Community-Led Total Sanitation (CLTS) in Cambodia

Draft Final Evaluation Report

Dr. Sok Kunthy and Rafael Norberto F. Catalla

January 2009

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Table of Contents Executive Summary 1 1 Introduction 9

1.1 Background of the Evaluation 9 1.2 Objectives of the Evaluation 9 1.3 Evaluation Methodology 10

1.3.1 Literature Review 10 1.3.2 Survey Tools 10 1.3.3 Sample Selection 11

2 The CLTS Approach and the TSRWSSP Project in Cambodia 14 2.1 Over-view of CLTS 14

2.1.1 Scope and coverage 14 2.1.2 Inception of CLTS in Cambodia 14 2.1.3 Implementation Approach 15

2.2 Overview of the TSRWSSP 20 3 Findings of Children and Household Surveys 22

3.1 Children Survey 22 3.1.1 Profile of Children Respondents 22 3.1.2 Sanitation and Hygiene Knowledge 22 3.1.3 Sanitation and Hygiene Practices and Perceptions 24

3.2 Household Survey 30 3.2.1 Respondents Profile 30 3.2.2 Land (Agricultural and Residential) and House Characteristics 30 3.2.3 Income and expenses 33 3.2.4 Current defecation practice at home 35 3.2.5 Household with Latrines 36 3.2.6 No Latrines/ open defecation practicing households 64 3.2.7 Comparison of Poor and Ordinary Households 75

4 Evaluation Findings 78 4.1 Relevance/ Importance of Latrines 78 4.2 Access 80 4.3 Equity 80 4.4 Effectiveness 81

4.4.1 In promoting community participation 81 4.4.2 In contributing to improved access to rural sanitation 82 4.4.3 Cost-Effectiveness 86

4.5 Sustainability 86 4.6 Experiences of the CLTS Approach of MRD 87

4.6.1 Achievements 87 4.6.2 Barriers and Opportunities for Strengthening and Scaling-up 89

4.7 Differences between CLTS and TSRWSSP 92 5 Conclusions and Recommendations 96

5.1 Conclusions 96 5.2 Recommendations 97

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Acronyms ADB Asian Development Bank ADRA Adventist Development and Relief Agency AR Awareness-raising AusAid Australian Assistance for International Development CDB Commune Data-base CDHS Cambodia Demographic and Health Survey CEDAC Cambodian Center for Study and Development in Agriculture CHHRA Cambodia Health and Human Rights Alliance CFP Commune focal persons CLTS Community Led Total Sanitation CRC Cambodian Red Cross DFID Department for International Development DoRD District Office of Rural Development DRHC Department of Rural Health Care DSA Daily Subsistence Allowance ExCom Executive Committee (of Provincial Rural Development Committee) FGD Focus group discussion HH Household INGOs International non-government organizations MOP Ministry of Planning MRD Ministry of Rural Development n Number of respondent NGOs Non-government organizations OV Other Villages Non-ODF Non- Open Defecation Free OD Open Defecation ODF Open Defecation Free PDRD Provincial Departments of Rural Development PHAST Participatory Hygiene and Sanitation Transformation PIU Project Implementation Units PMU Project Management Unit PVA Participatory Village Assessment RGC Royal Government of Cambodia RHAC Reproductive Health Association of Cambodia SPSS Statistical Program for Social Sciences SRC Swiss Red Cross S&H Sanitation and hygiene TSRWSSP/ TS Tonle Sap Rural Water Supply and Sanitation Project UNICEF United Nations Children’s Fund VFPs Village focal persons VIP Ventilated improved pit latrines WASH Water, Sanitation and Hygiene WFP World Food Program WSS Water Supply and Sanitation WSUGs Water and Sanitation User Groups ZOA ZOA Refugee Care Organization

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List of Tables Table 1 Number of Parent Respondents by Province and by Types of Village .......................................... 13 Table 2. Number of Children Respondents by Province and by Types of Village ...................................... 13 Table 3. Coverage of CLTS in Cambodia ................................................................................................... 14 Table 4. Current Achievement under Sanitation Component ...................................................................... 21 Table 5. Over-all Achievements in Well and Latrine Construction .............................................................. 21 Table 6. Costs of Latrines/ Latrines ............................................................................................................. 21 Table 7. Age of respondent ......................................................................................................................... 22 Table 8. Gender ........................................................................................................................................... 22 Table 9. Educational Attainment .................................................................................................................. 22 Table 10. Literacy ........................................................................................................................................ 22 Table 11. Present Schooling Status ............................................................................................................ 22 Table 12. Whether S&H practices are taught in school............................................................................... 22 Table 13. S&H practices taught in school .................................................................................................. 23 Table 14. Whether S&H practices are taught by parents ............................................................................ 23 Table 15. S&H practices taught by parents ................................................................................................ 23 Table 16. Whether siblings or friends are informed of S&H practices learned ........................................... 24 Table 17. Hand-washing practice ................................................................................................................ 24 Table 18. Time of hand-washing ................................................................................................................. 24 Table 19. Frequency of Hand-washing ....................................................................................................... 25 Table 20. When soap is used in hand-washing ........................................................................................... 25 Table 21. Cleansing material used in hand-washing................................................................................... 25 Table 22. Practice of hand-wiping/ drying ................................................................................................... 25 Table 23. Material used in hand-wiping/ drying ........................................................................................... 25 Table 24. Defecation practice at field/ chamkar .......................................................................................... 26 Table 25. Defecation practice in public areas ............................................................................................. 26 Table 26. Defecation practice at home ........................................................................................................ 26 Table 27. Cleansing materials after defecation ........................................................................................... 26 Table 28. Disposal of infants’ faeces ........................................................................................................... 27 Table 29. Whether OD is still practiced in field/ chamkar ............................................................................ 27 Table 30. Reasons for OD at field/ chamkar ............................................................................................... 27 Table 31. Frequency of latrine cleaning ...................................................................................................... 27 Table 32. Participation in latrine cleaning .................................................................................................... 28 Table 33. Tasks in latrine cleaning .............................................................................................................. 28 Table 34. Common illnesses in the last 3 months ....................................................................................... 28 Table 35. Knowledge of diarrhea prevention ............................................................................................... 28 Table 36. Practices to prevent diarrhea ...................................................................................................... 28 Table 37. Gender of Respondents .............................................................................................................. 30 Table 38. Educational Attainment................................................................................................................ 30 Table 39. Agricultural land ownership ......................................................................................................... 30 Table 40. Size of owned agricultural land in last 12 months ....................................................................... 30 Table 41. Residential land ownership ......................................................................................................... 30 Table 42. Sized of owned residential land ................................................................................................... 31 Table 43. Proof of residential land ownership ............................................................................................. 31 Table 44. Type of residential land ownership proof..................................................................................... 31 Table 45. Flooding in the last 12 months .................................................................................................... 31 Table 46. House ownership ......................................................................................................................... 31 Table 47. Construction materials of house walls ......................................................................................... 32 Table 48. Construction materials of roofs .................................................................................................... 32 Table 49. Source of cash income in last 12 months.................................................................................... 33 Table 50. Percent of respondents who could estimate incomes ................................................................. 34 Table 51. Estimated Incomes ...................................................................................................................... 34 Table 52. Current defecation practices of all Respondents ........................................................................ 35 Table 53. Types of HH latrine ...................................................................................................................... 36 Table 54. Types of latrine slabs ................................................................................................................... 36 Table 55. Types of latrine walls ................................................................................................................... 36 Table 56. Types of latrine roofs ................................................................................................................... 37 Table 57. Location and distance of latrines from water sources ................................................................. 37 Table 58. Presence of washing areas ......................................................................................................... 37

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Table 59. Washing facilities at latrines ........................................................................................................ 37 Table 60. Whether latrine is the first one built ............................................................................................. 38 Table 61. Number of latrines built before the current latrine ....................................................................... 38 Table 62. Types of latrines built before the current latrine .......................................................................... 38 Table 63. Sources of latrine materials by part ............................................................................................. 39 Table 64. Estimated cost of materials of latrines ......................................................................................... 40 Table 65. Source of money to purchase latrine parts.................................................................................. 40 Table 66. Sources of hand-washing water in the dry season ..................................................................... 41 Table 67. Sources of hand-washing water in the wet season ..................................................................... 41 Table 68. Dry-season source of drinking water ........................................................................................... 41 Table 69. Wet-season sources of drinking water ........................................................................................ 41 Table 70. Common illnesses reported ......................................................................................................... 42 Table 71. Knowledge on diarrhea prevention .............................................................................................. 42 Table 72. Reported ways to prevent diarrhea ............................................................................................. 42 Table 73. Perceived advantages of owning latrine...................................................................................... 43 Table 74. Perceived disadvantage of owning latrine ................................................................................... 43 Table 75. Defecation practices at home ...................................................................................................... 44 Table 76. Defecation practices at field/ chamkar ........................................................................................ 45 Table 77. Defecation practices in public places .......................................................................................... 45 Table 78. Defecation practices of children at home .................................................................................... 45 Table 79. Defecation practices of children at field/chamkar ........................................................................ 46 Table 80. Defecation practices of children in public places ........................................................................ 46 Table 81. Disposal of infants’ faeces ........................................................................................................... 46 Table 82. Cleansing materials used after defecation .................................................................................. 46 Table 83. Frequency of hand-washing ........................................................................................................ 47 Table 84. Instances of hand-washing .......................................................................................................... 47 Table 85. Materials used in hand-washing .................................................................................................. 48 Table 86. Reasons for hand-washing .......................................................................................................... 48 Table 87. Frequency of latrine cleaning ...................................................................................................... 49 Table 88. HH members who clean latrine ................................................................................................... 49 Table 89. Maintenance activity when latrine is full ...................................................................................... 49 Table 90. Maintenance activity when latrine is broken ................................................................................ 50 Table 91. Maintenance activity when latrine is old ...................................................................................... 50 Table 92. Whether repair is done by HH head/ respondent ........................................................................ 50 Table 93. Participation of HH members in latrine repair.............................................................................. 50 Table 94. S&H monitoring entities in villages .............................................................................................. 51 Table 95. Perceptions on changes in S&H situation ................................................................................... 51 Table 96. Reasons for perceived changes in S&H situation ....................................................................... 51 Table 97. Whether HH members have participated in first sanitation meeting ........................................... 52 Table 98. Participation of HH members in following sanitation meetings ................................................... 52 Table 99. Recollection of number of times joined in sanitation meetings ................................................... 52 Table 100. Number of times joined in sanitation meetings ......................................................................... 52 Table 101. How HH participated in sanitation meetings.............................................................................. 53 Table 102. Lessons learned from sanitation meetings ................................................................................ 53 Table 103. Whether HH visited by CLTS facilitators/ TS implementers ...................................................... 54 Table 104. Purpose of visits in CLTS villages (multiple responses) ........................................................... 55 Table 105. Purpose of visits in TS villages (multiple responses) ................................................................ 55 Table 106. Whether HH has been visited by village volunteer/ focal point ................................................. 55 Table 107. Reported tasks of village focal points (CLTS) ........................................................................... 55 Table 108. Reported tasks of village volunteers (TS) ................................................................................. 56 Table 109. Frequency of interaction with focal points ................................................................................. 57 Table 110. Reported discussion topics in interactions with focal points ..................................................... 57 Table 111. Presence of IEC materials in villages ........................................................................................ 57 Table 112. Participation of other groups in villages (multiple responses) ................................................... 58 Table 113. Whether poor were specifically targeted/ prioritized ................................................................. 58 Table 114. Whether ODF celebrations were held in villages ...................................................................... 58 Table 115. Groups/ individuals who participated in ODF celebrations ........................................................ 58 Table 116. How people/ organizations participated in ODF celebrations ................................................... 59 Table 117. Satisfaction with latrines ............................................................................................................ 59 Table 118. Reasons for dissatisfaction with latrines ................................................................................... 59

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Table 119. Satisfaction with CLTS/ sanitation project ................................................................................. 60 Table 120. Reasons for dissatisfaction with CLTS/ sanitation project ........................................................ 60 Table 121. Perceptions on what should be done to further improve S&H situation .................................... 60 Table 122. Perception on the most important activity to improve S&H ....................................................... 61 Table 123. Presence of other sanitation projects in villages ....................................................................... 61 Table 124. Reported other S&H projects in villages .................................................................................... 62 Table 125. Reasons for OD practice ........................................................................................................... 64 Table 126. Ranking of reasons for OD practice .......................................................................................... 64 Table 127. Possible ways to change OD practice ....................................................................................... 65 Table 128. Dry and wet season hand-washing water sources .................................................................... 66 Table 129. Dry and wet season drinking water source ............................................................................... 66 Table 130. Common illnesses HHs members experienced in last three months ........................................ 67 Table 131. Whether respondent knows how to prevent diarrhea ................................................................ 67 Table 132. Reported ways to prevent diarrhea (multiple responses) .......................................................... 68 Table 133. Defecation practice at home ...................................................................................................... 69 Table 134. Defecation practice in field/ chamkar ........................................................................................ 69 Table 135. Defecation practice in public place ............................................................................................ 70 Table 136. Defecation practice of children at field/ chamkar ...................................................................... 70 Table 137. Defecation practice of children in public places ........................................................................ 70 Table 138. Disposal of infants’ faeces ......................................................................................................... 70 Table 139. Cleansing materials used after defecation ................................................................................ 70 Table 140. Hand-washing habit of households ........................................................................................... 71 Table 141. Frequency of hand-washing ...................................................................................................... 71 Table 142. When hand-washing is done ..................................................................................................... 72 Table 143. Cleansing materials used in hand-washing ............................................................................... 72 Table 144. Reasons for hand-washing ........................................................................................................ 72 Table 145. Other S&H programmes in villages ........................................................................................... 73 Table 146. Reported names of organizations ............................................................................................. 73 Table 147. Types of other S&H programmes .............................................................................................. 73 Table 148. Activities of S&H programmes ................................................................................................... 73 Table 149. Perception on S&H improvements from programmes ............................................................... 74 Table 150. Reasons for S&H improvements ............................................................................................... 74 Table 151. Advantages of owning latrines .................................................................................................. 74 Table 152. Disadvantages of owning latrines .............................................................................................. 75 Table 153. Comparison between poor and ordinary households ................................................................ 76 Table 154. Reasons for OD practice in Other Villages................................................................................ 78 Table 155. Ranking of reasons for OD practice in Other Villages ............................................................... 78 Table 156. Possible ways to change OD practice ....................................................................................... 79 Table 157. Other S&H programmes in villages ........................................................................................... 79 Table 158. Types of other S&H programmes .............................................................................................. 79 Table 159. Advantages of owning latrines .................................................................................................. 79 Table 160. Disadvantages of owning latrines .............................................................................................. 79 Table 161. Access to Sanitation Facilities in Selected Target Villages ....................................................... 88 List of Figures Figure 1. Number of Survey Villages and Selection Process ...................................................................... 12 Figure 2. Institutional Structure of CLTS Approach under MRD ................................................................. 17 Figure 3. Flooding months of the year ......................................................................................................... 31 Figure 4. Household Assets ........................................................................................................................ 32 Figure 5. Agricultural/ Farming assets ......................................................................................................... 33 Figure 6. Sources of Income ....................................................................................................................... 33 Figure 7. Income by month .......................................................................................................................... 34 Figure 8. Ranking of Expenses .................................................................................................................. 34 Figure 9. Current defecation practices of all Respondents/ Households .................................................... 35 Figure 10. Mean costs of latrines by part and total cost (USD) ................................................................... 40 Figure 11. Defecation practices at home ..................................................................................................... 44 Figure 12. Defecation practices at field/ chamkar ....................................................................................... 45 Figure 13. Defecation practices when in public places ............................................................................... 45

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Figure 14. Frequency of hand-washing ....................................................................................................... 47 Figure 15. Instances when hand-washing is practiced ............................................................................... 47 Figure 16. Cleansing materials used in hand-washing................................................................................ 48 Figure 17. Reasons for hand-washing ........................................................................................................ 48 Figure 18. Reported S&H monitoring entities in villages ............................................................................. 51 Figure 19. Number of times attended community meetings ........................................................................ 53 Figure 20. Lessons learned from community meetings............................................................................... 54 Figure 21. Level of reported visits of Project Implementers/ Focal persons ............................................... 54 Figure 22. Frequency of interaction with village focal points (CLTS). ......................................................... 56 Figure 23. Frequency of interaction with village volunteers (TS) ................................................................ 56 Figure 24. Groups/ individuals who participated in meetings ...................................................................... 58 Figure 25. Satisfaction with latrines among HH .......................................................................................... 59 Figure 26. Perceptions on further improvement of sanitation situation ....................................................... 60 Figure 27. Most important activities to improve sanitation condition ........................................................... 61 Figure 28. Reasons for OD .......................................................................................................................... 65 Figure 29. Possible ways to change OD practice ........................................................................................ 65 Figure 30. Reported ways to prevent diarrhea ............................................................................................ 68 Figure 31. Defecation practice when at home ............................................................................................. 69 Figure 32. Defecation practices when in field/ chamkar .............................................................................. 69 Figure 33. Defecation practices when in public places ............................................................................... 70 Figure 34. Frequency of hand-washing ....................................................................................................... 71 Figure 35. Instances when hand-washing is done ...................................................................................... 72 Figure 36. Advantages of having a latrine .................................................................................................. 74 Figure 37. Disadvantages of having a latrine ............................................................................................. 75 Figure 38. Defecation Practices in Other Villages ....................................................................................... 78 Figure 39. Coverage in ODF Villages .......................................................................................................... 88 Figure 40. Coverage in non-ODF villages ................................................................................................... 89 Figure 41. Defecation Practices in CLTS and TSRWSSP villages ............................................................. 94 Figure 42. Drinking water and hand-washing practices in CLTS and TS villages ...................................... 94 Figure 43. Defecation practices among Hh without latrines in CLTS and TS villages ................................ 94

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Executive Summary Among the key constraints identified through the rural water and sanitation sector review in 2006

1 is the

lack of a strategic approach to sanitation and hygiene improvement. Subsidized sanitation approaches that have been adopted by most sanitation projects have not contributed meaningfully to improving the consistently low coverage of rural sanitation. CLTS (Community Led Total Sanitation) is a new approach to achieving better sanitation which fosters innovation and commitment within the community and motivates people to build their own sanitation infrastructure, without depending on hardware subsidies from external agencies. CLTS has been identified as one potential approach to accelerating rural sanitation improvement in Cambodia

2. However, since then no further study has been conducted to

assess the effectiveness of CLTS and subsidized sanitation approaches. A comparative study of the two approaches is therefore required with the results the formative evaluation contributing towards development of the National Strategy on Rural Sanitation and Hygiene Improvement. There were two main evaluation objectives - review the current experiences of the CLTS approach in terms of achievements; barriers; and opportunities for further strengthening and scaling-up and comparison the performance of the CLTS approach with that of subsidized sanitation approaches in terms of sustainability, equity and access, effectiveness, and efficiency/ cost-effectiveness of CLTS. The evaluation methodology comprised of literature review, interview surveys, FGDs, and observations in CLTS and TSRWSSP (TS) villages in six selected provinces, and discussions with CLTS facilitators at the national and provincial levels, project staff of the TS project, several key officers of MRD, UNICEF, Plan International, and the TS project. A national workshop was also held where the initial findings of the evaluation was presented for comments and validation from various stakeholders. Field surveys, the main source of information of the evaluation, were conducted in six of the nine provinces where the CLTS approach is currently being implemented. The TS project was selected as the subsidized programme to be compared with CLTS since it also started in 2006 and is being implemented in two of the six sample CLTS provinces. Six villages that were not exposed to CLTS or to the TS project were also surveyed to see the relevance of sanitation among rural households. Evaluation Findings

Relevance/ Importance of Latrines In villages not exposed to CLTS or to the TS Project, only 16.7% of households use latrines for defecation with the rest currently practicing open defecation (OD). The main reasons OD were no latrines/ latrines not yet built and no money to buy latrine materials. OD habit, tradition, and non-importance of latrine were the lowest ranked reasons. Most households in these villages think that the best way to encourage people to change their OD practice is through provision of latrines to all families or to provide materials for latrine construction to families from NGOs. Few indicated that the best way to change OD practice is through training on latrine-building and education/ awareness-raising on S&H. Further, most households also saw advantages in having own latrines because of improved hygiene/ cleanliness, convenience/ time-saving, and improved health. Access In 20

3 CLTS sample villages, comparing the number of latrines reported in the Commune Data-base

(CDB) 2007 to that reported built in 2006, there is about 69.4% coverage among all households particularly in the dry season when latrines are re-built and/ or repaired. However, at the time of the field survey, 41.9% were regularly using latrines. Those who were practicing reported not having latrines (either flooded or broken) or were still in the process of building/ re-building their latrines. Most latrines are unlined pit latrines (61%) and to a much lesser number, concrete ring pit latrines. Access to latrines greatly diminish in the wet season as most latrines particularly unlined dry-pit latrines, fail due to flooding, soil collapse, and from infestation of termites and ants. As such open defecation practices recur during the wet season. While the CLTS is intended to help every villager, the poorest cannot sustain their access to latrines.

1 Rural Sanitation and Hygiene in Cambodia: The Way Forward? Andy Robinson, WSP Cambodia, March 2007

2 Ibid.

3 2 villages in Otdar Meanchay does not appear in SEILA CDB 2007.

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Equity More than 80% of households were reported to have participated in the first and second meetings of the CLTS in villages. About a fourth of households are reported to have attended community meetings from 3-4 times. All poor households in villages were also reported to have participated in the CLTS meetings along with most of other villagers including elderly, children, disabled persons, and women. FGD results also indicate extensive participation of the poor households in community meetings. Villagers are reported as the main participants in ODF celebrations but the poor were not particularly identified as participants in ODF celebrations. Households are most visited by Village Chiefs who are almost always a key village focal person under the CLTS programme. PDRD and members of the commune councils also visit households but at much lesser instances than villages chiefs. Visits of DORD staff to villages are rare. In these visits, the most common purpose is to check whether latrines have been built and are being used. FGD results indicate that knowledge and skills on sanitation and hygiene have been built up among households in target villages. Knowledge on sanitation and hygiene was also built up from the community meetings where S/H topics were discussed then from constant/ regular visits from CLTS implementers and the village focal persons who also constantly remind villagers about proper S/H practices aside from encouraging them to make or maintain latrines. FGD results also indicate that there were no distinctions as to which sectors/ groups in the villages should benefit most under the CLTS programme. All villagers were targeted to build latrines without any special emphasis on the poor or the vulnerable groups. However, there is little evidence to show that the poor were selected as focal persons. Selection of focal persons in the village apparently depends on the choices of the commune council and the village chiefs or those nominated during the first community meetings. Effectiveness

In promoting community participation Under CLTS the need for community action is created as majority of villagers learn of the health dangers of OD and of the importance that all should build and use latrines to lessen if not eliminate such health dangers. The over-all effect is that most of the villagers actively participate in the agreed on community action, i.e. building and using latrines. Interactions with village focal persons, particularly the village chief, is also described as constant and regular – with focus on ensuring that latrines are built, used regularly, and maintained. Contribution to community CLTS activities is generally found in the process of building individual family latrines. Households build their own latrines using available materials from the village or nearby communal lands/ forests. There is very little evidence of one household giving materials or actually helping other households in building latrines. In CLTS, participation of households declines when durability issues of latrines become apparent and there is no immediate and effective solution available. While there are reports that VFPs have suggested re-building latrines in higher ground or by lining latrines with palm mid-ribs, these have proven to be ineffective against flooding, soil collapse and infestation from ants and termites. Durability issues which are the main cause of regular re-building during the dry season affect villagers negatively – they become weary or tired of the constant re-building effort. Among the poor and the poorest, participation wanes because of lack of resources and time to re-build latrines and in many cases because of low priority of latrines.

In contributing to improved access to rural sanitation At the time of the study, 41.9% in all CLTS villages were regularly using latrines for defecation. Study results also indicate that use of latrines at all times is also high - at home, only 10% of household members still practice OD, in public places on 7.5% practice OD, but in the field/ chamkar, nearly all still practice OD. FGD results support the survey findings. During the dry season, all villagers are reported to use latrines regularly whether their own or neighbors’ latrines. However, in the wet season the latrines collapse or become flooded - water goes inside the pit and bad smell comes out. People then feel averse to using the latrines; hence OD becomes a common practice in rice fields, bush areas, or forests. Household survey results indicate that generally there is regular cleaning of latrines. From FGDs, latrine cleaning is done more often during the dry season when the latrine pits are not flooded. Villagers say that unlike pour-flushed latrines which normally have smooth slabs, dry pits are not easy to clean because slabs are generally made of wood. Hence, cleaning just normally involves sweeping garbage from the latrine area.

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Household survey results show that more than half of households have washing areas in latrines were water for hand-washing is always available either in the latrine or brought from outside when latrines are used. Direct observations of latrines reveal that 55.2% had water inside the latrine structure. According to household survey results, generally, new latrines are built when the current latrine becomes full. When the latrines are broken the usual practice is to repair but when latrines are old, new ones are usually built. Repair of latrines involve the slabs, walls and roofs. Pits are generally never repaired – they are usually buried when full, broken, or old and new pits dug near the old latrine location. If households have money pour-flushed latrines will be built but if none, dry pit latrines will still be built. Villagers rebuild them by themselves not wanting to pay others for latrine repair or construction.

Households who regularly use latrines see improved S/H situation, convenience, and improved health as the main advantages of having latrines. Majority does not see any disadvantage in owning latrines but for some the bad smell coming from dry pit latrines is the main disadvantage. There is a high level of satisfaction with current types of latrines in all CLTS villages. For the few that are not satisfied, lack of money to buy concrete latrine/ slab, flooding in the wet season and unreliability of dry pit latrines are reasons given for their dissatisfaction. FGD results indicate the same. Villagers are happy with their latrines in the dry season and these are used regularly. But in the wet season, when latrines get flooded and/ or collapse villagers stop using latrines – they fear getting disease from the flooded/ collapsed latrines and think that OD is more sanitary than using the latrines. Nearly all think that their villages now have better S%H situation as compared to the time before CLTS was started. Reasons given for this perceived positive change were more latrines than before, no faeces everywhere, and more awareness about hygiene among villagers.

In promoting behavior change Among household that currently have latrines, use of latrines for defecation at all times among adults at home is 86.6%, at field/ chamkar at 11.9%, and in public places at 83.6%. Among children, use of latrines for defecation at all times at home is 71.6% (78.4% in non-ODF villages and 63.3% in ODF villages). In public places and in field/ chamkar, 10.5% use public latrines or other latrines (reported as neighbors’/other houses latrines. Among household without latrines/ currently practicing OD, the practice of chhik korb is a common (44.1% in all CLTS villages – 46.5% in non-ODF villages and 42% in ODF villages) at home but not when in the field/ chamkar or when in public places. The practice of chhik korb may already be an indication of behavior change since it demonstrates awareness or knowledge that faeces left in the open (unburied) constitutes a potential health risk/ hazard to others. The practice may also be an indication that people who practice OD are ashamed of their practice such that the more sanitary practice of chhik korb is resorted to. Practice of hand-washing with soap is reported nearly among all households. Hand-washing is done more than once a day and is done usually before eating, after defecation, and when hands are dirty. Forty percent (40%) of all households think that wide awareness raising on effects of OD should be done to further improve the sanitation and hygiene situation in their villages. Likewise, awareness raising on effects of OD was cited by 38.8% (40.5% in non-ODF and 36.7% in ODF villages) as the most important activity in villages to further improve S&H situation in their villages. However, it should be noted that majority of respondents (65.7% - 78.4% in non-ODF and 50% in ODF villages) think that provision of latrines to all families is the way to further improve S&H situation in their villages.

In contributing to institutional capacity building CLTS contributes to institutional capacity building in 3 inter-related ways. First, facilitation skills of MRD/ PDRD/ DoRD, commune focal points and village focal points are considerably built up from the trainings done and from the actual conduct of facilitation meetings in villages. These skills are further built on by regular sharing of experiences and resolution of emerging issues during quarterly meetings/ workshops that MRD sponsors among the PDRD and DoRD staff. Second, as is normal in government project implementation procedures, an implementation and monitoring structure is created at the national and the provincial levels. Third, CLTS also involves NGOs (either as direct implementers or sources of funding/ resources), district authorities, and commune authorities. Through this cooperation among government agency, local authority and NGOs, a support network is created for the CLTS approach.

4

Cost-Effectiveness

Unlined dry pit latrines cost very little if materials are sourced from the villages. Most households in CLTS villages do not buy materials used in latrine construction. Pits are unlined, while the other latrine parts (slabs, walls, roofs, water container) are made of materials that are sourced from the villages – old wood, bamboo, thatch, palm midribs, etc. which are either found within the village, given by neighbors, or obtained from nearby forests and bush areas. In some cases, latrine materials are provided by NGOs who also are implementing S&H activities in the villages. For those who purchase all latrine materials, the reported cost of a latrine in CLTS villages is USD 41.1 If only concrete rings and slabs are bought; the cost is about $21. In terms of repairs, households report $1 to $2.5 expenses excluding pit repairs.

Sustainability

Generally, latrines are regularly cleaned. For the majority that has unlined dry-pit latrines, latrine cleaning is done more often during the dry season when the latrine pits are not flooded. Cleaning normally involves sweeping garbage from the latrine area. Use of water in cleaning dry pit latrines is avoided to prevent water from getting in the pits. Observations also indicate that the inside of latrines particularly the slabs are clean and free from faeces. Dry-pit latrines are generally never repaired when full, broken or old. Instead, latrines are covered/ buried and new ones dug near the old latrine. What are repaired are the walls, roofs, and slabs (for latrines with non-concrete slabs) of latrines usually using village-sourced materials. Building new latrines and repair of upper sections is normally done in the dry season when residential lots are not or less flooded. Other issues which affect the durability of latrines such as loose soils and presence of ants/ termites that also cause latrine collapse have also been reported to focal persons and implementers. Study results reveal that 27% in CLTS villages have re-built their latrines. Those who have rebuilt their latrines generally build the same latrine as before (mostly, unlined dry-pit latrines) because of lack/ absence of money or materials for upgrading to better latrines such as pour-flushed latrines. The practice of open defecation among villagers re-emerges during the wet season of the year. Depending on the flooding conditions and the durability of latrines, OD can reach almost 100% in some villages (Khan Sar and Beng villages in Siem Reap where FGD participants reports that all latrines cannot be used). During dry season when latrines are not flooded and usable, OD still persists particularly when villagers are working in the field/ chamkar but also when at home and in public places.

Experiences of the CLTS Approach

Achievements

Increased Access to Sanitation Facilities in Target Villages: Since its inception in 2005, CLTS has expanded to 9 provinces and 258 villages in Cambodia where a total of 134 villages have attained ODF status. The number of latrines has substantially increased when compared to the number of latrines reported in the CDB 2007. While in most villages, the number of latrines do not yet match the number of households, the increase in coverage due to CLTS is already significant.

Emerging behavior change in rural communities: CLTS in rural communities has resulted to emerging behavior changes among rural families. These changes are evident in use of latrines at home and in public places by adults and by children. Among household without latrines, behavior change can also be seen in the increased practice of chhik korb.

Capacity building on CLTS: Improved capacities of CLTS facilitators at provincial, district, and village level and of focal persons at commune and village levels are also a key achievement of the CLTS approach in the country. At the provincial and district levels, there are at least three to five well-trained facilitators serving as the key delivery mechanism of CLTS in the nine target provinces. At the commune level, there are two well-trained focal persons and at the village level, there are at least five village focal persons which include the village chief. Focal persons at village level have also been well exposed to facilitation skills training. Outside of government and local authorities, a number of NGOs have also been well-trained on CLTS processes through the support of the DHRC at the national and the PDRDs at the provincial levels.

Barriers and Opportunities for Strengthening and Scaling-up

- Barriers

a. The CLTS approach still relies considerably on institutional rather than on community leadership.

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b. Physical conditions of rural villages: Most villages are flood-prone areas especially in the rainy season. Flood-prone areas do not suit unlined dry-pit latrines which are the basic latrine that is being built by villagers in CLTS villages.

c. Limitations in facilitation and technical skills among current group of facilitators; d. Sanitation and hygiene not prioritized in commune development plan/ planning; e. Absence of provincial-level intra and inter-departmental cooperation especially on sourcing of talented

facilitators and developing appropriate design technologies of latrines; f. Proximity to/ knowledge of subsidized programmes greatly limits participation; g. Lack of natural leaders within communities; h. Poorest cannot sustain functional latrines; and, i. There is a persisting attitude/ dependence among rural communities on external support/ grants.

- Opportunities The key opportunity for scaling-up CLTS in the country is the emerging knowledge of what works and what does not, what the physical and technical issues are, and what the limitations of the delivery mechanisms are. a. Current successes (particularly in ODF villages) merit and are clear bases for replication. Past

experience have shown that CLTS will not be sustainable in flood-prone villages. Therefore, in scaling-up CLTS, flood-prone villages must not be selected unless appropriate latrine-design technologies that are low-cost have been developed. Another is that clear proximity to on-going subsidized programmes erodes the effectiveness of CLTS but in villages where there have been subsidized programmes, ODF has been reached regularly in the dry season.

b. In-place institutional structure and delivery mechanism. Having selected and trained CLTS facilitators from within MRD/PDRD and local authorities, there is a permanent support structure and delivery mechanism that can be utilized in scaling-up CLTS in the country.

c. Emerging interest from major donors. Discussion with UNICEF and MRD indicate that there is an emerging interest from major development partners of Cambodia such as the DFID and AusAid in scaling-up and strengthening CLTS in the country.

d. Potential local funds sources from decentralization policy of central government. Through this policy of central government, districts and communes now have their own development budgets that can be used for district and commune prioritized activities.

Differences between CLTS and TSRWSSP

a. Access. In CLTS villages lesser number of households is able to own latrines since latrine building is un-supported and household initiated. Those households that do not have the resources particularly the poorest are not able to build their own latrines. In TSRWSSP, greater numbers of households have access to latrines since the Project’s intent is to provide latrines to all households in all target villages. However, in terms of actual use of latrines, there is greater access in CLTS villages as demonstrated by ODF status of many villages. Greater use is generally caused by behavior change and a good understanding that ODF status considerably reduces health risks associated with human faeces. In TSRWSSP villages, lesser use of latrines is reported by households. Village observations also indicate presence of latrine materials (rings and slabs) that have not been built into latrines and constructed latrines that are unused by villagers.

b. Equity. There is greater participation of community members including the poorest through a series of

triggering meetings under the CLTS approach and from constant visits from VFPs and external facilitators. The triggering processes create widespread understanding of the need to stop open defecation which in turn promotes near total participation in latrine building and regular use. Village chiefs and other village focal persons also ensure wide participation in meetings and in latrine building through frequent monitoring visits to households particularly among those that have not yet or are slow in building their latrines. While the poorest households are also reported as joining in the triggering meetings, their participation tends to be less sustained from several factors including lack of land to locate latrines, lack of time (frequently mobile for work), and low priority of latrines among household needs. In TSRWSSP villages, community participation is done through informed-choice meetings which are held twice or more but over extended time periods. In these meetings, villagers get to know what are their options in terms of availing of latrines – whether basic but free dry-pit latrines or paid but improved latrine types. Low attendances in meetings are reported as people await what results from the initial meetings. In some villages, participation is low since many villagers were not informed of the forthcoming meetings.

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c. Institutional capacity building. CLTS works within and through existing government and local authority structures. It does not create new structures or mechanism to deliver CLTS related services – facilitation and monitoring – in target villages. CLTS implementation runs vertically from key staff in the DRHC, to the PDRD/ DoRD in provinces and districts, to commune councils, and to village chiefs and village focal persons. While village focal persons are new mechanisms, they are voluntary positions and (ideally) spring from grass-roots actions. All involved staff and individuals are trained on CLTS approaches, facilitation skills, and on other sanitation and hygiene skills which therefore contributes to the over-all capacity of the MRD/ PDRD and local authorities as institutions of government. TSRWSSP, on the other hand, installs temporary Project Management Unit and Project Implementation Units at the national and provincial levels. This process requires re-assignment of existing government staff or hiring of new staff and building up project implementation skills through different training approaches and formal processes. After the Project is completed, the temporary management and implementation units are dissolved; hence, there is a possibility that not all trained staffs are retained in government agencies at national and provincial levels.

d. Cost-effectiveness. CLTS is more cost-effective than TSRWSSP more so in the short-term. But it can

also be more cost-effective in the long-term. There is no subsidy in CLTS. Very little cash is needed to build latrines under CLTS since most materials can be sourced from the villages or nearby forests/ shrub-lands. Little cash is also needed in repair of latrines. More importantly, greater behavior change is attained through CLTS which is the basic need for sustainability of sanitation in villages. ODF has also been reached through CLTS. CLTS can also be more cost-effective in the long-term if appropriate low-cost and durable latrine designs are developed for CLTS villages. On the other hand, all types of latrines provided under TSRWWSP are subsidized. A basic latrine costs $133 with 90% of costs borne by subsidies. While these latrines are durable and can be used far longer than latrines in CLTS villages, the cost of reaching 100% coverage and hence, possibly ODF, is very high. Such over-all cost is mainly borne by government through loans which in a developing country like Cambodia creates an enormous future financial burden.

e. Behavior changes. Figures 42 to 44 presents the differences between CLTS and TSRWSSP in terms of

emerging behavior changes among villagers. At home, more adults and children in CLTS villages regularly use latrines for defecation as compared to TSRWSSP villages. In public places, more adults in TSRWWSP villages use latrines. And in the field/ chamkar, more villagers in TSRWSSP practices OD than villagers in CLTS villages. In terms of boiling drinking water and hand-washing practices, it is clear that more households do so in CLTS villages than in TSRWWSP villages. And in households without latrines, the practice of chhik korb is higher in CLTS villages than in TSRWSSP villages.

f. Sustainability. CLTS promoted latrines have sustainability issues. Unlined dry-pit latrines are not

durable lasting from 6-10 months depending on physical conditions in villages. This latrine type is susceptible to failure from flooding, from collapse due to soil structure, from infestation of ants and termites, and from regular use. Because of less durability, households have to regularly re-build latrines during the dry season. However, in CLTS villages there is more monitoring of latrine use and maintenance. This monitoring ensures better sanitation practices and can allow households to learn of ways to make their latrines last longer. TSRWSSP promoted latrines are more sustainable, designed for durability and longevity. Basic latrines provided to beneficiaries are made of concrete rings and concrete slabs. Generally, the latrine pit is deeper and wider which allows for more useful life. TSRWSSP provided latrines can also be pumped-off lessening the need to build new latrines.

Conclusions and Recommendations

Conclusions

a. The CLTS approach has worked well in Cambodia but this is generally in the dry season. CLTS has dramatically increased access to dry-pit latrines (and in some cases, pour-flushed) particularly in the dry season. Participation of communities is widespread especially in ODF villages, and includes the poor and the poorest.

b. From almost 100% OD before CLTS, the approach has effectively caused a 41.9% (among total households) year-long use of latrines; frequent cleaning of latrines; installation of washing areas with soap and water; and regular re-building and repair of latrines. CLTS has also resulted to a positive outlook of communities in terms of advantages of owning latrines and a widespread satisfaction with latrine ownership and use and optimism on future sanitation conditions in communities

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c. CLTS promotes behavior change as indicated by extensive knowledge on ways to prevent/ avoid diarrhea; constant hand-washing practice especially before eating and after defecation; consistent use of latrines at homes; and increased practice of chhik korb.

d. CLTS also contributes to institutional capacity building through mobilization of trained facilitators at provincial to village levels within existing government and local authority structures. It does not create additional administrative and financial burden by mobilizing facilitators from among existing staffs. CLTS has also effectively installed of an implementation and monitoring structure from national to provincial levels and has created of a government-NGO-local authority network that supports and facilitates the CLTS approach. However, by limiting itself to existing structures/ staffs and local authorities, CLTS also faces limitations in the quality of facilitators and focal points.

e. CLTS is very cost-effective. Very little cash is spent when latrine materials are village-sourced as done by 61% of households in CLTS villages and only $ 1 to $ 2.5 is spent on regular repair. For better-off households a latrine would cost $ 21.25 if concrete rings and slabs are used and $ 41 if all materials are purchased. CLTS can attain ODF status

f. CLTS has sustainability issues. Unlined dry-pit latrines which are the commonly built latrines are not durable. This latrine type is prone to failure from flooding, loose soil conditions, termites and ants, and from constant use. There is also an absence/ lack of local knowledge and initiative to address durability issues of latrines which is often compounded by the lack of initiative and innovativeness among external facilitators to help communities address the latrine durability issue. Hence, participation wanes as households (especially the poor and poorest) grow weary of regular or frequent latrine repairs. Thereafter, open defecation re-surfaces as latrines fail in wet season

g. Over-all CLTS has had limited success in Cambodia. Its most visible indicator of success, ODF status, can only be attained in the dry season in almost all villages it has been implemented. There remain social, economic, technical, and institutional barriers that need to be addressed for CLTS to be strengthened and further scaled-up as a viable alternative to subsidized sanitation programmes.

h. Given, the barriers to sustaining ODF in CLTS villages, particularly the lack of durability of dry-pit latrines and the inability of the poorest/ most vulnerable households to regularly maintain their latrines, CLTS has to evolve to a locally-adapted approach that still prioritizes and promotes behavior change but at the same time directly supports the development, fabrication, and marketing of durable latrines / latrine materials and also directly provides for the sanitation needs of the poorest/ most vulnerable households.

Recommendations

Recommendations for Development Partners a. Standardize CLTS financial support system for PDRD, DoRD, and commune councils across all

provinces where CLTS is being supported. This would be done in consultation with MRD upgrading the current support system to that which would reflect the current economic situation – e.g. transportation allowance should be provided in terms of distance to CLTS communes/ villages. This would eliminate comparisons (and complaints) among and between PDRD/ DoRD facilitators.

b. Scale-up awareness-raising/ education on sanitation and hygiene in target villages. Awareness-raising on S&H is one of the main suggestions of households in terms of further improving sanitation conditions in villages. AR should also be constant and adapted to the specific local conditions of target villages in view of the fact that there is very low education attainment among the rural poor.

c. Expand support to CLTS approach to local schools, mobilizing children as change agents within their families and communities.

d. Continue supporting capacity building/ training/ re-training of facilitators at all levels including support to cross-visits to ODF villages by village level focal points and facilitators.

e. Support studies/ researches and piloting of low-cost but durable latrine models/ materials for latrine construction that are adapted to specific physical, geographical, and environmental conditions of target provinces, districts, or communes. Wherever possible indigenous/ locally-available materials should be utilized/ promoted in developing such low-cost latrine models.

5.2.2 Recommendation for MRD

a. Improve selection criteria in choosing target CLTS villages by utilizing technical information/ observations on villages not just relying on verbal reports from Commune Councils, etc. and train facilitators in use of improved selection guidelines.

b. Access technical skills within PDRD, PRDC or in other provincial government departments in selection of target villages and in developing appropriate design technologies for latrines – focusing on

8

local conditions and availability of materials (develop mechanisms for appropriately-designed latrines to be fabricated within target communities);

c. Develop/ implement social marketing strategies and mechanisms to allow the rural poor to access low-cost latrines or materials for latrine construction.

d. Develop ways where women will be involved in local design adaptations and fabrication of latrines and Introduce new technologies at appropriate times and if truly necessary, for example, in flood-prone areas;

e. Improve monitoring systems – extensive information collection and documentation but limited intervention.

f. Scale-up role of Commune Councils, i.e., not in direct implementation but as a start-up and monitoring agent with direct communications with provincial level facilitators. ;

g. Scale-up role of District Authorities to support initiatives of Commune Councils. Districts have their own budget to fund projects/ activities of communes which can be allocated to sanitation activities spearheaded by communes such as CLTS;

h. Create implementation and monitoring networks with other NGOs or civil society organizations (such as the Cambodia Red Cross and the Youth Star organization) that have extensive presence in communes and villages;

i. Adopt and utilize subsidized approaches where appropriate to further strengthen and scale-up the CLTS approach:

Provide low-cost latrines or latrine construction materials to the poorest and most vulnerable households – households who do not have enough residential land, the elderly/ disabled, and other household groups that cannot on their own build and maintain latrines.

Pilot shared latrines – among relatives living in close proximity – in rural communities where there is a prevalence of poorest household living in clusters at edges of villages.

Provide public latrines in gathering/ meeting areas in rural villages such as schools, pagodas, among others

j. Allow for longer gestation of behavior change and ODF status. Current focus on quick and extensive building of latrines in CLTS villages undermines the lynchpin of the CLTS approach which is behavior change.

Recommendations for PDRD a. Allow communities to assume leadership with limited intervention from external agents. This requires:

re-focusing of facilitation and monitoring styles/ approaches of external facilitators; selection of new and more community-development trained/ oriented staffs that may come from other agencies such as the Provincial Department of Women’s Affairs; actively seeking and/ or allowing emergence of natural leaders in communities; allowing for / developing more women as village focal persons; building-up capacity of current crop of VFPs i.e. re-train current group of VFPs, allow for more cross-visits and participation in capacity-building or reflection workshops, develop technical skills/ innovativeness in latrine-building and sanitation improvement in villages; and focus on behavior change rather than reaching ODF through latrine building.

b. Prioritize poorest segments – particularly in communities lacking in solidarity (diverse mix of ethnic/ social backgrounds) by: utilizing poor identification mechanism developed by the Ministry of Planning in identifying the poorest households in communities; focused awareness-raising and constant visits by VFPs, and exploring potentials of and pilot public or shared latrines within clusters of poor/ poorest households.

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1 Introduction

1.1 Background of the Evaluation

CLTS (Community Led Total Sanitation) is a new approach to achieving better sanitation which fosters innovation and commitment within the community and motivates people to build their own sanitation infrastructure, without depending on hardware subsidies from external agencies. CLTS does not seek to provide latrine infrastructure but facilitates self and community analysis of defecation habits and behavioral change on sanitation and hygiene practices. CLTS strives to promote community dialogue, analysis, and social action that can lead to improved sanitation and hygiene practices using locally available resources, tapping the skills and creativity of the people. Globally CLTS has been identified as a successful example in promoting socially-driven behavior change. In Cambodia, CLTS was initiated in 2004 when Dr.Kamal Kar facilitated training workshops for the staff of Concern Worldwide in Cambodia. Concern Worldwide facilitated CLTS with Commune Councils in four provinces, Pursat, Siem Reap, Kampong Chhnang and Kampong Cham. Among the key constraints identified through the rural water and sanitation sector review in 2006 is the lack of a strategic approach to sanitation and hygiene improvement. The hardware subsidy approach that has been adopted by most sanitation projects in Cambodia for a long time has not contributed meaningfully to improving the consistently low coverage of rural sanitation. The Cambodia Demographic and Health Survey (CDHS) 2005 shows the coverage of 15.7 percent which is a mere increase of 1.7 percent from the figure reported in CDHS 2000 (14 percent) The subsidy approach has also failed to demonstrate the capacity to reach poor households despite sector policies on poverty targeting. The hardware subsidies are often captured by non-poor households that are better able to meet project requirements for cash contributions, or have more influence on those allocating the project latrines. CLTS has been identified as one potential approach to accelerating rural sanitation improvement in Cambodia

4. However, since then no further study has been conducted to assess the effectiveness of the

different approaches, i.e. CLTS and those involving provision of subsidies directly to families in terms of contribution towards increased coverage of rural sanitation, sustainability, community participation and ownership, institutional/ capacity building. MRD is committed to enabling demonstration, documentation and dissemination of examples of successful approaches in rural sanitation improvement. A comparative study of the two approaches, i.e. CLTS which does not include hardware subsidies for families, versus those that do provide subsidies, is therefore required. It is expected that the results of this evaluation will contribute towards development of the National Strategy on Rural Sanitation and Hygiene Improvement, which will be developed later this year.

1.2 Objectives of the Evaluation

a. Review the current experiences of the CLTS approach being promoted by the MRD in collaboration with UNICEF and Plan International, in terms of achievements; barriers; and opportunities for further strengthening and scaling-up.

b. Compare the performance of the CLTS approach in sanitation improvement with that of sanitation

approaches that incorporate material subsidies according to the following: i. Sustainability, i.e. whether the facilities are maintained and effectively used and whether the

open defecation free status has been sustained; ii. Equity in terms of access of the poor and vulnerable to sanitation, circumstances and behavior

change among the poorest, most disadvantaged and most reluctant households; iii. Effectiveness in terms of promoting community participation; contributing to improved access to

rural sanitation; promoting behavior change particularly with regard to use of latrines for defecation especially among women and children, and in contributing to institutional capacity building; and

iv. Efficiency of CLTS as a cost-effective approach to achieving improved sanitation as compared to subsidized approaches.

4 Rural Sanitation and Hygiene in Cambodia: The Way Forward? Andy Robinson, WSP Cambodia, March 2007

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1.3 Evaluation Methodology

1.3.1 Literature Review

The evaluation required a review of initiatives that have been undertaken or that are still on-going towards improving rural sanitation with particular focus on eliminating open defecation practices. Review of literature focused on the sanitation programmes of MRD and those of INGOs and NGOs that the agency collaborates with. Available CLTS documents from MRD and UNICEF and those available on the TSRWSSP were the primary information reviewed for the evaluation. The review also looked at CLTS experiences in other countries and at studies that were published on CLTS.

1.3.2 Survey Tools

Most of the findings of this evaluation were based on primary information obtained from field surveys/ interviews in villages where CLTS and subsidized sanitation projects were implemented and among CLTS facilitators and focal persons and project implementers. The field surveys/ interviews were accomplished using household and children questionnaires, focus group discussion guides, and key informant interview guides. The household questionnaire also contained an observation guide section.

1.3.2.1 Questionnaires

Two questionnaires were prepared for the evaluation – a household questionnaire and a children questionnaire. The household questionnaire, generally administered with household heads, captured basic socio-economic information, and information on the four CLTS evaluation themes (access and equity, effectiveness, efficiency/ cost-effectiveness, and sustainability. The household level questionnaire was developed and finalized with the MRD, UNICEF, and Plan International. The household questionnaire incorporated a section on observations which allowed interviewers to see directly the condition of household latrines and evidence of its regular use. The questionnaire for children respondents was developed in response to Plan’s request to obtain feedback and perception from children on sanitation, hygiene, and health issues. The questions in the children questionnaire were extracted from the household questionnaire. Prior to the field survey, a two-day training was held with eight interviewers and four research assistants focusing on the purpose and use of each question in the two questionnaires. The questionnaires were tested in a CLTS village in Takeo Province selected with assistance from officers of the Department of Rural Health Care (DRHC) of the MRD. Results of the pre-test were then used in finalizing the questionnaires in consultation with UNICEF. The survey questionnaires are appended to this Report as Annex 1. The field work was conducted over a two week period from October 16 through October 28, 2008. Two teams [each comprised of a Team Leader (consultant), sub-team leader (for household and children interviews), four interviewers, and a research assistant (FGD facilitator)] conducted the survey. A field coordinator was assigned to each team by the DRHC. Annex 2 contains the names of the team members. Completed and checked questionnaires were encoded into a SPSS database by trained encoders and cleaned for tabulation by the team Database Specialist.

1.3.2.2 Focus Group Discussions

Focus group discussions (FGDs) were conducted in survey villages to generate supplementary information to the household and children questionnaires. Two FGDs were planned for each survey village – a women’s FGD and a community leaders. However, due to encountered limitations during the scheduled conduct of the discussions, several group discussions had to be combined. The survey team leaders and team FGD facilitator conducted the FGDs. During the discussions another member of the survey team acted as the note-taker. The FGD Guide is found in Annex 3 while the summarized results of the FGDs are presented in Annex 4. Annex 5 presents the names and positions of FGD participants.

1.3.2.3 Key Informant Interviews

Key informant interviews were conducted to obtain qualitative information on the evaluation issues contained in the evaluation framework. These interviews were conducted with organizations and individuals who were directly involved in the CLTS approach from provincial level down to village level. Hence, interviews and in some cases group discussions were conducted with the PDRD/ DoRD, UNICEF

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Provincial Advisers, the PRDC and its Executive Committee, district authorities, commune authorities and focal persons, village chiefs and village focal persons, and with NGOs. At the national level, interviews/ discussion were held with the staff of the DRHC/ MRD, the consultant Team Leader of TSRWWSP, and with key officers of UNICEF and Plan International. The questions posed to key informants generally followed the topics and subjects contained in both the household questionnaire and the FGD guide. This was purposely done to validate results of surveys and to obtain their views on CLTS particularly its implementation processes, its strengths and weaknesses (based on their experience), and its potentials for scaling-up in the country. Annex 6 presents the list of key informants interviewed as part of the data gathering process.

1.3.3 Sample Selection

1.3.3.1 Selection of Study Provinces and Survey Villages

The Consultant team first developed a selection criterion for sample villages which was then finalized after a series of consultations with MRD/ UNICEF/ Plan International. Villages which started CLTS in 2006 were prioritized to better see how sanitation has changed and sustained and only villages under UNICEF and Plan International support were considered. Among 2006 CLTS villages in the selected 6 sample provinces, the population size and access/ distance to villages (dependent on local knowledge of PDRDs) were then applied in selecting the sample villages in each sample province. In selecting the villages in the sample provinces, close consultations were done with the CLTS monitoring staff of DHRC-MRD. Lastly, to see difference among CLTS villages, the total number of sample villages (20) was divided equally among ODF villages (10) and non-ODF villages (10). Survey villages in the TS project were selected by PIUs in Siem Reap and Kampong Thom provinces. Figure 1 presents the detailed sampling process done by the Consultant team.

1.3.3.2 Selection of Subsidized Sanitation Project

To look at the differences between CLTS and subsidized sanitation approaches, the ADB-funded Tonle Sap Rural Water Supply and Sanitation Project (TSRWSSP or TS) was selected. The TS was selected from among several identified subsidized sanitation projects including the Economic and Social Relaunch of Northwest Provinces (ECOSORN) Project and the World Bank-funded North-east Village Development Project (NVDP) projects. The TS project was selected primarily because it was started in 2006 (the same year as CLTS) and had target villages in the same districts and communes in two of the six provinces sample provinces for the CLTS. Further, as an on-going project (also of the MRD), greater access to information (from the PMU and PIUs) was available. The ECOSORN project was not selected since sanitation is not a major component and was mainly implemented in Siem Reap, Battambang and Banteay Meanchay provinces, not in CLTS provinces except Siem Reap. On the other hand, the NVDP project implemented in Kampong Thom, Kratie, Stung Treng, and Kampong Cham was completed in 2003 which meant that identifying project implementer and beneficiaries for interviews/ data collection would prove difficult.

1.3.3.3 Other Villages

Villages that were not exposed to CLTS or TS (“other villages5” or OV) were also surveyed. Other villages

were added to the sample at the request of UNICEF to look at the relevance of sanitation facilities and programmes in such villages. One OV was selected for each of the six provinces covered by the survey. Selection of other villages was done by PDRD staff at the request of the Consultant team. In other villages, focus group discussions were not done. 1.3.3.4 Selection of Survey Respondents A total of 384 respondents comprised the village surveys – 256 (186 females and 70 males) household respondents (Table 1) and 128 (71 girls and 57 boys) children respondents (Table 2). With CLTS being the focus of the evaluation, majority of respondents were selected from CLTS villages [240 (160 adult and 80 children respondents) of the 384 total respondents).

5 These villages were initially termed as “Non Intervention” villages. However, during survey data processing, it turned

out that the selected villages had been already exposed to S&H projects/ activities from other NGOs such as World Vision, CARE, among others.

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Figure 1. Number of Survey Villages and Selection Process

No Name of Project

Province

CLTS Approach (2006 villages only)

Sample Villages

Total Survey Villages

CLTS Non-CLTS

& Non-TSRWWSP

c

Subsidized Rural Sanitation Programmesd

No. of ODF

villages

No. of CLTS

Villages

Total no. of

villages ODF CLTS Total Target

Name of Project

Complete On-going Total no.

of villages

1

UNICEF/ Seth Koma

Kampong Speu 3 10 13 3 1 4 1 none 5

2 Kampong Thom 5 11 16 3 2 5 1 ADB/ TSRWSSP

2 1 3 9

3 Prey Veng 3 10 13 1 3 4 1 none 5

4 Otdar Meanchey

3 10 13 0 3 3 1 none 4

5 Plan

International

Siem Reap 2 2 4 2 0 2 1 ADB/ TSRWSSP

2 1 3 6

6 Kampong. Cham

1 2 3 1 1 2 1 none 3

Total = 6 Provinces 17 45 62 10 10 20 6 4 2 6 32

Key Constraints:

1. Travel time in between villages

2. Number of Activities in villages: HH survey, FGDs (2), Interviews with Village Facilitators

3. Interviews with at provincial, district, and commune level

Changes:

1. The number of Non-CLTS/ Non-TSRWSSP villages 1 per province

2. The number of Subsidized villages 2 per province

Selection Process:

a Only 2006 villages will comprise the population b Selected villages will be the:

Population Size (HH) Primary Criteria - Small villages (below 100Hh) and Large villages (above 100Hh) will be selected

Poor/ poorest villages There is no comprehensive village classification by poverty. PDRD does not have poverty classification of villages

Distance/ Accessibility Using PDRD local knowledge

c To be identified by PDRDs from among neighboring villages of the selected sample villages d To be identified with Project Implementing Units (PIUs) of the TSRWSSP in Siem Reap and Kampong Thom

Provinces:

Stueng Treng province not considered as sample province due to distance, very few villages and late start of CLTS

Takeo province not considered as sample province since UNICEF and Plan International does not support CLTS in this province.

Svay Rieng was not selected since neighboring Prey Veng province was already selected and due to time constraints.

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Table 1 Number of Parent Respondents by Province and by Types of Village

Province

Type of Village

CLTS TS Other Villages Total

n N n n

Kampong Thom 40 24 8 72

Siem Reap 16 24 8 48

Odor Meanchey 24 - 8 32

Kampong Speu 32 - 8 40

Prey Veng 32 - 8 40

Kampong Cham 16 - 8 24

Total 160 48 48 256

Table 2. Number of Children Respondents by Province and by Types of Village

Province

Type of Village

CLTS TS Other Villages Total

n N n n

Kampong Thom 20 12 4 36

Siem Reap 8 12 4 24

Odor Meanchey 12 - 4 16

Kampong Speu 16 - 4 20

Prey Veng 16 - 4 20

Kampong Cham 8 - 4 12

Total 80 24 24 128

Household respondents were randomly selected through interval sampling of houses in the villages. Depending in the number of households in each sample village, the 8 respondents in each village represented from 2%

6 to 16%

7 of the total household population. The primary respondent was the

household head but in cases where the household head is not available, the spouse became the respondent. Children were also randomly selected in the villages but interviews were largely dependent on the agreement of the child to be interviewed or not. In cases where the child was hesitant or refused to be interviewed, another child would be randomly selected. The poor/ poorest were purposely selected as part of the village respondent sample. Of the 8 household respondents for each sample village, 2 were from the poor/ poorest families in the village. To identify these poor households, the assistance of the village chief (or his deputy) was sought. 1.3.3.5 Selection of Focus Group Participants (FGDs) Participants in FGDs were invited/ selected through the PDRD/ DoRDs in each sample province. PDRD/ DoRD staff went ahead of the survey teams to the sample villages and organized the conduct of the FGDs. Through the village chiefs, the villagers were informed of the forthcoming FGDs and volunteers were requested to attend particularly in the FGD for women. The FGD among community leaders required the presence of key village leaders such as the village chiefs, deputy village chiefs, members of the local development council, focal persons of the sanitation programmes, and other local leaders.

6 Kampong Chheu Teal village, Sambour commune, Prasat Sambour District, Kampong Thom – TS sample village.

7 Chrak Trach village, Moha Sang commune, Phnum Sruoch district, Kampong Speu – CLTS sample village

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2 The CLTS Approach and the TSRWSSP Project in Cambodia

2.1 Over-view of CLTS

2.1.1 Scope and coverage

The CLTS approach is being implemented in the country by the Department of Rural Health Care of the MRD as one of several strategies to increase access to and sustain sanitation particularly in the rural areas. As of the end of 2008, 258 villages in 9 provinces are covered by the CLTS approach. The over-all coverage of the CLTS approach since its inception in the country in 2005 is seen in Table 3 below. Table 3. Coverage of CLTS in Cambodia

No Name of Project Province

Number of CLTS Villages Number of ODF villages

2005 2006 2007 2008 Total 2005 2006 2007 2008 Total

1

UNICEF/ Seth Koma

Kampong Speu 1 10 31 34 76 1 5 12 2 20

Kampong Thom 1 10 20 50 81 0 10 16 0 26

Svay Rieng 0 10 20 48 78 0 7 7 9 23

Steung Treng 0 3 0 10 13 0 1 0 0 1

Prey Veng 0 10 20 60 90 0 7 9 9 25

Odor Meanchey 0 10 15 18 43 0 9 10 0 19

Sub-total 6 2 53 106 220 381 1 39 54 20 114

2

Plan International

Siem Reap 0 2 16 9 27 0 1 5 0 6

Kampong Cham 0 2 8 10 20 0 2 8 0 10

Sub-total 2 0 4 24 19 47 0 3 13 0 16

3 Lien Aid Kampong Speu 0 0 5 0 5 0 0 2 0 2

4 CRC/SRC/PDRD Takeo 0 0 10 0 10 0 0 2 0 2

Sub-total 2 0 8 63 38 109 0 6 30 0 36

Grand Total 9 Provinces 2 61 169 258 490 1 45 84 20 150

Source: Aggregated from Reports on CLTS

2.1.2 Inception of CLTS in Cambodia

As mentioned above, Concern World Wide Cambodia was the first organization to introduce the CLTS approach in Cambodia. However, Concern subsequently focused its programme on livelihood activities and rural sanitation was no longer supported as a specific programme. Consequently, the support for CLTS was not expanded further. Having conducted a study visit to Concern supported CLTS villages in 2005 and with the support from UNICEF, MRD embarked on piloting CLTS in July 2005. Two villages i.e. Slaeng village in Kampong Speu Province and Rolous Village in Kampong Thom Province were selected as the pilot villages. A 3-day training workshop was organized in Kampong Thom from the 31st of August to the 2nd of September, 2005 for PDRD staff to enable them to facilitate CLTS. The workshop was facilitated by MRD with staff of Concern World Wide as resource persons. A number of community leaders from the CLTS villages supported by Concern also participated as resource persons in the training. There were 25 participants in the workshop, those are the MRD/DRHC, PDRD staff, district representatives of both provinces, Kg. Thom and Kg. Speu, commune representatives and the Commune Focal Point for Women and Children and village chiefs from the two villages. Following the workshop MRD developed a training module for CLTS based on the guidelines from Dr Kamal Kar with the necessary adjustment to suit the local situation. The module includes general guidelines of CLTS, CLTS facilitation skills, steps of CLTS implementation, and detailed activities of CLTS implementation. A format for conducting PVA (Participatory Village Assessment) was also developed by MRD to collect baseline data through group discussions facilitated by MRD and PDRD staff soon after the ignition

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meeting in each of the two villages. The communities actively participated in the discussion, including 70 people, more women than men participated in Kg. Speu and 18 in Kg. Thom. MRD also developed a large size flip chart showing a number of simple latrine designs as well as posters to promote use of latrine and hand-washing. PDRD staff from the two pilot provinces facilitated the ignition process and conducted follow-up visits to monitor progress. Slaeng Village subsequently showed very encouraging results and in June 2006 managed to declare ODF (Open Defecation Free). With support from UNICEF, MRD facilitated a celebration with the village community and organized publicity of this achievement. Extensive coverage was made by local as well as international media with an article saying “A Party for Potty” – A Cambodian Village Celebrates Full Sanitation Coverage. Rolus Village also managed to see a significant number of families building latrine following the ignition process but never reached the ODF status. Subsequent assessment by MRD concluded that this village had more challenges compared to Slaeng including a larger number of families and flooding during the rainy season. The following are some lessons learned obtained by MRD and PDRDs from implementing the CLTS pilot as presented in a report prepared by MRD six months from the start of the pilot project:

- Communities are willing and able to build their own latrines without any subsidy but it needs intensive and good facilitation skills and intensive encouragement

- Reaching total sanitation or 100 percent coverage of latrines needs time and is especially difficult in large villages such as the one in Kampong Thom

- PDRD staff are capable and willing to serve as CLTS facilitators with proper training provided. Additional training on how to communicate effectively, how to facilitate community meetings, would be useful

- More community leaders are required if the size of the village is quite big. This is also to ensure that each community leader has the responsibility that is within his/her capacity

- Communities have various reasons for not having built latrines so far, for example about the reluctance to put the latrine in the house compound even though it is quite large

- Communities appreciate the high level of attention given by the facilitators to the results that they achieve in their village

- Dry latrines are very suitable – when they are used and maintained properly they do not cause bad smell

The success in Slaeng village attracted other NGO partners including Plan Cambodia and Swiss Red Cross to also implement CLTS in collaboration with MRD. In the six UNICEF-supported provinces, the implementation of CLTS has been decentralized since 2006. PDRDs of the respective province were responsible for planning, implementing and monitoring the activities while MRD provides technical support for training, monitoring and coordination.

2.1.3 Implementation Approach

CLTS is now either directly implemented by the DRHC-MRD with financial support from international donors/ organizations or by international NGOs whose staff are trained by DRHC and use the same 11-step CLTS facilitation process in villages. DRHC implements CLTS through its Provincial Departments of Rural Development (PDRD) and the District Rural Development units (DoRD). A core group of facilitators (usually around 5 persons) coming from the PDRDs and the DoRDs are trained on facilitation skills and on the 11-step CLTS process by key staff of the DRHC at the national level based on MRD guidelines. Training of trainers was repeated yearly so as to refresh knowledge and skills of facilitators. DHRC also regularly conducts quarterly workshops among national and provincial facilitators where CLTS experiences are shared and to resolve emerging issues. In trainings there is no over-all capacity building strategy i.e. national level trainings at times may involve participants from different levels at times and at other instances, only involve staff of provincial levels.

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The combination of PDRD and DoRD as the core facilitator group in target provinces resulted from the lack of qualified and in some instances the lack of staff at the provincial levels. While there may be more qualified government staff in other provincial departments (such as the Education, Women’s Affairs, etc.) the vertical nature of ministry operations precludes this strategy in obtaining and developing well-qualified facilitators at the provincial level.

2.1.3.1 Selection of Target Villages

In selecting villages, the DRHC in consultation with UNICEF officers, PDRD and commune chiefs developed broad selection guidelines including the following: Not near but not so far from the city; accessible; to enable frequently monitoring; not so rich, not so poor in terms of socio-economic condition; local authorities have strong will and commitment with sanitation improvement; high density of population because we expect that the needs to stop open defecation will be higher; not yet or limited assistance from other project or program on sanitation improvement. While the broad guidelines were provided to PDRD/ DoRD, the final decision/ selection of villages was at the provincial level and not with DRHC – with the knowledge that the PDRD/ DoRD knew the situation in villages much better than the DHRC. Hence, while in general selection of villages across provinces used similar guidelines, there were instances where not all or additional criteria were used. For example, PDRD Kampong Thom used no-flooding, houses are far from each other, commune council has strong commitment to support CLTS, and presence of primary school in village as the guidelines selecting villages for CLTS. However, in Siem Reap province, criteria used were support from local authorities, interest from villagers, physical conditions/ no flooding, no over-lap with other sanitation programmes, rural/ remote area, and poor existing sanitation situation. Also in Otdar Meanchay province, the criteria “no-overlap/ no previous sanitation programme” was not used since it was very difficult to find villages that had no previous or on-going sanitation programme either by government or by NGOs. In many cases, target villages were always flooded during the wet season. This meant that the selection process did not really look at the flooding conditions in the selected villages or that while the flooding criteria was not satisfied, all other criteria used were met. Selection of villages that are perennially flooded has caused access and sustainability issues within the CLTS approach.

2.1.3.2 CLTS Facilitators

At the commune level, PDRD/ DoRD work with commune focal persons for water and sanitation who were selected by the Commune Chief. Normally there are two commune focal persons, the council member in charge of health and sanitation and the member in charge of women’s affairs. Commune focal persons are also trained in the CLTS 11-step facilitation process, OD issues/ problems, latrine building, and other health related topics. Commune focal points monitor the CLTS process in villages by visiting households and meeting with village focal persons. Visits with households focus on monitoring of latrine construction and maintenance and discussing S&H issues and practices. As with the PDRD/ DoRD CLTS facilitators, commune focal persons work within a period of 6 months visiting villages where CLTS is being implemented at least once a month. Commune focal persons and transport allowance, from $1 to $2 every month in UNICEF provinces. At the village level, village focal persons (VFPs) are mobilized under the CLTS process. VFPs are supposedly the community leaders under the CLTS approach. However, because the term “leaders” is not widely accepted when bestowed on individuals in villages outside of the village chief, deputy village chief, village group leaders, etc., the term “focal persons” is used instead. Ideally, selection of VFPs would be through nomination by villagers of individuals they believe have the capacity, commitment, and time to be actively involved in CLTS in the village. However, often VFPs are selected/ nominated by the village chiefs – choosing those individuals he/ she personally knows or those who are the group leaders in the villages. The number of VFPs depends on the population size of the village. For large villages, there are at least 5 VFPs. For monitoring purposes and general support/ advice to the people, the village area is divided among the VFPs. VFPs also receive training on the 11-step CLTS process, on latrine-building, on OD issues/ problems, and on other S&H topics. Trainings are either done in the villages by CFPs or DoRD staff or at the provincial level with the PDRD facilitators. Technically, VFPs are volunteers and hence do not receive any incentive but when they attend trainings/ workshops outside of the village, they receive about $ 2.5 a day. Reported tasks/ responsibilities of the VFPs are: explaining to people build and use latrines to improve family and village health situation; encourage/ push people to build latrines as soon as they can; advice on latrine- building; and keeping the village chief, CFPs, DoRD/ PDRD, and other CLTS stakeholders informed on the process and status of latrine-building and use in the villages.

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Recently, PDRD has started to mobilize district authorities (Governors and Deputy-Governors) as CLTS focal persons. PDRD reports that district authorities were mobilized as an additional monitoring level to backstop the monitoring/ encouragement work of commune focal points and village chiefs. While they do not regularly visit/ monitor villages nor do they facilitate community meetings, district authorities serve more as encouragement factor to villagers who are not building or taking too much time in building latrines.

2.1.3.3 Institutional Structure of CLTS approach

Figure 2 below presents the current institutional structure of the CLTS approach in the nine provinces were the approach is being implemented. These structures developed and set in place in 2006

8 were

mainly for the CLTS activities implemented under the cooperation between MRD and UNICEF. However, at present the same structure is in-place in all nine CLTS provinces in the country. At the national level, seven staff at the DHRC comprises the CLTS national team while at the provincial level, 3-5 PDRD staff serve as facilitators within the CLTS provincial team. At the community level, PDRD and the DoRD assign two commune council members as focal points under the supervision of a DoRD CLTS facilitator. In CLTS villages, the village chiefs serve as the main focal point alongside volunteer community focal points.

Figure 2. Institutional Structure of CLTS Approach under MRD

PDRD

DoRD

Development Partners

I/ NGOSs

Commune CommuneCommune

DRHC - MRD

CLTS Team

CLTS Provincial

Team

Village VillageVillage

In provinces where MRD is facilitating CLTS with support from UNICEF, the UNICEF provincial adviser works directly with PDRDs in CLTS implementation. In other provinces where MRD works with support from other NGOs/ international organizations such as Plan International, Lien Aid, and Swiss Red Cross, similar support systems are also currently in place. NGOs also mobilize their own commune level staffs that support commune focal points in CLTS implementation – as was done by Plan in Siem Reap and Kampong Cham provinces.

2.1.3.4 Links with the PDRC/ ExCom and DSA and Transportation Support

Currently, CLTS under DRHC is funded by the UNICEF, the Plan International and Lien Aid organization.

8 Based on discussions with DHRC-MRD officers and staff

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The PDRDs in UNICEF provinces are supported by UNICEF through the Provincial Rural Development Committee (PRDC) which is chaired by the Provincial Governor. The day-to-day functions of the PDRC are handled by the Executive Committee (ExCom) which is led by a permanent member. The ExCom comprises of four units – the Local Administration Unit, the Contracts Administration Unit, the Finance Unit, and the Technical Support Unit. CLTS is part of the UNICEF-funded Water, Sanitation and Hygiene (WASH) project. PDRDs obtain funding from the PDRC through the ExCom based on an annual sub-contract between PRDC/ExCom and PDRD which is developed in consultation with the UNICEF staff based in the province. The ExCom submits the requests for funds to UNICEF on a quarterly basis and subsequently disburse the funds to PDRDs. The Finance Unit of the ExCom monitors the disbursement of the budgets by PDRD ensuring that the money is spent as budgeted. However, there is no monitoring on the outcomes of the activities funded by the PDRD CLTS budgets. Other than the funding process and the monitoring of budget expenditures, the PDRC/ ExCom have no other working interaction with the PDRD/ CLTS project. The UNICEF provincial based staff conducts regular monitoring of the CLTS activities as part of their responsibilities for monitoring UNICEF supported WASH activities Plan International works directly with the PDRD (provinces of Siem Reap and Kampong Cham) providing direct funding to CLTS activities developed by the PDRD. Plan directly works with the PDRD, constantly following up planned CLTS activities, emerging issues/ problems, and outcomes of planned activities. Plan also mobilized its own commune development facilitators who support the CLTS activities of the PDRD. One difference between the UNICEF and the Plan support to PDRDs is the financial support provided to CLTS facilitators of PDRD/ DoRD for daily allowance and for transportation expenses. UNICEF follows the SEILA developed financial support guidelines which provides $3.5 daily allowance and $3 per day transportation and motorcycle maintenance allowance (PDRD level) and $3.5 daily allowance and $2 daily allowance and motorcycle maintenance allowance (DoRD level)

9. This support is normally provided for 20

days per month for 6-7 months per year. On the other hand, Plan provides daily support based on the distance to target villages – Angkor Chum district at $11 /day, Angkor Thom district at $9/ day, and Banteay Srei district at $8/ day – inclusive of transportation and maintenance for the same period of time

10. This different support schemes have been noticed and reported by PDRDs of different provinces –

seeking the same incentives for all CLTS provinces based on Plan’s support design.

2.1.3.5 Monitoring

Monitoring of the CLTS process in target villages are carried on from the national to provincial and to the village/ community level. At the DHRC, seven staffs are assigned to cover the nine current target provinces. These staffs conduct monitoring visits with PDRD/ DoRD and also visit the target villages on a monthly basis. PDRD/ DoRD monitoring visits are done twice a week for six months. District authorities do not regularly visit villages but do so depending on the request of PDRD or the commune councils. Commune focal persons visit CLTS villages at least three times a month over a period of 6 months and more if the village chief invites/ asks for frequent visits. At the village level, village chiefs and other village focal persons monitor households either everyday or every week. It is apparent that within the 6-month period where CLTS villages are monitored, the combined monitoring of PDRD/DoRD, district and commune authorities and by village focal persons is very frequent perhaps too frequent. Responses of villagers also indicate this intensive monitoring as described in Section 3.2. While monitoring is very frequent, there appears to be limited documentation of what is actually happening in villages. As an example, while PDRD/ DoRD conducted a participatory village assessments at the initiation phase of CLTS in villages, no documentation are available currently that can be used as a reference to monitor changes. The main documentation available is the number of latrines built in each village. Records of problems and issues on latrine durability (e.g. what are the problems/ when they occur/ what steps were taken by villagers or by external facilitators, etc.) or status of the poorest in terms of latrine building and maintenance are not available. These information may be known among facilitators but these are not written down for future reference/ sharing.

9 Reported by PDRD/ DoRD staff at Kampong Thom province

10 Reported by PDRD staff at Siem Reap province

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2.1.3.6 Current and Potential Funding Sources

As mentioned above, the UNICEF and Plan International are currently the key funding sources of CLTS by government. Both these organizations provide resources for allowances and transportation costs of all facilitators/ focal points from the provincial level down to the commune level. They also provide resources for trainings and workshops that are done periodically. The Lien Aid NGO and the Swiss Red Cross also fund CLTS projects in other provinces in collaboration with PDRDs in such provinces. The World Bank funded Water and Sanitation Project (WSP) also supports CLTS in Cambodia but does not directly provide funding support for CLTS activities. Instead, the WSP has undertaken research and studies on on-going and new sanitation approaches in support of improving/ scaling-up CLTS in the country. WSP also implements pilot projects to test new approaches and technologies that can be integrated into the CLTS approach. For example, the WSP is currently starting-up the implementation of social marketing of sanitation materials to provide low-cost/ accessible latrines to rural villages. It has also supported pilot development and fabrication of low cost latrines using indigenous materials in selected villages. WSP is also presently undertaking a cost-benefit study of sanitation approaches in selected areas in the country. WSP has also supported the CLTS approach through provision of sanitation IEC materials to MRD such as posters and manuals on low-cost construction for rural latrines. For future scaling-up of CLTS in Cambodia, WSP interests lie in sharing resources to support any components of program. Based in discussions with DHRC, there appears to be emerging interest to support scaling-up of CLTS in Cambodia from the Department for International Development (DFID), the AusAid, and other development partners working in Cambodia. Within the government, the decentralization and deconcentration policy of the RGC is also creating potential funding sources for continued and expanded CLTS in current villages and in new villages that are not yet covered by other sanitation programmes of government or of NGOs. Discussions with district authorities

11 (deputy-governors) indicate that district can allocate funds to commune plans/ activities that

fall under the categories of environment, health, agriculture, among others, that provide trainings, awareness-raising and other “software” services. Communes have to develop plans and submit such to District for funding. At present, about $700 - $1,000 for each sector that the District decides to support or a total of $12,000 every year. At the commune level, depending on the size of communes (number of villages and population), communes also receive yearly development budgets (ranging from $7,000 to $12,000) that it can spend depending on its priorities. While sanitation/ hygiene activities currently take a back-seat to rural infrastructure projects (roads, wells, etc.), commune development funds can also be utilized to sustain and expand CLTS.

11

Interview with Deputy Governor of Kampong Svay District, Kampong Thom

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2.2 Overview of the TSRWSSP

The Tonle Sap Rural Water Supply and Sanitation Project is a 6-year $24M ADB-funded project that is being implemented by the Department of Rural Water Supply of the MRD. It aims to increase the percentage of the rural population with access to safe water supply to 50%, and sanitation facilities to 30%, in the Project areas. The ultimate goal of the Project is to improve the rural people’s quality of life in the Project areas of Battambang, Kampong Chhnang, Kampong Thom, Pursat, and Siem Reap provinces The target beneficiaries for safe water are 1.09 million rural people (20 liter/day/capital at less than 150 meters), and for latrine access to 0.7 million rural people by 2011. Priority is given to villages found in the poorest 20% communes (reference will be made to the database updated by the MOP with support of WFP) TSRWSSP has four specific objectives, namely: a) strengthen the community capability to design, co-finance, build, operate, and manage community-based water supply and sanitation facilities and increase hygiene awareness through information, education, and communication campaigns; b) improve access to safe water through the construction of adequate facilities based on community demand; c) expand access to sanitation facilities; d) and improve the capacity of government agencies, particularly at the local level, to plan and facilitate provisions for quality water and sanitation services in target communities. The project includes four components: Community Mobilization and Skills Development Program; Water Supply Improvement; Sanitation Improvement; and Capacity Building and Institutional Support. The Sanitation Improvement component comprises of construction of household latrines on a matching fund basis; (mainly pour flush latrines and ventilated improved pit latrines (VIP), and preceded or introduced concurrently with hygiene education), and construction of public latrines in schools, markets, health centers, pagodas and tourist spots. The Capacity Building and Institutional Support component intends to provide capacity building to MRD/PDRD/DORD/Commune councils and to private entrepreneurs involved in supply and management contracts in WSS. It will also establish of a Nation-wide Rural Water Supply and Sanitation database to serve as a national reference on rural water supply and sanitation coverage. TSRWSSP is technically supported by a Project Management Consultant, the Louis Berger Group, Inc. in association with SB R&D (a local consulting group in Cambodia). The Project Management Unit (PMU) headed by the Project Director at the Department of Rural Water Supply, Ministry of Rural Development is the key implementing mechanism at the national level. At the provincial levels, Project Implementation Units (PIU) headed by the PDRD Director at the PDRD Office in target provinces are the direct implementation mechanism. The PIUs are supported by the District Office of Rural Development (DORD) to facilitate and assist in Integration workshops for village selection and subproject identification process; by the Commune Councils in supervision and coordination of village interventions and facilitation of village engagements; and by the Village Development Committee and Water and Sanitation Users Group which participates in community participatory planning process, subproject preparation, supervision of village water systems and household latrines, and participates in village level project activities. In each target province, a qualified local NGO was selected to support the PIUs in project implementation particularly on the Community Mobilization and Skills Development component. According to interviews with PIUs and the PMU Consultant, the staffs of the PMU and the PIUs are organic staffs of MRD and PDRD who were re-assigned to be the TSRWSSP staff at the national and provincial level. This means that no new staff were recruited and hired for the Project whether at the national or the provincial levels. The Project started in 2006 but activities was mainly limited to setting up project management at national and provincial levels with actual delivery of project components starting in late 2006 to early 2007. Hence, the Project has only been effectively implemented for two years at present. As of November 2008, the Project’s Sanitation component has reached a total of 17,449 households providing different types of latrines/ latrines in the five target provinces (Table 4). This is seen in detail in Table 2 below. According to PMU Consultant officers, dry-pit and ventilated improved pit latrines are

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designed for the poorer households in target villages. At present, about 24% of total beneficiaries are the poor households. Combined well and latrine construction achievements are presented in Table 5 below. Table 4. Current Achievement under Sanitation Component

Province DP VIP WS PF Completed (30-11-08)

BTB 554 30 1,168 3,435 5,187

KCN 591 173 752 930 2,446

KTM 1,299 510 917 1,796 4,523

PST 395 98 349 1,669 2,511

SRP 425 166 580 1,611 2,782

Total 3,265 977 3,766 9,441 17,449

% 18.71% 5.60% 21.58% 54.11% 100% Source: TSRWSSP

Table 5. Over-all Achievements in Well and Latrine Construction

Type of Work BTB KCN KTM PST SRP Total

Drill well 789 697 250 300 646 2,682

Combined Well 192 150 428 93 194 1,057

Hand Dug Well 172 172

Household Latrine 5187 2446 4523 2511 2782 17,449 Source: TSRWSSP

The total costs of each type of household latrines under the Project are presented in Table 6 below. Four types of latrines are offered to beneficiaries through an “informed-choice” process – a meeting is held in villages and each type of latrine and their costs are presented to all interested villagers then villagers can choose the type of latrine they want according to their means. The basic latrine type, dry pit latrines, costs $133. If this type is chosen by a villager, 10% of the total cost should come as a contribution from the villager. However, no cash contribution is required for this type. Labor and materials for the upper structure of the latrine (walls and roofs) comprise the 10% contribution of households. Table 6. Costs of Latrines/ Latrines

No Type Unit 2006 2007 2008 Beneficiary Project

1 Dry Pit each 85.00 101.00 133.00 10% 90%

2 VIP each 100.00 116.00 133.00 20% 80%

3 Water Seal each 127.00 155.00 142.00* 40% 60%

4 Pour Flush each 141.00 222.00 145.00* 60% 40%

Source: TSRWSSP

One distinct approach on latrine provision of the Project is the establishment of Water and Sanitation User Groups (WSUGs) in the target villages. WSUG membership comprises of the main users of sub-projects (water wells, sanitation facilities) who are organized into viable maintenance units of the sub-projects. Members of WSUGs elect their board members. The board then becomes the direct link to project management in terms of sub-project management and maintenance. Through and in consultation with the WSUG Boards, the Project develops sanitation maps of the village, specific sanitation campaign activities, training plans, community motivation and mass actions, and a strategy for 100% latrine coverage within a given time-frame. Board members are trained on total sanitation concepts, on the guidelines for informed-choice and selection options, on various latrine technical design options, and on household latrine construction contract management. Thereafter, the Project selects and trains village sanitation technicians then conducts village-level sanitation awareness promotion campaigns. It is only after these series of steps that latrines are constructed among households who have gone through the informed-choice processes in village meetings.

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3 Findings of Children and Household Surveys 3.1 Children Survey The results presented in this section were from the questionnaire interviews with children randomly selected in the survey villages. FGDs among children were not conducted. 3.1.1 Profile of Children Respondents The mean age of children interviewed was 12 years in both CLTS and TS villages. Girls comprised 55% of the sample in CLTS villages and 62.5% in TS villages. See Tables 1 and 2. Table 7. Age of respondent

Age CLTS TS

Mean 11.5 11.8

Maximum 17.0 15.0

Minimum 6.0 8.0

Table 8. Gender

Gender

CLTS TS Total

N % n % n %

Male 36 45 9 37.5 45 43.3

Female 44 55 15 62.5 59 56.7

Total 80 100 24 100 104 100.0

In terms of educational level, 92.5% were in primary school in CLTS villages and 91.7% in TS Villages (Table 3). About 2% have never attended school. Literacy was 66.3% in CLTS villages and 79.2% in TS villages (Table 4). At the time of the survey, 86.3% were still studying in CLTS villages and 95.8% in TS villages (Table 5). Table 9. Educational Attainment

Education level

CLTS TS Total

N % n % n %

None 1 1.3 0 - 1 1.0

Primary School 74 92.5 22 91.7 96 92.3

Secondary School 5 6.3 2 8.3 7 6.7

Total 80 100 24 100 104 100.0

Table 10. Literacy

Literate

CLTS TS Total

N % n % n %

Yes 53 66.3 19 79.2 72 69.2

No 27 33.8 5 20.8 32 30.8

Total 80 100 24 100 104 100.0

Table 11. Present Schooling Status

Status CLTS TS Total

Studying 69 86.3 23 95.8 92 88.5

Stopped 11 13.8 1 4.2 12 11.5

Total 80 100 24 100 104 100.0

3.1.2 Sanitation and Hygiene Knowledge In CLTS villages, 71.3% of children respondents indicated that S&H practices were being taught in schools. In TS villages, this figure was at 87.5%. See Table 6. Table 12. Whether S&H practices are taught in school

Response CLTS TS Total

N % n % n %

Yes 57 71.3 21 87.5 78 75.0

No 17 21.3 3 12.5 20 19.2

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Don't know 6 7.5 0 - 6 5.8

Total 80 100 24 100 104 100.0

In both CLTS and TS villages, the main S&H practice learned was washing hands before eating (71.8%). In terms of S&H practices learned in school, reporting of washing hands after defecation was higher in TS villages (52.4%) than in CLTS villages (29.8%). Washing hands before eating and washing hands when dirty were reported at nearly the same percentages in both village types. For cleaning latrines, CLTS villages reported higher at 14% than TS villages (9.5%). See Table 13.

Table 13. S&H practices taught in school

Practices CLTS TS Total

N % n % n %

Washing Hands When they are dirty 15 26.3 6 28.6 21 26.9

Washing Hands When returning to the household 1 1.8 3 14.3 4 5.1

Washing Hands Before eating 41 71.9 15 71.4 56 71.8

Washing Hands After eating 13 22.8 3 14.3 16 20.5

Washing Hands After defecation 17 29.8 11 52.4 28 35.9

Washing Hands Before going to sleep 5 8.8 2 9.5 7 9.0

Washing Hands After waking up 0 - 1 4.8 1 1.3

Washing Hands Before preparing food 1 1.8 0 - 1 1.3

Washing Hands After washing baby 1 1.8 0 - 1 1.3

Drink Clean or Boil water before drinking 7 12.3 4 19 11 14.1

Have clean and hygiene food (cook well) 3 5.3 4 19 7 9.0

Total 57 100 21 100 78 100.0

According to majority of all children respondents, their parents taught hygiene and sanitation practices in their homes (79.8%). More children in TS villages indicated this than in CLTS villages (95.8% TS and 75% in CLTS). See Table 8. Table 14. Whether S&H practices are taught by parents

Response

CLTS TS Total

N % n % n %

Yes 60 75 23 95.8 83 79.8

No 19 23.8 1 4.2 20 19.2

Don't know 1 1.3 0 - 1 1.0

Total 80 100 24 100 104 100.0

Washing hands before eating was the main reported practice taught by parents (75% in CLTS and 65% in TS villages). Other reported practices taught by parents were washing hands after eating (25.7%), washing hands when dirty (23.8%), and washing hands after defecation (22.8%). Responses on washing hands after defecation were higher in TS villages (30.4%) than in CLTS villages (23.3%). Cleaning of latrines was not reported as being taught by parents. See Table 9.

Table 15. S&H practices taught by parents

CLTS TS Total

Practices N % n % n %

Washing Hands When they are dirty 14 23.3 5 21.7 19 22.9

Washing Hands When returning to the household 4 6.7 2 8.7 6 7.2

Washing Hands Before eating 45 75 15 65.2 60 72.3

Washing Hands After eating 15 25 4 17.4 19 22.9

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Washing Hands After defecation 14 23.3 7 30.4 21 25.3

Washing Hands Before going to sleep 3 5 3 13 6 7.2

Washing Hands After waking up 1 1.7 1 4.3 2 2.4

Washing Hands Before preparing food 1 1.7 0 - 1 1.2

Drink Clean or Boil water before drinking 6 10 3 13 9 10.8

Total 60 100 23 100 83 100.0

Majority of children indicated that they inform their sibling or relatives (52%) as to hygiene and sanitation practices they learned in school or from their parents. However, as to informing their friends about hygiene and sanitation practices, nearly 57% said otherwise. See Table 10. Table 16. Whether siblings or friends are informed of S&H practices learned

Informing siblings/ relatives CLTS TS Total

n % n % n %

Yes 40 50 14 58.3 54 51.9

No 40 50 10 41.7 50 48.1

Total 80 100 24 100 104 100.0

Informing Friends CLTS TS Total

n % n % n %

Yes 32 40 13 54.2 45 43.3

No 48 60 11 45.8 59 56.7

Total 80 100 24 100 104 100.0

3.1.3 Sanitation and Hygiene Practices and Perceptions

3.1.3.1 Hand-washing practices and perceptions12

Nearly all children reported washing their hands. Reporting is higher in TS villages at 100% as compared to CLTS villages which was at 98.8%. However, the difference is negligible since only one child in CLTS villages responded in the negative. See Table 11. Table 17. Hand-washing practice

Response

CLTS TS Total

n % n % n %

Yes 79 98.8 24 100 103 99.0

No 1 1.3 0 - 1 1.0

Total 80 100 24 100 104 100.0

Hand-washing is generally done by children before eating (91.3%), after defecation (37.9%), when dirty (35.9%), and after eating (26.2%). Hand-washing before eating is reported higher in CLTS village (92.4%) than in S villages (87.5%). Hand-washing after defecation was reported higher in TS villages (50%) than in CLTS villages (34.2%). See Table 12

Table 18. Time of hand-washing

Time

CLTS TS Total

n % n % n %

When they are dirty 30 38 7 29.2 37 35.9

When returning to the household from school/ outside 5 6.3 7 29.2 12 11.7

Before eating 73 92.4 21 87.5 94 91.3

After eating 23 29.1 4 16.7 27 26.2

After defecation 27 34.2 12 50 39 37.9

Before going to sleep 15 19 2 8.3 17 16.5

12

Hand-washing practices and perceptions are presented in the Report as reported by children respondents. There is no other information source other than the interview results. No observations were done on hand-washing practices since this would require extended stay with children in the survey villages.

25

After waking up 5 6.3 1 4.2 6 5.8

Before preparing food 2 2.5 1 4.2 3 2.9

Total 79 100 24 100 103 100

Majority of children (57.3%) wash hands three times a day while 28% wash hands twice a day. The rest wash their hands at four or more times a day. See Table 13.

Table 19. Frequency of Hand-washing

Frequency

CLTS TS Total

n % n % n %

One time/day 0 0 1 4.2 1 1.0

two times/day 23 29.1 6 25 29 28.2

three times/day 46 58.2 13 54.2 59 57.3

four times/day 6 7.6 2 8.3 8 7.8

Five times/day 3 3.8 2 8.3 5 4.9

More than five times/day 1 1.3 0 0 1 1.0

Total 79 100 24 100 103 100.0

Washing hands with soap by children is done before eating (89.3%), when the hands are dirty (34%), after defecation (28.3%), and after eating (29.1%). Hand-washing with soap before eating is reported higher in CLTS villages (91.1%) than in TS villages (83.3%). Hand-washing with soap after defecation is marginally higher in CLTS villages (30.4%) as compared to TS (29.2%). See Table 14.

Table 20. When soap is used in hand-washing

Instance

CLTS TS Total

n % n % n %

When they are dirty 29 36.7 6 25 35 34.0

When returning to the household from school/ outside 2 2.5 3 12.5 5 4.9

Before eating 72 91.1 20 83.3 92 89.3

After eating 26 32.9 4 16.7 30 29.1

After defecation 24 30.4 7 29.2 31 30.1

Before going to sleep 7 8.9 2 8.3 9 8.7

After waking up 2 2.5 2 8.3 4 3.9

Before preparing food 1 1.3 0 0 1 1.0

Other 0 0 1 4.2 1 1.0

Total 79 100 24 100 103 100.0

Water and soap is reported to be used regularly by nearly all children (92.2%) in hand-washing, followed by water only (46.6%), and then ash only (31.1%) – Table 15. Nearly all children (99%) wipe their hands after washing using clothes (88.2%) and scarves (11.8%). See Table 16 and 17.

Table 21. Cleansing material used in hand-washing

Cleansing material

CLTS TS Total

n % n % n %

Water Only 36 45.6 12 50 48 46.6

Ash Only 20 25.3 12 50 32 31.1

Sand Only 1 1.3 0 - 1 1.0

Water and Soap 72 91.1 23 95.8 95 92.2

Total 79 100 24 100 103 100.0

Table 22. Practice of hand-wiping/ drying

Response

CLTS TS Total

n % n % n %

Yes 79 100 23 95.8 102 99.0

No 0 - 1 4.2 1 1.0

Total 79 100 24 100 103 100.0

Table 23. Material used in hand-wiping/ drying

Material used

CLTS TS Total

n % n % n %

Clothes 67 84.8 23 100 90 88.2

26

Scarf 12 15.2 0 - 12 11.8

Total 79 100 23 100 102 100.0

Children say that they wash their hands to prevent disease (74.8%), to remove dirt/ make hands clean (52.8%), and to feel clean (10.2%). Report of washing hands for disease prevention is nearly the same across different village types, 73.4% for CLTS, 75% for TS, and 79.2% for OV villages. See Table 18.

3.1.3.2 Defecation practices and perceptions

Defecation practices When in the field/ chamkar all children defecate on the ground or forests (Table 19). When in public places, most (97.3%) use public latrines

13 with a few children asking for use of other people’s latrines

(Table 20).

Table 24. Defecation practice at field/ chamkar

Practice CLTS TS Total

n % n % n %

On the ground/forest 79 100.0 23 100.0 102 100.0

Total 79 100.0 23 100.0 102 100.0

Table 25. Defecation practice in public areas

Practice

CLTS TS Total

n % n % n %

In public latrine 70 97.2 20 95.2 90 96.8

Ask other villagers 2 2.8 1 4.8 3 3.2

Total 72 100 21 100 93 100.0

At home children generally defecate on the ground or forests (42.3%) or in Hh latrines (41.3%). Nearly 14% practice “chhik korb”

14. Use of latrines is higher in TS villages (58.3%) than in CLTS villages

(36.3%). Practice of chhik korb is higher in CLTS villages (16.3%) than in TS villages (4.2%). See Table 21.

Table 26. Defecation practice at home

Practice

CLTS TS Total

n % n % n %

On the ground/forest 36 45 8 33.3 44 42.31

In a water body 1 1.3 0 - 1 0.96

In your own latrine 29 36.3 14 58.3 43 41.35

In neighbor latrine 3 3.8 1 4.2 4 3.85

Digging pit 13 16.3 1 4.2 14 13.46

Total 80 100 24 100 104 100.00

Majority of children use water (53.8%) for cleaning after defecation. Leaves (31.7%), small wood or twigs (15.4%), and paper (13.5%) are also used for cleaning purposes. Use of water is highest in TS villages (66.7%) than in CLTS villages (50%). See Table 22.

Table 27. Cleansing materials after defecation

Materials

CLTS TS Total

n % n % n %

Water 40 50 16 66.7 56 53.8

Leaves 24 30 9 37.5 33 31.7

Paper 12 15 2 8.3 14 13.5

Small wood (twigs) 12 15 4 16.7 16 15.4

Other 6 7.5 0 - 6 5.8

Total 80 100 24 100 104 100.0

13

Public latrines indicated are latrines in markets, in pagodas, in schools, and in others that are for public use. 14

Practice of digging a hole about 6 inches to a foot deep and covering with soil and tamping down after defecation.

27

In cases where the children take care of infants, infants’ faeces are generally disposed of by digging a hole (55.8%). Other means of disposing of infants’ faeces are in latrines (22.1%), and throwing in the forest/ farm (11.5%). See Table 23.

Table 28. Disposal of infants’ faeces

Practice

CLTS TS Total

n % n % n %

In your own latrine 17 21.3 6 25 23 22.1

In a water body 1 1.3 2 8.3 3 2.9

Digging hole 43 53.8 15 62.5 58 55.8

Do not know 3 3.8 0 - 3 2.9

Defecate in latrine 1 1.3 0 - 1 1.0

Throw into the forest/Farm 9 11.3 3 12.5 12 11.5

Other 8 10 1 4.2 9 8.7

Total 80 100 24 100 104 100.0

According to nearly 92.3% of all children, open defecation is currently practiced by their family members when working in the field/ chamkar (Table 24). Reasons provided for this practice are the house is far (59.6%), no latrines in field/ chamkar (37.5%), and that open defecation in the field/ chamkar is a habit among people (15.4%). See Table 25.

Table 29. Whether OD is still practiced in field/ chamkar

Response

CLTS TS Total

n % n % n %

Yes 74 92.5 22 91.7 96 92.3

No 6 7.5 2 8.3 8 7.7

Total 80 100 24 100 104 100.0

Table 30. Reasons for OD at field/ chamkar

Reasons

CLTS TS Total

n % n % n %

Habit 15 18.8 1 4.2 16 15.4

The rice farm is far from home/ work far from home 45 56.3 17 70.8 62 59.6

No latrine 31 38.8 8 33.3 39 37.5

Total 80 100 24 100 104 100.0

Latrine Cleaning According to 30.2% of children interviewed, latrines are cleaned every 2 to 3 days or every day (30.5%), More than once a day cleaning is reported by 13.2% and less than once a week to 11.3% of the children. Some 15% of the children also indicate that latrines are rarely cleaned. Every day cleaning is nearly the same across village types (29.7% in CLTS and 31.3% in TS). Cleaning once every 2-3 days is practiced more in TS (37.5%) than in CLTS (27%) villages. See Table 26

Table 31. Frequency of latrine cleaning

Frequency

CLTS TS Total

n % n % n %

One time/day 11 29.7 5 31.3 16 30.2

More than one time/day 4 10.8 3 18.8 7 13.2

One time/2-3day 10 27 6 37.5 16 30.2

Less than one time/week 5 13.5 1 6.3 6 11.3

Rarely 7 18.9 1 6.3 8 15.1

Total 37 100 16 100 53 100.0

Nearly 66% of the children indicated that they helped in cleaning latrines. This practice is reported highest in TS villages (68.8%) as against in CLTS villages (64.9%). See Table 27. The tasks children indicated in cleaning latrines clean garbage and wastes (40%), washing with soap and water (37.1%), putting ash (28.6%), and washing with water only (14.3%). Cleaning garbage and waste was reported but only in CLTS villages. Washing with soap and water is reported more in TS villages (81.8%) and in OV villages (66.7%) than in CLTS villages (16.7%). Cleaning garbage and waste and putting ash is more common in CLTS villages since majority of latrines are dry-pit latrines where water is not generally used for cleaning.

28

On the other hand, washing with soap and water is much higher in TS villages since many households have pour-flushed/ sealed latrines and water is readily available. See Table 28.

Table 32. Participation in latrine cleaning

Response

CLTS TS Total

n % n % n %

Yes 24 64.9 11 68.8 35 66.0

No 13 35.1 5 31.3 18 34.0

Total 37 100 16 100 53 100.0

Table 33. Tasks in latrine cleaning

Tasks

CLTS TS Total

n % n % n %

Put ash 8 33.3 2 18.2 10 28.6

Wash with soap and water 4 16.7 9 81.8 13 37.1

Washing with water only 3 12.5 2 18.2 5 14.3

Clean the garbage/ waste 14 58.3 0 - 14 40.0

Total 24 100 11 100 35 100.0

Reported common illnesses in the last 3 months In CLTS villages, the most common illnesses reported by children were cold/ flu (44.2%), fever (37.5%), diarrhea (21.2%) and stomach aches (16.3%). Incidence

15 of diarrhea is reported higher in TS villages

(45.8%) than in CLTS villages (13.8%). See Table 29.

Table 34. Common illnesses in the last 3 months

Illnesses

CLTS TS Total

n % n % n %

Diarrhea 11 13.8 11 45.8 22 21.2

Typhoid 6 7.5 3 12.5 9 8.7

Fever 27 33.8 12 50 39 37.5

Stomach ache 10 12.5 7 29.2 17 16.3

Cold / influenza 36 45 10 41.7 46 44.2

Dengue 8 10 1 4.2 9 8.7

Headache/Dizzy 6 7.5 3 12.5 9 8.7

Total 80 100 24 100 104 100.0

Note: other illnesses reported with very low values are not included.

Most of the children

16 (59.1%) reported not knowing how to prevent diarrhea (Table 30). For those who

said they knew how to prevent diarrhea (31.8%), boil drinking water (42.9%) and being careful of what food to eat (42.9%) were the main responses. All other responses such as cooking food properly, wash hands, wash hands before eating, and clean cooking/ eating utensils were all reported equally at 14.3%. It is noteworthy that children did not report washing hands after defecation as a way to prevent diarrhea. See Table 31.

Table 35. Knowledge of diarrhea prevention

Response

CLTS TS Total

n % n % n %

Yes 5 45.5 2 18.2 7 31.8

No 5 45.5 8 72.7 13 59.1

Don't know 1 9.1 1 9.1 2 9.1

Total 11 100 11 100 22 100.0

Table 36. Practices to prevent diarrhea

Practices

CLTS TS Total

n % n % n %

Cook food properly – eat soon after cooking 1 20 - - 1 14.3

15

Diarrhea incidences are reported by children respondents. However, no information was provided as to the causes of such incidences. 16

Only children who mentioned diarrhea as a common disease are asked if they know how to prevent diarrhea.

29

Be careful about what kind of food you eat 2 40 1 50 3 42.9

Boil drinking water 2 40 1 50 3 42.9

Wash hands 1 20 - - 1 14.3

Wash hands before eating 1 20 - - 1 14.3

Clean cooking and eating utensils (Plates, bowls, pots, spoons, etc.) 1 20 - - 1 14.3

Total 5 100 2 100 7 100.0

30

3.2 Household Survey 3.2.1 Respondents Profile Majority of household respondents were females (74%) – Table 32. Nearly 42% reached primary school, 12% reached secondary school, and 5.6% were able to attain high school levels. About 40% had no education at all. See Table 33. Table 37. Gender of Respondents

Gender

CLTS TS Total

n % n % n %

Male 43 26.9 11 22.9 54 26.0

Female 117 73.1 37 77.1 154 74.0

Total 160 100 48 100 208 100.0

Table 38. Educational Attainment

CLTS TS Total

n % n % n %

None 65 41.4 18 40 83 39.8

Primary School 63 40.1 19 42.2 82 41.8

Secondary School 18 11.5 6 13.3 24 12

High School 9 5.7 2 4.4 11 5.6

Technical/ vocational 1 0.6 0 - 1 0.4

College undergraduate 1 0.6 0 - 1 0.4

Total 157 100 45 100 202 100

3.2.2 Land (Agricultural and Residential) and House Characteristics

Land characteristics Most of respondents owned agricultural land with only 9.6% having none. More respondents in CLTS villages (10%) had no land as compared to TS villages (8.3%) – Table 34. Over the last 12 months, size of agricultural land averaged 1.72 hectares in CLTS villages and 1.12 hectares in TS villages. See Table 35.

Table 39. Agricultural land ownership

Ownership

CLTS TS Total

n % n % n %

Yes 144 90 44 91.7 188 90.4

No 16 10 4 8.3 20 9.6

Total 160 100 48 100 208 100.0

Table 40. Size of owned agricultural land in last 12 months Area CLTS TS

Mean 1.72 1.12

Median 1.00 1.00

Maximum 20.00 3.30

Minimum .04 .04

Absence of residential land is higher in TS villages (10.4%) than CLTS villages (6.3%). See Table 36. Respondents in CLTS villages report the least land area (0.1 hectare and in TS villages (0.13 hectares). See Table 37. Majority (64.8%) of residential land had no official ownership documents (Table 38). Lack of residential land ownership documents is higher in TS villages (76.7%) than in CLTS villages at 61.3%. For those that had land ownership documents, most (91.2%) had land certificates and the rest had land titles. See Table 39.

Table 41. Residential land ownership

Ownership

CLTS TS Total

n % n % n %

Yes 150 93.8 43 89.6 193 92.8

No 10 6.3 5 10.4 15 7.2

31

Total 160 100 48 100 208 100.0

Table 42. Sized of owned residential land Size CLTS TS

Mean 0.10 0.13

Median 0.07 0.06

Maximum 0.50 0.56

Minimum 0.00 0.01

Table 43. Proof of residential land ownership

Response

CLTS TS Total

n % n % n %

Yes 58 38.7 10 23.3 68 35.2

No 92 61.3 33 76.7 125 64.8

Total 150 100 43 100 193 100.0

Table 44. Type of residential land ownership proof

Proof type

CLTS TS Total

n % n % n %

Land certificates 52 89.7 10 100 62 91.2

Land title 6 10.3 0 - 6 8.8

Total 58 100 10 100 68 100.0

Flooding in the last 12 months was reported higher in TS villages (35.4%) than in CLTS villages (22%). See Table 40. Flooding generally occurs from June to November but in CLTS villages flooding is reported from June to January (see Figure 3 below).

Figure 3. Flooding months of the year

Table 45. Flooding in the last 12 months

Flooding

CLTS TS Total

n % n % n %

Yes 35 21.9 17 35.4 52 25

No 125 78.1 31 64.6 156 75

Total 160 100 48 100 208 100

House characteristics Majority (95.2%) of respondents reported that the household owned their houses (Table 42). Main construction materials of walls of houses are plywood (54.3%) and palm/ bamboo/ thatch (48.6%). Table 43. Main construction materials of roofs are bamboo/ thatch/ palm (38.9%) and clay tiles (24.5%). Some houses had metal (19.7%) or zinc (16.8%) roofing material. See Table 44.

Table 46. House ownership

Mode of ownership

CLTS TS Total

n % n % n %

32

Owned by the household 156 97.5 42 87.5 198 95.2

Not owned/ no rent is paid 4 2.5 6 12.5 10 4.8

Total 160 100 48 100 208 100.0

Table 47. Construction materials of house walls

Wall Materials

CLTS TS Total

n % n % n %

No walls 5 3.1 0 - 5 2.4

Palm/bamboo/thatch 80 50 21 43.8 101 48.6

Stone with mud 1 0.6 0 - 1 0.5

Uncovered adobe 0 - 1 2.1 1 0.5

Plywood 78 48.8 35 72.9 113 54.3

Metal 1 0.6 0 - 1 0.5

Other 6 3.8 0 - 6 2.9

Total 160 100 48 100 208 100.0

Table 48. Construction materials of roofs

Roofing materials

CLTS TS Total

n % n % n %

Bamboo/ Thatch/ Palm 62 38.8 19 39.6 81 38.9

Plastic sheets 2 1.3 0 - 2 1.0

Metal 29 18.1 12 25 41 19.7

Ceramic tiles 4 2.5 0 - 4 1.9

Clay tiles 31 19.4 20 41.7 51 24.5

Zinc 35 21.9 0 - 35 16.8

Total 160 100 48 100 208 100.0

Assets Main household assets reported are bicycles, appliances, furniture, televisions, radios, and motorcycles. See Figure 4 below. As regards, agricultural/ farming assets, the main items reported were pigs/ poultry, oxen/ cows, harrows/ rakes, and ploughs (see Figure 5 below). Figure 4. Household Assets

33

Figure 5. Agricultural/ Farming assets

3.2.3 Income and expenses The main sources of cash income in the last 12 months of respondents are selling rice (46.2%), non-farm labour (40.4%), selling animal products (35.6%), and farm labour (24.5%). Across village types, selling rice is the main source of income. See Figure 6 below and Table 46. Majority (93.3%) of respondents were able to estimate income in the last 12 months (Table 47). Reported income in the last 12 months across all village types was at $1,053.4 or $2.93 per day. Reported incomes were higher in CLTS villages ($3.14/ day) than in TS villages ($2.2/ day). See Table 48. Incomes are reported to be highest during February and March across all villages (see Figure 7 below and Table 49). In both village types, health expenses are ranked first by respondents. Education expenses are ranked second while expenses for leisure/ entertainment are ranked third. Food expenses are ranked last. See Figure 8 below and Table 50 in Annex 7. Figure 6. Sources of Income

Table 49. Source of cash income in last 12 months

Source

CLTS TS Total

n % n % n %

Selling rice 75 46.9 21 43.8 96 46.2

Selling non rice crop 31 19.4 12 25 43 20.7

Selling animal product 54 33.8 20 41.7 74 35.6

Farm labour 42 26.3 9 18.8 51 24.5

Nonfarm labour 67 41.9 17 35.4 84 40.4

Business/trading 26 16.3 10 20.8 36 17.3

34

Salary 18 11.3 4 8.3 22 10.6

Gift from others 3 1.9 2 4.2 5 2.4

Total 160 100 48 100 208 100.0

Table 50. Percent of respondents who could estimate incomes

Response

CLTS TS Total

n % n % n %

Yes 150 93.8 44 91.7 194 93.3

No 10 6.3 4 8.3 14 6.7

Total 160 100 48 100 208 100.0

Table 51. Estimated Incomes Average CLTS TS

N 151 44

Last 12 months 1,130.9 792.1

Per day 3.14 2.20

Figure 7. Income by month

Figure 8. Ranking of Expenses

Note: Lower mean values means higher ranking

35

3.2.4 Current defecation practice at home Forty-one percent (41%, n=67) of all respondents indicated that latrines are usually used by household members for defecation. Use of latrines is highest in TS villages (62.5%) than in CLTS villages (41.9%). See Table 52 and Figure 9 below.

Table 52. Current defecation practices of all Respondents

Practice

CLTS TS

n % n %

Latrine 67 41.9 30 62.5

Open land 93 58.1 18 37.5

Total 160 100 48 100

Figure 9. Current defecation practices of all Respondents/ Households

36

3.2.5 Household with Latrines The succeeding sections describe the sanitation and hygiene situation/ conditions of households who indicated regular use (or currently have latrines) of household latrines for defecation as seen in Table 52.

3.2.5.1 Latrine Characteristics

Tables 53 to 59 present latrine characteristics in both CLTS and TS villages.

a. CLTS Villages In CLTS villages, most latrines are unlined pit latrines (61.2%) and concrete ring latrines (31.3%). Slabs are mostly open-hole-wood (65.7%), pour-flushed (20.9%) and open-hole-concrete slabs (11.9%). Walls are generally made of palm leaves (31.3%) and thatch (29.9%). Some respondents have latrine walls made of wood (13.4%) and of concrete/ bricks (11.9%). Roofs are made of thatch (35.8%), palm leaves (28.4%), or GI (galvanized iron) sheets (17.9%). About 81% of latrines are located downstream of the water source. Majority (53.7%) are 30 or more meters distant from the water source. Of latrines located upstream of the water source (19%), 69.2% are 30 or more meters away. About 57% of latrines have washing areas, all having water. Some 68% have soap. Only 10.5% have ash and only 13.2% have hand-drying cloth.

b. TS Villages Latrines are concrete rings (56.7%) or unlined pits (26.7%). There are those who have offset-tanks (10%) or connected to piped sewerage system (6.7%). Slabs are mostly open-hole-concrete (46.7%), pour-flushed (36.7%), or open-hole-wooden slabs (16.7%). Walls are generally made of thatch (40%), wood (23.3%) or concrete/ bricks (23.3%). Thatch (56.7%) comprises most of latrine roofs, while others use GI sheets (26.7%). There are some latrines (16.7%) that have no roofs. Eighty percent of latrines were reported as located downstream of the water source. Of those located downstream, 37.5% were 30 meter or more distance from the source. Fifty percent of latrines located upstream of the water source are 30 or more meters away from the water source. Only 33.3% of latrines have washing areas. All washing areas have water but only 40% have soap. No ash or drying cloth was reported.

Table 53. Types of HH latrine

Types CLTS TS

n % n %

Unlined pit 41 61.2 8 26.7

Concrete rings 21 31.3 17 56.7

Offset tank - - 3 10.0

Piped sewerage 1 1.5 2 6.7

Other 4 6.0 - -

Total 67 100.0 30 100.0

Table 54. Types of latrine slabs

Types CLTS TS

n % n %

Open hole-Wooden slab 44 65.7 5 16.7

Open hole – Concrete slab 8 11.9 14 46.7

Pour-flushed 14 20.9 11 36.7

Other 1 1.5 - -

Total 67 100.0 30 100.0

Table 55. Types of latrine walls

Types CLTS TS

n % n %

37

Concrete/brick 8 11.9 7 23.3

Wood 9 13.4 7 23.3

Galvanized steel 3 4.5 1 3.3

Thatch 20 29.9 12 40.0

Plastic sheet 1 1.5 - -

Salvaged materials 1 1.5 - -

No wall 1 1.5 - -

Palm /Coconut leaves 21 31.3 1 3.3

Bamboo 4 6.0 - -

Sack 4 6.0 3 10.0

Mat 1 1.5 - -

Others 1 1.5 - -

Total 67 100.0 30 100.0

Table 56. Types of latrine roofs

Types CLTS TS

n % n %

Concrete/brick 1 1.5 - -

Galvanized steel 12 17.9 8 26.7

Thatch 24 35.8 17 56.7

Plastic sheet 3 4.5 - -

Salvaged materials 1 1.5 - -

No Roof 7 10.4 5 16.7

Palm /Coconut leaves 19 28.4 - -

Total 67 100.0 30 100.0

Table 57. Location and distance of latrines from water sources

Down-stream CLTS TS

n % n %

<=10m 5 9.3 1 4.2

11 - 20m 9 16.7 6 25.0

21 - 30 11 20.4 8 33.3

30+m 29 53.7 9 37.5

Total 54 100.0 24 100.0

Upstream CLTS TS

n % n %

11 - 20m 2 15.4 2 33.3

21 - 30 2 15.4 1 16.7

30+m 9 69.2 3 50.0

Total 13 100.0 6 100.0

Table 58. Presence of washing areas

Response CLTS TS

n % n %

Yes 38 56.7 10 33.3

No 29 43.3 20 66.7

Total 67 100.0 30 100.0

Table 59. Washing facilities at latrines

Washing facilities CLTS TS

n % n %

Water 38 100.0 10 100.0

Soap 26 68.4 4 40.0

Ash 4 10.5 - -

Hand-drying cloth 5 13.2 - -

Brush 1 2.6 - -

Total 38 100.0 10 100.0

3.2.5.2 Latrine Improvements

In CLTS villages, about 27% of respondents indicated that their latrine was not their first latrine. About 61% of these respondents reported that they had built 2 latrines before, 16.7% had built 3 latrines before,

38

and 11% had built a latrine before. FGD results indicate that at present improvement or upgrading from unlined dry-pit latrines is very limited. And in terms of improvement, villagers only consider having pour-flushed latrines. Most of them ask for support from programmes/ government for better construction of latrines. There are some people who want to construct flush latrine and they are saving money. At present, there were little changes such as piling higher soil to prevent flooding, constructing latrines far from the households and downstream of water sources, and how the waste water can be transmitted. All the people said that they will improve their latrines from dry pit to pour flushed when they have enough money. If they don’t have money, they still used their old dry pit or pour flushed latrines. See Tables 60 to 62. In TS villages, 23.3% of respondents reported that they had built latrines before. Of this group, 43% had built 2 latrines before (pour-flushed and concrete ring latrines), 28.6% had built 3 before, and 14.3% had built a latrine before. In TS villages, some received already the latrines, but the others are still in the process of construction. And many households have just recently registered their names with the TS programme so that they will be able to receive the latrines soon. Some families regret that they did not register their name during the first of community meetings. See Tables 60 to 62.

Table 60. Whether latrine is the first one built

Response CLTS TS

n % n %

Yes 49 73.1 23 76.7

No 18 26.9 7 23.3

Total 67 100.0 30 100.0

Table 61. Number of latrines built before the current latrine

Number of latrines built before

CLTS TS

n % n %

1 2 11.1 1 14.3

2 11 61.1 3 42.9

3 3 16.7 2 28.6

4 2 11.1 - -

Not remember - - 1 14.3

Total 18 100.0 7 100.0

Table 62. Types of latrines built before the current latrine

Type

CLTS ADB TS Total

n % n % n %

The same - - 1 14.3 1 3.4

Pour flashed 10 55.6 1 14.3 12 41.4

Unlined pit 10 55.6 6 85.7 20 69.0

Concrete Ring 2 11.1 1 14.3 4 13.8

Total 18 100.0 7 100.0 29 100.0

3.2.5.3 Sources and cost of latrine materials and sources of money

a. Sources of materials Table 63 presents the sources of latrine materials in CLTS and TS villages. In CLTS villages, 50% of respondents indicate that materials for latrine pits are generally sourced

17 in the

village but about 43% say these are purchased. In TS villages, 64% of respondents say the materials come from the TS Project, village sourced (24%), or bought (8%). The TS project provides subsidized latrines parts – the concrete rings and the slab. The project does not provide materials for walls, roofing, and other materials for complete latrine construction. In CLTS villages, latrine covers/ slabs are also usually village sourced (64.1%). However, 18.7% indicate support from NGOs and 14% say latrine covers are purchased. In TS villages, latrine covers are mostly from TS (42%) but 32.2% say these are also sourced from the village or purchased (22.3%).

17

Materials are either found in the village, made by the household, owned material/ old material, or given by neighbor.

39

Some households in TS villages upgrade the project-provided concrete slabs with smooth/ tile slabs which they purchase. Materials for latrine walls in CLTS villages are mostly village sourced (78%). Some respondents indicate that materials are also bought (11.7%) or provided by NGOs (7.35%). In TS villages, latrine wall materials are generally village sourced (63.3%) or bought (36.7%). In CLTS villages, latrine roofs are generally sourced from the villages (75.4%) or purchased (16.4%). In TS villages these materials are village sourced (52%) and purchased (48%). In CLTS villages, majority (56.7%) purchase water containers although 30% also source this from the villages. In TS villages, most water containers are village sourced (60%) with 40% buying the containers.

Table 63. Sources of latrine materials by part Latrine Part/ Component

Source of materials

CLTS TS

n % n %

Latrine Pit

Bought 12 42.86 2 8.00

Don't know 2 7.14 - -

Village Sourced 14 50.00 6 24.00

Supported by NGO - - 16 64.00

Village Leader - - 1 4.00

Total 28 100.00 25 100.00

Latrine Cover

Bought 9 14.06 7 22.58

Don't know 2 3.13 - -

Village Sourced 41 64.06 10 32.26

Supported by NGO 12 18.75 13 41.94

Village Leader - - 1 3.23

Total 64 100.00 31 100.00

Latrine Walls

Bought 8 11.76 11 36.67

Don't know 2 2.94 - -

Village Sourced 53 77.94 19 63.33

Supported by NGO 5 7.35 - -

Total 68 100.00 30 100.00

Latrine Roof

Bought 10 16.39 12 48.00

Don't know 2 3.28 - -

Village Sourced 46 75.41 13 52.00

Supported by NGO 3 4.92 - -

Total 61 100.00 25 100.00

Latrine Water Container

Bought 17 56.67 2 40.00

Don't know 2 6.67 - -

Village Sourced 9 30.00 3 60.00

Supported by NGO 2 6.67 - -

Total 30 100.00 5

b. Cost of materials Table 64 and Figure 10 below present the mean costs of latrines in CLTS and in TS villages as estimated by respondents. Cost of latrines is much lower in CLTS villages at about USD 41.1

18 each

than in TS villages (USD 112.5). In CLTS villages the main cost items are the pit and the walls. Those who incur full $41.1 costs are those households who purchase latrine parts instead of sourcing the materials from the villages. Their latrines are dry pit latrines with concrete rings and slabs given the reported cost of the pits, slabs and walls of the latrines. In TS villages the walls and the water containers are the main cost items since the pit concrete rings and slabs are provided free by the TS project. Households in TS villages avail of the free concrete ring and slabs but the construction of the latrine itself is by the household including improvements such as smooth/ tiled slabs, concrete/ clay tile walls, water containers, and roofing.

18

Conversion to USD: USD 1 = 4,000 Cambodian Riel

40

Figure 10. Mean costs of latrines by part and total cost (USD)

Table 64. Estimated cost of materials of latrines

Latrine component CLTS TS

Mean Mean

Pit 12.3 19.0

Slab 6.3 8.7

Walls 12.1 44.4

Roof 4.8 12.2

Water Container 3.5 24.6

Other materials 2.3 3.7

Total Cost 41.1 112.5

c. Source of money for purchasing materials

Respondents only indicated two sources of money in purchasing latrine materials – NGOs/ sanitation programme and their own money. In CLTS villages, own money is generally used except for latrine covers where 80% of respondents indicate that NGOs are the sources. In TS villages, NGOs are the main source for latrine pit and cover materials but for latrine walls, roof, and water containers, own money is used. See Table 65. Reports of respondents as to other S&H programmes/ projects in both CLTS and TS villages indicate a high presence of NGOs (see 3.2.5.12 and 3.2.6.6) in the villages. This high NGO presence is apparently the reason why respondents indicate NGOs as the source of money for purchasing latrine parts. Table 65. Source of money to purchase latrine parts

Latrine Part/ Component

Source of money to purchase materials

CLTS TS

n % n %

Latrine Pit

NGO 9 45.0 16 80.0

Own money 11 55.0 4 20.0

Latrine Cover

NGO 12 80.0 13 65.0

Own money 3 20.0 7 35.0

Latrine Walls

NGO 5 45.5 - -

Own money 6 54.5 11 100.0

Latrine Roof

NGO 3 25.0 - -

Own money 9 75.0 11 100.0

Latrine Water Container

NGO 2 11.1 - -

Own money 16 88.9 2 100.0

Other materials

NGO - - - -

Own money 5 100.0 3 100.0

3.2.5.4 Sources of Water

Tables 66 to 69 present the sources of hand-washing and drinking water in CLTS and TS villages.

a. CLTS Villages

41

During dry season, water for hand-washing is generally sourced from bore-hole or hand-pumps (44.8%) and ring wells/ platform (26.9%). Ponds are also a source for hand-washing water for 13.4% of households. During the wet season, the same water sources are used (bore-holes/ hand-pump and ring wells) but rainwater use increases (17.9%). Drinking water during the dry season mainly comes from bore-hole/ hand-pump (37.3%), ring wells (26.9%) and traditional wells (11.9%). Some households (13.4%) drink water from ponds. In the wet season, bore-hole/ hand-pump (32.8%), ring-wells (25.4%), and traditional wells remain as sources of drinking water but use of rainwater nearly doubles to 32.8%.

b. TS villages Dry season hand-washing water sources are bore-hole/ hand-pump (50%), ring wells (26.7%), and traditional wells (20%). In the wet season, water sources remain the same. Drinking water sources during the dry season are bore-hole/ hand-pump (53.3%), ring wells (26.7%), and traditional wells (16.7%). In the wet season, the same sources are used but in lesser manner and some households use ponds and rainwater.

Table 66. Sources of hand-washing water in the dry season

Source of water CLTS TS

n % n %

Borehole + Hand pump 30 44.8 15 50.0

Ring Well + Platform 18 26.9 8 26.7

Traditional Well 7 10.4 6 20.0

River / Stream 1 1.5 - -

Pond 9 13.4 1 3.3

Private Water Seller 3 4.5 - -

Total 67 100.0 30 100.0

Table 67. Sources of hand-washing water in the wet season

Sources of water CLTS TS

n % n %

Borehole + Hand pump 27 40.3 15 50.0

Ring Well + Platform 17 25.4 8 26.7

Traditional Well 9 13.4 6 20.0

Shallow Pit 1 1.5 - -

Pond 6 9.0 2 6.7

Rainwater 12 17.9 - -

Private Water Seller 1 1.5 - -

Total 67 100.0 30 100.0

Table 68. Dry-season source of drinking water

Water Source CLTS TS

n % n %

Borehole + Hand pump 25 37.3 16 53.3

Ring Well + Platform 18 26.9 8 26.7

Traditional Well 8 11.9 5 16.7

River / Stream 1 1.5 - -

Pond 9 13.4 1 3.3

Rainwater 2 3.0 - -

Private Water Seller 3 4.5 - -

Bottled Drinking Water 1 1.5 - -

Total 67 100.0 30 100.0

Table 69. Wet-season sources of drinking water

Water source CLTS TS

n % n %

Borehole + Hand pump 22 32.8 14 46.7

Ring Well + Platform 17 25.4 8 26.7

Traditional Well 10 14.9 5 16.7

Pond 6 9.0 2 6.7

42

Rainwater 22 32.8 2 6.7

Total 67 100.0 30 100.0

3.2.5.5 Incidences of Diarrhea

Across both village types diarrhea incidence in the last 3 months was reported by 27.6% (n=29) of respondents. Incidence reports were higher in TS villages (33.3%, n=30) than in CLTS villages (22.4%, n=67). See Table 70.

Table 70. Common illnesses reported

Illnesses CLTS TS

n % n %

Malaria 4 6.0 6 20.0

Diarrhea 15 22.4 10 33.3

Typhoid 14 20.9 10 33.3

Fever 25 37.3 10 33.3

Bad stomach / stomach ache

5 7.5 7 23.3

Cold / influenza 42 62.7 21 70.0

Dengue 9 13.4 1 3.3

Headache/Dizziness 8 11.9 8 26.7

Tuberculosis 7 10.4 2 6.7

Other 24 35.8 8 26.7

Total 67 100.0 30 100.0

Tables 71 and 72 show the percent of respondents who indicated knowing how to prevent diarrhea and the reported ways to prevent the disease. In CLTS villages, among those that reported diarrhea disease in the last 3 months (n=15), 80% reported that they knew how to prevent the disease. Reported ways (multiple answers) to prevent diarrhea were boil drinking water (8.3%) and washing hands (33.3%). Washing hands after defecation as a way to prevent diarrhea was reported only once (8.3%). It may be noted that the practice of washing hands in general to prevent diarrhea would total to 58.3%. In TS villages, among those that reported diarrhea disease in the last 3 months (n=10) only 30% indicated knowing ways to prevent diarrhea disease. Reported practices (multiple answers) were cooking food properly (100%), boil drinking water (66.7%), and washing hands before eating and being careful of eaten food (both at 33.3%). Table 71. Knowledge on diarrhea prevention

Response CLTS TS

n % n %

Yes 12 80.0 3 30.0

No 1 6.7 6 60.0

Don't know 2 13.3 1 10.0

Total 15 100.0 10 100.0

Table 72. Reported ways to prevent diarrhea

Practices CLTS TS

n % n %

Cook food properly – eat soon after cooking

2 16.7 3 100.0

Be careful about what kind of food you eat

3 25.0 1 33.3

Boil drinking water 10 83.3 2 66.7

Wash vegetables with clean water

1 8.3 - -

Wash hands 4 33.3 - -

Wash hands after defecation

1 8.3 - -

Wash hands before eating 1 8.3 1 33.3

Wash hands before preparing food

1 8.3 - -

43

Clean cooking and eating utensils (Plates, bowls, pots, spoons, etc.)

1 8.3 - -

Other 2 16.7 - -

Total 12 100.0 3 100.0

3.2.5.6 Perceptions on advantages and disadvantages of having latrines

Tables 73 and 74 present the perceived advantages and disadvantages of having latrines in CLTS and TS villages. In CLTS villages, the main advantages cited in owning latrines in descending order were improved hygiene/ cleanliness (76.1%), convenience/ time-saving (67.2%), and improved health (67.5%). Most (73.1%) did not see any disadvantage but about 16% cited bad smell coming from latrines as the disadvantage. In TS villages, the main advantages reported were improved hygiene/ cleanliness (83.3%), convenience/ time-saving (70%), and improved health (26.7%). About 68% saw no disadvantage in owning a latrine but bad smell (20%), cost in maintaining (10%), and work in maintenance (10%) as the disadvantages.

Table 73. Perceived advantages of owning latrine

Advantages CLTS TS

n % n %

Improve hygiene/ cleanness 51 76.1 25 83.3

Improve health 44 65.7 8 26.7

More privacy 5 7.5 3 10.0

More comfortable 2 3.0 - -

Convenience/save time 45 67.2 21 70.0

Improve safety 7 10.4 2 6.7

Improve status/prestige 2 3.0 1 3.3

Do not Know 1 1.5 - -

Can make natural fertilizer 7 10.4 4 13.3

Total 67 100.0 30 100.0

Table 74. Perceived disadvantage of owning latrine

Disadvantages CLTS TS

n % n %

Bad Smell 11 16.4 6 20.0

Attracts flies 2 3.0 1 3.3

Cost to maintain it 3 4.5 3 10.0

Work to maintain it - - 3 10.0

No disadvantage 49 73.1 20 66.7

Do not Know 4 6.0 - -

More Mosquitoes - - 1 3.3

Total 67 100.0 30 100.0

3.2.5.7 Defecation Practices

Tables 75 to 82 and Figures 11 to 13 present the defecation practices of CLTS and TS households.

a. CLTS villages At home, households generally use their own latrine (86.6%) but also use public latrines

19 (6%) and

neighbor’s latrine (3%). However, some 10.4% still practice open defecation (OD). When in the field/ chamkar, OD is the general practice. When in public areas/ locations, public latrines are generally used (83.6%) but some (7.5%) practice OD. Children normally use own latrines when at home (71.6%) or through chhik korb (10.4%). However, about 18% of respondents indicate that children practice OD even when at home. When in the field/ chamkar children generally practice OD. However, when in public places children use public latrines

19

Latrines in schools, public markets, pagodas, and in other public places

44

(74.6%) most of the time. However, some 13.4% reported that children also practice OD in public places. The main reasons provided for OD in field/ chamkar was the distance to the houses but some (4.5%) said that OD is already a habit. Infant’s faeces are mainly disposed of in own latrines (49.3%) or by burying in the ground (44.8%). However, there were respondents that indicated disposal of infant’s faeces by throwing in water bodies (9%). After defecation, water (70%) and paper (22.4%) are generally used for cleaning. Small wood/ twigs (13.4%) and leaves (7.5%) are also used.

b. TS villages At home, households generally use their own latrines (80%). Some (10%) use neighbor’s latrines but a few practice OD (6.6%). All practice OD when in the field because of the distance to their houses. In public places, most (93.3%) use public latrines but some 10% still practice OD. At home, children normally use own latrines (56.7%) but chhik korb (23.3%) and OD is also practiced by children. Like adults, children practice OD when in the field/ chamkar. In public places, children use public latrines (86.7%) but about 13.3% still practice OD. Infant’s faeces are either buried (66.7%), taken to own latrine (30%), or thrown into water bodies (10%). In descending order, water (69%), leaves (37.9%), paper (20.7%), and small twigs (17.2%) are used for cleaning purposes after defecation. Figure 11. Defecation practices at home

Table 75. Defecation practices at home

Practices at home CLTS TS

n % n %

On the ground/forest 7 10.4 1 3.3

In a water body - - 1 3.3

In your own latrine 58 86.6 24 80.0

In neighbor latrine 2 3.0 3 10.0

In public latrine 4 6.0 - -

Other 1 1.5 1 3.3

Total 67 100.0 30 100.0

45

Figure 12. Defecation practices at field/ chamkar

Table 76. Defecation practices at field/ chamkar

Practices at field/ chamkar CLTS TS

n % n %

On the ground/forest 59 88.1 30 100.0

Other 8 11.9 - -

Total 67 100.0 30 100.0

Figure 13. Defecation practices when in public places

Table 77. Defecation practices in public places

Practices in public places CLTS TS

n % n %

On the ground/forest 5 7.5 3 10.0

In public latrine 56 83.6 28 93.3

Other 8 11.9 - -

Total 67 100.0 30 100.0

Table 78. Defecation practices of children at home

Practices at home CLTS TS

n % n %

On the ground/forest 12 17.9 6 20.0

In your own latrine 48 71.6 17 56.7

In neighbor latrine - - 1 3.3

In public latrine 1 1.5 - -

digging 7 10.4 7 23.3

Other 3 4.5 1 3.3

Total 67 100.0 30 100.0

46

Table 79. Defecation practices of children at field/chamkar

Practices at field/chamkar CLTS TS

n % n %

On the ground/forest 59 88.1 26 86.7

In a water body 1 1.5 1 3.3

In public latrine 1 1.5 - -

Other 6 9.0 3 10.0

Total 67 100.0 30 100.0

Table 80. Defecation practices of children in public places

Practices in public places CLTS TS

n % n %

On the ground/forest 9 13.4 4 13.3

In a water body - - - -

In public latrine 50 74.6 26 86.7

Other 8 11.9 1 3.3

Table 81. Disposal of infants’ faeces

Disposal practice CLTS TS

n % n %

Take in the own latrine 33 49.3 9 30.0

Through in the water 6 9.0 3 10.0

Bury 30 44.8 20 66.7

Through to field/forest 1 1.5 - -

Other 2 3.0 1 3.3

Total 67 100.0 30 100.0

Table 82. Cleansing materials used after defecation

Cleansing material CLTS TS

n % n %

Water 47 70.1 20 69.0

Leaves 5 7.5 11 37.9

Paper 15 22.4 6 20.7

Wood 9 13.4 5 17.2

Cloth 4 6.0 - -

Total 67 100.0 29 100.0

3.2.5.8 Hand-washing practices

All respondents in CLTS (n=67) and in TS (n=30) villages indicated that household members practice hand-washing. Figures 14 to 17 and Tables 83 to 86 present the hand-washing practices of households in CLTS and TS villages.

a. CLTS villages In terms of frequency, 92.5% indicated

20 that hand-washing is done more once a day and 6% reported

once every 2-3 days hand-washing (Figure 15). Hand-washing is normally done before eating (92.5%), after defecation (61.2%), when hands are dirty (43.3%), and after eating (35.8%). See Figure 16. Hand-washing with soap and water (92.5%) is generally practiced. However, hand-washing with water only (53.7%) and ash only (26.9%) is also practiced (see Figure 17). Reasons given for hand-washing were to remove dirt/ make clean (61.2%), to remove bacteria (59.7%) and to prevent diseases (46.3%). See Figure 18.

b. TS villages Nearly all (96.7%) of respondents indicated that hand-washing is done more than once a day (Figure 15). High rates of hand-washing may be due to the regular availability of water since the TS Project also provides pump-wells in all of its target villages. Hand-washing is generally done before eating (96.7%),

20

Observation of hand-washing practices required an extended stay in survey villages which the survey team could not undertake due to time and resource constraints.

47

after defecation (46.7%), and when hands are dirty (46.7%) – see Figure 16. Soap and water (83.3%), water only (56.7%) and ash (23.3%) are used in hand-washing (see Figure 17). Reasons given for hand washing were to remove bacteria (66.7%), to remove dirt/ make clean (63.3%), and to prevent disease (33.3%) – see Figure 18. Hand-washing Figure 14. Frequency of hand-washing

Table 83. Frequency of hand-washing

Frequency CLTS TS

n % n %

One time/day 1 1.5 - -

More than one time/day 62 92.5 29 96.7

One time /2-3days 4 6.0 1 3.3

Total 67 100.0 30 100.0

Figure 15. Instances when hand-washing is practiced

Table 84. Instances of hand-washing

Instance CLTS TS

n % n %

When they are dirty 29 43.3 14 46.7

When returning to the household

7 10.4 7 23.3

Before eating 62 92.5 29 96.7

After eating 24 35.8 4 13.3

After defecation 41 61.2 14 46.7

Before going to sleep 5 7.5 3 10.0

After waking up 3 4.5 3 10.0

Before preparing food 3 4.5 3 10.0

After washing baby 2 3.0 - -

48

Other 2 3.0 4 13.3

Total 67 100.0 30 100.0

Figure 16. Cleansing materials used in hand-washing

Table 85. Materials used in hand-washing

Materials used CLTS TS

n % n %

Water only 36 53.7 17 56.7

Ash 18 26.9 7 23.3

Soap 62 92.5 25 83.3

Sand 1 1.5 - -

Cloth 1 1.5 1 3.3

Total 67 100.0 30 100.0

Figure 17. Reasons for hand-washing

Table 86. Reasons for hand-washing

Reasons CLTS TS

n % n %

to remove dirt / make them clean

41 61.2 19 63.3

for personal appearance – to look good

2 3.0 1 3.3

prevent disease 31 46.3 10 33.3

to remove microbes / bacteria

40 59.7 20 66.7

Other 4 6.0 1 3.3

Total 67 100.0 30 100.0

49

3.2.5.9 Maintenance and repair of latrines

Tables 87 to 93 present the maintenance and repair practices of households in CLTS and TS villages.

a. CLTS villages Latrines are generally cleaned every day 35.8%) or once every 2-3 days (28.4%). However, 12% indicate that latrines are cleaned less than once a week or rarely cleaned at all (12%). The wife (72.9%) generally cleans the latrine. The husband does the cleaning about a third of the time. Children above 15 years also help in cleaning (6.8% and 11.9% boys and girls, respectively). Girls under 15 years (10.2%) also help in cleaning. When the latrine is full, most respondents (72.3%) say new latrines are built while the rest indicate that the latrine is pump-off (27.2%). When latrines are broken, nearly 64% report that the latrines are repaired but the other respondents indicated that new latrines are built. When latrines are old, majority (53.2%) report that new ones are built while the rest say they repair old latrines. Generally, latrines are repaired by the respondent (82.1%). Those that seek help in repairing latrines, normally ask the son/ daughter (27.3%), or another relative (27.3%), or the husband/ wife (18.2%) in latrine repairs.

b. TS villages Latrines are generally cleaned once every 2-3days according to 36.7% of respondents. More than once a day cleaning is reported by 13.3%, daily cleaning at 13.3%, less than once a week at 13.3% and rare cleaning at 13.3%. Similar to CLTS villages, the wife normally cleans the latrine (73.9%), then the husband (34.8%), and then girls over 15 years (13%). When the latrines are full, these are generally pumped-off (71.4%) although the rest (28.6%) build new latrines. If broken, latrines are normally repaired (77.8%). When latrines are old, these are also repaired (56.5%) but many (43.5%) build new latrines. A little over half of respondents indicate that they repair latrines by themselves. However, more than 40% report that they seek help in latrine repair. Assistance is normally sought from the contractor (42.9%), the son or daughter (42.9%), or the village chief (14.3%). Table 87. Frequency of latrine cleaning

Frequency CLTS TS

n % n %

One time/day 24 35.8 4 13.3

More than one time/day 7 10.4 4 13.3

One time /2-3days 19 28.4 11 36.7

Less than one time/week 8 11.9 4 13.3

Rarely 8 11.9 4 13.3

Never clean 1 1.5 3 10.0

Total 67 100.0 30 100.0

Table 88. HH members who clean latrine

HH Members CLTS TS

n % n %

Husband 20 33.9 8 34.8

Wife 43 72.9 17 73.9

Children <15 yrs - - 1 4.3

Children (girl) <15 yrs 6 10.2 2 8.7

Children (boy) <15 yrs - - 1 4.3

Children (girl) >15 yrs 7 11.9 3 13.0

Children (boy) >15 yrs 4 6.8 1 4.3

Total 59 100.0 23 100.0

Table 89. Maintenance activity when latrine is full

Activity CLTS TS

n % n %

50

Build new 47 72.3 8 28.6

Pump off 18 27.7 20 71.4

Total 65 100.0 28 100.0

Table 90. Maintenance activity when latrine is broken

Activity CLTS TS

n % n %

Build new 24 36.4 6 22.2

Repair 42 63.6 21 77.8

Total 66 100.0 27 100.0

Table 91. Maintenance activity when latrine is old

Activity CLTS TS

n % n %

Build new 33 53.2 10 43.5

Repair 29 46.8 13 56.5

Total 62 100.0 23 100.0

Table 92. Whether repair is done by HH head/ respondent

Response CLTS TS

n % n %

Yes 55 82.1 17 56.7

No 12 17.9 13 43.3

Total 67 100.0 30 100.0

Table 93. Participation of HH members in latrine repair

HH member CLTS TS

n % n %

Husband/wife 2 18.2 - -

Son/Daughter 3 27.3 3 42.9

Neighbor 1 9.1 - -

Village leader - - 1 14.3

Other relative 3 27.3 - -

Contractor/ construction 2 18.2 3 42.9

Total 11 100.0 7 100.0

3.2.5.10 Community Monitoring

a. CLTS villages The village chief (89.5%) is reported as the individual/ institution that monitor the sanitation and health situation. In descending order, the other institutions involved in monitoring are the PDRD (18.4%), the village focal persons or VFPs (13.2%), and the commune council (10.5%). DoRD is reported as a monitoring institution but by only 5.3% of respondents. See Figure 18 and Table 94. Nearly all respondents think that the sanitation situation has improved in the village, with only 6% saying otherwise (Table 95). Reasons given for this positive perception are: there are more latrines than before (57.6%), there are no faeces everywhere (27.3%), and greater awareness about hygiene (25.8%). See Table 96.

b. TS villages

In TS villages, 80% of respondents indicate the village chief as the monitoring entity while 20% say that PDRD also monitors S&H in the village. See Figure 18 and Table 94. Most of respondents (86.7%) say that the sanitation situation has improved in the villages (Table 95) because, there are more latrines than before (73.3%), no more faeces anywhere (26.7%), and better awareness of hygiene. See Table 96.

51

Figure 18. Reported S&H monitoring entities in villages

Table 94. S&H monitoring entities in villages

Official/ Organization CLTS TS

n % n %

PDRD 7 18.4 1 20.0

DORD 2 5.3 - -

Commune council 4 10.5 - -

Village chief 34 89.5 4 80.0

Village focal point 5 13.2 - -

Other project staff 2 5.3 - -

Total 38 100.0 5 100.0

Table 95. Perceptions on changes in S&H situation

Response CLTS TS

n % n %

Yes 63 94.0 26 86.7

No 4 6.0 4 13.3

The same - - - -

Total 67 100.0 30 100.0

Table 96. Reasons for perceived changes in S&H situation

Reasons for improvements CLTS TS

n % n %

Have latrine more than before

38 57.6 22 73.3

No faeces everywhere 18 27.3 8 26.7

Have NGO come to visit and advise

6 9.1 2 6.7

Awareness about hygiene 17 25.8 6 20.0

Reasons for no improvements

Have other supported 1 1.5 1 3.3

No idea 1 1.5 - -

Not take care - - 1 3.3

Not aware about hygiene 1 1.5 1 3.3

No advise about hygiene 1 1.5 1 3.3

Latrine more damage 2 3.0 2 6.7

Total 66 100.0 30 100.0

3.2.5.11 Participation in Sanitation Programmes

a. Attendance in Community Meetings

52

Tables 97 to 100 and Figure 19 present the attendance of households to sanitation meetings in CLTS and TS villages. In CLTS villages, nearly 84% of respondents indicated that they had attended the first meeting of CLTS in their villages. The second community meeting, nearly 87% reported that they had attended. However, about 21% could not recall how many times they had attended in total CLTS meetings in their villages. For those who could recall, 24.5% said that they attended community meetings thrice, 20.4% reported attending meetings twice, 13.2% had attended four times, and 11.3% had attended five times. It is also noteworthy that some 11.3% indicated that they had attended community meetings ten times. In TS villages, 53.3% reported that they had attended the first community meeting. In the second meeting, less than half (43.3%) attended. Among those who had attended meetings, 60% were able to recall the total number of meetings they had attended. Majority of respondents (55.6%) participated in community once, 22.2% participated twice, and about 17% attended community meetings thrice. Figure 20 below presents the total number of times villagers attended community meetings in the CLTS and TS programmes. Table 97. Whether HH members have participated in first sanitation meeting Participation in 1

st sanitation

meeting

CLTS TS

n % n %

Yes 56 83.6 16 53.3

No 11 16.4 14 46.7

Total 67 100 30 100

Table 98. Participation of HH members in following sanitation meetings Participation in subsequent sanitation meetings

CLTS TS

n % n %

Yes 58 86.6 13 43.3

No 9 13.4 17 56.7

Total 67 100 30 100

Table 99. Recollection of number of times joined in sanitation meetings

Response

CLTS TS

n % n %

Yes 53 79.1 18 60

No 14 20.9 12 40

Total 67 100 30 100

Table 100. Number of times joined in sanitation meetings

Number of times

CLTS TS

n % n %

1 6 11.3 10 55.6

2 11 20.8 4 22.2

3 13 24.5 3 16.7

4 7 13.2 1 5.6

5 6 11.3 0 0

6 1 1.9 0 0

7 1 1.9 0 0

8 1 1.9 0 0

10 6 11.3 0 0

20 1 1.9 0 0

Total 53 100 18 100

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Figure 19. Number of times attended community meetings

b. Participation in Community Meetings Table 101 presents how HH participated in community meetings and Table 102 and Figure 20 shows what HH learned from community meetings. In CLTS villages, most respondents (95.2%) said that they participated by attending the meetings, 16% reported that they joined in discussions, and about 10% reported that they had attended trainings. Main topics learned from the meetings were hygiene/ hygiene practices (75%) and how to construct latrines (30.9%). Describing the topics they learned from the meetings, respondents that in terms of hygiene they learned the importance of hygiene (65%), of drinking/ using boiled water (27.3%), the importance of cleanliness (20%), and about use of latrines in defecation (9%). As regards latrine construction, respondents reported that they learned the process of latrine making (20%) and what materials to use in latrine construction (11%). In TS villages, nearly all (95.2%) reported that their participation in community meetings was by attending such meetings. Nineteen percent said they participated in discussions while 9.5% indicated that they had participated in trainings. In terms of what they learned, 64.7% mentioned hygiene, 23.5% indicated well/ water supply and 17.6% said they learned how to construct latrines. Respondents described what they learned on hygiene as: its importance (47.1%), clean well/ cleanliness (35.3%), reduction in pollution (23.5), drinking boiled water (17.6%), and defecation in latrines (17.6%). Materials to be used (5.9%) and the process of latrine construction (5.9%) were how respondents described what they learned about latrines.

Table 101. How HH participated in sanitation meetings Manner of participation

CLTS TS

n % n %

Attend meeting 59 95.2 20 95.2

Discussing 10 16.1 4 19

Materials 3 4.8 1 4.8

Follow up activities 1 1.6 1 4.8

Training 6 9.7 2 9.5

Other 1 1.6 0 0

Total 62 100 21 100

Table 102. Lessons learned from sanitation meetings Lessons learned

CLTS TS

n % n %

How to make latrine 17 30.9 3 17.6

Hygiene 41 74.5 11 64.7

Well 4 7.3 4 23.5

Environment 1 1.8 - -

Health 2 3.6 - -

Total 55 100 17 100

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Figure 20. Lessons learned from community meetings

c. Visits from Project Implementers/ Focal persons Table 103 and Figure 21 below present the reported level of visits to households by project implementers and focal persons in CLTS villages. In CLTS villages, respondents reported that the Village Chief (84.9%) was the main project/ focal person that visited them, followed by NGOs (58.5%), the PDRD (26.4%), and then the commune council (9.4%). In TS villages, NGOs (65%) and the village chief (45%) were reported by respondents as the project implementers/ focal persons that visited their households. Table 103. Whether HH visited by CLTS facilitators/ TS implementers

Visit by implementers/ focal points

CLTS TS

n % n %

PDRD 14 26.4 1 5

DORD 3 5.7 - -

Commune council 5 9.4 - -

Village chief 45 84.9 9 45

Organization 31 58.5 13 65

Total 53 100 20 100

Figure 21. Level of reported visits of Project Implementers/ Focal persons

In CLTS villages, reported main purposes of visits of PDRD are checking latrines (71.4%), provide training on S&H (35.7%), and maintaining latrines (35.7%). For the village chiefs, checking latrines (68.9%) and follow-up of S&H condition (29%) were reported main purpose of visits. See Table 104. In TS villages, the main purpose of organizations and the village chief visits were to check latrines. In OV villages, the reported purposes of NGO visits were: teach/ follow-up on sanitation and hygiene (50%)

55

provide training on sanitation and hygiene (25%), and checking of cleaning materials in latrines (25%). See Table 105.

Table 104. Purpose of visits in CLTS villages

PDRD DoRD Commune FP Village Chief Organization

n % n % n % n % n %

Check the latrine 10 71.4 2 66.7 3 60 31 68.9 21 67.7

Check the cleaning materials 3 21.4

6 13.3 1 3.2

Provide Training on S&H 5 35.7 2 66.7 1 20 3 6.7 4 12.9

Teach/ follow up on S&H 2 14.3

13 28.9 14 45.2

Encourage villagers to improve S&H 3 21.4 1 33.3 1 20 9 20 8 25.8

Maintaining the latrines 5 35.7 1 33.3

9 20 3 9.7

Giving poster/ other information materials 1 7.1

Others 2 14.3

1 20 4 8.9 2 6.5

Total 14 100 3 100 5 100 45 100 31 100

Table 105. Purpose of visits in TS villages

Purpose

PDRD Village Chief Organization

n % n % n %

Check the latrine 1 100 8 88.9 9 69.2

Check the cleaning materials 1 100

Provide Training on S&H 3 33.3 2 15.4

Teach/follow up on S&H 1 11.1 4 30.8

Encourage villagers to improve S&H practices 2 15.4

Maintaining the latrines 1 7.7

Total 1 100 9 100 13 100

d. Knowledge of and interaction with Village Focal Persons

In CLTS villages, 77.6% of respondents reported that they knew who the village focal persons of CLTS were. In TS villages, 43.3% of respondents indicated that other volunteers were the focal persons of the project in the villages. In CLTS villages, the focal persons identified were the village chief/ deputy chief (46.2%), other volunteers (38.5%) and villager (25%). See Table 106.

Table 106. Whether HH has been visited by village volunteer/ focal point

Village Volunteer

CLTS TS

n % n %

Village leader/deputy village leader 24 46.2 - -

Villager 13 25 - -

Other volunteers 20 38.5 13 100

Total 52 100 13 100

In CLTS villages, the village chief’s/ deputy village chief’s main responsibilities reported by respondents were: advice to make latrines (54.2%); awareness on hygiene (37.5%); and advise to keep latrines (20.8%). Villagers’ main tasks were: hygiene awareness (61.5%) and advice to make latrine (53.8%). Volunteers’ main tasks were: hygiene awareness (35%), advice to make latrines (35%), and checking on latrines (30%). See Table 107.

Table 107. Reported tasks of village focal points (CLTS)

Tasks Village leader/deputy

village leader Villager Other Volunteer

n % n % n %

Awareness about hygiene 9 37.5 8 61.5 7 35

Advise to make latrine 13 54.2 7 53.8 7 35

check latrine 4 16.7 1 7.7 6 30

Advise to keep latrine 5 20.8 1 7.7 2 10

Invite for meeting

3 15

Provide gift or incentive

1 5

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Total 24 100 13 100 20 100

In TS villages, described main tasks of the volunteers were: advice on how to make latrines (38.5%), awareness on hygiene (30.8%), invite to meetings (23.1%), and advise to keep latrines (15.4%). See Table 108 below.

Table 108. Reported tasks of village volunteers (TS)

Tasks

TS

n %

Awareness about hygiene 4 30.8

Advise to make latrine 5 38.5

check latrine 1 7.7

Advise to keep latrine 2 15.4

Invite for meeting 3 23.1

Provide gift or incentive 1 7.7

Total 13 100

In CLTS villages, respondents said that generally their interactions with focal points were monthly (38.5%) and every-3-months (26.9%) interactions (Figure 22 and Table 109) presents the frequency of interactions of villagers with focal persons. In TS villages, frequency of interaction with the volunteers was reported at quarterly intervals (46.2%) and at monthly intervals (38.5% of respondents). However, 23.1% of respondents said that they rarely/ never interact with the volunteers. See Figure 23 and Table 109. Figure 22. Frequency of interaction with village focal points (CLTS).

Figure 23. Frequency of interaction with village volunteers (TS)

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Table 109. Frequency of interaction with focal points Frequency

CLTS TS

n % n %

Every day 7 13.5 - -

Every week 8 15.4 1 7.7

Every month 20 38.5 3 23.1

Every 3 months 14 26.9 6 46.2

Rarely/Never 3 5.8 3 23.1

Total 52 100 13 100

In CLTS villages, points of discussion during interaction with focal persons were awareness on hygiene and sanitation (42.6%) and advice to meeting about latrine issue (27.7%), latrine maintenance (19.1%), and follow-up on latrine use (17%), and encourage building latrines (14.9%). In TS villages, main discussion topics with volunteers reported by respondents were awareness on hygiene and sanitation (33.3%), encouragement to build latrines (33.3%), and advice to meetings on latrine issue (22.2%). See Table 110. Table 110. Reported discussion topics in interactions with focal points

Discussion topics

CLTS TS

n % n %

Awareness about hygiene/ sanitation 20 42.6 3 33.3

Follow up to latrine using 8 17 1 11.1

Advise to meeting about latrine issue 13 27.7 2 22.2

Keep cleaning latrine/take care 9 19.1 1 11.1

Encourage to build latrine 7 14.9 3 33.3

Total 47 100 9 100

e. Presence of IEC materials in villages Majority (66.7%) of respondents in CLTS villages reports that posters/ information materials on sanitation and hygiene are installed in the villages. However, in TS villages, most respondents indicate otherwise (69.2%). See Table 111.

Table 111. Presence of IEC materials in villages

Response CLTS TS

n % n %

Yes 44 66.7 8 30.8

No 22 33.3 18 69.2

Total 66 100 26 100

f. Participation of the Poor Figure 24 and Table 112 presents the types/ groups of people in villages that were reported to have attended community meetings. In CLTS villages, the poor (66.7% of respondents), the elderly (66.7%), and children (50%) were reported to be the main groups present in community meetings. Disabled persons, teachers, women, and monks also were reported to have participated. However, very few (only 8% of respondents) were able to identify the different types of people who participated in community meetings. In TS villages, the poor (100%), women (25%), and the elderly (25%), were reported by respondents as having participated also in community meetings. Similar to CLTS villages, very few (only 13% of respondents) were able to identify the different types of people who participated in community meetings.

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Figure 24. Groups/ individuals who participated in meetings

Table 112. Participation of other groups in villages Village groups

CLTS TS

n % n %

Poor people 4 66.7 4 100

Disable person 2 33.3 - -

Monk 1 16.7 - -

Teacher 2 33.3 - -

Women 2 33.3 1 25

Elder person 4 66.7 1 25

Children 3 50 - -

Total 6 100 4 100

Since very few respondents in both CLTS and TS villages indicated that the poor participated in community meetings, it cannot be fully concluded that there was indeed a high participation of the poor in community meetings. This is further highlighted in that 77.4% (n=53) of respondents in CLTS villages indicate that the poor were not specifically targeted or prioritized. Likewise in TS villages, 63.3% (n=30) of respondents said that the poor were also not specifically prioritized. See Table 113.

Table 113. Whether poor were specifically targeted/ prioritized Response

CLTS TS

n % n %

Yes 12 22.6 11 36.7

No 41 77.4 19 63.3

Total 53 100 30 100

g. ODF Celebrations

Open defecation free (ODF) status was not celebrated in TS villages according to respondents.

Table 114. Whether ODF celebrations were held in villages Response CLTS TS

n % n %

Yes 11 16.4 - -

No 56 83.6 30 100

Total 67 100 30 100

In CLTS villages, only 16.4% of respondents said that ODF status was celebrated in their villages (Table 117). Villagers (81.8%), village leaders (54.5%), representatives of Plan organization (45.5%), PDRD and commune council representatives (both reported at 18.2% of respondents), and UNICEF (9.1%) participated in the ODF celebrations (Table 115). ODF status was celebrated through “parties” (63.6% of respondents) and awareness raising on sanitation and hygiene (45.5%) – Table 116.

Table 115. Groups/ individuals who participated in ODF celebrations ODF participants CLTS

n %

59

Plan Organization 5 45.5

Villager 9 81.8

Village leader 6 54.5

Commune council 2 18.2

PDRD 2 18.2

UNICEF 1 9.1

Total 11 100

Table 116. How people/ organizations participated in ODF celebrations Manner of participation/ activity

CLTS

n %

Parties 7 63.6

Provide clothes 1 9.1

Awareness raising hygiene and sanitation 5 45.5

Total 11 100

h. Satisfaction with latrine facilities and the sanitation project

Figure 25 below and Table 117 presents the level of satisfaction with latrines among households in CLTS and TS village. Table 118 presents the reasons for dissatisfaction with latrines. Majority (91%) of respondents in CLTS villages were satisfied with their latrines. For those not satisfied, the reasons given were: no money to obtain cement latrine/ slab (50%), difficulties during flood season (33.3%), and latrines are easily damaged/ broken (33.3%). Likewise, in TS villages, majority (90%) of respondents are satisfied with their latrines. Reasons provided by those dissatisfied with their latrines were the same as in CLTS villages. Figure 25. Satisfaction with latrines among HH

Table 117. Satisfaction with latrines Response

CLTS TS

n % n %

Yes 61 91 27 90

No 6 9 3 10

Total 67 100 30 100

Table 118. Reasons for dissatisfaction with latrines

Reasons

CLTS TS

n % n %

Difficult during flood season 2 33.3 1 33.3

Ash latrine easy damage 2 33.3 1 33.3

Want to get cement latrine but no money 3 50 1 33.3

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As regards satisfaction with the current sanitation project in their villages, majority of respondents in both CLTS (97%) and TS (96%) villages were satisfied with the projects. In CLTS villages, those unsatisfied did not attend community meetings while those in TS villages cited the bad smell of latrines. See Table 119 and 120.

Table 119. Satisfaction with CLTS/ sanitation project Response CLTS TS

n % n %

Yes 65 97 24 96

No 2 3 1 4

Total 67 100 25 100

Table 120. Reasons for dissatisfaction with CLTS/ sanitation project

Reasons

CLTS TS

n % n %

Ash latrine is very smelly - - 1 4

No idea/not attend the meeting 2 3 - -

Total 2 100 1 100

i. Perceptions on improvement of sanitation/ hygiene situation in villages In CLTS villages, provision of latrines to all households was the main response (65.7%) as regards further improving the sanitation and hygiene situation in villages. The second main response was wider awareness raising (AR) on impacts of OD (40.3%) and the third was materials from NGO (11.9%). In TS villages, 73.3% of responses were on provision of latrines to all families. Wider AR on impacts of OD came in at second (50%) while the third main response was improving the quality of latrines built. Figure 26 and Table 121 shows the different responses of villagers as to how to further improve sanitation and hygiene situation in their villages. Figure 26. Perceptions on further improvement of sanitation situation

Table 121. Perceptions on what should be done to further improve S&H situation

Activities CLTS TS

n % n %

Make latrine all family 44 65.7 22 73.3

Widely awareness/ Explain about impact that cause from defecate outside the latrine

27 40.3 15 50.0

Advertising about latrine important through TV

3 4.5 3 10.0

NGO should be provide material

8 11.9 5 16.7

Improve to quality of building latrine

6 9.0 7 23.3

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Don't know 4 6.0 - -

Total 67 100.0 30 100.0

As regards the most important activity that should happen in villages so that the sanitation/ hygiene situation will improve, respondents in CLTS villages indicated that wider AR on impact of OD (38.8%) and provision of latrines to all (31.1%) were the most important activities needed. In TS villages, the main suggested activities were provision of latrines to all (56.7%) and wider AR on impact of OD (50%). See Figure 27 and Table 122 below. Figure 27. Most important activities to improve sanitation condition

Table 122. Perception on the most important activity to improve S&H

Activity CLTS TS

n % n %

Widely awareness raising/ explain about impact that cause from defecate outside the latrine

26 38.8 15 50.0

Improve quality building latrine

8 11.9 2 6.7

Make latrine all family 21 31.3 17 56.7

Support from NGO 6 9.0 - -

Don't know 8 11.9 - -

Total 67 100.0 30 100.0

3.2.5.12 Other Programmes on Sanitation/ Hygiene in villages

Table 123 show the percentage of respondents who indicated the presence of other S&H programmes in their villages while Table 124 show the names of organizations, type of programme implemented, and the activities under the programme. In CLTS villages, majority (81%) of respondents state that there are no other S&H programmes in their villages. For the 19% who indicate there are other programmes, such other programmes are described as domestic hygiene, water sources/ safe drinking water, and malaria/ dengue support programmes. Organizations recalled by respondents were World Vision, UNICEF, CEDAC, CARE, ACEDO, ZOA, and Red Cross. Frequency of recall of individual organization name depends on village location, for example, respondents in villages in Kampong Thom easily recalled World Vision while those in Otdar Meanchay could remember CARE and ZOA. In TS villages, while more respondents (36.7%) say that there were other programmes on S&H, types of programmes and the names of organizations recalled were very similar as to that in CLTS villages. Main organizations recalled by respondents were the World Vision, the local Health Center, and Mlob Baitong organization.

Table 123. Presence of other sanitation projects in villages Response CLTS ADB TS

62

n % n %

Yes 13 19.4 11 36.7

No 54 80.6 19 63.3

Total 67 100.0 30 100.0

Table 124. Reported other S&H projects in villages

Agency/organization Program Activities

CLTS

World Vision Domestic Hygiene (clothes, washing hand, housing)

Domestic hygiene (clothes, washing hand, take bath, housing)

UNICEF Domestic Hygiene (clothes, washing hand, housing)

Explain about benefit/important get from latrine/hygiene

Domestic hygiene (clothes, washing hand, take bath, housing

CEDAC Domestic Hygiene (clothes, washing hand, housing)

Domestic hygiene (clothes, washing hand, take bath, housing

Care

Well/safety drinking water Provide Material and Idea

Teaching/spread out information

Domestic Hygiene (clothes, washing hand, housing)

Teaching/spread out information

ACEDO

latrine

Explain about benefit/important get from latrine/hygiene (lat

Domestic hygiene (clothes, washing hand, take bath, housing

Well/safety drinking water

Provide Material and Idea

Safety drinking water

Teaching/spread out information

Domestic Hygiene (clothes, washing hand, housing)

Provide Material and Idea, Safety drinking water, Teaching/spread out information

Malaria/dengue fever Safety drinking water, Teaching/spread out information

ZOA

Well/safety drinking water

Provide Material and Idea

Safety drinking water

Teaching/spread out information

Domestic Hygiene (clothes, washing hand, housing)

Provide Material and Idea

Safety drinking water

Teaching/spread out information

Malaria/dengue fever Safety drinking water

Teaching/spread out information

Red Cross

Well/safety drinking water Provide Material and Idea

Teaching/spread out information

Domestic Hygiene (clothes, washing hand, housing)

Provide Material and Idea

Teaching/spread out information

Commune

Well/safety drinking water Safety drinking water

Teaching/spread out information

Domestic Hygiene (clothes, washing hand, housing)

Safety drinking water

Teaching/spread out information

Malaria/dengue fever Safety drinking water

Teaching/spread out information

Hygiene support committee

Domestic Hygiene (clothes, washing hand, housing)

Domestic hygiene (clothes, washing hand, take bath, housing

Cher Domestic Hygiene (clothes, washing hand, housing)

Explain about benefit/important get from latrine/hygiene (lat

Domestic hygiene (clothes, washing hand, take bath, housing

Don't know/no remember

latrine Domestic hygiene (clothes, washing hand, take bath, housing

Domestic Hygiene (clothes, Explain about benefit/important get from

63

washing hand, housing) latrine/hygiene (lat

Malaria/dengue fever Domestic hygiene (clothes, washing hand, take bath, housing

TS

World Vision

Well/safety drinking water

Provide Material and Idea

Teaching/spread out information

Domestic Hygiene (clothes, washing hand, housing)

Domestic hygiene (clothes, washing hand, take bath, housing

Health Center Malaria/dengue fever Provide Material and Idea

Teaching/spread out information

Mlob Baitong Domestic Hygiene (clothes, washing hand, housing)

Domestic hygiene (clothes, washing hand, take bath, housing

Don't know/no remember

latrine

Provide Material and Idea

Explain about benefit/important get from latrine/hygiene (lat

Well/safety drinking water

Provide Material and Idea

Domestic hygiene (clothes, washing hand, take bath, housing

Teaching/spread out information

Malaria/dengue fever Provide Material and Idea

Bird Flu Provide Material and Idea

AIDs Provide Material and Idea

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3.2.6 No Latrines/ open defecation practicing households As Table 51 shows, the percent of households without latrines/ practicing OD is 58.1% in CLTS villages and 37.5% in TS villages. The sections below present the sanitation and hygiene practices and situation of these households.

3.2.6.1 Reasons for OD and possible ways to change the practice

Among all households who currently practice OD, the main reasons provided for the practice are no latrine/ incomplete latrine (43.9%) and no money to buy materials for latrine (24.3%). In CLTS villages, the main reasons are the same but some 10.9% also cite flooding as a reason for OD. In TS villages, half of respondents say that they have no latrine or incomplete latrines and 44.4% say they have no money to buy materials for latrine construction. See Table 125.

Table 125. Reasons for OD practice

Reasons CLTS TS

n % n %

Latrine is not important 3 3.3 - -

Vast area to defecate (forest, field, etc)

7 7.6 - -

Habit of defecate during fields or forest working

9 9.8 2 11.1

No money to buy material 17 18.5 8 44.4

No latrine/not yet complete build

38 41.3 9 50.0

No space(plot) 7 7.6 1 5.6

Flooded area 10 10.9 - -

Damage latrine 8 8.7 - -

Other 4 4.3 - -

Total 92 100.0 18 100.0

However, when respondents were asked to rank their stated reasons for practicing OD, damaged latrines, flooding, and no plot/ place to construct latrines were all ranked first equally in CLTS villages. In TS villages the main reasons by rank for OD practices were no latrine/ not yet built and no space to build latrine. See Table 126.

Table 126. Ranking of reasons for OD practice Reasons CLTS TS

Mean Mean

Tradition that has been passed from one to another generation

2.5 2.0

Latrine is not important 2.8 .

Vast area to defecate (forest, field, etc)

1.0 .

Habit of defecate during fields or forest working

2.2 2.0

No idea . .

No money to buy material 1.1 1.1

No latrine/not yet complete build

1.1 1.0

No space(plot) 1.0 1.0

Flooded area 1.0 .

Damage latrine 1.0 .

Other 1.0 .

Overall, very few respondents cite tradition and unimportance of latrines as key reasons for currently practicing OD. The other reasons given in descending order are: habit of OD when working in field/ forests (10.8%), vast area to defecate (8.1%), no space to construct latrine (7.4%), flooded areas (6.8%), and damaged latrines (5.4%). Figure 28 present all reasons given for OD practice among all households currently practicing OD in CLTS and TS villages.

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Figure 28. Reasons for OD

Asked as to what are the possible ways to make households change OD practice, the main responses across all households were make/ provide latrines to all families (77.5%) and provide material for latrine construction from NGOs (25.2%). Very few respondents suggested provision of methods/ training on latrine construction and education on S/H as the main ways to make them change their OD practice. This trend is similar among different types of villages as shown in Figure 30 below and Table 130. Figure 29. Possible ways to change OD practice

Table 127. Possible ways to change OD practice

Activities/ ways

CLTS TS Total

n % n % n %

Make latrine all family 68 73.1 18 100 86 77.5

Provide method to do/make latrine 5 5.4 0 - 5 4.5

Provide material for doing/making latrine/supported by NGO 25 26.9 3 16.7 28 25.2

Education or aware about hygiene and sanitation 5 5.4 0 - 5 4.5

No Idea/Don't know 2 2.2 0 - 2 1.8

Total 93 100 18 100 111 100.0

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3.2.6.2 Sources of Water

Tables 128 and 129 present the sources of hand-washing and drinking water in the dry and wet seasons in CLTS and TS villages.

a. CLTS Villages

Main sources of water for hand-washing in the dry season are bore-hole/ hand-pumps (41.9%) and ring wells (25.8%). Other sources used are traditional wells and ponds (both reported at 11.8% of respondents. In the wet season, bore-hole/ hand-pumps remain the main source (38.7%) but rainwater becomes a more common source than ring-wells (28% versus 24.7%). Drinking water in the dry season are mainly sourced from bore-holes/ hand-pumps (37.6%), ring wells (28%) and traditional wells (14%). In the wet season, bore-holes/ hand-pumps remain the main source (34.4%) but rainwater replaces ring-wells as the secondary source (31.2% versus 26.9%)

b. TS villages The sources of hand-washing water in the dry season are borehole/hand-pump (38.9%), traditional wells (33.3%), and ring wells (27.8%). In the wet season, sources remain the same but some 5.6% indicate that paddy rice water is also used in hand-washing. Drinking water in the dry season comes from traditional wells (38.9%), borehole/ hand-pumps (33.3%), and ring wells (27.8%). In the wet season, rainwater also becomes a source (16.7%) along with the water sources used in the dry season.

Table 128. Dry and wet season hand-washing water sources

Dry season CLTS TS

n % n %

Borehole + Hand pump 39 41.9 7 38.9

Ring Well + Platform 24 25.8 5 27.8

Traditional Well 11 11.8 6 33.3

Shallow Pit 3 3.2 - -

River / Stream 4 4.3 - -

Pond 11 11.8 - -

Private Water Seller 3 3.2 - -

Total 93 100.0 18 100.0

Wet season

CLTS TS

n % n %

Borehole + Hand pump 36 38.7 7 38.9

Ring Well + Platform 23 24.7 5 27.8

Traditional Well 10 10.8 6 33.3

Shallow Pit 3 3.2 - -

River / Stream 1 1.1 - -

Pond 4 4.3 - -

Rainwater 26 28.0 - -

Paddy Field Water 1 1.1 1 5.6

Private Water Seller 1 1.1 - -

Total 93 100.0 18 100.0

Table 129. Dry and wet season drinking water source

Dry season CLTS TS

n % n %

Borehole + Hand pump 35 37.6 6 33.3

Ring Well + Platform 26 28.0 5 27.8

Traditional Well 13 14.0 7 38.9

Shallow Pit 3 3.2 - -

River / Stream 3 3.2 - -

Pond 9 9.7 - -

Rainwater 2 2.2 - -

Private Water Seller 3 3.2 - -

Total 93 100.0 18 100.0

Wet Season CLTS TS

67

n % n %

Borehole + Hand pump 32 34.4 6 33.3

Ring Well + Platform 25 26.9 5 27.8

Traditional Well 10 10.8 6 33.3

Shallow Pit 3 3.2 - -

River / Stream 1 1.1 - -

Pond 2 2.2 - -

Rainwater 29 31.2 3 16.7

Paddy Field Water 1 1.1 - -

Total 93 100.0 18 100.0

3.2.6.3 Incidence of Diarrhea

Reports of diarrhea incidence in the last 3 months were higher in TS villages (39%) than in CLTS villages at 23% - see Table 130. In terms of knowing how to prevent diarrhea, in CLTS villages 72.7% reported they knew how, while in TS villages 42.9% indicated they knew how to prevent diarrhea (Table 131).

Table 130. Common illnesses HHs members experienced in last three months

Illnesses CLTS TS

n % n %

Malaria 6 6.5 - -

Headache/Dizzy 13 14.0 5 27.8

Cough 7 7.5 3 16.7

Diarrhea 21 22.6 7 38.9

Typhoid 11 11.8 2 11.1

Fever 38 40.9 10 55.6

Bad stomach / stomach ache 12 12.9 5 27.8

Cold / influenza 53 57.0 13 72.2

Dengue 7 7.5 1 5.6

Other illness 8 8.6 - -

Total 93 100.0 18 100.0

Table 131. Whether respondent knows how to prevent diarrhea

Response CLTS TS

n % n %

Yes 16 72.7 3 42.9

No 5 22.7 4 57.1

Don't know 1 4.5 - -

Total 22 100.0 7 100.0

The main reported ways to prevent diarrhea were (in descending order), boiling drinking water (86.2%), cooking food properly (27.6%), washing hands (24.1%), and with similar percent values, being careful of food eaten (20.7%), washing vegetable with clean water (20.7%), and washing hands before eating (20.7%) were the means given (multiple answers). See Figure 30. Reports of boiling water to prevent diarrhea was marginally higher in TS villages (100% versus 94%). Reports of cooking food properly were also higher in TS villages (33.3% versus 25%). However, hand-washing was reported only in CLTS villages (25%). Likewise, washing hands after defecation was reported at 12.5% but only in CLTS villages. See Table 132.

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Figure 30. Reported ways to prevent diarrhea

Table 132. Reported ways to prevent diarrhea

Practices CLTS TS Total

n % n % n %

Cook food properly – eat soon after cooking

4 25.0 1 33.3 8 27.6

Be careful about what kind of food you eat

5 31.3 - - 6 20.7

Boil drinking water 15 93.8 3 100.0 25 86.2

Wash vegetables with clean water

4 25.0 - - 6 20.7

Wash hands 4 25.0 - - 7 24.1

Wash hands after defecation

2 12.5 - - 2 6.9

Wash hands before eating 4 25.0 1 33.3 6 20.7

Wash hands before preparing food

1 6.3 - - 1 3.4

Clean cooking and eating utensils

- - 1 33.3 2 6.9

Total 16 100.0 3 100.0 29 100.0

3.2.6.4 Defecation Practices

Figures 31 to 33 and Tables 133 to 139 present the defecation practices of households in CLTS and TS villages.

a. CLTS villages At home (adults and children), 63.4% practice OD while 44.1% practice chhik korb (Figure 32). When at the field/ chamkar, 88% of adults practice OD and chhik korb is done only by about 10% (Figure 33). When working in the field/ chamkar, reasons for OD are distance to houses (46.2%), no latrines (46.2%), and because it is a habit (19.4%). In public areas, 58.1% of adults use public latrines, 19.4% defecate on the ground, and about 13% use neighbors’ latrines. Some 14% of respondents said that they never defecate when in public areas. See Figure 34. Most (91.8%) children when at the field/ chamkar practice OD with only 7.1% practicing chhik korb. In public places, 67.1% of respondents indicate that children use public latrines and 23.5% defecate on the ground. About 11% say that children never defecate when in public places. Generally, what adults practice, is also practiced by children. Infant’s faeces are generally buried according to 88.2% of respondents. But some say faeces is either thrown in water bodies (8.2%) or in the forest/ field (4.7%).

69

Leaves (46.2%), water (40.9%), and paper (21.5%) are used for cleaning after defecation. Some (11.8%) say that small wood/ twigs are also used for cleaning.

b. TS villages At home, adults and children practice OD according to 88.9% of respondents while chhik korb is also practiced according 22.2% (Figure 32). When at field/ chamkar the same situation is reported but less are practicing chhik korb (11.1%) – see Figure 33. Reasons provided for OD are distance to the house (55.6%) and no latrine (55.6%). In public places, 66.7% of respondents indicate that public latrines are used but OD is also practiced at 22.2% of respondents (Figure 34). All children practice OD when in the field/ chamkar. In public places, most children are reported as using public latrines (87.5%). Infant’s faeces are normally buried (75%) but these are also thrown in to water bodies (18.8%) or into forests/ fields (18.2%). Water (50%), leaves (50%), and small wood/ twigs (33.3%) are generally used for cleaning after defecation. Figure 31. Defecation practice when at home

Table 133. Defecation practice at home

Practice CLTS TS

n % n %

On the ground/forest 59 63.4 16 88.9

Digging hole 41 44.1 4 22.2

Total 93 100.0 18 100.0

Figure 32. Defecation practices when in field/ chamkar

Table 134. Defecation practice in field/ chamkar

Practice CLTS TS

n % n %

On the ground/forest 81 88.0 16 88.9

In a water body 1 1.1 - -

70

Digging hole 9 9.8 2 11.1

Neighbor latrine 1 1.1 - -

Never 1 1.1 - -

Total 92 100.0 18 100.0

Figure 33. Defecation practices when in public places

Table 135. Defecation practice in public place

Practice CLTS TS

n % n %

On the ground 18 19.4 4 22.2

In public latrine 54 58.1 12 66.7

Neighbor latrine 12 12.9 - -

Never 13 14.0 2 11.1

Total 93 100.0 18 100.0

Table 136. Defecation practice of children at field/ chamkar

Practice CLTS TS

n % n %

On the ground 78 91.8 16 100.0

Digging hole 6 7.1 - -

Never 1 1.2 - -

Total 85 100.0 16 100.0

Table 137. Defecation practice of children in public places

Practice CLTS TS

n % n %

On the ground 20 23.5 1 6.3

In public latrine 57 67.1 14 87.5

In neighbor latrine - - - -

Never 9 10.6 1 6.3

Total 85 100.0 16 100.0

Table 138. Disposal of infants’ faeces

Practice CLTS TS

n % n %

Throw in the water 7 8.2 3 18.8

Bury 75 88.2 12 75.0

Leave open 1 1.2 - -

Through to field/forest 4 4.7 3 18.8

Total 85 100.0 16 100.0

Table 139. Cleansing materials used after defecation

Cleansing materials CLTS TS

n % n %

Water 38 40.9 9 50.0

Leaves 43 46.2 9 50.0

Paper 20 21.5 - -

Clothes 1 1.1 1 5.6

71

Small wood 11 11.8 6 33.3

Total 93 100.0 18 100.0

3.2.6.5 Hand-washing practices

Figures 34 and 35 and Tables 140 to 144 shows the hand-washing practices of households in CLTS and TS villages. All household members in CLTS and TS villages practice hand-washing. Hand-washing frequency is generally more than once a day in both village types (Figure 35). More than once-a-day hand-washing frequency is higher in CLTS villages (94.6%) than in TS villages (83.3%).

Table 140. Hand-washing habit of households

Response CLTS TS

n % n %

Yes 93 100.0 18 100.0

No - - - -

Total 93 100.0 18 100.0

Table 141. Frequency of hand-washing

Frequency CLTS TS

n % n %

One time every day 2 2.2 1 5.6

More than one time /day 88 94.6 15 83.3

One time/2-3day 2 2.2 1 5.6

Wash when dirty 1 1.1 1 5.6

Total 93 100.0 18 100.0

Figure 34. Frequency of hand-washing

Generally, in CLTS villages, hand-washing is done before eating (95.7%), when hands are dirty (50.5%), after eating (45.2%), and after defecation (32.3%) – Figure 36. Usually, soap and water (89.2%) or water only (74.2%) are used in hand-washing. Some (14%) also use ash in hand-washing. Reasons given for hand-washing are: make hands clean (63.4%), to prevent disease (54.8%), and to remove bacteria. In TS villages, all respondents say that hand-washing is done before eating. This is also done when hands are dirty (44.4%), after defecation (27.8%), and when returning to the house (22.2%) – Figure 36. Soap and water and water only in hand-washing are equally reported at 66.7%. For some 17%, ash is also used in hand-washing. The main reasons given for hand-washing are: to make hands clean (66.7%), to remove bacteria (61.1%), and to prevent disease (22.2%).

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Figure 35. Instances when hand-washing is done

Table 142. When hand-washing is done

Instance CLTS TS

n % n %

When they are dirty 47 50.5 8 44.4

When returning to the household

9 9.7 4 22.2

Before eating 89 95.7 18 100.0

After eating 42 45.2 3 16.7

After defecation 30 32.3 5 27.8

Before going to sleep 14 15.1 3 16.7

After waking up 3 3.2 1 5.6

Before preparing food 6 6.5 - -

Total 93 100.0 18 100.0

Table 143. Cleansing materials used in hand-washing

Cleansing material CLTS TS

n % n %

Water only 69 74.2 12 66.7

Ash 13 14.0 3 16.7

Soap 83 89.2 12 66.7

Sand 2 2.2 - -

Total 93 100.0 18 100.0

Table 144. Reasons for hand-washing

Reasons CLTS TS

n % n %

to remove dirt / make them clean

59 63.4 12 66.7

for personal appearance – to look good

13 14.0 - -

prevent disease 51 54.8 4 22.2

to remove microbes / bacteria

44 47.3 11 61.1

Total 93 100.0 18 100.0

3.2.6.6 Other Programmes on Sanitation/ Hygiene in villages

In both CLTS and TS villages, majority of respondents (88.9% in TS and 67.7% in CLTS villages) indicated that there were other programmes on sanitation and hygiene implemented in their villages (Table 145). However most of respondents (68.8% in TS and 63.5% in CLTS villages) could not recall the names of the organizations that implemented such programmes (Table 146). UNICEF and Plan were frequently identified by those who could recall organizations’ names in CLTS villages. In TS villages, World Vision, Red Cross, and Mlob Baitong were the mentioned organization names.

73

Table 145. Other S&H programmes in villages

Response CLTS TS

n % n %

Yes 63 67.7 16 88.9

No 29 31.2 2 11.1

Don't know 1 1.1 - -

Total 93 100.0 18 100.0

Table 146. Reported names of organizations

Name CLTS TS

n % n %

World Vision - - 2 12.5

UNICEF 5 7.9 - -

ADRA 1 1.6 - -

Care 1 1.6 - -

Plan 12 19.0 - -

ACEDO 1 1.6 - -

Red Cross 1 1.6 2 12.5

Health Center 1 1.6 - -

Commune/Village 2 3.2 - -

Hygiene support committee 1 1.6 - -

MLob Baitong - - 2 12.5

PDRD 3 4.8 - -

Neary Khmer - - 1 6.3

Do not remember 40 63.5 11 68.8

Total 63 100.0 16 100.0

Types of programmes reported were on generally on domestic hygiene (61.9%), latrines (39.7%), and water/ safe drinking water (9.5%) in CLTS villages. Some 11% could not recall the types of programme implemented in their villages. In TS villages, types of programmes were latrines (68.8%), wells (50%), and domestic hygiene (31.3%) See Table 147. As regards activities/ services of the other programmes, domestic hygiene was the most frequently mentioned (57.7%), then advise to make latrine (50.8%), and in equal reports, safe drinking water and AR on S&H (15.9%). In TS villages, programme activities were described as domestic hygiene and safe drinking water (both at 37.5%) and advice to make latrines. See Table 148.

Table 147. Types of other S&H programmes

Type CLTS TS

n % n %

Latrine 25 39.7 11 68.8

Well/safe drinking water 6 9.5 8 50.0

Domestic Hygiene 39 61.9 5 31.3

Do not remember 7 11.1 1 6.3

Total 63 100.0 16 100.0

Table 148. Activities of S&H programmes

Activities CLTS TS

n % n %

Provide Material and Idea 6 9.5 2 12.5

Explain about benefit/important get from latrine/hygiene

10 15.9 3 18.8

Domestic hygiene 36 57.1 6 37.5

Safe drinking water 10 15.9 6 37.5

Advise to do latrine 32 50.8 3 18.8

Meeting 2 3.2 3 18.8

Total 63 100.0 16 100.0

In CLTS villages, 88.9% said that their villages had better sanitation/ hygiene situations because of these other programmes. Main reasons given for the positive change in S&H situation were better awareness on hygiene (55.6%) and more latrines than before (49.2%). In TS villages 87.5% likewise indicated

74

better S&H condition in their village from these other programmes. Reasons provided were more latrines (75%) and presence of NGO in the community (43.8%). See Tables 149 and 150.

Table 149. Perception on S&H improvements from programmes

Response CLTS TS

n % n %

Yes 56 88.9 14 87.5

No 7 11.1 2 12.5

Total 63 100.0 16 100.0

Table 150. Reasons for S&H improvements

Reasons CLTS TS

n % n %

Have latrine more than before

31 49.2 12 75.0

Have NGO involve in the village/community

9 14.3 7 43.8

Awareness about hygiene 35 55.6 2 12.5

No idea 1 1.6 - -

Not take care 5 7.9 2 12.5

Not yet awareness about hygiene

1 1.6 - -

Total 63 100.0 16 100.0

3.2.6.7 Perceptions on advantages and disadvantages of having latrines

Figures 36 and 37 and Tables 151 and 152 presents the perceived advantages and disadvantages of having latrines among households in CLTS and TS villages. In CLTS villages, main advantages of owning a latrine given were: convenience/ time-saving (69.9%), improved hygiene/ cleanliness (63.4%), and improved health (39.8%). In TS villages, advantages given were: convenience/ time-saving (77.8%) and improved hygiene/ cleanliness (66.7%). Figure 37 below and Table 159 present cited advantages of having latrines in detail. In CLTS villages, 56% saw no disadvantages of owning a latrine. However, 16.1% said that the bad smell coming from the latrines was the disadvantage. Some respondents (25%) did not know if there were disadvantages in owning a latrine. In TS villages, most (83.3%) saw no disadvantage but bad smell (5.6%) and work to maintain latrines (5.6%) were mentioned as disadvantages. Figure 38 below and Table 160 presents the mentioned disadvantages of having a latrine across all village types. Figure 36. Advantages of having a latrine

Table 151. Advantages of owning latrines

Advantages CLTS TS

n % n %

Improve hygiene/ cleanness 59 63.4 12 66.7

75

Improve health 37 39.8 5 27.8

More privacy 4 4.3 4 22.2

More comfortable 8 8.6 2 11.1

Convenience/save time 65 69.9 14 77.8

Improve safety 14 15.1 4 22.2

Make fertilizer 3 3.2 2 11.1

Total 93 100.0 18 100.0

Figure 37. Disadvantages of having a latrine

Table 152. Disadvantages of owning latrines

Disadvantage CLTS TS

n % n %

Bad Smell 15 16.1 1 5.6

Cost to maintain it 2 2.2 - -

Work to maintain it 2 2.2 1 5.6

No disadvantage 52 55.9 15 83.3

Do not Know 23 24.7 1 5.6

Total 93 100.0 18 100.0

3.2.7 Comparison of Poor

21 and Ordinary Households

The key distinguishing characteristics of the poorest (including the elderly, vulnerable, and disabled) as compared to ordinary households are the following: majority have no education, fewer own agricultural land and land owned is smaller, main sources of income are non-farm labor, average income is twice as low, and fewer own residential land and land owned is smaller. In terms of OD practice, 75% of the poorest as compared to 52.5% of the ordinary practice OD. See Table 153 for the tabular comparison of poor and ordinary households. In FGDs, the poorest are generally described/ identified as those that have many children, have no rice fields, have no cows, no money, are frequently sick, have no proper house to stay, and mostly live near the edges of the village and/ or near the forests or in other people’s lands. Most of the poorest are also described as the elderly and the widows. In some villages, they are also described as refugees from border camps that have returned to their original villages

22. In the border provinces such as Siem Reap

and Otdar Meanchay23

the poorest are also described as those who frequently migrate to Thailand or elsewhere to sell their labour. In general, the poorest are reported to comprise from 8% to 50% of the village population

24.

21

In each village, 2 poor households (identified by the village chief or the deputy village chief) were purposively interviewed. 22

Trapeang Reussey village Kampong Thom 23

Kok Sang Kae, Prasat Bey, and Prey Norkor villages in Otdat Meanchay. 24

From estimates given by local officials and the PDRDs

76

In terms of their participation to CLTS, the poorest equally joined the first CLTS meetings with ordinary households but fewer joined in the second and subsequent CLTS village meetings. The same is reported in FGDs – meeting organizers especially the village chiefs make it a point to invite all people including the poorest families. After community meetings and with constant encouragement and monitoring from village focal persons, the poorest are reported to build their own pit latrines albeit over a longer time than ordinary households because of lack of time and resources. However, those who have no land, live in clustered houses, live at the edges of the forest, are reported as former refugees, or who regularly migrate for work do not generally build latrines. The main limiting factor reported is lack of land, no resources, no time, and easy access to forests/ bush areas. No education/ low understanding of importance of latrines/ stopping open defecation is also cited as major reason particularly among local officials (village chiefs, commune council members, and district authorities). Similar to experiences of all others who have built dry pit latrines, most of the poorest who have built latrines revert back to OD during the rainy season when the pit become flooded or collapse. However, unlike the ordinary households who usually repair and rebuild their latrines in the dry season, the poorest most likely will no repair their latrines unless there is considerable encouragement for village focal persons particularly the village chief. FGD results clearly indicate that most often it is not encouragement but push that is exerted by village chiefs and other focal persons. There are even reports that building of latrines becomes a pre-condition before village chiefs sign documents such as marriage applications. Key reported reasons for the poorest inability to re-build their latrines regularly are lack of resources (money, labor, and material), lack of time (frequent migration for work, selling labor), and latrines seemingly not a high priority.

Table 153. Comparison between poor and ordinary households

HH Type Comparison CLTS ADB TS

Educational Attainment (Percent)

Poor HH None 60.0 45.5

Ordinary HH Primary School 42.7 47.1

Agricultural land ownership (Percent)

Poor HH Yes 75.0 75.0

Ordinary Yes 95.0 97.2

Size of Agricultural Land (Area in Hectares)

Poor HH Mean .86 .69

Ordinary HH Mean 1.93 1.23

Source of Income in last 12 months (Percent)

Poor HH Non-farm labour

52.5 16.7

Ordinary HH Selling rice 54.2 44.4

Mean Income Per Day (USD/Day)

Poor HH Mean 1.82 0.95

Ordinary HH Mean 3.55 2.57

Main Expenditure Item

Poor HH Health 1.77 1.00

Ordinary HH Health 1.60 1.66

Residential Land Ownership (Percent)

Poor HH Yes 87.5 75.0

Ordinary HH Yes 95.8 94.4

Size of Residential Land (Area in Hectares)

Poor HH Mean 0.09 0.07

Ordinary HH Mean 0.11 0.14

Number of HH with Latrines (Number)

77

Poor HH Latrine 10 5

Ordinary HH Latrine 57 25

OD Practice (Percent)

Poor HH Open land 75.0 58.3

Ordinary HH Open land 52.5 30.6

Participation in Community Meetings (Percent)

Poor HH First meeting) 90.0 20.0

Poor HH Subsequent meeting

90.0 20.0

Ordinary HH First meeting 82.5 60.0

Ordinary HH Subsequent meeting

86.0 48.0

How participate in meetings (Percent)

Poor HH Meeting 100.0 100.0

Ordinary HH Meeting 94.3 94.7

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4 Evaluation Findings

4.1 Relevance/ Importance of Latrines25

In villages not exposed to CLTS or to the TS Project (or “other villages”), only 16.7% of households have latrines/ use latrines for defecation with 83.3% currently practicing OD. Out of the six villages visited, practice of OD was 100% in four villages and it was only in Prey Peal

26 village where more households

were using latrines versus than OD practice (Figure 38). The main reasons for practice of OD were no latrines/ not yet built (47.4%), no money to buy latrine materials (28.9%), and in equal instances, habit of OD and vast area to defecate (13.2%). Other reasons were no plot/ place to build latrines (7.9%). However, by rank, no space/ plot, no latrine, and vast area to defecate were reported as the main reasons for open defecation practice. OD habit, tradition, and non-importance of latrine were the lowest ranked reasons. See Tables 154 and 155. Figure 38. Defecation Practices in Other Villages

Table 154. Reasons for OD practice in Other Villages Reasons n %

Tradition that has been passed from one to another generation

1 2.6

Latrine is not important 2 5.3

Vast area to defecate (forest, field, etc) 5 13.2

Habit of defecate during fields or forest working 5 13.2

No money to buy material 11 28.9

No latrine/not yet complete build 18 47.4

No space(plot) 3 7.9

Total 38 100.0

Table 155. Ranking of reasons for OD practice in Other Villages

Reasons Ranking of

Mean Values

Tradition that has been passed from one to another generation

1.3

Latrine is not important 2.0

Vast area to defecate (forest, field, etc) 1.2

Habit of defecate during fields or forest working 1.9

No money to buy material 1.3

No latrine/not yet complete build 1.1

No space(plot) 1.0

Most households think that the best way to encourage people to change their OD practice is through provision of latrines to all families or to provide materials for latrine construction to families from NGOs.

25

Other villages were surveyed primarily to determine the relevance or importance of latrines/ sanitation among villages that were not extensively exposed to government or NGO sanitation and hygiene projects. Other villages were selected by PDRD in the each province. Non intervention villages were not part of the original Evaluation Terms of References but were included at the request of UNICEF. 26

CDB data for Prey Peal village indicate that more than 100 HH have latrines which can be attributed to NGO sanitation programs implemented in the village

79

Few indicated that the best way to change OD practice is through training on latrine-building and education/ awareness-raising on S&H. See Table 156.

Table 156. Possible ways to change OD practice Activities n %

Make latrine all family 32 80.0

Provide method to do/make latrine 1 2.5

Provide material for doing/making latrine/supported by NGO

10 25.0

Education or aware about hygiene and sanitation 2 5.0

Total 40 100.0

About half of households indicate that NGOs or government projects on S&H have been implemented in their villages (Table 157). NGOs mentioned were ADRA, CARE, Plan, Red Cross, RHAC, and CHHRA with most of S&H activities focusing on domestic hygiene/ sanitation (61%) and safe drinking water (22%). See Table 158.

Table 157. Other S&H programmes in villages Response n %

Yes 18 45.0

No 20 50.0

Don't know 2 5.0

Total 40 100.0

Table 158. Types of other S&H programmes Type n %

latrine 1 5.6

Well/safety drinking water 4 22.2

Domestic Hygiene 11 61.1

Malaria/dengue fever 1 5.6

no remember 3 16.7

Total 18 100.0

Most households saw advantages in having own latrines (Table 159). Main reasons given were: improved hygiene/ cleanliness (77.5%), convenience/ time-saving (60%), and improved health (32.5%) – Table 160. For the few that did not see any advantages in having own latrines (7.5%), the work required to maintain latrines was the given reason.

Table 159. Advantages of owning latrines Advantages n %

Improve hygiene/ cleanness 31 77.5

Improve health 13 32.5

More privacy 2 5.0

More comfortable 4 10.0

Convenience/save time 24 60.0

Improve safety 5 12.5

Do not Know 2 5.0

Make fertilizer 2 5.0

Total 40 100.0

Table 160. Disadvantages of owning latrines Disadvantages n %

Work to maintain it 3 7.5

No disadvantage 24 60.0

Do not Know 13 32.5

Total 40 100.0

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4.2 Access

In 2027

villages visited, comparing the number of latrines reported in the Commune Data-base (CDB) 2007 to that reported built in 2006, there is about 69.4% coverage among all households particularly in the dry season when latrines are re-built and/ or repaired (72.3%). However, at the time of the field survey, 41.9% were still regularly using latrines. Those who were practicing reported not having latrines (either flooded or broken) or were still in the process of building/ re-building their latrines.

Most latrines are unlined pit latrines (61%) and to a much lesser number, concrete ring pit latrines. Of these, 21% have pour-flushed latrines slabs. Pour-flushed latrines are accessed by the better-off households or those that benefited from previous sanitation programmes from organizations such as CARE, World Vision, among others.

Most of the latrines (81%) are located downstream of water sources and majority (53.7%) of these downstream-located latrines are 30m or more distant from the water sources. More than half of all latrines have washing areas with water and those with water, 68% have soap. In ODF villages, it is noteworthy that there is emerging thinking of other useful purposes of latrines, for example, 20% in ODF villages, see latrines as sources of fertilizers for crop production. Access to latrines greatly diminish in the wet season as most latrines particularly unlined dry-pit latrines, fail due to flooding, soil collapse, and from infestation of termites and ants. As such open defecation practices recur during the wet season. While the CLTS is intended to help every villager, the poorest cannot sustain their access to latrines. In the first instance, the CLTS process invigorated all to build latrines especially with the constant push from village chiefs and other village focal persons. Hence, even some of the poorest (e.g. those with space in their household plots) were able to access latrines. However, most of the poorest who live in clustered houses at the edges of villages (sometimes not even their own land) or who frequently move about for livelihood/ work purposes, were not able to build latrines. And for those who built latrines during the initial wave of optimism in villages, are unable to re-build due to low priority of latrines, lack of resources, and frequent migration for work.

4.3 Equity

More than 80% of households were reported to have participated in the first and second meetings of the CLTS programme. About a fourth of households are reported to have attended community meetings from 3-4 times. All poor households in villages were reported to have participated in the CLTS meetings along with most of other villagers including elderly, children, disabled persons, and women. FGD results also indicate extensive participation of the poor households in community meetings. FGD participants report that all villagers were invited to and most participated in the meetings. FGD results also indicate that in many villages, the number of women who attended CLTS meetings were higher than that of the men. In FGDs with women, married couple do not attend meetings together – one has to attend and one has to work. Since most often, it is the men who go to the field/ chamkar for work, the women then attend community meetings organized by the village chief such as the CLTS meetings.

Villagers are reported as the main participants in ODF celebrations (100% in non-ODF villages

28 and

77% in ODF villages). The poor are not particularly identified as participants in ODF celebrations. This generally follows reports that the poor were not specifically prioritized under the CLTS approach. Households are most visited by Village Chiefs who are almost always a key village focal person under the CLTS programme. PDRD and members of the commune councils also visit households but at much lesser instances than villages chiefs. Visits of DORD staff to villages are rare. In these visits, the most common purpose is to check whether latrines have been built and are being used. In instances when latrines have yet to be constructed, the focus of the visits is to strongly encourage households to make the latrine as soon as possible. In general, visits and subsequent interactions with focal persons occur

27

2 villages in Otdar Meanchay does not appear in SEILA CDB 2007. 28

Classification of ODF and Non-ODF villages is based on 2006 status. In the succeeding years, some non-ODF villages have attained ODF, for example, Prey Norkor village in Pong Ro commune in Otdar Meanchay province.

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on a monthly interval. However, interactions with village focal persons are more frequent, occurring every week or every day. Majority (66.7%) of respondents reports that posters/ information materials on sanitation and hygiene are installed in the villages. FGD results indicate that knowledge and skills on sanitation and hygiene have been built up among households in target villages. Most can build simple pit latrines following models/ process provided by CLTS implementers such as the PDRDs/ UNICEF/ Plan during the first or second meeting in the community. Results indicate that villagers do not find simple pit latrine construction as difficult. However, as to pour-flushed latrines, villagers say that they cannot build such latrine on their own. “Building a latrines is not so complicated, just dig the hole about 1.5 to 3 meters deep, then put the wooden slab a bit higher than the soil level, build the wall and roof, you can have a latrine already. We have to build cover as well to prevent the fly go inside and the smell coming out”. Knowledge on sanitation and hygiene was also built up from the community meetings where S/H topics were discussed then from constant/ regular visits from CLTS implementers and the village focal persons who also constantly remind villagers about proper S/H practices aside from encouraging them to make or maintain latrines. Reports that posters/ information materials on sanitation and hygiene were generally installed/ present in villages also contributed to the high level of knowledge on S/H among villagers. Although most respondents indicate that there were few previous and on-going sanitation and hygiene programmes of other NGOs and government agencies, such programmes may have also contributed to the high level of knowledge on S/H among villagers. FGD results indicate that there were no distinctions as to which sectors/ groups in the villages should benefit most under the CLTS programme. All villagers were targeted to build latrines without any special emphasis on the poor or the vulnerable groups. While poor and vulnerable households were more often visited by focal persons (because this groups generally lags in latrine construction), visits were for the purpose of verbal encouragement/ push rather than actual physical or material assistance in building their latrines. However, there were reports by some (for example, Kok Sangkea village in Otdar Meanchay province) village focal persons that vulnerable households (elderly, female-headed) were assisted by village focal persons in constructing latrines especially in digging the pit. There is little evidence to show that the poor were selected as focal persons. Selection of focal persons in the village apparently depends on the choices of the commune council and the village chiefs or those nominated during the first community meetings. Often, those nominated are individuals who have standing in the community such as the village chiefs, the deputy village chiefs, and group leaders in the village. The poor are described as not having time or enough educational background to be nominated and selected as village focal persons.

4.4 Effectiveness

4.4.1 In promoting community participation

Under CLTS the need for community action is created as majority of villagers learn of the health dangers of OD and of the importance that all should build and use latrines to lessen if not eliminate such health dangers. The over-all effect is that most of the villagers actively participate in the agreed on community action, i.e. building and using latrines.

The key community structure or mechanism created under CLTS is the village focal persons. These focal persons who generally comprise of the village chief and/ or his deputy, and key individuals selected from the village population serve as the launching and monitoring points for improving S&H conditions in the village. The focal persons are trained on facilitation skills and on technical aspects of latrine building. In turn, they teach and encourage all other villagers to build and maintain latrines and to stop OD. Survey and FGD results indicate a wide awareness among villagers of who the focal persons are and their duties/ tasks under the CLTS programme. Interactions with village focal persons, particularly the village chief, is also described as constant and regular – with focus on ensuring that latrines are built, used regularly, and maintained. This village mechanism is voluntary and members do not receive any incentives. They take the lead in organizing community meetings inviting all villagers whenever external facilitators/ monitoring entities such as the PDRD, DoRD, and commune council focal person visit the villages.

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While village focal persons are effective mechanisms for widespread participation in CLTS activities and in ensuring that the community indeed build and use latrines, it is apparent that there is a lack of technical skills/ initiative within focal persons to respond to latrine durability issues experienced and reported by many villagers. Since majority of latrines built are unlined dry-pit latrines, these are susceptible to flooding in the wet season and collapse due to soil structure, ants and termites, and also to constant use. The ability to respond to and manage these issues is not yet found in villages and requires external assistance from non-village facilitators/ focal persons.

CLTS effectively promotes regular maintenance of latrines through the monitoring visits of village focal persons and external facilitators. Study results indicate that most households with latrines regularly clean and maintain the upper sections of latrines and rebuild latrine pits in the dry season. However, in the wet season cleaning, maintenance and rebuilding is greatly reduced due in large part to the flooding/ water-logging situation in most residential areas in villages. Contribution to community CLTS activities is generally found in the process of building individual family latrines. Households build their own latrines using available materials from the village or nearby communal lands/ forests. There is very little evidence of one household giving materials or actually helping other households in building latrines. In CLTS, participation of households declines when durability issues of latrines become apparent and there is no immediate and effective solution available. While there are reports that VFPs have suggested re-building latrines in higher ground or by lining latrines with palm mid-ribs, these have proven to be ineffective against flooding, soil collapse and infestation from ants and termites. Durability issues which are the main cause of regular re-building during the dry season affect villagers negatively – they become weary or tired of the constant re-building effort. Among the poor and the poorest, participation wanes because of lack of resources and time to re-build latrines and in many cases because of low priority of latrines.

4.4.2 In contributing to improved access to rural sanitation

4.4.2.1 Use of latrines at all times

At the time of the survey, 41.9% in all CLTS villages were regularly using latrines for defecation. On non-ODF villages, latrine use was at 46.3% while in ODF villages it was at 37.5%. Study results also indicate that use of latrines at all times is also high. At home, only 10% of household members still practice OD (5.4% in non-ODF and 16.7% in ODF villages). OD is still practiced by only 7.5% of adults when at public places. Among children, 18% practice OD at home, 13.4% in public places, and nearly all when in the field/ chamkar. The main reason given for children’s different defecation practices is the children are too young to know better. Results of interviews with children also present a negative situation. Children report that when at home, 45% practice OD and in the field/ chamkar, all practice OD. However, children report that almost all use public latrines when in public places. Infant’s faeces are not also always disposed of properly with 9% of respondents indicating disposal by throwing in water bodies (13.5% in non-ODF and 6.7% in ODF villages). Responses of children indicate the same with some 13.3% saying that infant’s faeces are thrown into forests or fields. FGD results support the survey findings above. During the dry season, all villagers are reported to use latrines regularly whether their own or neighbors’ latrines. However, in the wet season the latrines collapse or become flooded - water goes inside the pit and bad smell comes out. People then feel averse to using the latrines; hence OD becomes a common practice in rice fields, bush areas, or forests.

4.4.2.2 Regular cleaning and maintenance of latrines

Household survey results indicate that generally there is regular cleaning of latrines. Once to more than once a day cleaning is reported at 46.2% (54% in non-ODF villages and 36.7% in ODF villages while once every 3 days is reported at 28.4% (24.3% in non-ODF villages and 33.3% in ODF villages). Similar cleaning frequencies are reported among children. However, less than once a week cleaning and rare

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cleaning is also practiced. From FGDs, latrine cleaning is done more often during the dry season when the latrine pits are not flooded. Villagers say that unlike pour-flushed latrines which normally have smooth slabs, dry pits are not easy to clean because slabs are generally made of wood. Hence, cleaning just normally involves sweeping garbage from the latrine area. Use of water in cleaning dry pit latrines is not done because villagers do not want the latrines to get wet. Apparently, knowledge of ash as a cleaning agent in latrine pits is not commonly known as indicated by the presence of ash in washing areas at only 10.5% Household survey results show that 57% have washing areas in latrines (54.1% in non-ODF and 60% in ODF villages). Water is always available in all latrines but soap is available in only in 68% (65% in non-ODF and 72.2% in ODF villages). Only 10.5% (5% in non-ODF and 16.7% in ODF villages) report having ash. FGD results indicate the same situation. Mostly, there are no cleansing materials in the latrines. “Anytime, we want to defecate, we will bring a tank of water and ashes with us. After defecation, we put the ashes into the pit, and then we clean our buttocks and wash hands with water in the latrines. We rarely wash hands with soaps after defecation. We wash hands only with water. This is our habit”

29.

FGD results further indicate that only those with pour-flushed latrines use water and soap regularly after defecation.

Direct observations of latrines reveal that out of 67 latrines, 55.2% had water inside the latrine structure. However, soap, ash, or rice husk near or at the washing area was observed only in 27% of observed latrines. According to household survey results, generally (72.3% over-all, 69.4% in non-ODF and 76% in ODF villages), new latrines are built when the current latrine becomes full. While there are respondents who indicate that full latrines are pump-off (27.3%), these may be those who own pour-flushed or sealed latrines. When the latrines are broken the usual practice is to repair but when latrines are old, new ones are usually built. Repair of latrines involve the slabs, walls and roofs. Pits are generally never repaired – they are usually buried when full, broken, or old and new pits dug near the old latrine location. If they have money pour-flushed latrines will be built but if none, dry pit latrines will still be built – “We don't have enough money to improve the latrines. We will build the pour flush when we have money. If we still do not have money, we will use only our dry pit but we will build it a bit higher than the soil level so that it might be easier for us to defecate during the rainy season”. Villagers rebuild them by themselves not wanting to pay others for latrine repair or construction. For those who need to repair pour-flushed latrines, local constructors in the village have to be hired. Villagers can repair the roof and wall but for the underground part, they could not repair it by their own because they have no enough instruments and skill to repair the latrines.

4.4.2.3 Perception on sanitation situation and satisfaction with current latrines

Households who regularly use latrines see improved S/H situation, convenience, and improved health as the main advantages of having latrines. Majority (73%, 83.8% in non-ODF and 60% in ODF villages) does not see any disadvantage in owning latrines but for some the bad smell coming from dry pit latrines is the main disadvantage. This cited disadvantage is highest in ODF villages at 30% of respondents. In all CLTS villages, 91% (92% in non-ODF and 90% in ODF villages) are satisfied with their latrines. For the few that are not satisfied, lack of money to buy concrete latrine/ slab, flooding in the wet season and unreliability of dry pit latrines are reasons given for their dissatisfaction. FGD results indicate the same. Villagers are happy with their latrines in the dry season and these are used regularly. But in the wet season, when latrines get flooded and/ or collapse villagers stop using latrines – they fear getting disease from the flooded/ collapsed latrines and think that OD is more sanitary than using the latrines.

Nearly all (94% - 94.6% in non-ODF and 93.3% in ODF villages) think that their villages now have better S/H situation as compared to the time before CLTS was started. Reasons given for this perceived positive change were more latrines than before, no faeces everywhere, and more awareness about hygiene among villagers.

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Report of women from FGDs in CLTS villages

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4.4.2.4 In promoting behavior change

Among adults, use of latrines for defecation at all times at home is 86.6% (94.6% in non-ODF and 76.7% in ODF villages), at fields/ chamkar at 11.9% (8.1% in non-ODF and 16.7% in ODF villages), and in public places at 83.6% (86.5% in non-ODF and 80% in ODF villages.

Among children, use of latrines for defecation at all times at home is 71.6% (78.4% in non-ODF villages and 63.3% in ODF villages). In public places and in field/ chamkar, 10.5% use public latrines or other latrines (reported as neighbor’s/ other houses latrines.

Among household without latrines/ currently practicing OD, the practice of chhik korb is a common (44.1% in all CLTS villages – 46.5% in non-ODF villages and 42% in ODF villages) at home but not when in the field/ chamkar or when in public places. The practice of chhik korb may already be an indication of behavior change since it demonstrates awareness or knowledge that faeces left in the open (unburied) constitutes a potential health risk/ hazard to others. The practice may also be an indication that people who practice OD are ashamed of their practice such that the more sanitary practice of chhik korb is resorted to. Boiling drinking water is the main way the villagers know how to prevent diarrhea (reported at 83.3% in both non-ODF and ODF villages). Washings hands (unreported in non-ODF, 66.5% in ODF villages) and being careful of what food is eaten (reported at 16.7% in both non-ODF and ODF villages) are the other 2 main ways reported by villagers. Washing hands after defecation as a way to prevent diarrhea was reported only in ODF villages (16.7%).

It should be noted that diarrhea incidence in the past 3 months was reported by 1 in 5 respondents (21.6% in non-ODF and 23.3% in ODF villages). This incidence rate is roughly the same as that reported in CDHS 2005 (20% for children under five years) but much higher than incidence rates reported in rural areas – 4.6% among males and 3.3% among females in the Cambodia Statistical Yearbook 2004.

Practice of hand-washing with soap is reported nearly among all households (92.5%, 94.6% in non-ODF and 90% in ODF villages). Hand-washing is done more than once a day (86.5% in non-ODF and 100% in ODF villages) and is done usually before eating (92.5% - 91.9% in non-ODF and 93.3%), after defecation (61.2% - 64.9% in non-ODF and 56.7% in ODF villages), and when hands are dirty (43.3% - 45.9% in non-ODF and 40% in ODF villages. Forty percent (40%) of all households (43.2% in non-ODF and 36.7% in ODF villages) think that wide awareness raising on effects of OD should be done to further improve the sanitation and hygiene situation in their villages. Likewise, awareness raising on effects of OD was cited by 38.8% (40.5% in non-ODF and 36.7% in ODF villages) as the most important activity in villages to further improve S&H situation in their villages. However, it should be noted that majority of respondents (65.7% - 78.4% in non-ODF and 50% in ODF villages) think that provision of latrines to all families is the way to further improve S&H situation in their villages.

4.4.2.5 In contributing to institutional capacity building

CLTS contributes to institutional capacity building in 3 inter-related ways. First, facilitation skills of MRD/ PDRD/ DoRD, commune focal points and village focal points are considerably built up from the trainings done and from the actual conduct of facilitation meetings in villages. These skills are further built on by regular sharing of experiences and resolution of emerging issues during quarterly meetings/ workshops that MRD sponsors among the PDRD and DoRD staff. In some instances, commune and village focal persons are also reported to participate in these regular workshops. Hence, a pool of trained and experienced facilitators is created which can be utilized in regular monitoring and supportive interventions in CLTS villages and for scaling-up CLTS in other parts of the country. Second, as is normal in government project implementation procedures, an implementation and monitoring structure is created at the national and the provincial levels. At the national level, this structure comprises of lead facilitators who are the resource persons in trainings of other facilitators at the provincial and sub-province levels. These lead facilitators are also key monitoring agents of the over-

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all CLTS approach – regularly visiting provincial facilitators and villages where CLTS is implemented. At the provincial level, this structure comprises of PDRD and DoRD facilitators. These facilitators are always directly involved in the CLTS process particularly at the initial triggering sessions in villages. Henceforth, they conduct regular monitoring visits with commune FPs and village FPs and with communities undertaking CLTS. This structure embodies the delivery mechanism of the CLTS approach. With the lack of natural community leaders, PDRD/DoRD facilitators remain the most viable mechanism through which CLTS can be expanded to other villages within current CLTS provinces or to other provinces where CLTS has not yet been implemented. Third, CLTS also involves NGOs (either as direct implementers or sources of funding/ resources), district authorities, and commune authorities. The involvement of district and commune authorities generally appears in areas where there is greater difficulty in achieving ODF in villages – i.e. many households are not building latrines or are taking longer times than other villagers. The district and commune authorities serve as additional incentives/ encouragement to villagers when they visit the villages to observe or follow-up in latrine building. PDRDs normally request for or facilitate the involvement of district authorities. NGOs for their part work with PDRD/ DoRD and with commune authorities by supporting CLTS activities being implemented by government. For example, Plan International in Siem Reap mobilizes its own staff that works with provincial to commune implementers of CLTS. Through this cooperation among government agency, local authority and NGOs, a support network is created for the CLTS approach – at all levels there is a support mechanism that can take action wherever and whenever necessary in terms of CLTS progress in target villages. While CLTS does indeed build up institutional capacity, its current form and manner of delivery is still limited. This limitation is particularly evident in the lack of skills and initiative (and maybe, most importantly, absence of innovativeness) at all levels in terms of responding to main barriers that deter access of all villagers to sanitation facilities and to sustainability of such facilities. This is particularly demonstrated in the repeating issue of latrine failures due to flooding, loose soil conditions, infestation by ants/ termites and constant use. Where flooding is already known as a yearly phenomenon, there has yet to be an effective response from provincial to commune levels. Villagers report these issues regularly to facilitators that visit villages but no effective response strategy has been given to them. It is apparent that most facilitators are locked-in within the 11-step CLTS particularly the triggering phases. It seems that in the post-triggering situation, not much is done anymore except to constantly encourage villagers to meet deadlines of latrine building. Maintaining the interest and commitment of villagers to manage their latrines becomes the key in attaining ODF and sustaining ODF after the triggering process. There is also an apparent lack of collaborative links within other sections in PDRD and with other government agencies. This is evident in two areas. First, selections of facilitators were limited within the PDRD. There may be more qualified and more experienced facilitators with other provincial agencies such as the Women’s Affairs, Education, and Social Affairs departments but this was not explored. Because CLTS is a community empowering process, facilitation skills becomes the lynchpin to the success of CLTS in villages. This means that the selection process for facilitators should have been stringent and extensive i.e. looking at all possible sources of good facilitators. Training would develop facilitation skills but for some individuals, facilitation is latent and these are the individuals that CLTS needs. Second, durability of latrines is perhaps the main reason for the lack of sustained use of latrines in most of CLTS villages. Responses to this durability issue reside on the design of latrines where the design is adopted to the particular characteristics of the target village. CLTS was started as a pilot project in 2005 and expanded in 2006. Now it has been some 3 years, but there is still no effective remedy to the durability problem of latrines. It may be time to look at other agencies, other organizations that have the technical skills and innovativeness to develop a positive response to the latrine durability issue. But perhaps, the main limitation to CLTS in terms of institutional building is the lack of real community leadership in the CLTS process. CLTS is still implemented as a “government project” where communities are taught, trained, and encouraged to build, use, and maintain latrines by government agencies and local authorities. Hence, the long-lived dependence of rural communities/ individuals to external support is maintained and perhaps in some cases, strengthened. PDRD staffs, district authorities and commune authorities still feel and think that it is their responsibility that communities build and use latrines. They therefore feel the need to constantly monitor and strongly encourage people to build and use latrines.

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4.4.3 Cost-Effectiveness

Unlined dry pit latrines cost very little if materials are sourced from the villages. About 67% (61% in non-ODF and 72% in ODF villages) do not buy materials used in latrine construction. Pits are unlined, while the other latrine parts (slabs, walls, roofs, water container) are made of materials that are sourced from the villages – old wood, bamboo, thatch, palm midribs, etc. which are either found within the village, given by neighbors, or obtained from nearby forests and bush areas. In some cases, latrine materials are provided by NGOs who also are implementing S&H activities in the villages. For those who purchase all latrine materials, the reported cost of a latrine in CLTS villages is USD 41.1 (USD 43.7 in non-ODF and USD 44.6 in ODF villages). However, this total estimated cost per latrine does not include the cost of labor in latrine construction. Family labor is the usual practice in latrine construction with only a few households hiring external contractors. If only concrete rings and slabs are bought, the cost is about $21. In terms of repairs, households report $1 to $2.5 expenses excluding pit repairs.

Basic knowledge in pit latrine construction among villagers is obtained from facilitators who come to the villages in the initial and early stages of the CLTS programme or from village focal persons who have been trained by provincial and district level CLTS facilitators. In the latter stages of CLTS, it is the village focal persons, particularly the village chief who provide advice on latrine construction and maintenance.

For non-village based CLTS facilitators – PDRD, DoRD and Commune Focal Persons – MRD and its funding partners (UNICEF, Plan International, among others) provide allowance for travel and food every time village visits are conducted. The number of village visits by external facilitators differs with DoRD staff and commune focal persons conducting more visits than the PDRD. At the point where ODF is attained in the village, a small budget is allocated from the CLTS programme to celebrate the achievement.

The contribution of communities in the CLTS programme is basically their labor in the construction of latrines, latrine materials found in or around villages, their participation in CLTS meetings, and their encouragement to other community members to build and maintain latrines. In general, there is no monetary contribution from communities in the CLTS programme.

The cost of achieving ODF in villages is the sum of latrine costs among all villagers, the cost of regular visits by CLTS facilitators particularly the external facilitators, and the cost of ODF celebrations in villages. Over-all the cost of achieving ODF (which has been demonstrated very well in many villages especially in the dry season) is very small as compared to other sanitation programmes. The downside is that shared latrines are not common facilities in villages. Villagers who do share latrines are usually relatives. This means that in villages with a large segment of poorest households living in close clusters, the feasibility of shared/ public latrines may be low at present – requiring extensive educational activities to allow acceptance and use of shared latrines. The other key issue in terms of cost-effectiveness is that unlined dry-pit latrines need to be regularly re-built since these latrine types are very susceptible to flooding and collapse. Repeated rebuilding increase the over-all costs and when OD resurfaces in the wet season, health hazards increase as do health costs in consequence.

4.5 Sustainability

Generally, latrines are regularly cleaned. Once to more than once a day cleaning is reported at 46.2% (54% in non-ODF villages and 36.7% in ODF villages while once every 3 days is reported at 28.4% (24.3% in non-ODF villages and 33.3% in ODF villages). For the majority that has unlined dry-pit latrines, latrine cleaning is done more often during the dry season when the latrine pits are not flooded. Cleaning just normally involves sweeping garbage from the latrine area. Use of water in cleaning dry pit latrines is avoided to prevent water from getting in the pits. For those who have pour-flushed latrines, latrines are cleaned regularly throughout the year using water.

Observations also indicate that the inside of latrines particularly the slabs are clean and free from faeces. Among 67 latrines observed, 91% where observed to clean inside especially the slab.

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Latrines are mostly cleaned by the wife (72.9% - 70.6% in non-ODF and 76% in ODF villages) and the husband (33.9% - 29.4% in non-ODF and 40% in ODF villages). Girls over 15 years (11.9% - 14.7% in non-ODF and 8% in ODF villages) and girls under 15 year (10.2% - 14.7% in non-ODF and 4% in ODF villages) also help in latrine cleaning.

Dry-pit latrines are generally never repaired when full, broken or old. Instead, latrines are covered/ buried and new ones dug near the old latrine. What are repaired are the walls, roofs, and slabs (for latrines with non-concrete slabs) of latrines usually using village-sourced materials. Digging new pits and/ or repair of the upper section of latrines are mostly done by household head or the spouse (82.1% - 75.7% in non-ODF and 90% in ODF villages). For those who need help in latrine building or repair, immediate family members and relatives are asked for assistance. Assistance from village focal persons or from the village chiefs/ deputies was not indicated.

For those who have pour-flushed latrines, repair of latrines (including the pit) are reported to done usually by external contractors – the household pays someone else to repair the latrine having no skills/ knowledge on such type of repair.

Building new latrines and repair of upper sections is normally done in the dry season when residential lots are not or less flooded. Flooding in CLTS villages is reported to occur from the month of June to the month of January (highest on the months of July to October on a yearly basis with). While assistance from village focal persons or from the PDRD, commune councils are not sought in terms of actual building or repair of latrines, villagers have reported the problem of regular flooding and collapse of latrines to focal persons and implementers when they are in the village. Other issues which affect the durability of latrines such as loose soils and presence of ants/ termites that also cause latrine collapse have also been reported to focal persons and implementers.

Study results reveal that 27% in CLTS villages (19% in non-ODF and 37% in ODF villages) have re-built their latrines. In non-ODF villages, 43% have re-built latrines at least twice and in ODF villages, 73% have also rebuilt their latrines at least twice. Those who have rebuilt their latrines generally build the same latrine as before (mostly, unlined dry-pit latrines) because of lack/ absence of money or materials for upgrading to better latrines such as pour-flushed latrines. Among the few that improved their latrines (28% in non-ODF and 18% in ODF villages), support from NGOs and own money was used in upgrading.

In ODF villages, 70% of households knew that their village had attained ODF and participated in the ODF celebrations. ODF celebration was described as like having a “party” but with talks and discussions on further improving S&H conditions in the villages.

The practice of open defecation among villagers re-emerges during the wet season of the year. Depending on the flooding conditions and the durability of latrines, OD can reach almost 100% in some villages (Khan Sar and Beng villages in Siem Reap where FGD participants reports that all latrines cannot be used). Household interviews indicate that at the time of the survey 53.8% in non-ODF villages and 62.5% in ODF villages were practicing OD. During dry season when latrines are not flooded and usable, OD still persists particularly when villagers are working in the field/ chamkar but also when at home and in public places.

Monitoring of S&H in villages is commonly reported in all CLTS villages. Generally, the village chief (89.5% - 94.1% in non-ODF and 85.7% in ODF villages) is reported as the key monitoring mechanism in the villages. Monitoring is done through household visits where status of latrines are checked (for construction completion, maintenance or constant use), training/ teaching on S&H, and encouragement on further improvement on S&H conditions. PDRDs and village focal persons are also identified as part of the monitoring mechanism but in much lesser instances than the village chiefs. 4.6 Experiences of the CLTS Approach of MRD 4.6.1 Achievements

4.6.1.1 Increased Access to Sanitation Facilities in Target Villages

Since its inception in 2005, the CLTS approach of DRHC-MRD has been implemented in 9 provinces and 239 villages in Cambodia. Since 2005, a total of 134 villages have attained ODF status. In the

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villages covered by the study, the number of latrines has substantially increased when compared to the number of latrines reported in the CDB 2007. While in most villages, the number of latrines do not yet match the number of households, the increase in coverage due to CLTS is already significant. Coverage is highest among ODF villages visited as compared to non-ODF villages. See Tables 8 and Figures 40 and 41 below. Table 161. Access to Sanitation Facilities in Selected Target Villages

Province Village # of Families

1

# of Latrines

2

Category3

No. of HH

4

CLTS in 2006

5

In Use6

Kampong Thom

Prasat 102 57 non-ODF 109 76 34

Trapeang Ruessei

154 70 non-ODF 155 77 35

Ta Aong 197 164 ODF 164 156 125

Ropeak Pen 84 2 ODF 87 87 61

Slaeng Khpos 121 2 ODF 103 103 41

Siem Reap

Beng 146 1 ODF 148 124 6

Khan Sar 121 0 ODF 115 85 14

Otdar Meanchay

Prasat Bei 179 25 non-ODF 184 147 25

Prey Veng

Svay Char 191 180 ODF 203 160 104

Trapeang Brabos

264 21 Non-ODF 182 17 0

Snao 112 37 Non-ODF 106 92 57

Samnoy 196 0 Non-ODF 193 53 21

Kampong Speu

Chrak Trach 50 0 ODF 50 37 28

Ta Menh 73 8 Non-ODF 73 15 0

Prey Sdok 67 67 ODF 57 57 43

Krang Slaeng 101 97 ODF 97 35 28

Kampong Cham

Svay Popeah 102 85 ODF 86 65

Trapeang Chhuk

100 61 Non-ODF 84 67 30

1 CDB 2007

2 CDB 2007

3 DRHC Records

4, 5, 6 Reports from FGDs

Figure 39. Coverage in ODF Villages

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Figure 40. Coverage in non-ODF villages

4.6.1.2 Emerging behavior change in rural communities

CLTS in rural communities has resulted to emerging behavior changes among rural families. These changes are evident in use of latrines at home and in public places by adults and by children. Among household without latrines, behavior change can also be seen in the increased practice of chhik korb. Behavior change is also evident in hand-washing practices which done by nearly all households frequently and done before eating and after defecation. There is also a high level of knowledge in diarrhea prevention through boiling of drinking water. A significant number (40%) also think that wide awareness raising on effects of OD should be done to further improve the sanitation and hygiene situation in their villages. However, majority of respondents (65.7% - 78.4% in non-ODF and 50% in ODF villages) think that provision of latrines to all families is the way to further improve S&H situation in their villages.

4.6.1.3 Capacity building on CLTS

Capacities of CLTS facilitators at provincial, district, and village level and of focal persons at commune and village levels are also a key achievement of the CLTS approach in the country. At the provincial and district levels, there are at least three to five well-trained facilitators serving as the key delivery mechanism of CLTS in the nine target provinces. At the commune level, there are two well-trained focal persons and at the village level, there are at least five village focal persons which include the village chief. Focal persons at village level have also been well exposed to facilitation skills training. Outside of government and local authorities, a number of NGOs have also been implementing CLTS approaches in their target villages. Staffs of these NGOs are also well-trained on CLTS processes through the support of the DHRC at the national and the PDRDs at the provincial levels. 4.6.2 Barriers and Opportunities for Strengthening and Scaling-up 4.6.2.1 Barriers a. The CLTS approach still relies considerably on institutional leadership rather than community

leadership. While there may have been efforts to build up or nurture local leaders outside of village chiefs and traditional leaders in villages, as of the study visit to CLTS villages, most if not all CLTS leaders are the village chiefs – who has been the traditional entry point to implementing development interventions in villages. Interviews with other village focal persons also indicate that while they do go around encouraging people to build, use, and maintain latrines, it is the village chief who carries the authority to convince people to follow encouragements given. Monitoring visits of commune focal points and district focal points also suggest the traditional approach to compliance. In Otdar Meanchay, PDRD/ DoRD discussions indicate that when people are not afraid of village focal persons or the village chief, then there is a need for stronger encouragement from communes, district, and even provincial levels.

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b. Physical conditions of rural villages. Most villages where CLTS has been implemented are flood-prone areas especially in the rainy season. Flood-prone areas do not suit unlined dry-pit latrines which are the basic latrine that is being built by villagers in CLTS villages. Not only are these type of latrines susceptible to flooding, they can also fail from loose soil, from ants and termites infestation and from constant use. In some areas, while the ground is not flooded above, water seeps into the latrines from below flooding the pit and making it unusable for many villagers. While flooded latrines can still be used in these cases, villagers feel the latrines are unsafe and the bad smell that comes from the flooding also discourage the latrine’s use. In villages that are far from forests or shrub lands there is also lack of free durable materials that can be used in strengthening pit walls of latrines. Hence, materials that do not last long such as palm midribs are used for lining pits.

c. Limitations within current crop of facilitators. Discussions with PDRD/ DoRD facilitators indicate that

they were selected from existing staff of PDRD and from DoRD (in cases where there is not enough staff at PDRD). All have received two main types of training under the CLTS approach – the CLTS approach/ 11-step process and the PHAST training. Most have also undergone refresher trainings and have joined quarterly workshops that DHRC organizes amongst different PDRD/ DoRDs. Most have been with the CLTS approach since 2006 but there are also those who are relatively new to CLTS – a year or less working at PDRD. Other than the two main trainings, facilitators indicate that they have not attended any other particularly technical training as regard latrine design. In facilitating community meetings, all indicate that the 11-step process is followed but not strictly according to the designed steps. For example, village focal persons who should be selected by the villagers themselves are selected through commune councils or village chiefs and then are brought to training at provincial levels. Thereafter, community triggering is done in the target CLTS villages. In succeeding meetings in villages, facilitators agree that durability issues have been reported to them but to date no effective solution has been suggested or explained to villagers. This indicates a lack of technical knowledge to opportunely develop/ design appropriate responses to such durability issues. Since most have been facilitators for some time, this also suggests a lack of initiative or innovativeness on their part to find ways to help villagers since villagers seem not to be able to develop/ innovate ways to address latrine durability issues. Lack of technical knowledge, constant use of the 11-step process, and lack of initiative also indicates that the current group of facilitators was selected from staffs that did not have the appropriate background, experiences, and skills to be effective CLTS facilitators. Discussions with facilitators also indicate an intensive monitoring approach to latrine building, use, and maintenance in target villages. The combined frequency of monitoring visits by PDRD/ DoRD, district authorities, commune focal points, and village chiefs would suggest that villages and households are visited at least twice a week and more so as regards the village chief who is reported as visiting households as often as once a day. This may have resulted to building and maintenance of latrines just to comply with the encouragements of authorities and external focal points rather than actual attitude and behavior change.

d. Sanitation and hygiene not prioritized in commune development plan/ planning. Commune

development plans are prepared yearly by communes and submitted/ presented in district integration workshops where potential funding sources for the communes’ prioritized plans are sought. However, communes at present generally prioritize infrastructure plans such as road improvements and maintenance and water-supply projects. This prioritization normally also includes health issues but sanitation projects are usually not in the top priorities of communes.

e. Absence of provincial-level intra and inter-departmental cooperation especially on sourcing of talented

facilitators and developing appropriate design technologies of latrines. At present, CLTS is implemented/ facilitated by a specific unit within MRD-PDRD. There is no direct collaboration with other units within PDRD or with other provincial agencies that may have the resources and skills that would truly promote sustained latrine access and use in CLTS villages. CLTS requires technical support to respond to durability issues of latrines that will be free or low-cost innovations utilizing locally-available materials. This technical support may be available in other units of PDRD or with other provincial agencies or even with NGOs and the private sector. Currently, this has not yet been explored by MRD/ PDRD leadership. Likewise, naturally-gifted or well-experienced community facilitators may be present in other government agencies (such as the Women’s Affairs or the Social Affairs provincial departments) and among NGOs but this has also not been explored to date. While the approach of using existing structures and staffs within PDRD is good in terms of institutional

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capacity building, it limits potential sources of technical knowledge and good facilitators which is very crucial to success of CLTS.

f. Proximity to/ knowledge of subsidized programmes greatly limits participation. This is especially

evident in areas where the TSRWWSP is now being implemented – Kampong Thom and Siem Reap – where there also CLTS initiatives. In Beng and Khan Sar villages for example, people are not re-building latrines they first built under the CLTS approach. Most are just waiting until the TSRWWSP project starts in the village. There is also the persisting belief/ attitude/ dependence among rural communities on external support/ grants. This was revealed when villagers were asked what would be the main way to improve sanitation and hygiene conditions. Majority of villagers stated that latrines should be provided or that NGOs should provide materials for building latrines.

g. Lack of natural leaders within communities. Discussion with village focal person indicate that in CLTS

leadership still resides within the village chief, the deputies or the group leaders in the village. Among households, the village chief is the most reported monitoring person. At times, villagers do not even know who are the other village focal persons but immediately recall the activities of the village chief under the CLTS approach. Village chiefs and group leaders have been the entry point of external intervention before and still remain so in CLTS. Even among external facilitators, the village chief is the one requested to select village focal persons who are then brought to provincial levels for training on the CLTS approach and facilitation skills. This situation/ process greatly limits the emergence of other leaders within the village.

h. Poorest cannot sustain functional latrines. In all villages where CLTS has been implemented, there is

always a sub-group that has difficulty in building and maintaining their latrines. These are generally the poorest households in villages. They are characterized as living in the edges of villages, in closely clustered settlements, and are frequently mobile in search of work mostly through selling their labor. Often they do not have spare resources for latrine building, lack the space/ plot to place latrines, or are not informed/ educated enough on the individual and community benefits of latrines. And because they often reside in the edges of villages, they also have easy access to forests, rice-fields, and shrub-lands where they can defecate.

i. Persisting attitude/ dependence among rural communities on external support/ grants. There is still a

common belief among most of villagers that latrines should be provided by external programmes of government or that materials for latrine building should come from NGOs. Among district authorities and commune council members/ focal points, most also believe that CLTS is a preparatory step – changing the behavior of villagers as regards use of latrines for defecation – to be followed by subsidized strategies when durability issues of latrines emerge particularly during the wet season.

4.6.2.2 Opportunities The key opportunities for scaling-up CLTS in the country is the emerging knowledge of what works and what does not, what the physical and technical issues are, and what the limitations of the delivery mechanisms are. The barriers discussed above are issues that emerged during the study and should provoke insights that would contextualize CLTS more to the inherent conditions and situations in rural Cambodia. Some of the barriers can be addressed immediately such as appropriate selection of villages, obtaining support from communes, creating links between departments for technical support and sourcing of facilitators, and further developing skills/ attitudes/ innovativeness among current facilitators. Other barriers (attitudes of rural communities, lack of natural leaders, and reliance on traditional leadership) will take a longer time to be appropriately addressed. The situation of the poorest segments in rural villages may even require hidden subsidies so as to create and ensure sustained access to sanitation facilities among this segment. In essence, the barriers themselves are opportunities for scaling-up if taken positively and addressed properly. On the other hand, there are clear accomplishments through CLTS that can be immediately used as means to scale-up/ strengthen CLTS. Some of these are discussed below. j. Current successes (particularly in ODF villages) merit and are clear bases for replication. Replication

means learning from past experiences and undertaking the same approach with appropriate changes wherever necessary. For example, the improvement of selection guidelines or its use in its current form should be strictly followed. Past experience have shown that CLTS will not be sustainable in flood-prone villages. Therefore, in scaling-up CLTS, flood-prone villages must not be selected unless appropriate latrine-design technologies that are low-cost have been developed. Another is

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that clear proximity to on-going subsidized programmes erodes the effectiveness of CLTS but in villages where there have been subsidized programmes, ODF has been reached regularly in the dry season. There is already a pool of facilitators that can be drawn from in implementing CLTS in new villages. Learning from current experiences, the facilitators needs to be re-trained, re-focused and maybe in extreme cases, replaced with more skilled or naturally-adept persons who may come from other agencies, from NGOs or from civil society. Good facilitators within the current pool can take the lead in CLTS processes in new target villages while at the same time select and train new facilitators in such villages – moving towards a new pool of good facilitators that come from communities.

There is emerging behavior change among rural households in the current CLTS villages, especially as regards defecation practices at all times. Behavior change is the primary factor in success of CLTS but there are many factors that contribute to behavior change. In villages that have a higher year-long sustained rate of ODF, the key reasons that resulted to behavior change should be examined, documented and used as key processes in scaling-up CLTS. Directly related to the emerging behavior change among households in CLTS villages, there is a growing demand for latrines/ materials for latrine construction. Households in CLTS villages, particularly those villages that attained ODF, are getting used to regularly using latrines throughout the year. There is also evidence/ reports that households construct new or repair their latrines when latrines are broken, get full, or are old. Further, when queried as to how to further improve sanitation situation in villages, majority of households indicate the need for all to have latrines in their houses. Among households that currently do not have latrines/ practice OD, the main reasons cited are no latrines/ not yet built or re-built and no money to buy materials. OD tradition, OD habit, and unimportance of latrines are also cited as reasons but by few households. All these indicate that if low-cost (as majority of households are poor) latrines or latrine construction materials are accessible, it is highly likely that households would find a way to purchase at the time when their own-built latrines start to fail/ become unusable.

k. In-place institutional structure and delivery mechanism. Having selected and trained CLTS facilitators

from within MRD/PDRD and local authorities, there is a permanent support structure and delivery mechanism that can be utilized in scaling-up CLTS in the country. However, as discussed in the barriers section above, facilitators and focal points may require re-training or additional skills - strengthening on facilitation skills, shifts in community empowerment methods/ styles, and monitoring of and being pro-active to conditions/ issues and changes in CLTS villages.

l. Emerging interest from major donors. Discussion with UNICEF and MRD indicate that there is an

emerging interest from major development partners of Cambodia such as the DFID and AusAid in scaling-up and strengthening CLTS in the country. These interest of major development partners who have been usually supportive of subsidized approaches, present a clear opportunity to expand the coverage of CTLS in the country. Other development partners who are currently working with MRD (UNICEF, Plan International, Lien Aid, and Swiss Red Cross) are also keen to continue implementing CLTS in the country.

m. Potential local funds sources from decentralization policy of central government. Through this policy

of central government, districts and communes now have their own development budgets that can be used for district and commune prioritized activities. While the level of prioritization of sanitation activities is still low at present, this can be reversed with appropriate training and planning activities with communes. While available fund at both levels are small (about $12,000 in districts and from $5,000 to $10,000 in communes) the monetary needs of CLTS is very limited. Since CLTS is geared towards community understanding, behavior change, and then empowerment, most activities requires small amounts – daily allowances and transportation expenses for facilitators – which are well within the budgets of districts and communes.

4.7 Differences between CLTS and TSRWSSP g. Access. In CLTS villages lesser number of households is able to own latrines since latrine building is

un-supported and household initiated. Those households that do not have the resources particularly the poorest are not able to build their own latrines. In TSRWSSP, greater numbers of households have access to latrines since the Project’s intent is to provide latrines to all households in all target

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villages. However, in terms of actual use of latrines, there is greater access in CLTS villages as demonstrated by ODF status of many villages. Greater use is generally caused by behavior change and a good understanding that ODF status considerably reduces health risks associated with human faeces. In TSRWSSP villages, lesser use of latrines is reported by households. Village observations also indicate presence of latrine materials (rings and slabs) that have not been built into latrines and constructed latrines that are unused by villagers.

h. Equity. There is greater participation of community members including the poorest through a series of

triggering meetings under the CLTS approach and from constant visits from VFPs and external facilitators. The triggering processes create widespread understanding of the need to stop open defecation which in turn promotes near total participation in latrine building and regular use. Village chiefs and other village focal persons also ensure wide participation in meetings and in latrine building through frequent monitoring visits to households particularly among those that have not yet or are slow in building their latrines. While the poorest households are also reported as joining in the triggering meetings, their participation tends to be less sustained from several factors including lack of land to locate latrines, lack of time (frequently mobile for work), and low priority of latrines among household needs.

In TSRWSSP villages, community participation is done through informed-choice meetings which are held twice or more but over extended time periods. In these meetings, villagers get to know what are their options in terms of availing of latrines – whether basic but free dry-pit latrines or paid but improved latrine types. Low attendances in meetings are reported as people await what results from the initial meetings. In some villages, participation is low since many villagers were not informed of the forthcoming meetings. The poorest do not usually participate in meetings as reported by villagers from FGDs conducted in TS villages. While HH survey results in TS villages indicate a 100% participation of the poor in community meetings, only 13% of all respondents indicated this level of participation of the poor. Findings of the HH survey also indicate that 63% of all respondents in TS villages report that the poor were not prioritized under the Project.

i. Institutional capacity building. CLTS works within and through existing government and local authority

structures. It does not create new structures or mechanism to deliver CLTS related services – facilitation and monitoring – in target villages. CLTS implementation runs vertically from key staff in the DRHC, to the PDRD/ DoRD in provinces and districts, to commune councils, and to village chiefs and village focal persons. While village focal persons are new mechanisms, they are voluntary positions and (ideally) spring from grass-roots actions. All involved staff and individuals are trained on CLTS approaches, facilitation skills, and on other sanitation and hygiene skills which therefore contributes to the over-all capacity of the MRD/ PDRD and local authorities as institutions of government. TSRWSSP, on the other hand, installs temporary Project Management Unit and Project Implementation Units at the national and provincial levels. This process requires re-assignment of existing government staff or hiring of new staff and building up project implementation skills through different training approaches and formal processes. After the Project is completed, the temporary management and implementation units are dissolved; hence, there is a possibility that not all trained staffs are retained in government agencies at national and provincial levels. This possibility exists since government salaries would be lower than that provided under the Project, potentially causing trained staff to look for employment elsewhere. However, at village level, the Project establishes and trains Water and Sanitation User Groups (WSUGs) which are intended to be viable long after the Project is completed to maintain wells and latrine facilities provided by the Project.

j. Cost-effectiveness. CLTS is more cost-effective than TSRWSSP more so in the short-term. But it can

also be more cost-effective in the long-term. There is no subsidy in CLTS. Very little cash is needed to build latrines under CLTS since most materials can be sourced from the villages or nearby forests/ shrub-lands. Little cash is also needed in repair of latrines. More importantly, greater behavior change is attained through CLTS which is the basic need for sustainability of sanitation in villages. ODF has also been reached through CLTS. CLTS can also be more cost-effective in the long-term if appropriate low-cost and durable latrine designs are developed for CLTS villages. On the other hand, all types of latrines provided under TSRWWSP are subsidized. A basic latrine costs $133 with 90% of costs borne by subsidies. While these latrines are durable and can be used far longer than latrines in CLTS villages, the cost of reaching 100% coverage and hence, possibly

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ODF, is very high. Such over-all cost is mainly borne by government through loans which in a developing country like Cambodia creates an enormous future financial burden.

k. Behavior changes. Figures 42 to 44 presents the differences between CLTS and TSRWSSP in terms

of emerging behavior changes among villagers. At home, more adults and children in CLTS villages regularly use latrines for defecation as compared to TSRWSSP villages. In public places, more adults in TSRWWSP villages use latrines. And in the field/ chamkar, more villagers in TSRWSSP practices OD than villagers in CLTS villages. In terms of boiling drinking water and hand-washing practices, it is clear that more households do so in CLTS villages than in TSRWWSP villages. And in households without latrines, the practice of chhik korb is higher in CLTS villages than in TSRWSSP villages.

Figure 41. Defecation Practices in CLTS and TSRWSSP villages

Figure 42. Drinking water and hand-washing practices in CLTS and TS villages

Figure 43. Defecation practices among Hh without latrines in CLTS and TS villages

l. Sustainability

CLTS promoted latrines have sustainability issues. Unlined dry-pit latrines are not durable lasting from 6-10 months depending on physical conditions in villages. This latrine type is susceptible to failure from flooding, from collapse due to soil structure, from infestation of ants and termites, and from regular use. Because of less durability, households have to regularly re-build latrines during the dry season. However, in CLTS villages there is more monitoring of latrine use and maintenance. This monitoring

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ensures better sanitation practices and can allow households to learn of ways to make their latrines last longer. TSRWSSP promoted latrines are more sustainable. These are designed by Project engineers for durability and longevity. Basic latrines provided to beneficiaries are made of concrete rings and concrete slabs. Generally, the latrine pit is deeper and wider which allows for more useful life. TSRWSSP provided latrines can also be pumped-off lessening the need to build new latrines.

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5 Conclusions and Recommendations 5.1 Conclusions i. The CLTS approach has worked well in Cambodia but this is generally in the dry season. CLTS has

dramatically increased access to dry-pit latrines (and in some cases, pour-flushed) particularly in the dry season. Participation of communities is widespread especially in ODF villages, and includes the poor and the poorest. High participation is attained through triggering of total community action against OD, by constant visits/ encouragement to households by Village Chiefs and other VFPs, and through regular visits of provincial, district, and commune CLTS facilitators or focal persons.

j. From almost 100% OD before CLTS, the approach has effectively caused a 41.9% (among total

households) year-long use of latrines; frequent cleaning of latrines; installation of washing areas with soap and water; and regular re-building and repair of latrines. CLTS has also resulted to a positive outlook of communities in terms of advantages of owning latrines and a widespread satisfaction with latrine ownership and use and optimism on future sanitation conditions in communities

k. CLTS promotes behavior change as indicated by extensive knowledge on ways to prevent/ avoid

diarrhea; constant hand-washing practice especially before eating and after defecation; consistent use of latrines at homes; and increased practice of chhik korb. Behavior change is further indicated in the perception changes among people – i.e. that open defecation can further reduced/ eliminated by educating people on its negative impacts

l. CLTS also contributes to institutional capacity building through mobilization of trained facilitators at

provincial to village levels within existing government and local authority structures. It does not create additional administrative and financial burden by mobilizing facilitators from among existing staffs. CLTS has also effectively installed of an implementation and monitoring structure from national to provincial levels and has created of a government-NGO-local authority network that supports and facilitates the CLTS approach. However, by limiting itself to existing structures/ staffs and local authorities, CLTS also faces limitations in the quality of facilitators and focal points.

m. CLTS is very cost-effective. Very little cash is spent when latrine materials are village-sourced as

done by 61% of households in CLTS villages and only $ 1 to $ 2.5 is spent on regular repair. For better-off households a latrine would cost $ 21.25 if concrete rings and slabs are used and $ 41 if all materials are purchased. CLTS can attain ODF status

n. CLTS has sustainability issues. Unlined dry-pit latrines which are the commonly built latrines are not

durable. This latrine type is prone to failure from flooding, loose soil conditions, termites and ants, and from constant use. There is also an absence/ lack of local knowledge and initiative to address durability issues of latrines which is often compounded by the lack of initiative and innovativeness among external facilitators to help communities address the latrine durability issue. Hence, participation wanes as households (especially the poor and poorest) grow weary of regular or frequent latrine repairs. Thereafter, open defecation re-surfaces as latrines fail in wet season

o. Over-all CLTS has had limited success in Cambodia. Its most visible indicator of success, ODF status,

can only be attained in the dry season in almost all villages it has been implemented. There remain social, economic, technical, and institutional barriers that need to be addressed for CLTS to be strengthened and further scaled-up as a viable alternative to subsidized sanitation programmes.

p. Given, the barriers to sustaining ODF in CLTS villages, particularly the lack of durability of dry-pit

latrines and the inability of the poorest/ most vulnerable households to regularly maintain their latrines, CLTS has to evolve to a locally-adapted approach that still prioritizes and promotes behavior change but at the same time directly supports the development, fabrication, and marketing of durable latrines / latrine materials and also directly provides for the sanitation needs of the poorest/ most vulnerable households.

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5.2 Recommendations 5.2.1 Recommendations for Development Partners

f. Standardize CLTS financial support system for PDRD, DoRD, and commune councils across all provinces where CLTS is being supported. This would be done in consultation with MRD upgrading the current support system to that which would reflect the current economic situation – e.g. transportation allowance should be provided in terms of distance to CLTS communes/ villages. This would eliminate comparisons (and complaints) among and between PDRD/ DoRD facilitators.

g. Scale-up awareness-raising/ education on sanitation and hygiene in target villages. Awareness-raising on S&H is one of the main suggestions of households in terms of further improving sanitation conditions in villages. AR should also be constant and adapted to the specific local conditions of target villages in view of the fact that there is very low education attainment among the rural poor.

h. Expand support to CLTS approach to local schools, mobilizing children as change agents within

their families and communities.

i. Continue supporting capacity building/ training/ re-training of facilitators at all levels including support to cross-visits to ODF villages by village level focal points and facilitators.

j. Support studies/ researches and piloting of low-cost but durable latrine models/ materials for latrine construction that are adapted to specific physical, geographical, and environmental conditions of target provinces, districts, or communes. Wherever possible indigenous/ locally-available materials should be utilized/ promoted in developing such low-cost latrine models.

5.2.2 Recommendation for MRD

k. Improve selection criteria in choosing target CLTS villages by utilizing technical information/ observations on villages not just relying on verbal reports from Commune Councils, etc. and train facilitators in use of improved selection guidelines.

l. Access technical skills within PDRD, PRDC or in other provincial government departments in selection of target villages and in developing appropriate design technologies for latrines – focusing on local conditions and availability of materials (develop mechanisms for appropriately-designed latrines to be fabricated within target communities);

m. Develop/ implement social marketing strategies and mechanisms to allow the rural poor to access low-cost latrines or materials for latrine construction. Social marketing strategies and mechanisms should explore possible partnerships with the private sector and with NGOs who have projects/ programmes on sanitation improvement.

n. Develop ways where women will be involved in local design adaptations and fabrication of

latrines and Introduce new technologies at appropriate times and if truly necessary, for example, in flood-prone areas;

o. Improve monitoring systems – extensive information collection and documentation but limited

intervention. Monitoring should focus on the experiences and lessons learned among CLTS communities that would guide future CLTS activities in other villages. Documentation should not focus only on the number of latrines constructed. Where possible, baseline conditions before CLTS is implemented should be clearly documented in target villages and used in determining changes in sanitation conditions/ practices throughout the CTLS implementation.

p. Scale-up role of Commune Councils, i.e., not in direct implementation but as a start-up and

monitoring agent with direct communications with provincial level facilitators. This would require training of Commune Councils on strategy development and implementation and guidance for inclusion and prioritization of sanitation projects under the Commune Development and Investment plans;

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q. Scale-up role of District Authorities to support initiatives of Commune Councils. Districts have their own budget to fund projects/ activities of communes which can be allocated to sanitation activities spearheaded by communes such as CLTS. Further, district authorities have proven to be effective “encouragement mechanisms” in districts where CLTS have been/ are being implemented. Communities/ families have a greater tendency to follow suggestions/ encouragements from village and commune leaders when district authorities are seen or known to be involved in the community activity e.g. monitoring by district authorities of sanitation conditions in villages and of extent of ownership and use of latrines.

r. Create implementation and monitoring networks with other NGOs or civil society organizations (such as the Cambodia Red Cross and the Youth Star organization) that have extensive presence in communes and villages. Such partnership with these organizations would lessen dependence on commune councils and village chiefs in CLTS implementation and monitoring. This approach would also benefit from the community organization/ development skills and experiences and communication skills of civil and non-government organizations.

s. Adopt and utilize subsidized approaches where appropriate to further strengthen and scale-up the CLTS approach:

Provide low-cost latrines or latrine construction materials to the poorest and most vulnerable households – households who do not have enough residential land, the elderly/ disabled, and other household groups that cannot on their own build and maintain latrines.

Pilot shared latrines – among relatives living in close proximity – in rural communities where there is a prevalence of poorest household living in clusters at edges of villages.

Provide public latrines in gathering/ meeting areas in rural villages such as schools, pagodas, among others

t. Allow for longer gestation of behavior change and ODF status. Current focus on quick and

extensive building of latrines in CLTS villages undermines the lynchpin of the CLTS approach which is behavior change.

5.2.3 Recommendations for PDRD

c. Allow communities to assume leadership with limited intervention from external agents. This requires

re-focusing of facilitation and monitoring styles/ approaches of external facilitators;

selection of new and more community-development trained/ oriented staffs that may come from other agencies such as the Provincial Department of Women’s Affairs;

actively seeking and/ or allowing emergence of natural leaders in communities;

allowing for / developing more women as village focal persons;

build-up capacity of current crop of VFPs i.e. re-train current group of VFPs, allow for more cross-visits and participation in capacity-building or reflection workshops, develop technical skills/ innovativeness in latrine-building and sanitation improvement in villages; and focus on behavior change rather than reaching ODF through latrine building.

d. Prioritize poorest segments – particularly in communities lacking in solidarity (diverse mix of ethnic/ social backgrounds) by:

utilizing poor identification mechanism developed by the Ministry of Planning in identifying the poorest households in communities;

focused awareness-raising and constant visits by VFPs, and

exploring potentials of and pilot public or shared latrines within clusters of poor/ poorest households.