of the country which
meant households often had to hire the services of persons skilled in excavating rocky soil.
3) Willingness to Replace Damaged Latrines does not necessarily Translate into Action –
The majority of the respondents expressed a willingness to repair or rebuild latrines in the event that
they collapsed or became damaged in other ways. However, the evaluation team did come across
several latrines that had collapsed or had become severely damage as a result of the rains, and yet,
no action had been taken to rebuild or repair the damage. The most cited reasons for inaction were
lack of money to rebuild/replace materials and time constraints. In some cases, people had asked for
external support to help them rebuild the latrines with imported materials. It would seem that with
many more rainy seasons in the future, more latrines will not survive, and the motivation to replace
or repair them in such circumstances does appear to be low at present. In this context, the most
likely outcome is that affected communities will slowly revert to open defecation if appropriate
actions are not taken.
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Box
Box 5.4 B0ox This challenge was not only seen with latrines. Data collectors also saw lots of plate racks that had fallen apart, and hardly any efforts had been made to rebuild them. The significance of this evidence lies is that it raises doubts as to whether many/most people can truly commit themselves to rebuilding latrines, if they cannot in fact undertake the less demanding and inexpensive task of repairing or replacing damaged plate racks. 4) Dependency Syndrome: Kailahun District borders Guinea and Liberia, and was considerably
devastated during the war. Consequently, Kailahun appears to be a priority district for NGO
activities in Sierra Leone. Many of the communities have received support of many forms,
ranging from food and shelter to clothing. Because of the high level of exposure to NGO support,
it seems that the culture of looking up to NGOs to provide free basic human services is fairly
entrenched in the minds of many rural communities in the district. So, in most of the
communities that were visited, it was difficult for the population to buy into the CLTS concept
that more or less asked them to construct latrines without NGO assistance. Overall, the interest
in CLTS was less enthusiastic and in most cases people were still waiting for NGOs to build
latrines for them at some point in the future.
5.2.2 Environmental Factors 1) Poor Durability of Local Materials Used to Construct Latrines: Households in ODF communities
widely consider local materials used to construct latrines as being less resilient to withstanding
climatic factors such as intense tropical rainfall and sunshine. As a result, the thatch roofs of the
latrines need to be replaced on almost an annual basis. Other house owners also expressed
concerns that the wooden slabs rotted easily, thus raising fears of the risk that someone might
fall into the pit.
Box 5.4
M: Did the visitors come here at all?
Box 5.3 M – If your latrine gets broken will you be willing to rebuild it? P7-“If they got damaged we will rebuild them again since we have learnt about health we continue to rebuild the latrines if these ones damage. Except we cry back to Concern who have brought this good news for us”. P6-“Except Concern help us with Zinc and Iron rods so we can make guarantee and lasting latrines” FGD Men – Mabome – Tonkolili M – Ok Sir, what factors will have to influence community members to replace materials currently used to construct latrines, such as sticks, grass, palm fronds etc. R – “Except we are assisted because we don’t have money” IDI Community Leader_Bathlol2_Koya_Port Loko M – How much will it cost one to get a latrine here” P4 – “We’ve spent roughly about Le 300,000 (Three hundred thousand Leones) which is too high for us
here. We raised such funds through our farming activities.”
FGD Women – Mathinkaneh – Port Loko
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R2: Some people came here to dig and cut sticks but did not do it because the work was difficult. What we are afraid of is that the sticks we use can rot and the big hole is under the mud. In case it gets broken (one day with somebody) while shitting?” FGD MALE, SANDIA
Already, the fears are being confirmed by evidence of latrines that had collapsed after the walls took so much beating from the rains and became oversaturated with water. In other cases, bugs had eaten up the sticks that held the latrine walls together. A sample photo of a damaged latrine after bug infestation is shown in Picture 2.
Picture 2: CLTS Latrine Damaged by Bug Infestation
In terms of latrine longevity, the general perspective with regards to the number of years that such latrines will last is less than three (3) years. 2) Continued Dependence on Open Water Sources for Drinking: Many ODF communities continue to
collect drinking water from contaminated sources, including streams and rivers that are polluted
by upstream users. While this does not necessarily pose any direct threat to the latrines that
have been constructed, it does expose them to the risk of consumption of human faeces,
thereby undermining the programme outcome of reducing sanitation related illnesses, including
diarrhoea and cholera.
Again, the point has to be re-echoed that CLTS is separate from water supply.
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5.2.2 Structural Factors
Lack of Enthusiasm on the part of Some Leaders for CLTS: This evaluation has unearthed some
hidden challenges around the issue of leadership/political support for CLTS that will have
implications for maintaining and sustaining the momentum for CLTS. Local Councils have not been
visible in the planning and implementation of CLTS, although they are reported as applauding the
approach. This raises concern regarding the sustainability of CLTS in the absence of IPs.
For the most part, community headmen and religious leaders are found to be supportive of CLTS.
However, there are a few community leaders such as in Sandia and Sakiema in the Kailahun District,
who were not fans of CLTS, and so did not spread the message or even encourage their people to
buy into the CLTS approach. Another poor leadership example is the case of a CLTS Task Force
member in Kailahun District who was reported to construct VIP latrines in the community, which is
at odds with the CLTS approach.
5.2.3 Implementation Related Factors
Parallel Subsidy-Led Sanitation Projects: In Kono District, institutions like IRC and World Vision are
implementing parallel subsidy-led sanitation projects in the district. Communities are more likely to
lean towards the subsidy-led option than to the CLTS approach.
Reluctance on the part of IPs to Make the Switch from Subsidised to Subsidy Free Latrines: IPs in
Kailahun District were initially supporting the implementation of subsidised sanitation projects—
constructing water wells and latrines. When Oxfam, the main IP made the switch from providing
subsidies to the CLTS approach, communities grew disinterested and disappointed that OXFAM had
broken its promise to finance latrine construction in their communities. Against this background, IPs
in Kailahun were also finding it difficult to make the U-turn and convince communities to build
subsidy-free latrines.
Infrequent Monitoring Visits to Triggered Communities: Monitoring visits to triggered communities
were few and far between and did not follow any particular order. Many IPs across regions had only
one or two staff members permanently assigned to CLTS activities. Added to this, many IPs faced
funding and other logistical constraints, which prevented them from making frequent monitoring
visits to triggered communities. Consequently, triggered communities which are not monitored
frequently, may lose enthusiasm to construct latrines and are likely to slip back to open defecation
status.
5.3 Equity Issues The CLTS approach in itself does not particularly target equity issues, though equity issues get
addressed during the course of implementation. Favourable and hindering factors for equity are
discussed below.
5.3.1 Favourable Factors
Good Geographical Spread of CLTS: IPs have not taken the easy approach by just reaching communities that are easily accessible, but have worked to achieve an even geographical spread for CLTS. Quite a good number of CLTS communities such as Bandajuma and Kpogbolu in
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Kailahun District are truly hard to reach communities. Facilitators and enumerators alike had to travel along deplorable road networks to reach some CLTS communities.
Marginalised Groups Equally Benefit from CLTS: Many communities like Kpogbolu in Kailahun district have devised strategies to support marginalised groups (the very old, very poor or handicapped) from practicing open defecation. The most common strategy promoted by Oxfam, allows vulnerable groups to use the nearest available latrines.
Box 5.5
“M: ...You know there are people in the communities who are either physically or economically incapacitated to construct their own toilets. For example amputees and the aged and CLTS is total sanitation. Even if everybody has toilets and I don’t have and practise OD, it will hinder that community becoming a sanitised one and attaining ODF status. Is there anything in place to address those vulnerable groups so that they will not hinder the community in attaining ODF status?
R: Yes, Oxfam, in all their implementation phases, is very mindful of these vulnerable groups. So even with CLTS, it is clearly communicated during the mobilisation process. That if someone vulnerable still practises OD, and everybody else does not, the community is still at risk. So we move them to action to ensure that those who cannot construct their own latrines will be aided and supported by the community. So in terms of sanitation benefits and health outcomes, everybody will be at the same wavelength.” IDI-IP, OXFAM, KAILAHUN
The challenge is for proper arrangements to be made with house owners to ensure latrines used by marginalized groups are constantly kept in a hygienic state.
5.3.2 Hindering Factors
Insufficient Considerations for Female Participation in CLTS: In as much as women were addressed/sensitised during triggering, there were many communities where they did not even talk—either because they were not asked any particular questions or because their husbands or other male participants were present in the meeting. If the implementation had targeted women as major advocates for CLTS, then women must be specifically targeted as a separate group during triggering meetings to ensure their active participation in the implementation of CLTS.
Insufficient Considerations for Participation of Children in CLTS Activities: Typically, Pre-
triggering and triggering meetings were organised during morning and early afternoon hours
which also coincided with the school going hours. In Moyamba district, children mentioned
that because they were at school at the time triggering was done, they did not get to hear the
important messages discussed during triggering meetings. Children who missed participating in
triggering activities were more likely to continue open defecation practices.
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6. PROSPECTS FOR SCALING-UP CLTS CLTS has been implemented in Sierra Leone for less than 3 years. Yet it has become quite popular
with key stakeholders that implement sanitation policies and programmes in the country. This is not
surprising in view of what has been achieved within the relatively short period of time. Hundreds of
latrines have been built, mostly in rural communities where open defecation was rife and sanitation
related diseases were also widespread as a consequence. It therefore appears that the argument to
bring CLTS to scale is compelling and it is a path that the MoHS, UNICEF and other stakeholders have
already embarked on. This section of the report examines the opportunities in and challenges to
scaling-up CLTS. It is important for these factors are considered and addressed in an expanded CLTS
programme.
6.1 Opportunities for Scaling-Up Based on understanding of events in the CLTS implementation environment, four prevailing factors
seem to be favourable for scaling-up the programme (see Figure 6.1).
Figure 6.1 - Conditions Favourable to CLTS Scale Up
I) Willingness on the part of Government to Support CLTS: The Ministry of Health and
Sanitation has fully embraced the concept and has thrown full weight behind its implementation.
Government is gradually putting structures in place, such as the CLTS national and district taskforce,
to coordinate the implementation of the programme. Effectiveness of the taskforce itself is gradually
evolving. Officials in the Environmental Health Division of MOHS are already considering the process
of incorporating CLTS into existing policy and legislative frameworks that are relevant to sanitation.
There are also thoughts on the part of ministry officials to work quickly towards introducing laws
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that will significantly favour CLTS over subsidy driven latrine construction programmes. In view of
these developments, the policy environment is looking favourable to the implementation of CLTS.
II) Donor willingness to support CLTS programme: Gradually, some donors are showing interest
in CLTS, and have already sponsored some programmes. For instance, UKaid and UNICEF have
shown great interest in the programme and have supported many NGOs - mostly indigenous
agencies - to facilitate the process in many districts in the country. Similarly, GOAL and Plan Sierra
Leone have been successful in mobilising funds from overseas partners to also facilitate CLTS
activities. The European Commission office in Sierra Leone, recommitted funding it had already set
aside to subsidise latrine construction in Kailahun District in accordance with CLTS activities. It may
seem donors and development partners of Sierra Leone are gradually buying into the approach. This
an advantage that the Government of Sierra Leone should speedily take advantage of before it filters
away.
III) Significant NGO Interest in CLTS: Interest in implementing CLTS seems to have already
gathered sufficient steam among local NGOs. Many of them have past experience of managing rural
sanitation programmes while others with little experience of sanitation programmes are quite
enthusiastic to learn from the experience of colleagues. As a matter of fact, the country already has
a stock of highly skilled CLTS trainers and facilitators that received their own training from the
pioneer of the CLTS. Some of these trainers are themselves employees of NGOs that already
implement CLTS, and have remained in the network of trainers that are providing training in CLTS
facilitation for new entrants. It does appear that with this level of interest among the NGO
community, there can be no better time for the government and the donor community to form the
necessary partnership with (local) NGOs to extend the programme to more rural communities in the
country.
IV) High Interest and Enthusiasm on the part of Communities: The selling point of CLTS is the
strong element of community ownership that characterises the process. Because facilitators only
blow the whistle on health hazards of open defecation, and let the community occupy the driving
seat in taking actions to end it, local people often feel that the initiative to build latrines is theirs and
therefore they usually work very hard to make the process succeed. For this reason, communities
are not only preoccupied by the task of building latrines, but they are also firm about taking actions
to stop open defecation in the community over the long term by instituting bye-laws, etc.
6.2 Challenges to Scaling-Up Several factors have to be addressed by government and other stakeholders as they move on with
expanding CLTS programmes in the country. Some of the key challenges are highlighted in Figure
6.2, which will be subsequently discussed in detail.
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Figure 6.2 - Challenges to Scaling-Up CLTS
I) Limited Consensus on Framework for Scaling-Up: It seems at this point that all partners have come to the conclusion of expanding CLTS, mainly in the direction of rolling out the programme to hundreds of other communities that have not been reached. There is some sort of agreement among partners to this end. However, it does appear that an agreement is yet to evolve on the scope and content of the proposed expansion. Many partners have pointed out that the scale-up phase of the programme should also incorporate additional activities for communities that have become open defecation free. For instance, some IPs have interpreted CLTS in a much broader context, to imply wholesome sanitation for the community. Hence, it goes beyond latrine construction, to encompass the provision of improved drinking water for communities that do not have one. They make the point that an ODF community will continue eating shit if it sourced drinking water from a stream that is already polluted with human faeces from upstream. Hence, there is a need for the MoHS, UNICEF and IPs to reach consensus on framework for scaling-up. An IP, such as GOAL has also maintained that developing a sanitation market needs to be at the heart of any CLTS scale up plan. GOAL is already implementing a pilot project in sanitation marketing in the Gorama Mende Chiefdom, Kenema District. It entails training and provides loans to members in ODF communities to produce and market affordable sanitation products, such as concrete slabs and soap. So far the programme has had some success, as some people are buying the products. On many occasions the product is taken for sale on market days and influential people have been involved in trading the products. However, the project has not escaped challenges. There have been instances of embezzlements and poor loan recovery, effectively causing delay in further production. While these and other challenges may exist, the need to develop affordable sanitation products that are durable clearly exist and this is going to determine the progress of communities up the sanitation ladder. However, many IPs are yet to explore this subject and perhaps bring it into the broader discussions on CLTS scaling-up. Another point that deserves attention is the area of follow up activities for ODF communities. From interviews with IPs, it was hard to gauge what arrangements they had put in place to support or
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guide ODF communities to make their way up the sanitation ladder. It may seem that agencies have done quite well in terms of guiding communities to build latrines, but less so in terms of facilitating the evolution of institutions and structures at community. Agencies have to appreciate that evidence of sustainability is in itself a key pillar for scaling-up. There have been indications that some communities have begun the first step backwards. Many plate racks have collapsed, yet, they have not been rebuilt. There was evidence to show that latrines had collapsed or at least not satisfactorily managed. Overall, communities are concerned that local materials are not durable, and this poses a significant threat to sustainability, let alone talk about maoving up to the next level in the ladder. II) Anticipated Programme Cost of Scaling-Up: Regardless of what direction the IPs wanted the scale-up to follow, they all acknowledged that it will be very expensive, perhaps more than the cost of pre-triggering, triggering and post-triggering combined together. If, for example, the focus is on improving water supply for communities that are exposed to unsafe drinking water sources, then the cost of drilling and completing water wells may run into several millions of Leones per well, which might exceed the cost of facilitating latrine construction itself. Similarly, the decision to spread into new geographical locations is also an expensive affair. Either way, the scaling-up of CLTS will be costly, which calls for IPs, the MOHS and other actors to figure out the most cost-effective way of designing and delivering the programme. At this stage, cost estimates obtained from HELP-Sierra Leone and MOVE-Sierra Leone indicate that pre-triggering requires at least two million Leones while Triggering up to attainment of ODF would require a minimum of three million Leones per community. III) Limited Support to CLTS Taskforce: The national and district CLTS task forces are at the forefront of the effort to spread the programme across the country. They play a vital role in coordinating the programme, including at district levels. This ensures that IP efforts are not duplicated in any community while preventing conflicts over struggle for operational communities among the IPs. However, they do need support to be able to fully carry out their functions and live up to the expectations of IPs and the other stakeholders. At district levels, the task force leadership (which is usually the DHMT) struggles to get hold of transport in order to visit and verify ODF status. This often leaves them dependent on IPs to convey them to sites. Similarly, the national task force coordinating offices also need essential office equipments and supplies - including computers and a database to keep comprehensive records of CLTS activities in the country. These are challenges that need to be addressed to ensure that the role of the task force will be much more effective as the programme goes to scale. IV) Some DMOs Less Enthusiastic about CLTS: The majority of the district medical officers do support CLTS and are playing an active role in the process. It was however reported that DMOs in some districts have hardly shown any interest in the programme while a few seem to act in ways that hindered implementation. The evaluation team did not have the opportunity to get the views of these DMOs. It is however likely though that they may be sceptical about the programme. It is up to the MOHS to encourage all DMOs to be active and fully supportive of CLTS. It is less likely that the programme will yield more positive results in districts where the DMO is not fully onboard. V) Challenges of Targeting Bigger Communities: So far, much of the CLTS programme has been targeted at small rural communities, although sometimes communities of other were also targeted. Many IPs raised the concern that as the programme is scaled up, they will inevitably have to target bigger communities. They are fully aware of the challenges that come with size. What they are less clear about is the degree of modification required to make to the programme design in order to succeed in fairly large villages and other peri-urban settlements that do not have inadequate sanitation facilities including latrines.
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VI) Ongoing Competition between IPs over Approach: Some IPs have continued to subsidise latrine construction, not because they necessarily want to set up a competitive environment with CLTS, but simply the fact that their own programmes were designed to provide financial subsidies. However, the two models are contradictory, and there is every chance that the subsidy approach does serve as a disincentive to communities that may be ordinarily inclined to build latrines at their own cost. This phenomenon is already playing itself out at Kailahun, where communities are not that enthusiastic about CLTS because they were aware of other agencies that provided subsidies to build latrines.
7. RECOMMENDATIONS
7.1 Recommendations to Improve Programme Implementation
1 IPs Need to Consider the Farming Calendar when Planning Triggering Activities. This evaluation has shown that rural communities are less willing to neglect farming activities (upon which their livelihood depend) for the sake of latrine construction. A couple of days off the farm may affect progress in crop production, especially if this coincides with busy periods involving clearing and ploughing. It would be more helpful for IPs to intensify triggering towards the end of the harvest period in November and the month of December and even January - when farmers have some slack as a result of a lull in farming activities. IPs would also want to do much of their triggering in the Dry Season to minimise the rains disrupting CLTS activities.
2 Mode of Community Organisation to Construct Latrines. This evaluation has discovered that
communities which dug latrines based on group work were more effective at completing latrines as compared to others that organised construction on individual basis. In the future, IPs should therefore encourage communities to facilitate the formation of household labour into groups to do the digging. This will surely expedite the process of digging and constructing.
3 There is a Need for the MoHS to Develop Policy and Guidelines for NGOs that work in the
sanitation sub-sector. CLTS and the subsidy-led approach to latrine construction conflict with each other. CLTS implementers strongly hold the view that any form of subsidy for latrine construction should be discontinued. Before coming to this conclusion, it might be helpful for the MoHS and other stakeholders to undertake a comparative study on the effectiveness of both approaches, so that whatever decision is reached, it will be informed by evidence.
4 Women and Children Need to Participate more in Triggering Meetings, so their views could
be adequately sought. Facilitators should for example move away from organising one triggering meeting for all key actors. It may also be more prudent for facilitators to schedule triggering meetings outside of school hours to make sure children are present at the meetings. It might be also helpful to coordinate activities of CLTS and school-led total sanitation in the future.
5 IPs Need to Expand the Design of the CLTS Programme, Taking into Account Community Lifestyle. People defecate in the bush at farm sites and some children continue to defecate in the community. It is therefore recommended for IPs to expand the design of the CLTS programme in the future, by encouraging communities to also build temporary latrines at farm sites.
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6 Every School with a Latrine should have Stools for Children that Cannot Use the Latrine
Latrines at school sites do not have stools, where children aged 5 years and below can defecate. Because school latrines are risky for young children, they often defecate in the bush and at the back of the school latrines.
7 There is a need for the National and District Sanitation Task Force to Develop Guidelines that will Govern the Selection Decisions of IPs. Without this, different agencies will use different models, some of which might have unintended short-run and long-term consequences on the outcome of the programme.
B) Recommendations to Enhance Sustainability
8 Natural Leaders are emerging as the most active persons that influence and monitor bye-
laws to maintain ODF status, and also of encouraging other community members to keep
the community clean and hygienic. Hence, IPs Need to Strengthen the Capacity of Natural
Leaders in Community Mobilisation and Sanitation Promotion Methodologies.
9 The Establishment of a Chiefdom Sanitation Forum will contribute to maintaining ODF
status and Helping Communities to Progress up the Sanitation Ladder. This body should
include Natural Leaders and chiefs of CLTS communities in the Chiefdom, where they will
meet once every three or six months to review ODF status and develop activities and
initiatives to take them to higher levels of the sanitation ladder. This forum can also help
facilitate networking among Natural Leaders to enhance sharing of experience and best
practices as well as the coordination of activities in the chiefdom. It is also feasible for this
forum to take on a follow up and monitoring role in the post-ODF period in the district.
10 The forum will need facilitation from the district task forces, especially at inception and
possibly a couple of years into their formation. It will be important for the task force to
involve Local Council administration (who will over time assume the responsibility of
providing oversight and facilitation to the forum).
11 IPs should Strengthen the Capacity of Local Structures to Monitor the ODF Status of
Communities at Post-ODF Periods. This is going to be important in uncovering opportunities
and threats to ODF sustainability, which they can feed into the design of future CLTS
programmes.
C. Recommendations for Scaling-Up CLTS
12 As IPs and other key actors consider scaling up CLTS, there is a Need to Review the Role of
DHMTs as CLTS Implementers. As CLTS spreads out to cover more communities in the
country, programme monitoring and coordination will be critical to success. It seems that
DHMTs are best positioned to take on this role in their capacity as leaderss of the various
district task forces. The course of CLTS will be better served if the emphasis on the future
role of DHMTs is shifted from implementation to that of monitoring and coordination.
13 The Role of Local Councils also Needs to Emerge and be Obvious at the Scale-Up Phase.
Important sanitation functions are devolved to local government under the decentralisation
act of 2002. Councils should be encouraged to be actively involved in task force activities.
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14 IPs would need to consider developing a sanitation market and products that are affordable
to communities as a way of supporting them to climb up the sanitation ladder.
15 Convergence with WASH Programme (as a WASH package at institutional level) and WASH in
Schools Programme.
16 The issue of water scarcity in many ODF communities remains a serious concern, especially
when considering that people in ODF communities who rely on open sources may continue
drinking water polluted with human faecal materials. Hence, it is proposed that a water
supply programme be considered in the scale-up phase.
17 IPs and the donor community are encouraged to support more pilot initiatives towards the
promotion of a sanitation market in the country. Development of this market is critical to
provide the environment that will make it less difficult for communities to climb up the
sanitation ladder.
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Recent Figures for Water and Sanitation in Sierra Leone
National WATSAN policy is soon to be launched
Community-Led Total sanitation implemented in2108 villages;790 have been declared Open Defecation Free (ODF)
Open defecation is practiced by 36 % of the rural population(JMP 2010)
Access to safe water sources ranges, 84% urban areas, and 32% rural areas (DHS, 2008)
Improved sanitation facilities only used by 13% of the population (DHS, 2008), with 6% and 26% coverage in rural and urban areas respectively.
Access to water for the poorest is 11% compared to 91% for the richest. (2009 PRSP- Sierra Leone)
Access to sanitation is 1% versus 79% for the poorest and richest respectively. (2009 PRSP- Sierra Leone)
One of the main (of the top three) causes of under-five deaths is diarrhoea at 20%
Under-five mortality rates has not significantly decreased, 262 (1990 was 290); only went down 10%, which is alarming
58% of children’s faeces in disposed of safely
Key Facts about Diarrhoea 5,000 children die every day due to
infectious diarrhea, which is caused primarily by inadequate sanitation.
17% of under-five deaths are attributable to diarrheal disease, making it the second largest killer of children, after pneumonia.
Recent research suggests that poor sanitation and hygiene are either the chief or underlying cause in over half of the annual 10 million child deaths.
(IYS Factsheet 1, Sanitation is vital for health, 2008)
….in Sierra Leone: Diarrhea disease prevalence 18.1% (6-11
years), 7.8% (<6 yrs) (DHS 2008) Child health: 31% children <5 with diarrhea
receiving ORT or increased fluids, with continued feeding (MICS 2005)
TERMS OF REFERENCE FOR PROPOSAL ON THE EVALUATION OF COMMUNITY LED TOTAL SANITATION IN SIERRA LEONE
UNICEF AND MINISTRY OF HEALTH & SANITATION, SIERRA LEONE
AUGUST 2010
1.0 Background
1.1 Health, Sanitation and Hygiene
Lack of access to sanitation and water and unsafe hygiene practices and behaviour has been shown to have a significant effect on health; this contributes 6.3% to all global deaths. It is estimated that 88% of all diarrhoeal deaths are related to unsafe water, sanitation and hygiene. Sierra Leone still has high infant and under five mortality and morbidity ratios; diarrhoea which is linked to WASH is amongst the top three killer diseases of under five children in Sierra Leone. At current rates of progress, Sierra Leone is not on target to meet the MDG sanitation targets. Furthermore, even if the targets were to be met, 2.1 million (33%) of Sierra Leoneans will still be without access to improved sanitation. In addition, there are wide discrepancies between access to sanitation in rural and urban areas. National coverage for water and sanitation are 51% and 13% respectively. As progress towards the MDG sanitation target is monitored, the importance of ensuring that those served with sanitation facilities do not slip back into the unserved segment of the population cannot be overemphasized.
Unsafe hygiene practices including lack of hand washing with soap at critical times contribute heavily to the diseases burden of diarrhoea and pneumonia. Increased access to sanitation and adoption of key hygiene behaviour practices can make significant improvement in health indicators. UNICEF Sierra Leone as part of its contribution to the reduction of maternal and under five mortality and morbidity
has a Child Survival and Development Programme; the programme has a Water, Sanitation and Hygiene component. 1.2 CLTS Background
There is little evidence of sanitation programmes that have successfully delivered sustainable improvements at a scale required to achieve national targets that are in line with the MDG sanitation target(1). The UNICEF WASH Project in 2008 formally initiated the Community Led Total Sanitation (CLTS) approach to sanitation in Sierra Leone. In late 2007, UNICEF undertook sensitisation of key WASH stakeholders on CLTS through informal means as wells during workshops and meetings. At the start of 2008, UNICEF supported a visit by Kamal Kar, a global pioneer of CLTS, to Sierra Leone. Outputs of the visit to Sierra Leone included the development of district plans for CLTS, training of 80 key government and NGO staff and orientation of decision makers on the CLTS approach. CLTS contributes to the Intermediate Result 1.3.2 of the UNICEF WASH Project.
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CLTS is a community empowerment approach to the construction and use of latrines by the community themselves by relying on local resources and without any subsidy for construction; it is stimulated by facilitators from within or outside the community. The immediate objective of the CLTS approach is to trigger communities to stop the practice of open defecation. The focus is on behaviour change as opposed to targeting latrines construction alone. This includes sustained latrine use as well as other key behaviour practices such as hand washing with soap at critical times. The process of CLTS is collective and builds social cohesion within the community, thus creating the enabling environment for other community based interventions. 1.3 Current CLTS Strategy in Sierra Leone
The CLTS Programme is designed to be implemented in three phases, namely inception, development and scale up phases. The project is now in the development, transitioning to the scale up phase. Inception Phase The purpose of this phase of the programme are as follows:
To advocate with the government and other WASH stakeholders to adopt CLTS as one of the sanitation strategies
To provide an initial group of strategically placed WASH practitioners who can contribute to/initiate the start up of CLTS implementation
Development Phase The purpose of this phase of the programme are as follows:
To create an enabling policy, social and political environment for CLTS implementation
To provide the social structure and human resource base for the horizontal spread of CLTS
To provide ongoing advocacy for the CLTS approach in Sierra Leone
To inform/adapt the CLTS approach through the project cycle activities of implementation and evaluation
Scale Up Phase The purpose of this phase of the programme is as follows:
To ensure CLTS adoption and spread through local structures 1.4 CLTS Progress to date
Since the inception of CLTS in Sierra Leone in 2008, 2108 villages have been triggered and 790 verified Open defecation Free (ODF). UNICEF has through Project Cooperation Agreements (PCAs) with various local and international NGOs supported the implementation of CLTS in six districts of Sierra Leone. Financial and capacity building support has also been provided to the Environmental Health Division of the Ministry of Health and Sanitation for CLTS development and implementation. Key CLTS activities to date include;
Training of – NGO workers as CLTS facilitators
Training of – volunteers and community based workers as CLTS facilitators
Formation of a National CLTS Task Force
Learning trips by CLTS National Task Force
Formation of CLTS District task Forces
Development of harmonised tools for monitoring and implementation of CLTS
The CLTS approach to increasing access to sanitation is linked to national as well as development partner’s agendas.
Sierra Leone 2008 – 2012 PRSP Prioritizes scale up of CLTS
The National CLTS Task Force comprises over twenty five NGOs as well as the Ministry of Health and Sanitation
UNICEF Global WASH Sanitation Strategy which is the Community Approaches to Total Sanitation (CATS) includes CLTS as one of the sanitation strategies
2.0 Purpose and Rationale
The main purpose of the consultancy is to provide a national evaluation of CLTS in Sierra Leone. Specifically, the study objectives are:
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1. To evaluate CLTS with respect to its sustainability , relevance, effectiveness and impact in Sierra
Leone, including the assessment of equity issues
2. Contribute to the scale up of CLTS nationally by identifying opportunities and constraints for the scale
up process
CLTS is wide spread in Sierra Leone at this stage; regionally Sierra Leone is also at the fore front of CLTS implementation. It is thus necessary to evaluate the approach at this stage to document the process to date and lessons learnt and to provide an independent opinion on CLTS and recommend opportunities and options for scale up. Although the study will be participatory through consultations with all stakeholders, it is intended that the study be unbiased and present an independent report to UNICEF and stakeholders. The study will also complement the proposed Sanitation Marketing Study funded by UNICEF. Scope: The study will be carried out in all districts of Sierra Leone plus the Western Area. It is envisaged that the evaluation will cover the following levels and will include but not be limited to the following questions/issues;
National
- How do national policies impact the implementation of CLTS
- How effective has the national coordination of CLTS been to date
- What has been the contribution of CLTS to increasing improved sanitation coverage with respect to
the MDGs
- What are the recommendation for further action, research and support for CLTS scale up
- How to ensure that CLTS is further institutionalised within the relevant government structures
- What has been the contribution of CLTS with regard to ownership, policy and budgeting for
sanitation
- Mapping of the cost of CLTS by district/regions and total cost of going to scale
- Assess and obtain comparison of the effectiveness and efficiency of CLTS across the districts and
regions
- Quantify the extent of CLTS in terms of number of communities triggered, achievement of ODF,
household and population
Implementation and District level
- Document the various approaches/innovation used by agencies implementing CLTS
- Availability and quality of facilitation at institutional level
- Availability and quality of natural leaders for CLTS spread and scale
- How much contribution have natural leaders made to the achievement of ODF;how many
communities have they triggered on their own
- How to best utilise existing community human resources (especially natural leaders) as well as local
government structures and traditional leadership to spread CLTS
- How sustainable is CLTS
- How far has human rights and gender been given adequate consideration in the implementation of
CLTS
- How appropriate and useful are the existing CLTS tools and what is their level of social acceptance.
Are there recommendations for further tool development
- What are the strengths and weakness encountered during implementation of CLTS
- What is the cost of CLTS by implementing institutions
- What factors or means of communication can contribute to the spread of CLTS implementation
-
Monitoring and Evaluation
- How effective has the monitoring of CLTS been
- Recommendations for participatory monitoring to include communities themselves
3.0 Terms of Reference
Under the guidance of the WES Manager and in consultation with the Ministry of Health and Sanitation, District Councils, Ministry of Energy and Water Resources and the National CLTS task Force, the selected institution will undertake the following major tasks;
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Task 1 Prepare inception report and presentation
An inception report with oral presentation to UNICEF team comprising of WASH, M&E, Programme
Communication and ERA resource group on the following:
Research objectives
Justification of the proposed methodology
Research/Data collection tools
Sampling strategy
Key implementation challenges and risks
Additional program design considerations
Detailed Implementation work plan and time table
The inception report will also propose appropriate research tools/ questionnaires to elicit qualitative and quantitative data on CLTS process, relevance, sustainability, effectiveness and impact. The tools will include but not limited to focus group discussions, semi structured observations, discussions with stakeholders. Task 2
To initially pre test and subsequently undertake necessary field visits to administer finalised research
and data collection tools
Scope of Work and Methodology Data will be collected on a national sample basis. This will enhance the completeness of the study in that CLTS communities that are not directly funded by UNICEF are also evaluated. The consultant will identify a suitable sampling scheme, to be approved by UNICEF or its designated agent. Task 3
To analyse the data and prepare a draft report
Scope of Work The consultant will analyse the data and use the findings to prepare a draft report. The report must provide sufficient information to contribute to the scaling up process of CLTS by UNICEF and the Government of Sierra Leone as itemised in Task 4 below. It is expected that consultations will also be held with stakeholders during the writing of the report. Task 4
To facilitate validation of the draft report and subsequently provide a final report Scope of Work The consultant will validate the findings in the draft report by facilitating stakeholders Validation Workshop; the recommendations of the validation will feed the final report. The final report must contain the following:
Executive summary—including activities reviewed; methodology/tools used; major sources of data and information; summary of major findings, and lessons learned; and recommendations; and any limitations or constraints to the research. Note: This section needs to 'capture' the reader and provide all the key information. Keep as brief as possible (to around 2-3 single A4 pages) and free of as much technical terms or jargon as possible
Introduction—origin and rationale of the research; rationale, purpose and objectives, strategies and significance of project review; review team composition and competencies
Research Methodology, approach and design—methodology; context (purpose, partners, visited sites, and duration); key criteria for research; data collection sources, methods and tools, and analysis parameters and tools.
Analysis and Findings/Lessons Learned—provide an analysis/interpretation of the findings relevant to the key objectives; analysis of data collected; and specify gaps identified that could be addressed. Use graphs, tables, diagrams etc. to aid understanding and interpretation...
Conclusions and Recommendations, conclusions—should be linked with the findings; specific prioritized recommendations for possible interventions (with cost estimate, if possible), and identify short-term and long-term milestones relevant to the research objectives.
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References: detailed list of primary and secondary sources of information; key contact information
Appendices and/or Annexes—list of documents reviewed; persons interviewed (including case studies if possible); sites visited; the general discussion format(s) for various tools used to collect data, i.e. focus group discussions, interviews, and meetings, etc.; implementation schedule and plan of activities; terms of reference and budget; and list of abbreviations used should also be attached to the report.
In addition, the final report will include:
Cleaned and fully referenced electronic data sets in an agreed format with copies of the original data
collection forms;
Full transcripts of all in-depth interviews and focus group discussions in an electronic format;
Task 5
To develop and pre-test standardised tools for baseline data collection on health, latrines availability and
use, for CLTS operational areas
Scope of Work and Methodology
The selected institution will develop and pre-test baseline tools for use by all CLTS stakeholders or implementing agencies. Data collection will be obtained through standard data collection tools; health data will be collected through the Peripheral Health Units. This task will run concurrently with other tasks. This part of the study will take into account the ongoing UNICEF funded study on Public Private Partnership for Hand washing With Soap 4. 0 Deliverables
Deliverable Time Frame (weeks) Payment (% of total)
Inception Report 2 30
Finalised Data Collection tools 2
Data collection forms completed 4 30
Draft Report 2
Validation Workshop 0.5 30
Final Report 1.5 10
5.0 Responsibilities of the Consultant
The selected institution will be responsible for the following:
Set up and manage the study;
Pre-test of survey instruments before the final field work
Logistics arrangements and expenses i.e. travel, accommodation, allowances, communications, and
stationery;
Training field surveyors
Assurance of quality of field work/data collection and data entry;
Detailed analysis of results
It is the responsibility of the institution to recruit, train and supervise a suitable team of field workers. UNICEF
may choose to provide technical support to the agency at key stages of the assignment which may include:
the appraisal of technical submissions; review of proposed detailed study designs and guidance from prior
experience; assistance with the training of field workers during piloting of instruments, fine tuning and
finalizing of proposal; monitoring of the quality control system to evaluate progress and refocus if necessary;
review of first draft report and recommendations for production of the final report.
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Qualitative interviews should be recorded on tape, translated, and transcribed; carefully labelled and indexed with
date, time, and respondent details; and returned to the client for safekeeping.
6.0 Responsibilities of UNICEF
The UNICEF WES Manager will be the primary focal point to review and evaluate the consultant’s performance. UNICEF may provide assistance (in the form of introduction) to facilitate access to sanitation stakeholders that the selected institution requires to meet. UNICEF reserves the right to reject any member of the proposed evaluation study team 7.0 Reporting and Supervision
The selected institution will work under the direct supervision of the WES Manager. Monthly progress meetings, (documented by the selected firm) will be held between the firm and the UNICEF WES Manager Other partners may be invited by mutual consent between UNICEF and the selected firm. In addition, the selected institution is encouraged to keep in close weekly contact with the WES Manager. 8.0 Qualification and Selection of Institution
The selected institution will have proven professional experience in the evaluation of rural Public Health and/or
Water and Sanitation projects, particularly in the West Africa region.
The proposed team must be multi functional (with social scientists, engineers) to ensure that all aspects of the
study are executed in the most professional manner. The submitted technical and financial proposal must include
curriculum vitae of all proposed team members, their roles in the study and time to be spent on the project.
Furthermore, any stand by staff is also to be included.
UNICEF requests that special attention be given to: 1) the development of a detailed work plan including quick
mobilization of field staff, 2) a system for the management and quality assurance of the study, 3) complete CVs of
the proposed staffing.
9.0 Selection Criteria
The proposal will be evaluated against the following criteria:
Experience in undertaking similar work: Previous experience in similar studies, particularly in the
West Africa sub region will form an important evaluation criterion
Relevant experience in Sierra Leone/ West Africa
Meeting the scope of work and proposed time schedule: Your proposal should include information
specific to accomplishing the scope of work and the specified tasks. Any accompanying information, such as examples of protocols should be included in the technical portion of the response. The proposal may also include any qualifications to the tender
Quality, clarity and thoroughness of proposed Methodology/ Study design:
A clear understanding of the evaluation study requirements is essential and bidders will be assessed
against their understanding of the study requirements
Cost competitiveness: Bidders should note that cost competitiveness is an important evaluation
criteria used to select candidates and should offer their most competitive proposal.
Bidders shall provide itemized costs for the total scope of this project, based on the scope of work presented above. The final scope of work may be subject to negotiation; however, awards will be made against the original scope of work. Bids should include itemized costs for key elements of the scope of work, as follows:
1. Estimated total level of effort and associated costs, including data collection costs
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2. Itemization of all other costs, including agency costs, agency fees, service tax, administrative costs, supplies, etc.
3. Rates of key staff. 4. Percent participation in total level of effort according to key staff. 5. Estimated schedule of other anticipated expenses (travel, sub-contracted resources, supplies,
outside resources, etc.). REFERENCES -Available on request