STRENGHTHENING CAPACITY FOR SCALING UP COMMUNITY LED TOTAL SANITATION IN GHANA:

Initiating A National Campaign Towards Achieving Sanitation MDG& More Through Local Empowerment

Dr. Kamal Kar (International Consultant, CLTS Foundation, India)&

Bisi Agberemi (WASH Specialist, UNICEF. Nigeria)

March, 2011

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Table of ContentsPage

Table of content 2

Acronyms and List of Abbreviations 3

Acknowledgement 4Executive Summary 5

1.0 Introduction 2.0 Specific Terms of Reference 83.0 Structure of Report 94.0 Review of CLTS Practice in Three Regions 114.1 Review of CLTS Practice in Eastern Region 114.2 Review of CLTS Practice in Northern Region 154.3 Review of CLTS Practice in Central Region 254.4 Main Blockage of CLTS 285.0 Training of Trainers’ CLTS Workshop 325.1 Training of Trainers’ CLTS Workshop – Dodowa 325.2 Training of Trainers’ CLTS Workshop – Elmina 356.0 Other Miscellaneous Activities 386.1 High Level Sensitization Meeting on CLTS 386.2 Public Lecture on CLTS 386.3 Northern Region Sensitization Workshop on CLTS 396.4 National Learning Alliance Platform 406.5 Meeting with Central Regional Minister 406.6 Meeting with Hardware Manufacturers and Engineers 407.0 Recommendations 437.1 General Recommendations 437.2 Region and District Specific Recommendations 447.3 National and Policy Recommendations 46Annexure 49

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Acronyms and List of Abbreviations

APDO - Afram Plains Development OrganizationBCC - Behavioural Change CommunicationCC - Community ConsultantCDO - Community Development OfficerCLTS - Community Led Total SanitationCWSA - Community Water and Sanitation AgencyDEHO - District Environmental Health OfficerDFT - District Facilitation TeamEHA - Environmental Health AssistantEHO - Environmental Health OfficerEHSD - Environmental Health and Sanitation DirectorateEU - European UnionGoG - Government of GhanaINGO - International Non-Governmental OrganizationI-WASH - Integrated Water, Sanitation and HygieneKNUST - Kwame Nkrumah University of TechnologyKVIP - Kumasi Ventilated Improved Pit MDG - Millennium Development GoalMLGRD - Ministry of Local Government and Rural DevelopmentNGO - Non Governmental OrganizationNL - Natural LeaderNTWG - National Technical Working GroupOD - Open DefecationODF - Open Defecation FreeREHO - Regional Environmental Health OfficerV.I.P - Ventilated Improved PitWASH - Water, Sanitation and Hygiene

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AcknowledgementSpecial thanks go to UNICEF Ghana and National Technical Working Group (NTWG) on Sanitation for organizing this mission aimed at institutional strengthening and capacity development for scaling up of CLTS in Ghana. The excellent manners in which all the planned trips, meetings and workshops were organized contributed significantly to the successful execution of the assigned tasks. The invaluable contributions of Othniel Habila (Chief, WASH Section, UNICEF Ghana), Lorretta Roberts (WASH Specialist, UNICEF Ghana), Emma-Joan Halm (UNICEF Ghana); Demedeme Naa Lenason (Ag. Director, MLGRD), Kweku Quansah (MLGRD), Theodora Adomako-Adjei (CWSA) and other members of NTWG further made the assignment exciting and very productive.

The participation of Hon. Elvis Afriyie Ankrah (Deputy Minister, Ministry of Local Government and Rural Development), Hon. Moses Bukari Mabengba (Regional Minister of Northern Region) and Hon. Ama Benyiwa Doe (Regional Minister of Central Region) in meetings and workshops organized as part of efforts of strengthening capacity for effective CLTS implementation in Ghana and for agreeing to champion scaling up of CLTS in the country are well acknowledged. The active participation of all relevant stakeholders at national, regional, district and community levels are also acknowledged.

The release of Bisi Agberemi (WASH Specialist) by UNICEF Nigeria Country Office to participate in the mission is also appreciated.

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Executive SummaryCommunity Led Total Sanitation (CLTS) was first introduced in Ghana in 2006 and the approach was piloted in Eastern, Central, Greater Accra, Upper West, Upper East and Northern Regions by CWSA, UNICEF, WaterAid and Plan. Based on the outcome of CLTS piloting over the past 6 years, the approach has been adopted in the revised Environmental Sanitation Policy (2010) of Ministry of Local Government and Rural Development for rural sanitation thereby providing the necessary policy framework for scaling up of CLTS. As part of piloting, quite a large number of communities were triggered with few communities eventually achieving Open Defecation Free (ODF) status. An assessment of the approach conducted in 2009 highlighted the potentials of CLTS for scaling up sanitation in the country and also identified inadequate and poor quality facilitation as the major challenges confronting effective CLTS implementation.

In recognition of the challenges being confronted in scaling up of CLTS and towards addressing the identified gaps, UNICEF in collaboration with National Technical Working Group on Sanitation invited Kamal Kar and Bisi Agberemi to provide technical supports in strengthening the systems and institutional capacity for speedy scaling up of CLTS in Ghana. This exercise was conducted from February 7 to March 14, 2011 and basically involved review of CLTS practice in three regions, Training of Trainers’ workshops on CLTS and sensitization activities for scaling up CLTS in the country.

The review of CLTS practice was conducted in Eastern, Northern and Central regions from February 9 to 18, 2011 with the principal aim of obtaining relevant information for better understanding of CLTS implementation focusing on strategy being adopted, capacity for implementation, institutional arrangement and challenges for scaling up. The review was conducted with active participation of members of NTWG on sanitation and involved extensive consultations with all relevant stakeholders at national, regional, district and community levels. From the review exercise, it could be observed that there are great potentials for CLTS in the country if the identified challenges blocking the scaling up of the approach can be systematically addressed.

Apart from the inadequate capacity for quality training and facilitation of CLTS, the following are the major blockage of scaling up: Disharmony among the donors in adoption of core principles of CLTS and tendency to

provide hardware household subsidy; Old mindset of technology prescription and promotion of V.I.P/KVIP Long term promotion of communal latrines by the government and ingrained mindset of

communities towards the use of communal latrines. Ingrained attitudes of traditional village chiefs towards free communal latrines and

subsidy orientation.

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Absolute institutional in-coordination Non-existence of technical coordinating mechanism at regional/district level. Old mindset of counting toilets instead of ODF villages. Inadequate funding of District Environmental Health and Sanitation Department and total

dependence of this department on external funding for carrying out basic activities like triggering in communities, follow up visits, conducting ODF evaluations and celebrations etc.

Based on the gaps identified during the CLTS review, two National Training of Trainers hands-on workshops were organized in Dodowa (Greater Accra Region) and Elmina (Central Region) to equip the participants with facilitation skills and strategies for scaling up CLTS. The workshops were organized by Ministry of Local Government and Rural Development with financial and technical supports from UNICEF, Plan and WaterAid. Over 120 participants comprising of national, regional and district senior government officials and representatives of NGOs had their skills enhanced on CLTS facilitation and 24 communities were triggered for CLTS implementation during the workshops. Also, Natural Leaders from the 24 triggered communities made presentations of their sanitation profile and ODF plans at the hotel venues of the workshops to the admiration of all participants reinforcing their commitments to achieve ODF in their communities within a short period as indicated in their plans.

Towards creating mass awareness on CLTS among relevant stakeholders and kick starting the process of scaling up CLTS in the country, the following additional activities were carried out; High level sensitization meeting on CLTS involving senior government officials of all

relevant ministries, agencies and parastatals as well as representatives of donors, UNICEF, NGOs, media and traditional institutions.

Public lecture on CLTS in University of Ghana, Legon. Northern Region sensitization workshop for all the 20 districts in the region towards

achieving the regional set target of achieving ODF by 31st December, 2012. The Regional Minister of Northern Region had made declaration of achieving ODF in the region by end of December, 2012 during an advocacy and sensitization visit earlier made to the minister.

CLTS presentations at the National Learning Alliance Platform Meeting with Hardware manufacturers and engineers. High level sensitization meetings and discussions on scaling up CLTS with senior

political leaders such as the Deputy Minister of Local Government and Rural Development, Deputy Minister of Ministry of Water Resources, Works and Housing, Northern Regional Minister and Central Regional Minister.

The following are the major recommendations which emerged from the visits to different regions and districts, interaction with officials and staff at different levels and meetings with UNICEF and NGOs staff:

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In view of the fact that there is an acute shortage of well trained facilitators of CLTS in most regions and districts particularly within the Directorate of Environmental Health and Sanitation, a small team of at least 5 facilitators in each district of the country must be developed and trained within the next one year. The planning and organization of these trainings should be facilitated by MLGRD, CWSA, UNICEF, PLAN and WaterAid and the 10 Regional Councils while the resource persons for these workshops should comprise of a team of at least 4 or 5 very good trainers drawn from the participants trained in the two workshops (Dodowa and Elmina). Each training workshop must be hands-on and should trigger 10-12 communities around each training venues in different regions. In other words, roughly 20 of such training workshops (2 workshops per region) should be able to trigger 200 to 240 villages in different regions of the country. This should not be very difficult, as major actors in sanitation sector can pull resources together for the urgent training of required facilitators that would support the scaling up of CLTS in the country.

All district EHOs, CDOs and other key people in each district involve in CLTS implementation must go through Hands-on training which gives them a total clarity on the approach, facilitation for triggering and essential follow up. In the absence of basic training exposure, different kinds of practices in the field have been noticed, most of which cannot be classified as CLTS.

Highest priority and focus must be given to follow up the 24 triggered villages (12 around Dodowa and 12 around Capecoast) during the two workshops. In the same version, very strict follow up arrangement must be made to ensure post-triggering follow up of 200/240 villages to be triggered in the next 20 regional training workshops (2 in each region). All the basic trainings should be completed by October 2011. However, utmost precaution must be exercised not to rush through in organizing these training workshops. Quality of training must receive utmost attention and priority.

Post ODF follow up should be the key in scaling up CLTS country wide. Recommended activities under post ODF follow up are as follows;

o Develop the best ODF villages into training/learning centres for other villages of the district. Continuously bring village leaders and community members to these learning centres (ODF villages) for face-to-face interaction with ODF villages and dissemination of the spirit of collective local actions towards achieving ODF.

o Identify potential Community Consultants of CLTS from among the best Natural Leaders emerging from ODF villages.

o Develop a clear scaling up strategy (with provision of funding) using the Community Consultants. Preferably the scaling up process by the Community Consultants (wherever possible) should begin around end of October 2011. It is interesting to note that the 2 Natural Leaders (Afenyo Ekormend & Ganu Mawuko) from Afram Plains who participated in Dodowa workshop have already triggered four neighbouring communities around them. These two NLs were the first people to put the learning from the workshops into use. This needs to be institutionalized at any cost.

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Focus should be on developing ODF districts and regions rather than focusing on few ODF villages.

CWSA should extend their direct support beyond the regional level to the districts by participating in the district level sanitation meetings and organizing trainings for the identified National Leaders (NLs) and Community Consultants (CCs) emerging from each districts and thus strengthening community led scaling up of CLTS.

With the declaration by the Regional Minister of 31st December, 2012 target to achieve ODF in the Northern Region, all efforts must be made to provide the required technical supports to the region in achieving this target. A draft roadmap for scaling up of CLTS in entire Northern region of Ghana has been prepared and shared with all relevant stakeholders.

Each Region should develop plan for achieving ODF with inputs from all stakeholders including the NGOs. UNICEF should facilitate the finalization of these plans which will guide effective scaling up and coordination of all interventions in the region. In other words, the regional plans are comprehensive plans of all districts in each region. This bottom-up planning process needs to be facilitated by involving DEHO, Community Development Officer, District Planning Officer, District Coordinating Director and Chief Executive Officer of the district with support from REHO and Regional Officer of CWSA. This is one important area where CWSA may extend all necessary help and support.

It is suggested that before initiating the Regional planning process of all the regions, new learning from the Northern and Central Regions be documented and disseminated to all the other 8 regions.

It is strongly recommended that the National Sanitation policy of Ghana which has explicitly mentioned the adoption of CLTS approach should be disseminated to all the concerned stakeholders at the regional and district levels. Specific measures need to be taken by national government to bring the NGOs, donors and lenders still implementing subsidy approach on the same page in order to avoid any further confusion and disharmony. Circulars should be issued under the signature of National Minister of Local Government and Rural Development to all implementing agencies on the need to strictly adhere to policy provision of no subsidy on hardware household latrine construction in the country.

The country wide scaling up strategy should be developed involving large number of natural leaders as community consultants. The process of selection of potential NLs from the existing and emerging ODF villages must begin as soon as possible. A cadre of at least 50 NLs in each district should be developed as Community Consultants (CCs) and a pool of community consultants should also be developed at regional level to support the scaling up efforts. MLGRD should formulate appropriate mechanism to support the CCs and use them as active partners in scaling up CLTS in the country. The NTWG on Sanitation should develop generic guidelines in local languages to guide the operations of NLs/CCs. NTWG should also support basic training materials and guidelines as well as documentaries which could be distributed to the teams of CCs.

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1.0 IntroductionConsidering the access to improved sanitation in Ghana, which is estimated at about 13% with worse situation in rural areas (7%), the country is among those in Sub-Saharan Africa that are presently off-track towards achieving MDG sanitation targets1. Efforts have been made in the past by governments and other implementing agencies towards addressing this low level of sanitation development but these have not resulted in large scale implementation required to significantly increase access to improved sanitation. Only a marginal increase of 4% in access to improved sanitation was recorded from 2000 to 2008 and if this trend continues, achieving the MDG sanitation target of 54% will be an illusion.

As part of the measures of addressing the poor access to improved sanitation, Community Led Total Sanitation (CLTS) was piloted in Eastern, Central, Greater Accra, Upper West, Upper East and Northern Regions from 2006 to 2010 with a view of scaling up the approach to cover all the regions in the country using the lessons learnt from the pilot. CLTS was first introduced in the country in 2006 and CWSA, UNICEF, WaterAid Ghana, Plan Ghana have been involved in piloting the approach working with EHSD staff, DWSTs, NGOs, Consultants and Community Based Hygiene Promotion Volunteers. An assessment of the approach conducted in 2009 highlighted the potentials of CLTS for scaling up sanitation in the country and also identified inadequate and poor quality facilitation as the major challenges confronting effective CLTS implementation.

Based on the outcome of CLTS piloting over the past 6 years, the approach has been adopted in the revised Environmental Sanitation Policy (2010) of Ministry of Local Government and Rural Development for rural sanitation thereby providing the necessary policy framework for scaling up of CLTS. There is high level of commitments and political will among governments and other stakeholders to scale up CLTS but very little progress has been achieved so far. Although large numbers of villages were triggered in the course of piloting, the emergence of ODF villages in Ghana was dismally low. 1.1 Rationale of the MissionIn recognition of the challenges being confronted in scaling up CLTS and towards addressing the identified gaps, UNICEF in collaboration with National Technical Working Group on Sanitation contracted Kamal Kar to review CLTS practice in Ghana and based on the findings of the review; strengthen the capacity of major implementers in effective scaling up of CLTS.

Quite a number of countries in West Africa including Ghana introduced CLTS more than five to six years ago, without much progress in scaling up the approach. Apart from the general reasons of poor quality trainings, follow up and institutional support, other issues related to mixing up CLTS with the earlier approaches contributed to poor scaling up. These second generation challenges of CLTS could not be addressed by providing hands-on training alone.

1 2010 WHO/UNICEF JMP Report

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With a view to addressing some of these challenges, an exploratory review mission supported by UNICEF Nigeria was planned and carried out by Kamal Kar and Bisi Agberemi in Nigeria from July to August, 2010 to have a deeper understanding of the country wide variations of practice of CLTS on the ground. The study led by Kar and Agberemi involved active participation of key government agencies and other sanitation stakeholders. Based on the study findings, a special Hands-on training was designed and conducted in which about 80 participants drawn from different agencies from all over the country were trained. These reconnaissance visit followed by hands- on training workshop resulted in significant improvement in CLTS implementation and rapid scaling up in Nigeria. Bisi Agberemi’s wealth of experience of sanitation in Nigeria contributed in developing and fine tuning the government’s approach in adopting CLTS in the country.

Being convinced with the style and approach of reviewing the field situation and designing a special capacity building strategy in Nigeria, UNICEF Ghana invited Kamal Kar and Bisi Agberemi to provide technical supports in strengthening the systems and institutional capacity for speedy scaling up of CLTS in Ghana. Kamal Kar arrived Ghana on February 7, 2011 while Bisi Agberemi joined him on February 11, 2011 to carry out the exercise. The whole mission was carried out from February 7 to March 14, 2011.

2.0 Specific Terms of ReferenceThe major assignment was to conduct an assessment of capacity for CLTS facilitation in Ghana and train a core group of master trainers and facilitators on CLTS. This involved the following specific tasks; Review the evaluation report of CLTS in Ghana and other relevant literature on CLTS.

Undertake field visits to the four CLTS pilot regions (Northern, Central, Eastern and

Greater Accra Regions) to identify CLTS training needs together with a stakeholder team

formed by the National Technical Working Group (NTWG) on Sanitation.

Discuss major findings with Government officials in the target regions.

Prepare a report on the training needs assessment based on the field visit and present to

National Level Stakeholders.

Develop training modules and session plans for the National Trainer of Trainers

workshop on CLTS.

Facilitate a national training workshop on CLTS for 50 master trainers and facilitators.

Undertake an assessment of the master trainers based on an agreed set of criteria to be

jointly developed by the consultant and the NTWG and recommend the final list of

master trainers and facilitators equipped to effectively support the roll out of CLTS at

regional and district level.

Provide coaching and mentoring for the selected CLTS master trainers in a live training

workshop session focused on training 50 district level functionaries in one district.

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Provide training on CLTS to potential CLTS Managers and Champions from

Government, Non-Governmental Organisations and Development Organisations.

Prepare final consultancy report assessing the capacity building exercise and providing

recommendations for scaling up and improving national capacity building on CLTS.

Towards achieving the set objectives, a work plan was developed with active participation of all relevant stakeholders and this work plan with some minor amendments guided the implementation of the above tasks as much as possible.

3.0 Structure of ReportThis report gives detailed information of activities carried out during the mission and has been structured and categorised into the following sectionsSection 1: Review of CLTS Practice in Ghana which contains major findings from the field visits to three regions of Ghana (Eastern, Northern and Central) highlighting the present practices of CLTS. This also includes review of capacity of implementing agencies; review of scaling up strategies being adopted; advocacy and sensitization of policy makers on CLTS implementation.Section 2: CLTS training workshops for master trainers and facilitators. This section gives brief reports on the two workshops conducted in Dodowa (Greater Accra Region) and Elmina – funded by PLAN, WaterAid and UNICEF (Central Region)Section 3: Other activities like high level sensitization meeting, public lectures, Northern Region One-day sensitization workshops and consultations with political leaderships. These activities were carried out as part of the efforts to kick start and lay solid foundation for scaling up of CLTS in Ghana. Section 4: Recommendations, Way forward and Conclusion contain major recommendations from the field visits and training workshops that will support the scaling up of CLTS in the country.

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SECTION 1:REVIEW OF CLTS

PRACTICE

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4.0 Review of CLTS Practice in three RegionsThe review was conducted in Eastern, Northern and Central regions from February 9 to 18, 2011 with the principal aim of obtaining relevant information for better understanding of CLTS implementation focusing on strategy being adopted, capacity for implementation, institutional arrangement and challenges for scaling up. The review was conducted through;• Extensive consultations with all relevant stakeholders at national, regional, district and

community levels.• Field visits to selected ODF communities.• In-depth consultations and meeting with Natural Leaders.• Advocacy and sensitization of political and traditional leaders.• Community mobilization and sensitization• Participatory analysis of CLTS practice.• Briefing and de-briefing sessions with relevant stakeholders on major findings and way

forward.These exercises were conducted with active participation of members of NTWG on Sanitation, Regional Environmental Health Officers, District Environmental Health Officers, representatives of NGOs in each of the regions visited and other relevant stakeholders.

4.1 Review of Practice of CLTS in Eastern Region The team visited Eastern Region from February 9 to 11, 2011and had series of consultations with government officials, NGOs, Natural Leaders and members of selected ODF communities. A courtesy call was paid to the Deputy Minister in Koforudia (Headquarter of Eastern Region) to brief him on the review exercise and creates awareness on the need to mobilize resources (human and financial) for scaling up CLTS in the region. Also at the meeting with the minister were the Regional Coordinating Director (Mr. S.A. Bawa) and other senior government officials.

After the brief meeting with the Deputy Minister, the team visited Kwahu North and Kwahu South districts in company of Regional Officer of CWSA and other Regional Officials. At Donkorkon, the capital of Kwahu North District the team met and had discussions with the District Coordinating Officer (Mr. A.K. Boahene), District Environmental Officers and other senior district officials on CLTS implementation in the district. There were other rounds of discussions with senior officials of Afram Plains Development Organization (APDO) focusing on introduction and implementation of CLTS in the region. Although the NGO has extensive experience in participatory approaches, CLTS was actually introduced to APDO by Ms. Metta Backgaard of DANIDA and after som time; the NGO excelled in training and capacity building on CLTS. APDO is one of the leading NGOs promoting CLTS not only in the Eastern region but in most part of the country and has also supported CLTS implementation in South Sudan. The NGO is partnering with UNICEF in the areas of capacity building on CLTS in 10 districts of Northern Region.

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Meeting with Natural LeadersAbout 40 Natural Leaders (men and women) were invited by APDO to participate in an interactive meeting with the team. The meeting was very enlightening and lively. All the Natural Leaders came from different villages which were all Open Defecation Free (ODF).

Based on the discussions held with Natural Leaders (NLs), the major challenges presently being faced in transforming their villages to ODF are; Mothers were more difficult to convince to stop open defecation and little children

continue to defecate in the open Loose soil and collapsing of pits. New settlers in the village often went out for open defecation. As they missed the

triggering exercise, it becomes difficult to convince them to stop open defecation. Illiteracy and lack of understanding on CLTS principles. Some people do not attend meetings where decisions to stop open defecation are made Some people do not participate in community development activities.

It was reported by Natural Leaders from at least 4 ODF villages that they spontaneously triggered their neighbouring villages and assisted some of them to achieve ODF status. The Natural Leaders giving the opportunity are willing to clean the entire Kwahu North District by transforming all the 344 villages into ODF. In order to achieve this, the Natural Leaders requested for the following; Canoes and bicycles for reaching various villages ID cards to proof that they were trained Natural Leaders. Additional training and orientation on how to trigger CLTS in villages. From the

discussions, it was understood that the Natural Leaders mostly use verbal method of communication and did not use any triggering methods while spreading CLTS in neighbouring villages.

Community radio to spread the message. Some materials for demonstration of low cost latrine construction Microphones to address entire communities. Gum booths/Wellington boots for the raining season. Technology and training supports for dealing with problems of loose soil.

There was a great deal of excitement among the Natural Leaders and two of them were invited for the National Training of Trainers workshop on CLTS which took place in Dodowa from February 20 to 26, 2011 with the plan that these people on return will share their experience and train other Natural Leaders.

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Visit to ODF VillagesThe team visited two ODF villages namely Odumase and Batorkope. Odumase village was saturated by free supply of V.I.P latrine in the past which were never used. When APDO triggered CLTS two years before, most of the community members started using the abandoned V.I.P latrines and many shared the same latrines with others. However, the basic principles of V.I.P latrines were difficult to comply with as the community created windows for ventilation. There were many holes and cracks in many of the V.I.P latrines visited mainly due to old age and dilapidation resulting in a lot flies in these latrines. Because of the V.I.P latrine structure and principle, there were no provision for drop hole cover and use of ash. What was most interesting was that the person who constructed a new latrine after triggering of CLTS in these villages also used a V.I.P latrine model. This person was a better-of farmer but it took more than 5 months to complete the construction of his toilet.

The lessons learnt from the visits were; Triggering of CLTS did generate a general awareness and was effective in changing

hygiene behaviour and stopping open defecation. The abandoned V.I.P latrines were brought to use but the purpose was defeated. High cost of V.I.P latrines blocks the full potential of CLTS. The design of V.I.P latrine prevented emergence of innovation of low cost latrine designs. As Masons are essential part of V.I.P latrine construction, it slows down the pace of

scaling up.

Batorkope village was one where there was no earlier V.I.P latrine intervention before CLTS was introduced. The community members in this village of 16 households constructed their own latrines after triggering. It was observed that the poor members of the community were struggling to construct the same V.I.P latrine. It was not known whether the external facilitators asked them to construct V.I.P latrines or the community picked up the ideas from the neighbouring villages. But it was understood for sure that the CLTS triggering perhaps failed to encourage the communities to innovate their own latrine designs. The culture of V.I.P latrines was so deeply ingrained both in the minds of the NGO staff and the community that image of any latrine was V.I.P.

The team visited an open air demonstration of different toilet models developed by APDO. APDO constructed demonstration latrines of different kinds but all them were V.I.P models where cement and bricks were extensively used. This was perhaps another reason for promotion of one singular latrine model in all villages which hinders the spread of CLTS.

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Fig.1: Abandoned and dilapidated V.I.P latrine in Odumase put into use after CLTS triggering

Based on the discussions with relevant stakeholders and field observations, the CLTS implementation in Eastern Region can be depicted in the model below (Fig.2)

4.2 Review of Practice of CLTS in Northern Region

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Fig.2: Model of CLTS Implementation in Eastern Region

The team comprising of Kamal Kar, Bisi Agberemi and some members of National Technical Working Group (NTWG) on Sanitation visited Northern Region from February 13 to 17, 2011 to review CLTS implementation in the region. A consultation meeting was held with a cross-section of stakeholders from the Northern Region on February 13 for briefing and finalization of all necessary logistics for review of CLTS practice in the region. Present at this meeting were representatives of APDO (Northern Region), CWSA (Northern Region), members of NWTG, UNICEF WASH Officer (Tamale), Directorate of Community Development and Regional Environmental Health Officer. The meeting provided the opportunity of obtaining more information on the roles and responsibilities of major stakeholders in the implementation of CLTS.

Meeting with UNICEF Chief of Field OfficeThe meeting was held in UNICEF office, Tamale on February 14, 2011 for discussions and better understanding on the roles of UNICEF in promoting CLTS in the region. In attendance at this meeting were eleven participants comprising of UNICEF staff, representatives of NGOs and the Programme Officer, Ministry of Local Government and Rural Development, Accra. The Chief of Field Office welcomed the participants while Kamal Kar gave a brief remark on the purpose of the visit to Northern Region.

The discussions were very interactive highlighting the achievements made so far in implementing CLTS and the challenges militating against scaling up the approach. UNICEF is presently supporting ten out of the twenty districts in the region under the Integrated WASH Project being funded by EU. The sanitation component of EU project is skewed towards subsidy approach; hence UNICEF’s supports under this project are mainly through capacity building and provision of materials for fabrication of slabs for construction of household latrines in selected communities. The focus of the project is on latrine rather than on total sanitation with very limited provision for community members to have the choice of selecting and constructing latrine options that better suits their economic situation.

Some of the identified challenges in CLTS implementation by UNICEF include; Slow rate of achieving ODF by triggered communities. Difficulty in sustaining the momentum after triggering of communities Low capacity at district and area council levels for implementation of CLTS. Poor coordination, facilitation and management of project delivery at district level.

Meeting with Regional MinisterThe team visited the Regional Minister, Hon. Bukari Moses Mabengba in his office on February 14 to sensitize him on the CLTS concept as an appropriate approach for scaling up sanitation development in the region. Also present at the meeting with Regional Minister was the Regional Coordinating Director, Mr. Joseph M. Dasanah. After extensive discussions on sanitation situation in Northern Region and its implications on the social economic well being of the people, the Regional Minister set the target of December 31, 2012 for achieving open defecation free region. Towards achieving this target, the minister called for supports from all

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the stakeholders to partner with governments in the development and implementation of roadmap for scaling up CLTS in the region.

Meeting with CLTS StakeholdersThe meeting of all relevant stakeholders implementing CLTS in the Northern Region was held on February 14 in Regional Minister’s office. The meeting attracted 27 participants comprising of senior government officials from national, regional and district offices, NGO representatives, media and UNICEF. The main purpose of the meeting was to interact with relevant stakeholders towards obtaining information on status and roles of individual organizations in the implementation CLTS in the region.

The Regional Minister officially declared the meeting open and gave opening remarks reinforcing the earlier pronouncement of Northern Region achieving open defecation free status by December 31, 2012. The Regional Coordinating Director was also present throughout the meeting and gave a closing remark.

The Regional Environmental Health Officer made a presentation on CLTS implementation in the region. The major highlights of the presentation were; Community Based Hygiene Volunteers piloted in 16 communities in 4 districts. CLTS approach to hygiene and sanitation promotion commenced in 2008 in 10 districts. Community Based Hygiene Volunteers concept mainstreamed in CLTS approach. Trainings conducted for Regional and District staff by APDO and TREND. Parts of the processes of equipping the implementers with necessary skills on CLTS

included exchange visits to Ethiopia and Bangladesh. District Facilitation Team (DFT) trained Area Council Staff on CLTS. Training on BCC and use of PHHE tools for hygiene promotion. Integrated Hand washing with soap, regular clean up activities, construction and use of

soak away pits for waste water disposal and management; and refuse disposal into CLTS. Introduction of latrine slab support for household latrine construction in some project

communities. Within a period of 2 years, 385 communities in 4 districts were triggered out of which 21

communities achieved ODF which is just about 5%.The main challenges in the implementation of CLTS in the region as identified by REHO include; Low capacity at district level and Area Council in facilitation and documentation of

processes and experiences. There are some donor interventions that contradict the core principles of CLTS; World

Vision (NGO) support communities with materials for construction of household latrines while UNICEF provides materials for fabrication of slabs.

Low commitment and support from political and administrative leadership Irregular follow up visits to communities. Poor quality of training on CLTS at district level. In some instances 2-day trainings on

CLTS were conducted for Area Council Staff.

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Meeting with Natural LeadersThe meeting took place in Regional Coordinating Council residence on February 14 and attracted 14 Natural leaders (6 female+8 male) representing 7 communities in the region, District Environmental Health Officers and other senior government officials. The meeting was aimed at obtaining further information and sharing of experiences on CLTS implementation in the region. The meeting was very informal and interactive with a lot of experience sharing among participants.

Some issues that came out from the discussions include; The Natural Leaders are promoting CLTS in their communities and neighbouring

communities. Free materials for slab fabrication were provided to communities under the Integrated

WASH Project by UNICEF which also confirmed the earlier presentations from UNICEF and Regional Environmental Health Officer. All the communities represented at the meeting received materials for fabrication of slabs.

New settlers in the communities have not benefitted from the free slab and presently sharing latrines with other members of the community or go to the bush with hoe to defecate and bury their faeces.

There is a lot of mix up in the approaches among implementers; some give materials for slab fabrication while some give precast slab.

There are still some misconceptions and shallow understanding of CLTS principles

Visit to School of Hygiene TamaleScaling up of CLTS approach requires mobilization of available human resources to facilitate pre-triggering, triggering and post- triggering processes, hence the need for the sensitization meeting held with students and staff of School of Hygiene Tamale on February 14. About 375 students and teachers attended the sensitization meeting which focused on explaining the concept of CLTS and potential roles of students of School of Hygiene in promoting the concept in the region.

Possibilities of mobilizing the students for two months field experience to open defecation communities throughout their course duration were discussed with the principal of the school. The plan is to form the student into groups of five and send to them to open defecation communities to provide additional support on CLTS implementation. A sensitization workshop and some training on CLTS have to be conducted for the students before being deployed to communities.

Field Visits to Fatenayili ODF Community, Karaga District – February 15 Fatenayili is a small village established about five years ago with 24 households. Members of the community migrated from two other neighbouring communities in search of better infrastructural facilities such as school, water and sanitation. The community was triggered for implementation of CLTS by the District Facilitation Team in 2008 and local latrines were

20

constructed and open defecation stopped within 7 days after triggering. The community has Voluntary Hygiene Promoters who conduct regular hygiene promotion and environmental sanitation activities. There was quite high level of knowledge among community members on hygiene and sanitation practices and they seem to have imbibed good hygiene practices including stopping open defecation. The community has been declared ODF and is working towards sustaining this status.

Fatenayili is one of the communities being supported by UNICEF under the Integrated WASH Project. Although the community had the tendency of achieving ODF without any external supports and was actually moving towards this, UNICEF still supported the households with materials for fabrication of slabs. These slabs were fabricated and installed but these were later abandoned for more attractive single compartment alternating Ventilated Improved Pit (V.I.P) latrines constructed with materials provided by World Vision (NGO) for each household in the community. The World Vision provided all the necessary materials for construction of V.I.P latrines while each household dug the pit. At the end of these interventions, each household has pit latrine with concrete slab supported by UNICEF and a single compartment V.I.P latrine. In most cases, the pit latrines supported by UNICEF were not being used.

This is a case of misdirected and uncoordinated interventions by the district. Although the community has achieved ODF, the approach adopted cannot be classified as CLTS. The approach is not community-led and it is prescriptive forcing all the community members to adopt V.I.P latrine. This approach is not sustainable as demonstrated by the new settlers who just moved to the community and cannot afford to construct V.I.P latrine and have to result to sharing of toilets with other community members while still waiting for their own free gift of V.I.P latrines. As more new settlers move to the community and they cannot afford to construct V.I.P latrine which has been adopted as the standard, the ODF status of the community can be compromised as these new settlers without latrine might result to open defecation.

After extensive sensitization of the community, some community members volunteered to support neighbouring communities to stop open defecation.

Visit to Binduli ODF Community, Karaga District – February 15

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Fig.3: Latrine proliferation in Fatenayili, Karaga District of Northern Region

Latrines constructed with freematerials from UNICEF

Latrine constructed by community on their own after triggering

Free Latrines from World Vision

The situation in this community is similar to the earlier community visited expect that there is no World Vision support but UNICEF supported with materials for fabrication of slabs. The community has been declared ODF but still had some elements of hardware supports which are against the core principles of CLTS. This model is not sustainable as the community members will continue to wait for support from UNICEF instead of using their resources to construct low cost latrines. This factor becomes extremely important when planning for scaling up.

De-briefing Session at Karaga District OfficePresent at this meeting were the District Chief Executive, District Coordinating Director, Senior district officials, other senior government officials from Northern region and Accra as well as representatives of NGOs. Karaga district has an estimated population of 75,000 and a total of 176 communities including 6 major small towns.

The district team was briefed on major findings of the visit to Fatenayili and Binduli communities some of which include; Poor coordination of NGO interventions in the communities. Promotion of highly subsidized and un-affordable V.I.P latrines. Donation of materials for fabrication of slabs for household latrine construction. The models observed in the two communities visited are not sustainable, replicable and

appropriate for scaling up sanitation in the district.

After a brainstorming session, the following suggestions were made to address some of the issues raised on the field visits to selected communities; Formation of Area Council Project Development Team for effective coordination of

interventions in the district. Sustained sensitization of communities on CLTS implementation. Formation and training of more Community based Voluntary Hygiene promoters. More involvement of traditional, religious and opinion leaders in project implementation. Institutionalize coordination meetings among all the NGOs working on CLTS in the

district. Develop district plan for achievement of ODF in all the communities. Community empowerment and human resources development for effective CLTS

implementation. Identify and train more Natural Leaders to facilitate CLTS implementation in the district.

De-briefing Session with Chief of UNICEF Tamale OfficeThe de-briefing session took place in the conference room of UNICEF Tamale Office and was meant to update the Chief of Field Office on some of the major findings of the field visits. Some of the observations and suggestions for consideration are; There is high political will from the government to implement CLTS as demonstrated by

the declaration of the Regional Minister of December 31, 2012 to achieve ODF in Northern Region.

CLTS can really work in the region and this has been demonstrated in few communities.

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The major hindrances to effective implementation of CLTS in the region are; Donation of V.I.P latrine materials by World Vision; Donation of materials for fabrication of slabs by UNICEF; and Poor coordination of donors/NGOs working on CLTS at district level.

There is need to keep up the momentum generated from the Regional Minister’s declaration by embarking on sustained sensitization and advocacy activities to all the districts in the region. CLTS champions can be identified and mobilized to support the sensitization activities.

The region should embark on CLTS campaigns and the focus of intervention should be on soft ware components of capacity development, sensitization, community mobilization and empowerment and monitoring and evaluation.

Achieving the set targets of the Regional Minister requires change of mindset among the implementers. The implementers have to belief in CLTS principles and are willing to adhere strictly to the guiding principles.

Visit to Tasondo – Zabzugu/Tatale District – February 16The estimated population of Tasondo is 733 and there are 58 households. The community was triggered for CLTS implementation in 2008 by the District Environmental Health Officer and the community is now ODF with 61 household latrines. APDO (NGO) provided technical support in training of Natural Leaders on CLTS facilitation.

The community members demonstrated high level of knowledge on hygiene and environmental sanitation practices during discussions and were very proud of their ODF status which they are guarding seriously.

The main features of CLTS implementation in the community include; The community never benefitted from the hard ware subsidy for household latrine

construction. Full community empowerment with community members making their own choice of

latrine designs and construction. Each household has traditional latrines without any external support and the latrines are well kept without any foul odour. No prescription of toilet design.

Presence of highly resourceful Community based Voluntary Hygiene Promoters/Natural leaders for CLTS and hygiene promotion.

Improved environmental sanitation and hygiene practices including hand washing with soap; cleaning of the environment, bush clearing, stopped eating dead animals, etc

Based on the discussions with community members, the stopping of

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Fig.4: Simple Pit latrines constructed in Tsaondo

open defecation in the community has contributed significantly to the health and social economic well being of the people.

The Natural Leaders are willing and already planning to support neighbouring communities to stop open defecation as part of the measures of scaling up CLTS in the district.

There was a good facilitation support from District Environmental Health Officer and his team.

This particular model is low cost, effective, sustainable and appropriate for scaling up sanitation in the district.

De-briefing Session with District Chief ExecutiveThe meeting took place in the district office at Zabzugu and in attendance were senior district officials, senior government officials from Northern Region and Accra as well as Representatives of NGOs. The discussions focused on the major findings from the visit to Tasondo and the need to replicate the model in all the communities in the district.

The senior management team of the district was sensitized on the declaration by the Regional Minister to achieve ODF in Northern Region by end of 2012 and the need for the district to commence actions immediately on scaling up the successful model. After extensive discussions, the District Chief Executive made the following commitments; District Assembly to visit Tasondo ODF community as the first step towards replication

of the model to other communities in the district. Set out funds to motivate communities towards achieving ODF. Provide logistic supports to the District team to facilitate CLTS implementation. Use part of the supplementary budget being expected for CLTS promotion. At least 80% of all the communities in the district achieve ODF within a year.

De-briefing meeting with Stakeholders in TamaleThe meeting took place in UNICEF Tamale office principally to review the findings from the field visits and all the consultations held with relevant stakeholders. The following challenges were collectively identified as militating against effective implementation of CLTS in Northern Region; Poor coordination of NGO/donor interventions especially at district level. Low capacity for effective facilitation of CLTS Implementation of subsidy approach under the guise of CLTS. Poor logistic support to DFT for effective monitoring and follow up activities. Poor facilitation of CLTS implementation. Poor commitment and adherence to CLTS principles.

Some suggestions for immediate actions include;UNICEF Develop exit strategy to pull out from donation of materials for fabrication of slabs and

work out modalities for utilization of the slabs already produced without significantly

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compromising CLTS principles. Donation of slabs is totally against the core principles of CLTS and cannot be effectively scaled up.

Facilitate sustained sensitization and advocacy activities at regional and district levels to mobilize for political and financial commitments in scaling up successful CLTS models.

Provide technical support to Region and districts to develop road map/action plan for achieving ODF in Northern Region by end of 2012.

Continue to play strategic roles in promoting partnerships among several stakeholders, mobilizing financial resources for scaling up of CLTS and serve as focal point for knowledge management on CLTS in Ghana.

Region Organize one –day sensitization workshop on CLTS for all the 20 districts in Northern

Region. The participants for the workshop should comprise of; District Chief Executive; District Coordinating Director; District Planning Officer; and District Environmental Health Officer. The workshop is aimed at sensitizing the districts on modalities of achieving ODF in the Northern Region by end of December 2012.

Conduct step-down CLTS sensitization activities at district level for greater awareness of the approach towards achieving the set targets.

Develop and implement roadmap/action plan for achieving ODF in Northern region by end of 2012.

Provide necessary guidance and support districts in the coordination of all NGOs/donors interventions on CLTS.

Develop and implement training plans for developing capacity of DFTs and NGOs in CLTS facilitation.

Support training of DFTs and NGOs in CLTS facilitation

Based on discussions with relevant stakeholders implementing CLTS in Northern Region and field observations, CLTS implementation in the region can be depicted using the two models below (Figs. 5 and 6)

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Figure 5: Model of CLTS Implementation in Northern Region - 1

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Fig.6: Model of CLTS Implementation in Northern Region-2

4.3 Review of Practice of CLTS in Central Region In continuation of the review of CLTS practice in Ghana, the team visited Central Region on 18th February, 2011. As part of the team were representatives of NTWG on sanitation, Regional Environmental Health Officer and District Environmental Health Officers.

CLTS was first piloted in the region by CWSA in 2007 in 3 districts after which other partners such as PLAN and UNICEF joined in the piloting exercise. Five out of the seventeen districts are presently implementing CLTS in 55 communities of the region.

PLAN Ghana CLTS interventions in the region were through PRONET (NGO) and TREND. TREND was contracted by CWSA, UNICEF and PLAN to conduct trainings of EHAs and other facilitators on CLTS implementation. All the trainings of facilitators on CLTS in the region were conducted by TREND.

Based on the verification and certification exercise conducted by the Regional team in November 2010, there is no ODF community in the region after more than five years of CLTS piloting. About 20 communities actually declared themselves as ODF but could not be certified due to the ongoing open defecation practices observed during the verification exercise. These communities could not sustain ODF due to lack of effective follow up mechanism, promotion of single technology option of V.I.P latrine which is very expensive and the use of communal latrines which often collapse forcing the people to return back to open defecation.

Visit to Oboyembo Village, Agona EastThe team visited Oboyembo Village for on the spot assessment of CLTS implementation in the region. Oboyembo is one out the three triggered communities of Agona East district which has a total of 285 communities. The village was triggered in early 2009 and temporarily stopped OD by end of 2009 with 43 out of 90 households in the village having V.I.P latrines while the rest depended on the communal latrines constructed immediately after the community was triggered. The communal latrine collapsed in 2010 and most of the community members without household latrines resulted to open defecation.Although, no external hardware subsidy for the construction of individual household latrines, some community members struggled to construct V.I.P latrines which are very expensive (a single compartment V.I.P latrine cost about GHC 210). The promotion of V.I.P latrines blocked the use of other types of low cost simple pit latrines which can easily be afforded by all the community members as part of the

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Fig.7:. V.I.P latrine constructed in Oboyembo, Central Region

first step of stopping OD with provision of moving up the sanitation ladder after achieving ODF.Oboyembo case study gives a typical example of CLTS implementation in most communities in the Central Region which is characterised by a mix of V.I.P latrine promotion, ineffective follow up mechanism, poor facilitation skills and use of communal latrines. Based on discussions with relevant stakeholders and field observation, CLTS implementation in Central Region can be depicted with the model below. (Figure 8).

Main Blockage of Scaling up of CLTS in Ghana?

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Fig. 8: Model of CLTS Implementation in Central Region

4.4 Main Blockage of Scaling of CLTSBased on the review of CLTS in the three regions and various consultations with stakeholders at national, regional, district and community levels, it could be generally observed that there are great potentials for CLTS in the country. There is high level of political commitments and favourable policy environment to support scaling up of CLTS. Ghana is among few countries in Sub-Saharan Africa that has adopted CLTS as the main strategy for rural sanitation delivery. Despite the favourable environment, there are still a lot of challenges blocking effective scaling up of CLTS in the country.

Apart from the inadequate capacity for quality training and facilitation of CLTS, the following are the major blockage of scaling up: Disharmony among the donors in adoption of core principles of CLTS and tendency to

provide hardware household subsidy; Old mindset of technology prescription and promotion of V.I.P/KVIP Long term promotion of communal latrines by the government and ingrained mindset of

communities towards the use of communal latrines. Ingrained attitudes of traditional village chiefs towards free communal latrines and

subsidy orientation. Absolute institutional in-coordination Non-existence of technical coordinating mechanism at regional/district level. Old mindset of counting toilets instead of ODF villages.

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Inadequate funding of District Environmental Health and Sanitation Department and total dependence of this department on external funding for carrying out basic activities like triggering in communities, follow up visits, conducting ODF evaluations and celebrations etc. Except 10 I-WASH districts of Northern Region supported by UNICEF and a few districts in other regions supported by International NGOs, most of the 170 districts in the 10 regions of the country do not have adequate financial resources to support any meaningful CLTS promotion. Since any kind of sanitation interventions in the country largely depend on District Environmental Health and Sanitation machinery, scaling up of CLTS will almost be impossible considering the present level of funding. Sustainable development cannot be achieved with dependence on external support agencies for some basic things like provision of transport support to DEHO for triggering and post triggering activities. This needs urgent political and administrative attention

30

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Fig. 9: Main blockage of Scaling up CLTS in Ghana

Fig. 10: Blockage of Scaling up of CLTS by V.I.P Latrine

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Fig. 11: Blockage of CLTS Scaling up by Communal Latrines

5.0 National Training of Trainers’ WorkshopsTwo national Training of Trainers’ workshops were conducted for key sector professionals from National, Regional and district levels. The schedules for the workshops were designed to address the capacity gaps from the CLTS review and how to scale up CLTS in the country. Ordinarily, hands-on training workshops for CLTS facilitators are for five days, in view of the peculiarity and special features of CLTS practice in Ghana, the first National Training of Trainers workshop was designed for 6 days to address all the identified issues during the CLTS review.

The specific objectives of the workshops include;1. True empowerment approach of CLTS with a special focus on Community Led initiative

in its’ true sense clearly understood by all the participants.2. Region-wide variations of practice of CLTS, shortfalls, strengths and weaknesses and

scopes for improvement to get the best out of community empowerment approach analysed and compared.

3. Skills of facilitation of CLTS and enhanced capacities to conduct training of trainers strengthened.

4. Challenges related to mixing of old practices with CLTS and ways of improving inter-institutional coordination for speedy scaling up of CLTS process in Ghana clearly understood

5. Strategies for scaling up CLTS in respective regions and districts with a special focus on the use of natural leaders as community consultants and all other possible options developed

6. At least one year (2 years for the Northern Region) plans of actions for scaling up of CLTS including monitoring and networking mechanisms to keep track of the progress made by different regions developed

The two workshops were facilitated by Kamal Kar and Bisi Agberemi with supports from members of NTWG on Sanitation.

5.1 National ToT Workshop on CLTS -Dodowa, Greater Accra RegionThe first workshop was conducted at Forest hotel, Dodowa from 21st to 26th, 2011. The workshop was organized by Ministry of Local Government and Rural Development in collaboration with Community Water and Sanitation Agency with financial and technical supports from UNICEF. A total of 60 participants drawn from Environmental Health and Sanitation Directorate at National, Regional and District levels from all the 10 regions in the country; CWSA national and regional officers, Representatives of NGOs, Natural Leaders from selected ODF communities and UNICEF attended the workshop.

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Brief opening remarks were presented by Ms. Lorretta Roberts (WASH Specialist, UNICEF Ghana) highlighting the background and rationale for organizing the workshop while Hon. Nobel Kakra Van Hair, Municipal Chief Executive of Adenta presented some brief remarks as part of the opening ceremony.

Special Features of this workshopThe workshop was conducted using participatory approaches with full engagement and active participation of the participants throughout the workshop. Power point presentations, group work, role play, video documentaries and practical demonstrations were extensively used to effectively achieve the workshop objectives.

Following the programme of events designed for the workshop, the major highlights include the following; Power point presentation on overview of Sanitation in Ghana by Mr. Naa Lenason

Demedeme (Acting Director, EHSD, MLGRD) focusing on access to improved sanitation facilities in the country, existing opportunities of improving on the deplorable sanitation situation, challenges and way forward.

Kamal Kar facilitated the combined presentations on Why CLTS and CLTS Global Experience which was conducted using group work and discussions on past sanitation projects that have failed or did not achieve the planned results and the reasons for their failure. After extensive discussions by the groups, the main reasons for failure of identified past sanitation projects include

o Low community involvement and participation in the planning and implementation of the projects.

o The projects were donor driven.o Technology prescription (KVIP/VIP, Sanplat etc)o Hardware subsidy for construction of household latrines.o Focus on latrine rather than behaviour change.o Poor collaboration amongst stakeholderso Inadequate fundingo Supply driven.o Water used as a bait for sanitation interventions

Rationale, origin and basic principles of CLTS were later explained and this was followed by a BBC video documentary on CLTS (Clean living).

Presentation on the Major Findings on Review of CLTS Practice in 3 Regions by Bisi Agberemi focusing on the key issues and challenges in scaling up CLTS in the country.

Participants were divided into 6 groups of uniform mix of gender, local language skills, institutions/agencies, past exposure to CLTS and places of work for the purpose of field visits to trigger 12 selected communities. The names of groups and the communities visited are;

Group Name Village (Day 1) Village (Day 2)Global Aboom Sota Oslongba

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PDF Remedy Pukpe ApeseODF Associates Odumse OdumaseZanu PF Obompaase FiankonyaChake Adumanya KpeglokopeBolimbo Ayenya Abonya

Presentation and classroom demonstration of different types of CLTS triggering tools and rehearsal by each of the groups for field work using role plays.

Field visit to 12 communities for triggering exercise. Each group triggered two communities in two days of the workshop. There were plenary sessions on each day of triggering for experience sharing, learning from the mistakes made during triggering and reinforcing some of the key principles of CLTS facilitation.

A large event of community presentation of sanitation profile by the triggered communities was organized in the courtyard of Forest Hotel, Dodowa. The selected potential Natural Leaders from all the 12 triggered communities made fascinating presentations of their sanitation profile and ODF plan to all the participants. Present at the community presentation apart from the regular participants were; The Representative of Honourable Minister of the Northern Region (Northern Region Coordinating Director); Damgbe West District Chief Director; Damgbe West District Finance Officer; Chief of WASH, UNICEF Ghana. The community presentations were very educative and demonstrated the potentials of CLTS triggered communities to stop open defecation within a very short period. The ODF dates for each of the triggered communities are shown in the table below;

Village Date of Achieving ODF Village Date of Achieving ODFSota March 23, 2011 Oslongba May 31, 2011Pukpe May 31, 2011 Apese April 30, 2011Odumse April 30, 2011 Odumase April 30, 2011Obompaase April 30, 2011 Fiankonya May 15, 2011Adumanya April 30, 2011 Kpeglokope April 30, 2011Ayenya March 11, 2011 Abonya March 12, 2011

Based on community presentations, there were remarks and conviction on the potentials and possibilities of CLTS to scale up sanitation in Ghana from most of the participants.

A 20 minute video capturing collective local actions by some communities immediately after triggering was shown to all the participants. This generated a huge excitement and enthusiasm among the visiting communities and the workshop participants.

Discussions on better inter institutional collaboration and Way forward: This was carried out through Group work and Role play for better understanding of institutional roles and responsibilities as well as collaboration for effective CLTS implementation.

Development of Action Plans for CLTS implementation and discussions on the way forward. At the end of the workshop, the participants declared 20 point consensus for implementation (Annex 4).

Final workshop evaluation was conducted and below is the result of the evaluation;

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Description RatingLess than 20%

20% – 40%

40% – 60%

60% – 80%

More than 80%

To what extent your expectations have been fulfilled?

20 33

To what extent do you feel that the learning from the workshop will be useful to your work?

3 50

To what extent do you feel confident in training others?

1 2 50

To what extent do you rate your institutional environment which might enable or disenable you to implement CLTS?

1 3 49

To what extent do you rate the workshop in terms learning (classroom + village, facilitation materials) ?

2 51

To what extent do you rate overall logistics of workshop, accommodation, food, etc?

29 22

5.2 National Training of Trainers’ Workshop – Elmina, Central RegionThe second National CLTS workshop was held in Coconut Grove Hotel Elmina from March 7-11, 2011. This particular workshop was jointly sponsored by Plan Ghana, WaterAid and UNICEF with 60 participants in attendance. The participants comprised mainly staff from NGOs, MLGRD, Regional and District Environmental Health Departments, Schools of Hygiene, Community Development Department, CWSA, School Health Education Programme and UNICEF.

The workshop had same objectives as the first one conducted at Dodowa and the same agenda was adopted with few amendments to reflect the 5-day duration of the workshop. The duration of Dodowa’s workshop was 6 days.

The Country Director of PLAN Ghana represented by Mr. William Agyekum Accriah (Head of Programmes) gave the welcome address while the Regional Minister ably represented by

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Ms. Dorcas Hutchful Aidoo gave the opening remarks and declared the workshop open. The keynote address was presented by Mr. Kweku Quansaah of MLGRD.

The workshop was conducted using the same methodology and approach as the previous one and the proceedings of workshop activities are essentially similar. Participants were divided into 6 groups with appropriate mix of gender, past experience in CLTS facilitation, organization and place of work to trigger 12 communities as part of the workshop to practically demonstrate CLTS facilitation and triggering processes. Community presentation of sanitation profile and ODF plan from the 12 triggered

communities was held in Coconut Grove hotel on March 11 and in attendance were all the workshop participants, media personnel, UNICEF Chief of WASH Section and Natural Leaders from the 12 communities. This event generated a lot of lively discussions and the triggered communities demonstrated their capability and willingness to achieve ODF without external support of hardware subsidy for household latrine construction. The ODF dates for each of the triggered communities are shown in the table below;

Village Date of Achieving ODF* Village Date of Achieving ODF*Abbina April 30, 2011 Atonkwa May , 2011Eduegyie June 15, 2011 Old Odomase May 10, 2011Nyamebeyere May 30, 2011 Ahomfie No. 2 June 14, 2011Brenyi May 30, 2011 Bronyibima June 14, 2011Kakanasi Yesunkwa June 30, 2011Kokor Mensa Ekroful

April 30, 2011 Mpeasem

*Dates need to be confirmed. There was a brief session with the Central Regional Minister; Hon. Ama Benyiwa Doe on

the last day of the workshop resulting from an earlier invitation extended to the Minister during the courtesy call on her by Kamal Kar and Bisi Agberemi a day before. The Minister was accompanied to the workshop by the Regional Coordinating Director. The Minister was briefed on the objectives and the outputs of the workshop by Kamal while the UNICEF Chief of WASH made some remarks on the ongoing efforts at scaling up CLTS in Ghana. The Minister gave her remarks highlighting the importance of sanitation to the health, social and economic well being of the people and gave her commitments to support CLTS implementation in Central Region. The Minister’s presence at the workshop was motivating and a clear indication of the required high level political support for scaling up CLTS in Central Region.

Final workshop evaluation was conducted and below is the result of the evaluation;

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Description RatingLess than 20%

20% – 40%

40% – 60%

60% – 80%

More than 80%

To what extent your expectations have been fulfilled?

14 39

To what extent do you feel that the learning from the workshop will be useful to your work?

3 50

To what extent do you feel confident in training others?

7 46

To what extent do you rate your institutional environment which might enable or disenable you to implement CLTS?

1 13 38

To what extent do you rate the workshop in terms learning (classroom + village, facilitation materials) ?

53

To what extent do you rate overall logistics of workshop, accommodation, food, etc?

7 8 13 19 2

Note: Detailed workshop report to be prepared and disseminated by Ministry of Local Government and Rural Development.

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6.0 Other Miscellaneous Activities6.1 High Level Sensitization Meeting on CLTSThis high level sensitization meeting was organized by Ministry of Local Government and Rural Development with the primary objective of creating awareness on CLTS among policy makers, senior government officials and heads of parastatals of all relevant government ministries and agencies as well as donors, international development agencies, NGOs and media. The meeting was held at Alisa hotel, Accra on February 28, 2011 and in attendance were participants comprising of senior government officials from all relevant ministries and agencies, representatives of UNICEF, World Bank, CIDA, WaterAid, Plan (NGO), media and traditional chiefs.

The Deputy Minister of MLGRD, Honourable Elvis Afriyie Ankrah gave the welcome address while keynote addresses were presented by Representatives of CIDA and UNICEF. Mr. Demedeme Naa Lenason (Acting Director, EHSD) made a presentation on Environmental Sanitation in Ghana: Key Issues which generated a lot of discussions among the participants.

The main presentation on Scopes and Challenges of CLTS in Ghana was jointly presented by Kamal Kar and Bisi Agberemi and the paper dealt extensively with rationale of CLTS, origin, concept and principles of CLTS, potentials of CLTS in scaling up rural sanitation in Ghana and major findings from review of CLTS practice in 3 Regions of Ghana. Apart from the general overview of CLTS, the paper also focussed on the identified blockages for scaling up CLTS in Ghana and addressed some issues on the way forward for sanitation development in the country. The paper generated a lot of lively discussions among participants seeking for more clarifications on CLTS and its application within Ghana context.

The meeting was well organized and timely as it provided the opportunity of clearing a lot of misconceptions on the core and non-negotiable principles of CLTS as well as enlightened the participants on its’ great potentials for scaling up rural sanitation in Ghana. There are a lot of sanitation projects presently or about to be implemented with subsidy approach and these have to be addressed for scaling up of CLTS in the country as the two approaches are not compatible.

6.2 Public Lecture on CLTSIn furtherance of creating awareness on CLTS among all relevant stakeholders in Ghana, a public lecture was organized by the Department of Biological, Environmental and Occupational Health Sciences of University of Ghana in collaboration with Ministry of Local

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Government and Rural Development on March 2, 2011 in University of Ghana, Legon. Present at this event were; Deputy Minister, MLGRD (Mr. Elvis Afriyie Ankrah), Deputy Minister, Ministry of Water Resources, Works and Housing (Dr. Mustapha Ahmed), UNICEF Country Deputy Representative, UNICEF Chief of WASH, Acting Dean, School of Public Health, University of Ghana, Head of Department of Biological, Environmental and Occupational Health, Acting Director, EHSD (MLGRD), UNICEF WASH Specialist, Senior government officials of MLGRD and CWSA as well as Representatives of some NGOs. The main audience were the students and lecturers of School of Public Health, University of Ghana and over 300 participants attended the public lecture.

The public lecture was chaired by Prof. James Grant Monney of KNUST while remarks were made by UNICEF Country Deputy Representative, Deputy Minister, Ministry of Water Resources, Works & Housing, and Deputy Minister, Ministry of Local Government and Rural Development reinforcing their organizational commitments in supporting the scaling up CLTS in Ghana. The main theme of the public lecture presented by Kamal Kar was on CLTS principles and its potentials for scaling up rural sanitation.

6.3 Northern Region Sensitization Workshop on CLTSResulting from the earlier visit and meeting with the Regional Minister and his declaration of achieving ODF for the whole of Northern Region by December 31, 2012, a sensitization workshop was organized on March 3, 2011 for all the 20 districts in the region. The meeting was held in RCC residence in Tamale and over 100 participants comprising of Honourable Minister of Northern Region, Northern Region Coordinating Secretary, Acting Director, EHSD of MLGRD, District Chief Executives, District Coordinating Directors, District Environmental Health Officers, District Planning Officers, UNICEF Chief of Field Office, Tamale, UNICEF Officers and Representatives of NGOs in Northern Region.

The Honourable Minister of Northern Region presented the welcome address reinstating the declaration and his commitments towards achieving ODF Northern Region by end of 2012. He advised the District Chief Executives to develop and implement plans for implementation of CLTS that will guarantee the achievement of the planned targets. The minister requested that Regional Coordinating Director submits monthly progress reports on status of CLTS implementation in all the 20 districts. The Acting Director, EHSD of Ministry of Local Government and Rural Development presented a goodwill message on behalf of his Minister pledging support of his ministry to the region in achieving the set target. There was also a goodwill message from the Chief of UNICEF Field Office in Tamale at the event and promised UNICEF’s support in realising the set objectives.

The Regional Environmental Health Officer presented an overview of sanitation situation in the Northern Region highlighting the achievements and challenges in CLTS implementation in the region. Kamal Kar made a presentation on CLTS while Bisi Agberemi shared the major findings of CLTS practice in Ghana with the participants. Video documentary on CLTS was shown at the event to further reinforce the message on CLTS principles and

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potentials. The Road map for achieving ODF Northern Region was presented and this was followed by extensive discussions on the way forward.

At the end of this workshop, the participants were fully sensitized on CLTS and demonstrated commitments and sense of urgency in achievement of the set targets. The steps to be followed have been discussed at the workshop and highlighted in the Road map shared with all the participants.

Considering the high level of political commitment from the Minister of Northern Region, the region can actually achieve the set targets if well articulated plans using the information shared at the sensitization workshop can be developed and implemented with support from all relevant stakeholders. Achieving ODF in Northern Region is very strategic and will serve as impetus to motivate other regions to take urgent actions in scaling up CLTS towards improving on the present low level of access to improved sanitation and achieving MDG sanitation targets in the country. . 6.4 National Learning Alliance PlatformThis meeting was organized by the WASH Sector Resource Centre Network as part of the efforts of creating awareness on CLTS in the country. The meeting was held on March 4, 2011 at Coconut Grove Hotel Accra and attracted participants from NGOs, MLGRD, CWSA, Media and UNICEF.

Mr. Kweku Quansaar made a presentation on the Community Led Total Sanitation in Ghana while Kamal Kar presented Community Led Total Sanitation: Concept and Practice. There were a lot of discussions on the presentations for better understanding of the core principles of CLTS.

There was a panel discussion with the topic- Scaling up Sanitation and Hygiene in Ghana: the case of CLTS. The discussions focused on potentials of CLTS in scaling up sanitation and hygiene delivery which if properly applied will contribute significantly to increase in access to improved sanitation in Ghana.

6.5 Meeting with Central Regional MinisterA courtesy call was paid on the Central Regional Minister, Hon. Ama Benyiwa Doe on March 10, 2011 in her residence to sensitize her on CLTS concept and solicit for support in scaling up CLTS in the region. Also present at the meeting with Regional Minister were the Regional Coordinating Director, Regional Environmental Health Officer and other senior regional government officials. There were brief discussions on CLTS approach and the Minister promised to support scaling up of CLTS in the region.

6.6 Meeting with Hardware Manufacturers and EngineersIn continuation with consultation and sensitization of all relevant stakeholders on CLTS implementation, a meeting with hardware manufacturers and engineers was organized on

41

March 14, 2011. The meeting which took place in Coconut Grove Hotel, Accra attracted participants from MLGRD, CWSA, NGOs, UNICEF, Private Sector, Regions, District and ODF communities. Prof. James Grant Monney chaired the meeting while Mr. Demedeme (Acting Director, EHSD of MLGRD) delivered the opening remarks. The goodwill message from UNICEF was presented by Mr. Othniel Habila (Chief of WASH Section).

The specific features of the meetings include; Photo exhibition of different latrine options by NGOs, Regions and Districts. Presentation on CLTS – Making the Technology link: Lessons learned from Integrated

Approach to Guinea Worm Eradication through Water, Sanitation and Hygiene in the Northern Region of Ghana by UNICEF WASH Officer, UNICEF Tamale. The focus on sanitation component of the project and highlighted major achievements in CLTS implementation, challenges confronted and the way forward.

Presentation on Evaluation of CLTS by Lorretta Roberts (WASH Specialist, UNICEF Ghana) highlighting the major findings of the evaluation which was conducted in 2009 and status of implementation of recommendations emanating from the evaluation.

Presentation on Global Perspective of CLTS by Kamal Kar focusing on CLTS origin, concept, core principles, spread of CLTS and strategies for scaling up CLTS.

Presentation on Major Findings of CLTS Practice in 3 Regions by Bisi Agberemi covering the various models of CLTS being implemented and major blockage of scaling up CLTS in the country.

Extensive discussions on all the above presentations and the way forward.

It is on record that this was the first time this type of workshop was being organized underlying the importance of hardware manufacturers and engineers in ensuring effective CLTS implementation in the country.

42

RECOMMENDATIONS

43

7.0 RECOMMENDATIONSThis chapter has been divided into three sections which are; General Recommendations Region and District specific recommendations National and Policy Recommendations.Most of these recommendations have been discussed extensively during various meetings and consultations with relevant stakeholders.

7.1 General RecommendationsIn this section, recommendations related to training, capacity building, post triggering follow up, post ODF follow up, inter-institutional coordination and scaling up has been covered. These recommendations mainly emerged from the visits to different regions and districts, interaction with officials and staff at different levels and meetings with UNICEF and NGOs staff. The following are the major recommendations: In view of the fact that there is an acute shortage of well trained facilitators of CLTS in

most regions and districts particularly within the Directorate of Environmental Health and Sanitation, a small team of at least 5 facilitators in each district of the country must be developed. Considering the large number (5 into 170 districts in the country), one year training plan with appropriate funding should be developed by NTWG on Sanitation for the training of these facilitators. In this respect, it is recommended that major sanitation players of Ghana like MLGRD, CWSA, UNICEF, PLAN and WaterAid and the 10 Regional Councils should convene planning meetings in all the 10 regions of the country and workout a standard plan of training and capacity building for all the districts in the respective regions. These trainings must be of very high quality and the quality of the training must not be compromised. A team of at least 4 or 5 very good trainers drawn from the participants trained in the two workshops (Dodowa and Elmina) be formed who should lead these training workshops. Each training workshop must be hands-on and should trigger 10-12 communities around each training venues in different regions. In other words, roughly 20 of such training workshops (2 workshops per region) should be able to trigger 200 to 240 villages in different regions of the country. This should not be very difficult, as major actors in sanitation sector can pull resources together for the urgent training of required facilitators that would support the scaling up of CLTS in the country.

Expect in Zabzugulu/Tatale district of Northern Region, none of the district officials of the Department of Environmental Health received any formal training on CLTS. This was clearly reflected in the excellent work done by the District EHO of Zabzugu/Tatale and his team. The community involvement and overall outcome of Tsaondo community was definitely far more superior than any other communities visited. This clearly demands an immediate training and exposure of all the district EHOs and CDOs on CLTS. The key

44

people of each district involve in CLTS implementation must go through Hands-on training which gives them a total clarity on the approach, facilitation for triggering and essential follow up. In the absence of basic training exposure, different kinds of practices in the field have been noticed, most of which cannot be classified as CLTS. Before the poor practice spread to a large scale, it is strongly recommended that training for above mentioned officials from all the districts ready to implement CLTS be organized as soon as possible.

Highest priority and focus must be given to follow up the 24 triggered villages (12 around Dodowa and 12 around Capecoast) during the two workshops. In the same version, very strict follow up arrangement must be made to ensure post-triggering follow up of 200/240 villages to be triggered in the next 20 regional training workshops (2 in each region). All the basic trainings should be preferable be completed by October 2011. However, utmost precaution must be exercised not to rush through in organizing these training workshops. Quality of training must receive utmost attention and priority. Please see Annex 3 the list of master trainers recommended from the two workshops.

Post ODF follow up should be the key in scaling up CLTS country wide. Recommended activities under post ODF follow up are as follows;

o Develop the best ODF villages into training/learning centres for other villages of the district. Continuously bring village leaders and community members to these learning centres (ODF villages) for face-to-face interaction with ODF villages and dissemination of the spirit of collective local actions towards achieving ODF.

o Identify potential Community Consultants of CLTS from among the best Natural Leaders emerging from ODF villages.

o Develop a clear scaling up strategy (with provision of funding) using the Community Consultants. Preferably the scaling up process by the Community Consultants (wherever possible) should begin around end of October 2011. It is interesting to note that the 2 Natural Leaders (Afenyo Ekormend & Ganu Mawuko) from Afram Plains who participated in Dodowa workshop have already triggered four neighbouring communities around them. These two NLs were the first people to put the learning from the workshops into use. This needs to be institutionalized at any cost.

o For detail of generic activities for scaling up of CLTS, please see annex 5

The need for developing critical mass of ODF villages has been adequately emphasised. This is the time Ghana should start developing ODF districts and regions rather than focusing on few ODF villages here and there. Innovative models of scaling up CLTS must be developed where community consultants should be involved.

7.2 Region and District specific recommendationsInnovative attempts were made to turn this mission into an action oriented national initiative rather than just organizing two training workshops for capacity building and identifying the problems related to scaling of CLTS in Ghana. Though none of these activities were included in the TOR, we thought it appropriate to initiate some of these actions to move Ghana on

45

track of CLTS right from this mission. Some of these actions included; Dialogue with political leaderships and encouraging them to get involved in steering CLTS in their respective regions and emerge as champions. In the process, the Regional Minister of Northern Region (Hon. Bukari Moses Mabengba), Deputy Minister of Ministry of Local Government and Rural Development (Hon. Elvis Afriyie Ankrah) and the Regional Minister of Central Region (Hon. Ama Benyiwa-Doe) were convinced on the urgent need of changing all 20 districts of Northern Region and 17 districts of Central Region into ODF. The great benefits of CLTS in terms of better health, increased income and reduced regional expenditure on health services were appreciated by these senior leaders at the regional and national levels.

The Northern Regional Minister agreed to declare a region wide campaign to make the entire region into ODF by December, 2012. This decision followed by the announcement by the Regional Minister was historic and was welcome by all the major sanitation actors of the country. Minister’s speech in support of CLTS was covered by the most important news media of the country. Some special events were facilitated in order to initiate and support the Minister’s declaration. It is strongly recommended that all efforts must be made to support this declaration and make this a success. Since UNICEF has been supporting the 10 districts of the region under Integrated WASH project, UNICEF should also extend visible support to the other 10 districts at least in terms of training and human capacity development.

A generic milestone of activities/roadmap have been worked out (see annex 5 for details) which could be useful in achieving ODF regions. It is strongly recommended that CWSA provides all necessary support to the Regional Council of Northern, Central and Greater Accra Regions to make these hopes of ODF region a reality

The network of CWSA is extended only up to regional level, it is recommended that they make all efforts in extending their direct support to district level by various means. Some of the possible linkages discussed during the Dodowa workshop are as follows; Participating in the district level sanitation meetings by sending one representative from

the region on a regular basis. Identifying and Organizing trainings for the National Leaders (NLs) and Community

Consultants (CCs) emerging from each districts and thus strengthening community led scaling up of CLTS.

In this context, it is recommended that CWSA start supporting the training of NLs to prepare them as CCs. CWSA could take the help of APDO in training the NLs/CCs. Mr. Modoc of APDO has already started such initiative in Afram Plains area. Since the Regional Minister of Northern Region has declared that the entire region should achieve ODF by December 31, 2012, the training of the key persons of all the 20 districts of the region must be completed at war footing. A draft roadmap for scaling up of CLTS in entire Northern region of Ghana has been attached in the annex.

46

Each Region should develop plan for achieving ODF with inputs from all stakeholders including the NGOs. UNICEF should facilitate the finalization of these plans which will guide effective scaling up and coordination of all interventions in the region. In other words, the regional plans are comprehensive plans of all districts in each region. This bottom-up planning process needs to be facilitated by involving DEHO, Community Development Officer, District Planning Officer, District Coordinating Director and Chief Executive Officer of the district with support from REHO and Regional Officer of CWSA. This is one important area where CWSA may extend all necessary help and support. The following should be clearly spelt out in the district and regional plans; Delegate lead role to NGOs to facilitate CLTS implementation in each district. The region must allocate minimum funding support which must include; Logistic support

for CLTS implementation (Bicycles from CWSA to districts); Cost of evaluation/certification; ODF celebration ( Sign posts, participation of other community members such as Traditional Chiefs in ODF celebration), Post ODF activities (Training and Capacity building of selected NLs of becoming CCs.

Institutionalized regional coordination meeting for all stakeholders implementing CLTS in the region. This meeting can be rotated amongst the districts within the region.

It is suggested that before initiating the Regional planning process of all the regions, new learning from the Northern and Central Regions be documented and disseminated to all the other 8 regions.

Monitoring Progress of the DistrictsDistrict monitoring mechanism to be initiated at the regional level has been discussed at length with Steve Adonko (REHO of Northern Region) and Martin Amevor (REHO of Central Region). The REHO have been advised to take pictures of all DEHOs and allocate RED, YELLOW AND GREEN cards based on the bi-monthly progress in terms of number of ODF villages and number of NLs/CCs that emerged from each districts. The target of ODF villages and NLs could change with time while new targets can be set for each district depending on the progress being made.

Both Martin and Steve have been advised to allocate the responsibilities of taking the lead roles to the major NGOs/INGOs (Plan, WaterAid, Pronet, APDO, TREND etc). It has been suggested that the coordinating roles of NGOs be explained at a regional level meeting and their full cooperation solicited. Both the REHOs have been advised to depict allotment of NGOs to different districts on a large map of the region. This display could also be an effective tool of monitoring the progress made by each district under the coordination of each NGO. Similarly, the Regional Technical Working Group on Sanitation (as recommended) should monitor the progress made by the districts under the leadership of lead NGOs of a particular or a number of districts.

7.3 National and Policy Recommendations

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It is strongly recommended that the National Sanitation policy of Ghana which has explicitly mentioned the adoption of CLTS approach should be disseminated to all the concerned stakeholders at the regional and district levels. There exist a lot of gaps at different levels on the present policy of Government of Ghana (GoG). In spite of the fact that GoG promoted no subsidy-CLTS approach under the National Sanitation Strategy, a number of NGOs like World Vision, CRS have been providing free or subsidized household toilets to communities. Such a disharmony in approach is not only creating a lot of confusion at field level but also spoiling the conducive environment for scaling up of CLTS in the districts. Specific measures need to be taken by national government to bring the NGOs, donors and lenders on the same page in order to avoid any further confusion and disharmony. Circulars should be issued under the signature of National Minister of Local Government and Rural Development explaining the following: Any hardware household subsidy on sanitation goes against the provision of National

Sanitation policy. All Bilateral, Multi-lateral, NGOs and INGOs, must consult, collaborate and seek

approval of MLGRD before embarking on any programme on sanitation in any district. Actively discourage construction of communal latrines and promotion of VIP/KVIP

instead all agencies should encourage household latrines built by communities themselves. This will not only reduce dependence on external support agencies but also decentralise household latrine construction encourage community innovations in solving their sanitation problems.

It appears that the Sanitation component of Sustainable Rural Water Supply and Sanitation Project being funded through a loan (US$70 million) from World Bank is about to commence. Inspite of all efforts made by CWSA and the government of Ghana to eliminate the elements of free distribution of latrine slabs, it still not clear whether this major project will finally follow the government strategy of adopting no-subsidy CLTS approach. It is strongly recommended that any such initiatives by the lenders/donors must be prevented at all cost. Failing which, all these initiatives made so far to institutionalize community led approach will be in futility.

Since the national government of Ghana has decided to adopt CLTS as a major policy strategy for rural sanitation development, it is essential that the country wide scaling up strategy must also be in place. It is difficult to imagine that all the 170 districts of the country covering 10 regions will be covered under CLTS using the services of the government and NGOs staff alone. Therefore, it is essential to involve large number of natural leaders as community consultants for scaling up CLTS across the country. In most ODF villages visited, natural leaders spontaneously engage themselves in spreading the message to their neighbouring villages. This process happen more at an informal level. It is strongly recommended that this process of scaling up NLs must be formalized and a cadre of at least 50 NLs in each district be developed as community consultants. The process of selection of potential NLs from the existing and emerging ODF villages must begin as soon as possible. It is therefore recommended that pool of CCs be developed at the district and regional levels with the full support of MLGRD. The ministry may formulate appropriate mechanism to

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support the CCs and use them as active partners in scaling up CLTS. The NTWG on Sanitation should develop generic guidelines in local languages to guide the operations of NLs/CCs. NTWG should also support basic training materials and guidelines as well as documentaries which could be distributed to the teams of CCs.

More recommendations on institutional strengthening and capacity development for effectively scaling up CLTS in the country are contained in Dodowa Consensus (Annex 4). It also recommended that the Dodowa Consensus with further inputs from participants of the Elmina workshop be circulated to all the regions.

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Annexure 1:

NATIONAL TRAINING OF TRAINERS WORKSHOP ON COMMUNITY LED TOTAL SANITATION IN GHANA.

FOREST HOTEL, DODOWAFEBRUARY 20 – 26, 2011

Workshop Programme

DAY 1 – 21st FebruarySession-I : IntroductionTime Activity Responsibility/

Facilitator9.00 -9.05 Welcome Remarks, back ground of this workshop

and introduction of TrainersLorretta Roberts(LR)

9.05- 9.15 Keynote Address Director, EHSD Ministry of Local Government and Rural Development

9.15- 9.45 Introduction of Participants /Ice breaking Kamal Kar (KK)9.45- 10.20 Expectations/Fears KK and Bisi(BA)10-20- 10.30 Workshop Objectives BA10.30- 10.45 House keeping Norms / Administrative Instructions Kweku Quansah(KQ)10.45- 11.00 Selection of teams for Time keeping, Rapporteurs,

Logistics, Documentation and Village visitKK/Theodora(TAA),

11.00 - 11.30 TEA BREAKSession-II: Technical Session11.30 – 12.00 Overview of Sanitation Situation in Ghana Naa Demedeme12.00 – 13.15 Why CLTS? KK/BA13.15 – 14.15 L U N C H B R E A K14.15 – 15.15 Sharing of experience of the practice of CLTS from

5 different regions.Regions to throw light on the process of Pre Triggering, Triggering and Post Triggering activities

KK and BA

15.15 – 16.00 Presentation of findings on CLTS implementation from 3 Regions

KK/ BA

50

16.00 -16.30 TEA BREAK16.30 – 17.00 Presentation on CLTS global experience KK17.00 – 17.20 Group formation for Village Triggering KK/BA17.20 – 17.45 Roles and Responsibilities of Group members KK

17.45 – 18.00 Day 1 Workshop Evaluation BA/LR

DAY 1I – 22nd February, 2011Session-III: Technical Session9.00- 9.30 Brief Recap of Day I Activities Day 1 Rapporteur9.30- 10.30 Attitude and Behaviour Change

Role playsKK

10.30- 11.00 T E A B R E A K11.00- 13.00 Triggering tools for CLTS KK/BA13.00 – 14.00 LUNCH14.00 – 15.15 Triggering tools for CLTS (continued) KK/BA15.15 – 16.00 Groups to work out strategies for triggering16.00 – 16.30 TEA BREAK16.30 – 17.15 Presentations of Group Triggering Strategies17.15 – 17.45 Preparation for village work.

Role of group members, distribution of materials, arrangements for transport, guide for villages, post triggering follow-up arrangements.

KK/BA/TAA/KQ

17.45 – 18.00 Final checking on field visits and wrap up. TAA/KQDAY 1II – 23rd February, 2011Session IV: Practical Demonstration/Field Visit9.00 – 18.00 Field visit and triggering with communities

Presentations of Field Experience.

Group leaders

DAY 1V – 24th February, 2011Session V: Practical Demonstration/Field Visit9.00 – 18.00 Field visit and triggering with communities

(Groups to check their triggering materials and replenish if required)

Presentations of Field Experience

Group leaders

DAY V – 25th February, 2011Session VI: Technical Session

51

9.00- 10.00 Brief Recap of Previous day.Rendering help to visiting community members in arranging the presentation/ exhibition.

Group leaders

10.00 – 10.30 TEA BREAK10.30- 12.00 Presentations by the Triggered Communities

Video show of work initiated by communities if any.

Community leaders

12.00 – 13.00 Arrangements for follow-up supports to 12 triggered communities.

TAA/KQ

13.00 – 14.00 LUNCH BREAK

14.00 – 15.00 Review of experience and learning from community presentations

KK

15-00 – 16.00 Ideas for scaling up in districts and regions – Inputs from Resource persons.

KK/BA/LR/KQ/TAA

16.00 – 16.30 TEA BREAK16.30 – 17.30 Formation of groups according to regions.

Groups to initiate work for next one or two years detailed plans

KK/BA

DAY VI – 26th February, 2011Session VII: Technical Sessions/Closing9.00 – 11.00 Group Work on Action Plan continued11.00 -13.00 Group presentations of Action Plans

13.00 – 14.00 LUNCH BREAK14.00 – 15.00 Monitoring and Reporting Structure on the progress

of scaling up CLTS in GhanaOthniel/LR/Steve/Martin/ TAA

15.00 – 15.30 General Discussions on way forward KK15.30 – 16.00 Evaluation of the workshop KK/BA

16.00 – 16.30 Closing Remarks LR/KQ

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NATIONAL TRAINING OF TRAINERS WORKSHOP ON COMMUNITY LED TOTAL SANITATION IN GHANA.

COCONUT GROVE HOTEL, ELMINAMARCH 7 – 11, 2011

WORKSHOP PROGRAMME

DAY 1 – 7th March, 2011Session-I : IntroductionTime Activity Responsibility/

Facilitator9.00 -9.05 Welcome Remarks Samuel Paulos(SP)

9.05- 9.15 Keynote Address Director, EHSD/MLGRD9.15- 9.45 Introduction of Participants /Ice breaking Kamal Kar (KK)9.45- 10.20 Expectations/Fears KK and Bisi(BA)10-20- 10.30 Workshop Objectives BA10.30- 10.45 House keeping norms / administrative instructions Daniel Sarpong(DS)10.45- 11.00 Selection of teams for Time keeping, Rapporteurs,

Logistics, Documentation and Village visitKK/ KQ /Theodora(TAA),

11.00 - 11.30 TEA BREAKSession-II: Technical Session11.30 – 12.00 Overview of Sanitation situation in Ghana Naa Demedeme12.00 – 13.15 Why CLTS? KK/BA13.15 – 14.15 L U N C H B R E A K14.15 – 15.15 Sharing of experience of the practice of CLTS from

5 different regions.Regions to throw light on the process of Pre Triggering, Triggering and Post Triggering activities

KK and BA

15.15 – 16.00 Presentation of findings on CLTS implementation from 3 Regions

KK/ BA

16.00 -16.30 TEA BREAK16.30 – 17.00 Presentation on CLTS global experience KK17.00 – 17.20 Group formation for Village Triggering KK/BA17.20 – 17.45 Roles and Responsibilities of group members KK/LR

17.45 – 18.00 Day 1 Workshop Evaluation BA/DS

53

DAY 1I – 8th March, 2011Session-III: Technical Session9.00- 9.30 Brief recap of Day-I activities Day 1 Rapporteur9.30- 10.30 Attitude and behaviour change

Role playsKK

10.30- 11.00 T E A B R E A K11.00- 13.00 Triggering tools for CLTS KK/BA13.00 – 14.00 LUNCH14.00 – 15.15 Triggering tools for CLTS (continued) KK/BA15.15 – 16.00 Groups to work out strategies for triggering16.00 – 16.30 TEA BREAK16.30 – 17.15 Presentations of Group Triggering Strategies17.15 – 17.45 Preparation for village work.

Role of group members, distribution of materials, arrangements for transport, guide for villages, post triggering follow-up arrangements.

KK/BA/TAA/KQ

17.45 – 18.00 Final checking on field visits and wrap up. TAA/KQDAY 1II – 9th March, 2011Session IV: Practical Demonstration/Field Visit9.00 – 18.00 Field visit and triggering with communities

Presentations of Field Experience.

Group leaders

DAY 1V – 10th March, 2011Session V: Practical Demonstration/Field Visit9.00 – 18.00 Field visit and triggering with communities

(Groups to check their triggering materials and replenish if required)

Presentations of Field Experience

Group leaders

DAY V – 11th March, 2011Session VI: Technical Session9.00- 10.00 Brief recap of previous day.

Rendering help to visiting community members in arranging the presentation/ exhibition.

Group leaders

10.00 – 10.30 TEA BREAK10.30- 12.00 Presentations by the Triggered Communities

Video show of work initiated by communities if any.

Community leaders

12.00 – 13.00 Arrangements for follow-up supports to 12 Dorcas Hutchful (DH)/Martin

54

triggered communities.13.00 – 14.00 LUNCH BREAK14.00 – 15.00 Action Plans :Group Work and Preesentation KK15-00 – 16.00 Monitoring and Reporting Structure on the progress

of scaling up CLTS in GhanaGabby/Martin/ DH/TAA

16.00 – 16.30 TEA BREAK

16.30 – 17.30 General Discussions on the Way Forward Evaluation of the workshop Closing

KK/BA

55

56

Annexure 2:LIST OF PARTICIPANTS FOR NATIONAL TRAINING OF TRAINERS’ WORKSHOP ON CLTS - DODOWA

NAME ORGANISATION DESIGNATION CONTACT EMAIL1. Abednego Chigumbu

UNICEF - TAMALE WASH Officer 0244 942528 achigumbu@unicef.org2. Abrefa Mensa

CWSA ESS 0209 285421 abremensws@yahoo.com3. Adams Nathaniel

RWDP-CoC CEO 0244 160776/0303302794 Niisasah@yahoo.com4. Alhassan Amadu Suadiku

Dangbe West EHA 024 3138532 -5. Agnes Maku Korletey

EHSD EHA 0244721131 maamemaku@yahoo.com6. Asamani Cletus

EHSD DREHO 0244162204 asamini@yahoo.com7. Awudu Modoc

Afram Plains Devt Org. Executive Director 020 8864711 Kmodoc2002@yahoo.com8. Benjamin Arthur

CONIWAS Executive Sec. 024210584 benjamimarthur@yahoo9. Bisi Abgeremi

UNICEF – NIGERIA WASH Specialist bagberemi@unicef.org10. Daniel Atitogo

EHSD – AR D - REHO 0244 647884 atitogo@yahoo.co.uk11. Daniel Attramah

CWSA – WR ESS 0209 040631 attramadan@yahoo.co.uk12. Demedeme N. L.

MLCRD/EHSD Ag. Director 0244 220564 naademedeme@gmail.com

13. Dominic DapaahAPDO

Program Director, Northern Region 0243750403 dapsdomi@yahoo.com

14. Douglas TagoeEHSD – WR D - REHO 0244 527147 dougietag@yahoo.com

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15. E. K. AmaviEHSD DEHO 0242 559863 emmanuelamavi@yahoo.com

16. E. T. NyavorCWSA ESS 0244 227824 etnyavor@hotmail.com

17. Emmanual AdiiCWSA ESS 0244845879 adiiemma@yahoo.com

18. Emmanuel K. KoomsonEHSD DWST 0243306476 emmakoos@yahoo.com

19. Fati AlhassanComm. Dev't DD II 0266 026039 fatalhassan@hotmail.com

20. Faustina AmpiahMLGRD/EHSD EHA 0244 486323 faustina.ampiah@yahoo.com

21. Felix Donkor-BaduCWSA/GAR ESS 0244682800 fingaro2000@yahoo.com

22. Felix MaapehEHSD DREHO 0246593843

23. Felix OwusuJomlet Media – Accra Editor 0268 951108 slypoopo@yahoo.com

24. Francis AbotsiEnv. Health Dep't REHO 0244 705126 fabotsi@yahoo.com

25. Grace M. KonorEHSD – AR PORT HEALTH - ASH 0244 024137 gracekonor@yahoo.com

26. Gregory VittorMLGRD/EHSD EHA 0243 817883

27. Hon. Nubyl K. VanlareAdenta Mun. Assembly Mun. Chief Exec. 0242 228476 kakranvanlare@aol.com

28. Iddrisu AliduEHSD – NR DEHO 0243 011832

29. Iddrisu ImoroEHSD DEHO 0244788986

30. Issac Acheampong FiankoEHSD DREHO 0244514860 achiefiako@yahoo.com

31. J. Adjei – Frimpong MLGRD, Enchi – WR DEHO 0244077945/ ja.frimpong@yahoo.com

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0272 21339632. J. O Appiah

CWSA- Kumasi E.S.S 0244224378 joappia@yahoo.com33. Jeevan Gblekumah

EHSD – BA PEHA 0249 57888534. Joyce Mako Appiah

CWSA/GAR ESS 0244831914 jmaku@yahoo.com35. Kamal Kar India Originator of CLTS - kamalkar@yahoo.com36. Kaanye Liribu EHSD ACEHA 0243313775 -37. Komendja Afenyo

Battorkope Community Natural Leader 020809629  -38. Komladzei E. Divine

CWSA-BAR E.S.S 0279646040 ethelbert@yahoo.com39. Kweku Quansah EHSD Program Officer 020 8123972/0302682015 kwekuquans@yahoo.com40. Leticia Ackun

CWSA ESS 0244 645372 agyeiwaakom@yahoo.com41. Lorretta Roberts

UNICEF WASH Specialist 0243 132113 lroberts@unicef.org42. Louisa Dayang

CWSA ESS 0208 23433343. Martin Amevor

EHSD – ER REHO 0244 884810 mamevor2003@yahoo.com44. Mawuko Ganu

Mafi; Eastern Region Natural Leader 0342098093 -45. Michael Dogbe

EHSD- GAR DREHO 0208224182 dogbemichael@yahoo.com46. Michele Adjei-Fah FreeLance Rapporteur/Head of

Secretariat020 8529087 madjeifah@gmail.com

47. Moses B. BagbieleCWSA – NR ESS 0208 395369 bmosesbanona@yahoo.com

48. Muaz M. KamilEHSD DEHO 020826128 mumka1973@yahoo.com

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49. Naatu FredaEHSD DEHO 0244815944 fredaanaam@yahoo.com

50. Nii Lantei WellingtonTREND Group BCC Specialist 0275 747857 nii_wellington@yahoo.com

51. Ohene ErnestEHSD DREHO 0242169419 eomrnestohene@yahoo

52. Othniel Habila UNICEF WASH Chief - ohabila@unicef.com53. Paulina Kuka

EHSD DWDA 024320953254. Paulina Kukah

EHSD SEHO 0243 709532

55. Pauline Abrafi OppongCWSA – CR ESS

0244 073035/0208 111745 abrafiadomako@hotmail.com

56. Peter SerinyeGWON Co-ordinator 0208 164831 serinye2010@gmail.com

57. Prince ArhinEHSD DWST 024362435

58. Rhoda BoakyeWasteCare Assis. San. Eng. 0243 239306 rasbyaee@yahoo.com

59. Samuel Agyekum SarpongProNet Proj. Manager 0244 562626 gyemuel@yahoo.com

60. Samuel Agbeko AhiakuEnvt. Health Dept PEHT 020 1938161/0244818332 asagbeko@yahoo.co.uk

61. Sibdow B. FatiEHSU SEHO 0247 526456 sibdowFati@uk.com

62. Sidik YakubuEHSD DEHO 0206412272 sadik.yakubu@rocketmail

63. Simon Y. LaariCRS/TAMALE SPO (WASH) 0279 239886 simon.laari@crs.org

64. Stephen NtowWASH Health Solution Director 0244 802265 steve_ntow@yahoo.com

65. Steve AdongoEHSU REHO 0244 433889 sbkadongo@yahoo.com

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66. Thompson EdwardCWSA ESS

0248 113298/034 2025281 Kwekueson06@yahoo.com

67. Yahaya MohammedEHSD DEHO 0246323123 Yahayam23@yahoo.com

68. Zanu Emmanuel BokorGreater Accra DWDA 0242 676274  -

61

LIST OF PARTICIPANTS FOR NATIONAL TRAINING OF TRAINERS’ WORKSHOP ON CLTS - ELMINA

Name Organisation Designation Contact Phone Contact Email

1. Appiah, Ambrose Boateng Forbet Community Development Officer 0243614253 ambrose.appiah@yahoo.com

2. Kpeno, Emma ProNet-North Community Development Expert 0209381275 kpeno2000@yahoo.com

3. Amadu, Salam M. ProNet-North 0248556611 mwinibalo@yahoo.com

4. Atteh Stephen RUWSS HEO 0242709252

5. Abandoh, Derek ProNet-South HEO 0243767883 abandoh.derek@yahoo.com

6. Adaarizaeya, Zephaniah Pronet 0242268955 adazeph2007@yahoo.co.uk

7. Dwamena, Mark A. WaterAid-ORAP Community Dev. S Hygiene 0246189903 markdwamena@yahoo.com

8. MacPherson, Ronnie 10D Park Consultant 447827943072 Ronnie@10DPARC.com

9. Commey, Emmanuel Afutu Envil Health DEHO 0245190595

10. Akormedi, Matthew Adsen Consult Coordinator 0244145376

11. Osei, Vinolia Department of

Community

Development

Regional Director 0204455118

12. Kamaldeen, Iddrisu Plan GH Coordinator 0244970480

0265661782

13. Nuamah, Prince Plan GH 0265661706

14. Assibi, Alfred SOH Tamale Principal 0244874790 alfredassibi@yahoo.com

15. Asosega, Donatus SOH Tamale Tutor 0240120383 donatusasosega@yahoo.com

16. Adipah, Henry N. SOH Accra Principal 0244748874 narteh2a@yahoo.com

62

17. Tsayawo, Victus SOH, Ho Principal 0246633513

18. Sarfo-Mensah, Abena G WaterAid Special Asst. to CR on Gender,

Rights, and Equity

0264383342 abena.sarfomensah@gmail.c

om

19. Sulaiman, Issah-Bello WaterAid Programme Officer 0209248820

20. Dorcas Hutchful Aidoo CRCC Assistant Director 0244658108

21. Soley, Foster UNICEF WASH Officer 0244805625

22. Halm, Emma John UNICEF WASH PA 0548697013

23. Fah, Michele A. RAD RAP 0208529087

24. Abduramane, Abubakari ACDEP OPS MGR 0243117922

25. Mensah, Ivan CWSACR ITS 024374927

26. Alagna, Williams DCD Regional Director 0244845045

27. Yapel, Fidelis Plan Ghana WATSAP Coordinator 0265661778 yapel.fidelis@plan-int.org

28. Boadu, Richard Plan Ghana Programme Area Manager 0243646491 Richard.boadu@plan-int.org

29. Debrah, Kofi Adade Plan Ghana Northern Sector Manager 0208390326 kofida@yahoo.com

30. Ametewee, Edem Plan Ghana Community Development

Coordinator

0263009544 fuzayi@yahoo.co.uk

31. Acquah, William Agyekum Plan Ghana PSM 0263009523

32. Tisatu, Babatunde WaterAid- Rural

Aid

Programme Officer 0246394488 tymbzfaras@yahoo.com

33. Imoro, T. Sayibu Water Aid- New CEO 0245367707 Sayibu0256@gmail.com

63

Energy

34. Kafari, Bernedette GES (SHEP) Reg. SHEP 0244712519 bkafari@yahoo.com

35. Adu-Gyamfi, Eric CWSA ESS 0208170733 allamosah2000@yahoo.com

36. Bawinia, Clement K. School of Hygiene,

AR

Tutor 0244388924 kbawinia@yahoo.com

37. Sanani, Destina WaterAid Programme Officer destinasamani@wateraid.org

38. Kar, Kamal CLTS Foundation Consultant for Plan Ghana kamalkar@yahoo.com

39. Bisi Agberemi UNICEF WASH Specialist bagberemi@unicef.org

40. Daniel Sarpong Plan Ghana WATSARP Advisor 0244488440 daniel.sarpong@plan-

international.org

41. Larbi, William TREND Community Expert 0248705707 vas.timol@yahoo.com

42. Tay, Vincent TREND Programme Officer 0275264301 veetay@hotmail.com

43. Asomanip, Seth Plan Ghana CF 0208165891

44. Nusenu, Vincent School of Hygiene,

Ho

0244586017 vnusenu@yahoo.com

45. Letsa, Cynthia Assin North ANMA EHA 0242536326

46. Agyemang, Francis Gomoa East Afranse DWST 0242864276

47. Osew-Addo, Edward AAK Abura

Dunkwa

EHA 0246709062

48. Hamza, Ibrahim AAK Abura

Dunkwa

EHA 0246825911

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49. Mawusi, Dennis A. Assin South District

Assembly Nsuaem-

Kyekyenere

EHA 0242185722

50. Saaka, Bukari Water Vision Tech.

Ltd, WA

Field Supervisor 0208874051

51. Annan, Emmanuel KEEA M WST EHA 0243283546

52. Appiah, Hayford KEEA M. WST EHA 0242809764

53. Amponsah, I. K. M. WST EHA 0541241813

54. Gmakame, James KEEA MEHO 0244954330

55. Gyekye, Ellen GES/SHEP Programme Officer 0244419297

56. Donyinah, Alex Kwame RWDP-COC Community Animator 0246545040 kwamedonyinah@yahoo.co

m

57. Alofei, Edmund Plan Ghana (MPA) Community Facilitator 0265661738 ealofei@yahoo.com

58. Adu-Wusu, Gabriel K. WaterAid Programme Manager 0244818285 gabrieladu-

wusu@wateraid.org

59. Dzekle, Ben K. Env. Health DWST 0243833717

60. Adomako-Adjei, Theodora CWSA ESC 0244819042 Coconut Groove

61. Vittor, Gregory Env. Health EHA 0242817883

65

Annexure 3:List of Recommended Potential Master Trainers

Name Agency Region GenderMASTER TRAINERS

1 Abrefa Mensah WR2 Douglas Tagoe WR3 Adjei Frimpong WR4 Daniel Ahramah WR5 Asamani Cletus UE R6 Johnson O. Appiah AR7 Daniel Atitogo AR8 Grace Kunar AR9 Isaac Acheampong-

FiankoER

10

Loticia Ackun ER

11

Atteh Stephen ER

12

Edward Thompson ER

13

E.T. Hyavor VR

14

Samuel Agbeko Ahiaku VR

15

Akormedi Mathew VR

16

Nusenu Vincent VR

17

Faustina Ampiah GAR

18

Joyce Maku Appiah GAR

19

Michael Dogbe GAR

20

Paulina Kukah GAR

21

Baurinia Clement GAR

22

Iddrisu Alidu NR

23

Iddrisu Imoro NR

24

Moses B. Bagbiele NR

2 Sibdow B. Fati NR

66

526

Sidik Yakubu NR

27

Destina Samani NR

28

Felix Maapeh NR

29

Jeevan Gblekumah

30

Steve Adongo NR Male

31

Joseph Appiah PLAN Male

32

Alex Kwame Donyinah Church of Christ Male

33

Yahaya Mohammed NR Male

1 Kweku Quansah MLGRD Male2 Theodora Adomako-

AdjeiCWSA Female

3 Samuel Sarpong Agyekum

PRONET Male

4 Lorretta Roberts UNICEF Female5 Modoc Awudu APDO Male6 Vincent Tay TREND Male7 Abednego Chigumbu UNICEF Male8 Nii Lantei Wellington TREND Male9 Dominic Dapaah

67

Annexure 4:National Training of Trainer’s Workshop on Community Led Total

Sanitation21-26 February 2011, Forest Hotel, Dodowa, Greater Accra Region, Ghana

Dodowa Consensus

Background

Ghana’s sanitation coverage of 13% is our national shame. The 2% increase recorded from 2006 (11%) to 2008 (13%); our highest in recent years; implies that it will take the country forty years to reach the MDG sanitation target of 54% if we continue at this rate.

As a pace setter on many fronts in Africa, this is not an acceptable situation for Ghana and we need to put in drastic and radical measures to ensure that we reverse this trend.

Community Led Total Sanitation (CLTS) has been identified as the approach that has demonstrated the potential to propel developing countries which have challenges in scaling up rural sanitation towards the requisite MDG target.

The approach has been piloted in Ghana and the critical lessons have been learnt. CLTS has been adopted as a national strategy in rural communities and small towns (Pop. ≤ 5000).

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PreambleDesirous of maintaining Ghana’s position as a pacesetter in Africa;

Motivated by the successes of the CLTS approach in 43 other countries worldwide;

Believing that there is sufficient political will to achieve the MDG target on sanitation as shown by our government’s high prioritisation of sanitation;

Having experienced and realised the potential that CLTS offers in terms of not only bridging the sanitation gap but initiating multi-dimensional development through local empowerment;

Being encouraged by the recent findings of the CLTS assessment in Ghana in 2009; and

Having witnessed the great potential unleashed via the use of CLTS in selected communities in the Dangme West District during the training sessions:

Declaration

We the participants of the National Training Workshop on CLTS, held at the Forest Hotel, Dodowa from the 21st -26th February, 2011 and facilitated by the originator of CLTS, Dr. Kamal Kar hereby declare the following by consensus.

1. We acknowledge CLTS as the recommended approach for rural sanitation as outlined in the National Environmental Sanitation Policy (NESP) and National Environmental Sanitation Strategy and Action Plan (NESSAP).

2. We believe that the adoption of CLTS and the expected outcomes would form a basis for sustainable and rapid progress towards achievement of sanitation MDGs in Ghana and more. In this regard, we recommend that CLTS be widely publicised through knowledge management interventions that would ensure a widespread and complete understanding of the approach as well as stakeholder buy-in.

3. We recognise that for CLTS to make an impact in the country, we need to embark on a drive to make entire geographical areas (Regions, Districts, traditional areas, etc.) Open Defecation Free (ODF) rather than focus on a few communities to become ODF. In this regard, we commend the declaration by the Northern Regional Minister and the Regional Coordinating Council to make the Northern Region Open Defecation Free by 31st December, 2012. We encourage other Regional Ministers, District Chief Executives and traditional leaders to emulate this shining example.

4. We believe that the key strategy to adopt in scaling up CLTS in the country is to empower Natural Leaders to become champions and facilitators of CLTS. A scheme should be established to encourage these Natural Leaders to emerge and replicate

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themselves in a manner that appreciates their efforts and recognises them. The scheme should make provision for the establishment of a network of Natural Leaders.

5. To facilitate the declaration of entire areas as ODF, we recommend the establishment of a national ODF league showing the status of districts and the setting up of awards for high performing districts and regions every year.

6. To facilitate the initiation of this league, each region is to select at least one district in which focussed effort will be put into achieving district wide ODF by December, 2011.

7. We recognise that children are an integral part of the community and have attributes that could be utilised to promote CLTS. We acknowledge the contribution of children in their role as pressure groups in getting their parents to stop open defecation and their communities to become ODF. We recommend that a strategy be developed to harness the power of children to promote ODF declaration in their communities in the Ghanaian context.

8. We agree with the Lusaka declaration of 19th November, 2010 by CLTS Practitioners from 12 African countries, that after the attainment of ODF status, there is the need for access to markets, creative financing and skills for climbing up the sanitation ladder. Creating this access should be done in a manner that does not compromise the core principles of CLTS.

9. We declare that latrines, of any type including Ventilated Improved Pits (VIPs) that do not cut off access to excreta by flies are in reality fixed points of open defecation and do not contribute to diarrhoeal control or access to improved sanitation. We recommend that the squat holes of all such latrines be covered and ash be used to control flies.

10. We recommend that as part of measures to scale up CLTS in the country, CLTS indicators should be incorporated into the assessment criteria of the Functional Organisational Assessment Tool (FOAT). Progress towards open defecation free districts will therefore be one of the key criteria underlying the allocation of the District Development Fund (DDF) for Metropolitan, Municipal, and District Assemblies (MMDAs).

11. We acknowledge the lead role of the Environmental Health and Sanitation Directorate (EHSD) in sanitation and hence in CLTS. We encourage all sector stakeholders to support them play this role at all levels (national, regional and district).

12. As the lead agency for sanitation in Ghana, we recommend that the EHSD of the MLGRD issue a directive demanding compliance with the national policy and strategy on sanitation with respect to CLTS. The directive should highlight the fact that individual household hardware subsidies undermine CLTS. The EHSD should in collaboration with all key stakeholders institute measures to identify and ensure compliance by all organisations and projects.

70

13. We understand that sanitation is implemented by multiple stakeholders and recognise the attendant requirements for ensuring stakeholder collaboration. We acknowledge the efforts made towards this through the establishment of the National Technical Working Group on Sanitation. We recommend the immediate establishment of interagency coordinating committees on sanitation to enhance collaboration among stakeholders at the district and regional levels. There should be effective collaboration between EHSD and CWSA at the regional level in this regard.

14. We acknowledge the role of the MMDAs in the management of development interventions in their areas of jurisdiction. We recommend that all proposals and projects funded outside the MMDAs Plans, be discussed with MMDAs for approval before implementation. In this respect NGOs are to seek approval from MMDAs before implementing projects in their area of jurisdiction. We encourage MMDAs to take control of development interventions in their area. We encourage them to be firm and resist any sanitation interventions contrary to CLTS principles

15. We recommend the immediate development of national, regional and district plans for scaling up CLTS in Ghana in line with the NESP and NESSAP and as integral components of District Environmental Sanitation Strategy and Action Plans (DESSAPs).

16. We recognise DESSAPs and DWSPs as official Sanitation Plans of Action in Ghana that require requisite resources for effective implementation

17. We call on MMDAs to adhere to appropriating the 5% of the Common Fund allocation, earmarked for sanitation, to promoting progress towards the MDG target for sanitation through support for CLTS initiatives in the DESSAPs and DWSPs.

18. We recognise that for CLTS to thrive, capacity building is required and we call on all stakeholders to support this capacity building effort with a special focus on environmental health staff and community natural leaders and volunteers.

19. We recommend that the EHSD as the lead agency for sanitation and hence CLTS should strengthen its capacity to manage CLTS interventions in the country by appointing full time staff to be in charge of CLTS at the national, regional and district levels.

20. We recommend that the EHSD immediately adopts measures to incorporate ODF performance indicators into the performance assessment criteria of Environmental Health Staff

We the undersigned plead to all relevant stakeholders to do their best to implement the above consensus to make an Open Defecation Free Ghana on or before 2015.

Dodowa , 26th February, 2011

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Annexure 5:Roadmap for Scaling up CLTS in Northern Region

The following major activities are suggested to achieve ODF Northern Region by 31 st

December, 2012; Conduct one-day CLTS sensitization workshop for all the 20 districts in Northern Region

to sensitize all relevant stakeholders on the target and plan of achieving ODF by 31st

December, 2012. Conduct Hands-on Training workshop on CLTS (at least one) for each district before end

of June, 2011. Training could be arranged by facilitators from CWSA, MLGRD, APDO and TREND. These trainings should be jointly organized and facilitated by two/three teams of trainers drawn from the trained facilitators from Dodowa and Elmina workshops.

For each district training, 10 to 12 villages should be triggered by the participants during the training workshop. These triggered villages must be followed by the respective teams to declare them as ODF. These few villages will be the starting point of spread of CLTS in each district. Each district will use these ODF villages as training/learning laboratories. Village leaders from other villages should be brought to these ODF villages for exposure and spread of CLTS. In other words, by the end of June, at least 200 villages in all the 20 districts should be triggered. This is particularly relevant for the non-UNICEF assisted districts.

Provide technical supports and necessary follow up to make all the 365 triggered villages (within UNICEF assisted districts) ODF in the 10 UNICEF assisted districts in Northern Region.

Each district should develop ODF plan which should be harmonized into regional plan

72

Each district should try to develop a cadre of Natural Leaders (NLs) and teams of Community Consultants to spread CLTS in the neighbouring villages. In other words, before October 2011, ideally, at least 10 teams of NLs should be proving triggering supports to their neighbouring villages in 10 districts. To start with, NLs from Karaga and Zabzugu-Tatale districts could be engaged in this venture.

Potential NLs must be identified from ODF/triggered communities from the different districts. Special hands-on training workshop on CLTS triggering should be organized to equip the potential NLs with necessary skills for triggering and post triggering activities.

Map out clear roles and responsibilities for all NGOs implementing CLTS in the region with each NGO leading CLTS facilitation and follow up in each district depending on their areas of operation.

Develop simple monitoring and reporting mechanism for gathering information on progress in CLTS implementation from community to district to region.

Monthly Review meetings should be organized at regional headquarters to evaluate the progress in terms of ODF villages and successful NLs developed.

Performance of each district should be measured and recorded as RED, YELLOW AND GREEN Cards (Details explained to REHO)

A conference of NLs and district officials should be organized in Dec. 2011/Jan. 2012 in the district with the highest number of ODF villages. In that workshop, special reward should be given to the best district by the Regional Minister.

A high level team of CLTS trainers should be developed at Regional level to review the quality of trainings offered and conduct verifications before ODF declaration.

Resource pool of NLs and Community Consultants (CCs) should be developed in each district and centrally at the Regional level.

Organize at least one TV/Radio programme monthly where NLs from ODF villages should play the key role (main speaker) for information and experience sharing on CLTS implementation.

Conduct major review and assessment of status of CLTS implementation in the region and further mentoring and training by CLTS foundation by early 2012.

Develop documentary on CLTS in local languages for further sensitization of communities.

Develop 2- page guidelines in local languages for NLs who will be involved in triggering villages.

MLGRD/CWSA should facilitate the development of MoU between NLs/CCs and Communities/NGOs indicating incentives for services rendered.

Models of Community innovative latrines should be demonstrated in a village or district headquarters to serve as resource centres for obtaining information on CLTS implementation including where to get NLs.

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Annexure 6:List of Some Key Persons Met during the course of the mission

S/No Name Designation Agency/OrganizationNATIONAL - UNICEF1 Rene Van Dongen Deputy Representative UNICEF Ghana2 Othniel Habila Chief, WASH Section UNICEF, Ghana3 Lorretta Reberts WASH Specialist UNICEF, Ghana

NATIONAL GOVERNMENT/ NGOs

4 Hon. Elvis Afriyie Ankrah Deputy Minister Ministry of Local Government and Rural Development

5 Dr. Mustapha Ahmed Deputy Minister Ministry of Water Resources, Works and Housing

6 Mr. Demedeme Naa Lenason Acting Director MLGRD7 Mr. Kweku Quansah Programme Officer MLGRD8 Theodora Adomako-Adjei CWSA9 Samuel Sarpong Agyekum Programme Manager PRONET10 Vincent Tay TREND11 Nii Lantei Wellington BCC Specialist TREND12 Peter Serinye Coordinator GWJN13 Mr. William Agyekum Accriah Head of Programmes PLAN, Ghana14 Daniel Sarpong WATSAN Advisor PLAN Ghana15 Dr. I. Norman Acting Head of Dept,

Dept. of Biological, Environmental and Occupational Health Sciences

University of Ghana

EASTERN REGION

74

16 Deputy Minister Eastern Region17 Mr. S.A. Bawa Regional Coordinating

DirectorEastern Region

18 Mr. A.K. Boahene District Coordinating Officer

Kwahu North, Eastern Region

19 Modoc Awudu Chief Executive Officer

APDO

NORTHERN REGION20 Hon. Bukari Moses Mabengba Regional Minister Northern Region21 Mr. Joseph M. Dasanah Regional Coordinating

DirectorNorthern Region

22 Mr. Steve Adongo Regional Environmental Officer

Northern Region

23 Ms. Shaya Asindua Chief, Field Office UNICEF Tamale24 Kabuka Banda WASH Specialist UNICEF Tamale25 Mr. Abednego Chigumbu WASH Officer UNICEF Tamale26 Dominic Dapaah Programme Director APDO (Northern Region)27 Samuel Amoako Mensah WASH Officer UNICEF Tamale28 Williams Alagina Regional Director Dept. of Community

Development29 Moses Bagbiele ESS CWSA – NR30 Ms. Destina Samani Programme Officer WaterAid (Northern

Region)31 Ofori MacCarthy Regional Director CWSA32 T. Sayibu Imoro CEO NewsEnergy33 Simon Laari Senior Programme

OfficerCRS

34 Hon. Suleiman Huseini Issah District Chief Executive

Karaga District

35 Mr. Evarist Dery District Coordinating Director

Karaga District

36 Hon. Umar Abdul Wahab District Chief Executive

Zabzugu/Tatale District

37 Mr. Mohammed Jimba Deputy Director of Administration

Zabzugu/Tatale District

38 Mr. Yahaya District Environmental Health Officer

Zabzugu/Tatale District

EASTERN REGION39 Hon. Ama Benyiwa-Doe Regional Minister Eastern Region40 Mr. Kwame Oppong Regional Coordinating

DirectorEastern Region

41 Mr. Martin Amevor Regional Environmental Health Officer

Eastern Region

42 Ms. Dorcas Hutchful Aidoo Assistant Director Eastern Region

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