CATS Project Report by Shafiq Rahman

CATS project report november 2016

Project Report

Community Approaches to Total Sanitation (CATS) november 2016 Published by Plan International Bangladesh Concept Proshanto Ranjan Sharma Roy, Project Manager GoB-UNICEF CATS project, Plan International Bangladesh Content Mark Ellery, Consultant Kazi Rashed Hyder, Consultant Edited and Technical Input Md. Zillur Rahman, Head of WASH Programme, Plan International Bangladesh Michelle MacInnesRae, Programme Manager, Plan International Canada George Yap, WASH Advisor, Plan International Canada Photo credit Plan International Bangladesh Design and Layout ASM Shafiqur Rahman / BCKEND360 Print Execute Printed in Bangladesh

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Contents Acronyms abstract acknowledgement Executive summary

02 03 04 05

1. Introduction 2. Project implementation 3. implementation modalities 4. achievement of targets 5. cats project results 6. challenges with mitigation plan 7. key lessons learned 8. reflection of stakeholders 9. conclusion

07 13 23 26 36 40 42 44 47

Acronyms AECM BCC BHE CAP CATS CHT CLTS C2C C4D DAM DC DGHS DLP DPE DPHE DSHE EPI FGD GoB HtRAs HP HWD INGO KAP LGI LGSP LSE MIS MoU M&E NGO NL OD ODF O&M PCA SLTS SMC ToR ToT UNICEF UNO UP WASH WATSAN WinS

Accelerating action towards Ending Child Marriage Behaviour Change Communication Bureau of Health Education Community Action Plan Community Approaches to Total Sanitation Chittagong Hill Tracts Community Led Total Sanitation Child to Child Communication for Development Dhaka Ahsania Mission Deputy Commissioner Directorate General of Health Services Defect Liability Period Directorate of Primary Education Department of Public Health Engineering Directorate of Secondary and Higher Education Expanded Programme on Immunization Focus Group Discussion Government of Bangladesh Hard to Reach Areas Hygiene Promotion Hand Washing Device International Non-governmental Organization Knowledge Attitude and Practice Local Government Institution Local Government Support Program Local Sanitation Entrepreneur Management Information System Memorandum of Understanding Monitoring and Evaluation Non-Governmental Organization Natural Leader Open Defecation Open Defecation Free Operation and Maintenance Programme Cooperation Agreement School Led Total Sanitation School Management Committee Terms of References Training of Trainers United Nation Childrenâ&#x20AC;&#x2122;s Fund Upazila Nirbahi Officer Union Parishad Water, Sanitation and Hygiene Water and Sanitation WASH in School

abstract Plan International Bangladesh implemented the â&#x20AC;&#x153;GoB-UNICEF Community Approach to Total Sanitation (CATS)â&#x20AC;? Project. The project assisted towards 500 communities and 200 schools in five hard-to-reach Upazilas located in the coastal and hilly areas of Barisal and Chittagong Division. The project applied Community Approaches to Total Sanitation (CATS) and achieved a significant outcomes both in community and schools such as 200,000 people living in Open Defecation Free (ODF) environment; 333,000 people have increased their knowledge on handwashing with water and soap and 85,000 people have adopted improved handwashing practices after use of toilets; ensured the access of gender sensitive WASH facilities in 100 schools and handwashing devices in 200 schools and 45,000 students have adopted improved hand washing practices after using the toilet.

acknowledgement The GoB â&#x20AC;&#x201C; UNICEF Community Approach to Total Sanitation (CATS) project implemented during December 2014 to September 2016 which was a partnership initiatives of UNICEF and Plan International Bangladesh. The aim of the project was to achieve open defecation free (ODF) in the hard-to-reach areas of Bangladesh where open defecation was high (22% to 27%) as well as improving hygiene practices among community and school students. The locations of the project was in Taltoli Upazila of Barguna district, Charfashion and Sadar Upazila of Bhola district under Barisal Division; and Laxmichari Upazila of Khagrachari district and Alikadam Upazila of Bandarban district under Chittagong Hill Tracks (CHT). The project has achieved a significant improvement on sanitation and hygiene practices within short period of time by using appropriate approaches and techniques which is briefly documented in this report. The partner NGOs (DAM/Green Hill) and Local Government Institutions (20 Union Parishads) contributed a lot and faced many challenges for achieving this huge progress. The project covered about 330,078 population (96,894 female, 100,849 male and 132,335 children) in 20 Union Parishads and 200 schools in 5 Upazilas. These achievements would not have been possible without the effective coordination and technical support from the Department of Public Health Engineering at different levels as well as support from the Directorate of Health, Directorate of Primary Education, Directorate of Secondary and Higher Education and the Upazila Administration. Plan International also acknowledged the valuable contribution of various stakeholders such as Local Sanitation Entrepreneurs, Para Workers of ICDP, SMC, Teachers, Student council, Natural Leader, Children, Headman, Karbari, adolescents, etc. I am particularly grateful to the adolescent and children for being a constant source of community motivation and inspiration. I would like to thanks the WASH Project team of Plan International Bangladesh and partner NGO; especial thanks to the Project Manager for his leadership and hardworking in accomplishing the task. I would like to thanks Md. Zillur Rahman, Head of WASH Programme, Plan International Bangladesh for his supervision and guidance for successful implementation of the project. I wish to acknowledge Mr. Mark Ellery and Mr. Kazi Rashed Hyder, WASH consultant for their valuable time, effort and resources which were channeled into producing this project report. I am thankful to the colleagues of Plan International Canada for their continual follow up, technical and financial support. I would like to thanks the colleagues of Barisal and Chittagong Divisional office as well as the Admin Department for the successful implementation and printing this Project Report. I am very much grateful to the Country Director and the Director Business Development of Plan International Bangladesh for their strategic guidance and inspiration in the implementation of the project. Finally, we are thankful to UNICEF Bangladesh for this PCA to implement the project; effective coordination both at Central and Regional offices. Country Director (Acting) Plan International Bangladesh

Executive summary Bangladesh has made significant progress in reducing the proportion of women, men, girls and boys without access to protected water, sanitation and hygiene facilities. While the majority of these water, sanitation and hygiene facilities are accessible, for the majority of Bangladesh citizens (particularly the poor and other vulnerable groups), these facilities remain insufficient, unaffordable, and low quality, undermining equitable health, nutrition & education outcomes in the country. In rural Bangladesh, the health risks of faecal containment by poorly constructed and maintained latrines and the low use of soap for hand-washing (despite the high availability of latrines and soap) are particularly pernicious. Plan International Bangladesh has been implementing the “GoB- UNICEF Community Approach to Total Sanitation (CATS)” project. This report seeks to document the accomplishments of this 22 month project which commenced in December 2014 ending in September 2016. The CATS project reached 762 communities and 200 schools in five hard-to-reach Upazilas located in the coastal and hilly areas of Barisal and Chittagong division. The project applied the Community Approaches to Total Sanitation (CATS) toward the following specific outcomes: • • • • •

200,000 people live in Open Defecation Free (ODF) environment 100,000 people in targeted areas shift from open to fixed place defecation 85,000 people have adopted improved hand washing practices after use of toilets 333,000 people have increased their knowledge on hand washing with water and soap 45,000 students have adopted improved hand washing practices after using the toilet.

A number of training manuals like training for SMC, teacher, student council, para worker, natural leader, adolescents, health worker, local sanitation entrepreneur etc. and IEC/BCC materials were developed under the project. These were important for conducting various awareness campaigns and capacity building activities at community, local government and policy levels to realise the eradication of the practice of open defecation, use of improved sanitation and adoption of good hygiene behaviours. In August 2015, Plan International Bangladesh and UNICEF signed another Programme Cooperation Agreement (PCA) for the implementation of project titled “Accelerating action towards ending child marriage” (AECM). To help ensure CATS and AECM achieved their goals, the donor granted both projects a six months extension ((April – September 2016). The AECM project established four SaniMarts in two Upazilas in Bhola District to improve menstrual hygiene management (MHM) among women and adolescents girls, improve income earning opportunities for adolescent girls, improve their attendance at school and reduce the risks of child marriage. With the support of local sanitation entrepreneurs, targeted adolescent girl groups are producing and marketing thousands of sanitary pads per month and using their newly gained entrepreneurial skills to sell them. Awareness raising and sensitization sessions on MHM in schools and communities were also conducted which engaged boys and men as well as girls and women. According to the donor-commissioned endline survey completed to evaluate Plan International Bangladesh, CARE and Practical Action on, the three main implementing

INGOs for the CATS project, there were significant increases in the awareness, access and practice of sanitation and handwashing behaviours over the project period. Effective sanitation coverage as defined in the UNICEF tracer matrix also increased significantly over the project period although there remains room for further improvement. Despite increases in awareness, access and practice of sanitation and handwashing behaviours, effective coverage as defined in UNICEFâ&#x20AC;&#x2122;s sanitation tracer matrix was still much lower, though notably increased when compared to the baseline. With regards to the practice of open defecation in assisted communities, the sustainability survey of both community members via FGDs and household survey respondents indicates that communities are in the early stages and that for ODF conditions to be sustained, and to minimize slippage, continued monitoring and follow-up is required by local authorities. Girls do not have access to proper facilities for menstrual hygiene management in school, i.e. waste bin and clean private space for changing and cleaning, in school. The CATS project rehabilitated existing sanitation facilities at targeted schools but had no scope to provide additional latrine and menstrual hygiene management facilities. This was a key lesson learned of this project as there is scope to improve further with respect to equity and equality issues to reduce gender disparity. The end-line study showed that the latrine to student ratio was 1:89, which about two times more crowded than the Bangladesh National WASH in school standard though an improvement from the baseline (1:118). This suggests that there is a need to increase of school latrine chambers proportional to students. With regard to sustainability, sourcing of funds from the SLIP fund or SMC for the O&M of WASH facilities was new since the project baseline. This was consistent with improvements in the O&M of school WASH facilities in regards to the appointment of caretakers, availability of cleaning materials & cleanliness. Further consideration for sustainability that the WASH interventions would be sustained at least as long as monitoring, supervision and support remains active across communities, schools and local government representatives. Increased awareness of national policy along with budgetary allocations and recall of training knowledge were all positive indications of potential for sustainability of the interventions in schools.

1. Introduction 1.1 Background 1.2 Context 1.3 The CATS Project

1.1 Background This report presents the accomplishments of the project â&#x20AC;&#x153;GoB-UNICEF Community Approach to Total Sanitation (CATS)â&#x20AC;? managed by Plan International Bangladesh which was implemented in five Upazilas under Barisal and Chittagong division since December 2014. It is expected that the experience and learning depicted in this report can inform future WASH programming and project design.

1.2 Context 1.2.1 Sanitation Access to basic sanitation facilities is high in Bangladesh with only 1% of the population practising open defecation in 20151. The affordability of basic sanitation facilities is high with the biggest shift away from open defecation occurring amongst the poorest quintile2. While the proximity of access to sanitary facilities is high, the sufficiency of latrines is compromised with 26% of the population relying on facilities shared by more than two families. As a result, the use of improved sanitation facilities only increased from 33% of the population to 61% over the MDG period1. A national hygiene baseline survey finding in 2014 found that the cleanliness of latrines was poor with only 34% of the population having access to hygienic latrines3. An evaluation of the sustainability of sanitation in 2011 found that while the durability of latrines was low (< 5 years) the practice of accessing local markets to replace latrines was high4. Faecal sludge management is poor throughout the country with almost all faecal waste being dumped into open fields, storm water drains or surface waters. According to a sanitation survey conducted by GoB in 2014 (Divisional Commissioner), open defecation rates in the Upazilas of Char Fashion (Bhola), Laxmichari (Kagrachari) and Alikadam (Bandarban) are 20-25 times higher than the national average of 1 percent.

%OD 28%

21%

14%

Bhola Sadar

char Fashion

Taltoli

Alikodom

Laxmichari

Open defecation status in CATS project areas

WHO & UNICEF (2015). Joint Monitoring Programme for Water Supply & Sanitation for Bangladesh WHO & UNICEF (2015), Joint Monitoring Programme for Water Supply & Sanitation 2015 MDG Update (fig. 32) 3 icddr,b (2014) Bangladesh National Hygiene Baseline Survey, WaterAid and Policy Support Unit, LGD, GoB 4 Hanchett S et al. (2011). Long-Term Sustainability of Improved Sanitation in Rural Bangladesh, World Bank 1 2

1.2.2 Hygiene According to the Bangladesh National Hygiene Baseline Survey, handwashing stations proximity to latrines were accessible for more than two thirds of the households in Bangladesh however only 40% of these stations had both soap and water available5. While the general awareness of improved hygiene is high, structured observation revealed that washing both hands with soap was much lower after defecation (30%), before feeding children (3%) and before preparing food (1%)6. Menstrual hygiene management (MHM) remains a challenge in Bangladesh. Amongst menstruating girls and women, old cloth was the predominant menstruation management material (82-86%) amongst which only 22% of school girls, 21% of girls at home and 21% of women washed and dried cloth appropriately1. Use of unclean materials puts girls and women at increased risk of infections. The lack of MHM-friendly sanitation facilities in schools is can also serve as a disincentive for adolescent girls to attend school when experiencing their period. As per DHS 2011, the proportion of households with soap and water (in a convenient location) is lowest in Barisal division with only 13.6 percent, indicating that more efforts are needed to ensure handwashing practice.

Proportion of Households 30.00%

22.50%

15.00%

24.20%

24.30%

25.10%

Rajshahi

Chittagong

Sylhet

26.60%

28.20%

20.30% 13.60%

7.50%

0.00%

Barisal

Khulna

Rangpur

Dhaka

Proportion of households where soap and water were observed

1.2.1 WASH in Schools Preventing disease transmission in schools can improve school attendance, cognitive development and educational attainment of girls and boys which in turn has an impact on national development outcomes. According to the Bangladesh National Hygiene Baseline Survey, an improved functional drinking water source was found in 80% of schools and 41% of them appeared to be clean. While the majority of schools (84%) had a functional improved toilet for students, in only 45% of schools were the latrines unlocked. The adequacy of these latrines at an average of 213 students per cubicle was well below the national standard of 50 students per cubicle. Approximately one-third of all schools had water and soap available inside or near (<30 feet) the improved toilet accessed by students and a quarter of the toilets were clean. Approximately one-third of school studentsâ&#x20AC;&#x2122; hands appeared to be clean and 28% washed both hands with soap during a handwashing demonstration.

5 6

icddr,b (2014) Bangladesh National Hygiene Baseline Survey, WaterAid and Policy Support Unit, LGD, GoB icddr,b (2014) SHEWA-B Programme Health Impact Study Report, UNICEF and DPHE

MHM remains a challenge especially in schools. Among menstruating girls and women, old cloth was the predominant menstruation management material with 40% of surveyed girls reporting that they miss school during menstruation for a median of 3 days a month. Almost one‐third thought that menstrual problems interfered with school performance. Just over half of students reported that they were forbidden from religious activities; while 74% of them were forbidden from non‐religious activities during menstruation (National Hygiene Survey 2014). It is understood that inadequate WASH facilities at school contribute to this period of absence from school during menstruation5.

1.3 The CATS Project The initial Community Approach to Total Sanitation (CATS) project commenced on December 2014 implemented by Plan International Bangladesh in 5 Upazilas in 4 Districts and was scheduled to end in March 2016 but was extended until October 31st, 2016, with activities ending September 2016. Since December 2014, Plan International Bangladesh has been implementing the project titled “GoB UNICEF Community Approach to Total Sanitation (CATS)” in the Barisal and Chittagong Divisions where 500 communities and 200 schools were targeted in 5 Upazilas. At the completion of the project in September 2016, a total of 762 communities had been identified, triggered, declared and certified as ODF.

1.3.1 CATS Project Goal The CATS project aimed to achieve 100 percent open defecation free status and promote hygiene among the targeted population in 500 communities and 200 schools of 20 Union Parishads in five Upazilas in four districts through Community Approaches to Total Sanitation (CATS).

Sanitation

1.3.2 Project Objectives

Outcome 1 Improved access and use of good sanitation practices and promotion in 500 communities Results

At least 200,000 people live in an Open Defecation Free (ODF) environment At least 100,000 people in targeted areas shift from open to fixed place defecation 100 Local sanitation entrepreneurs trained, linked with LGIs and targeted communities

Activities

Selection of OD community CLTS: pre-triggering, triggering, post-triggering Development of the potential Natural Leaders Strengthen the capacity of Local Sanitation Entrepreneurs and established linkages ODF declaration & certification Spreading the CATS experiences to other communities Observation National Months and International Days Monitoring by ODF certification team and community

hygiene wash in school Others

Outcome 2 Improved handwashing practices among dwellers in 500 communities Results

85,000 people adopt improved hand washing practices after the use of the toilet 333,000 people have increased their knowledge on hand washing with water and soap (including at least 75,000 school girls and boys)

Activities

Social mobilization for WASH demand generation Development of IEC & BCC materials Conduct HP sessions in each community Conduct quarterly participatory monitoring at community and school Training on ODF and HP for para workers Training on HP for Health Worker Interactive campaign Theatre for Development (TfD) show Mobile film show Workshop and meeting Participatory progress review Advocacy and influence activities Demonstration, documentation & project learning sharing

Outcome 3 Improved handwashing practices among children in 200 schools Results

Water, sanitation and hand washing facilities are sustainably used and maintained 45,000 students adopt improved hand washing practices after using the toilet

Activities

WASH in Schools (WinS): selection, establish benchmarks Awareness campaign and mobilization activities for WinS Conduct HP sessions Orientation of SMC & Teacher on School Sanitation and Household Hygiene Education (SSHHE) Training of Resource Teacher on SSHHE Training of Students Council on SSHHE Debate and art ceremony at school level Rehabilitation of sanitation facilities/installation of hand washing/ water facilities

Intervention The CATS project also includes capacity building of health staff to promote hygiene practices (especially hand washing with soap) through awareness raising and outreach interventions within communities. In addition, WASH facilities in schools are being rehabilitated, and hygiene practices are being promoted through the child to child approach. Activities

Organise project start up workshop Capacity building training on CATS Baseline survey including a KAP study Project orientation and launching ceremony Project Endline Survey Project exit workshop

3. Improved hygiene practices maintained in School

2. Household members improve hygiene practices related to hand washing after using toilets

1. People achieved better hygiene outcomes through changed sanitation behaviours

Outcomes

3.2. 45,000 children from 200 schools have adopted improved hand washing practice after using toilets

3.1. Water, sanitation and hand washing facilities are rehabilitated and sustainably used and maintained

Number of school children who are effectively washing their hands with water and soap after the use of toilets (B=TBD, Target=+45,000)

Number of schools with Water and sanitation facilities (B:TBD; Target: + 100) Number of schools with adequate hand washing facilities (B:0, Target:200) Number of schools with budgetary allocation for operation and maintenance of WASH facilities (B=TBD; Target = +100)

Number of community members who are effectively washing their hands with water and soap after the use of toilets (B=TBD; Target = +84,000).

2.2. 84,000 community members have adopted improved hand washing practice after using toilets

Number of Local Sanitation Entrepreneurs serving project areas communities (B=TBD; target = +100)

1.3. Local Sanitation Entrepreneurs identified and linked with LGIs and targeted communities Number of people in project communities able to recite at least 3 critical times for hand washing (B=TBD; Target =+333,000)

Number of households in the project area with additional fixed-place defecation facilities (B=TBD; Target = 20,000)

1.2. 100,000 people (in project area) have shifted from open defecation to fixed place defecation

2.1. 333,000 people have increased their knowledge about 3 critical time for hand washing

Number of communities certified open defecation free (Baseline: 0, Target: +500) Population living in an certified open defecation free environment (B:0, Target 200,000)

Objectively Verifiable Indicators (with baselines and Targets)

1.1. At least 200,000 people (in project area) live in an open defecation free environment

Outputs

CATS Project Result Framework

• Political unrest and instability prevails within tolerable limit • Major disasters (Flood and cold wave) remains in tolerable limit • The Government priority for Total Sanitation will remain priority. • Union level Health and Family Planning staff will remain cooperative. • LGIs will cooperate

Risks & Assumptions

• Baseline report • Monitoring and Progress report • Evaluation report

• Political unrest and instability prevails within tolerable limit • Major disasters (Flood and cold wave) remains in tolerable limit • The Government priority for School Sanitation will remain priority. • The primary education department will cooperate

• Baseline report • Political unrest and • Monitoring and instability prevails within Progress report tolerable limit • KAP study • Major disasters (Flood • Evaluation and cold wave) remains report in tolerable limit

• KAP Baseline (OD map and CAP) report • Progress reports • Evaluation report

Sources/Means of Verification

2. Project implementation 2.1 Baseline and KAP study 2.2 Capacity Building of LGIs 2.3 Community Engagement 2.4 CLTS triggering 2.5 Verification and Certification of ODF 2.6 Community based monitoring 2.7 Hygiene Promotion by Schools & Health Workers 2.8 WASH in school (WinS) 2.9 The AECM Project 2.10 Establishment of SaniMart 2.11 Market Facilitation 2.12 Advocacy 2.13 Linkage to UNICEFâ&#x20AC;&#x2122;s MoRES 2.14 Sustainability of Results

2.1 Baseline and KAP study The project commenced with a community meeting to oversee the situation on open defecation and hygiene practices of selected communities through consultation with natural leaders, a transect walk and rapport building. Following this, a study was carried out to query the knowledge, attitudes and practices (KAP) of the communities in regards to open defecation and hygiene in the project area. A baseline study was also undertaken to assess the defecation and hygiene related issues in communities and schools as well as to establish a benchmark to examine the change triggered by the interventions.

2.2 Capacity Building of LGIs The project interventions were coordinated through the Upazila office but implemented at the Union Parishad, Ward, Para (cluster household) level. These local government institutions played the coordinating role in ensuring the involvement of all government and non-government stakeholders in the implementation of total sanitation. The project developed the capacity of the UPs to take a lead role in community mobilization and implementing sanitation activities in their respective unions with the goal of creating an enabling environment to work collectively to achieve common goals. The capacity of Union Parishad members on CATS was enhanced through training and orientation enabling these LGI representatives to take the lead in the implementation of the CATS process. The project trained two WASH Facilitators per Union Parishad in Barisal division and three WASH Facilitators in the Chittagong Hill Tracts. The training focused on both the specific issues and needs of women and girls, as well as the demonstrated catalyst role that they play in CATS. The training package covered the present WASH situation of the union, implementation approaches, participation women and girls in decision making process, local resources mobilization, GoB polices and strategies, role and responsibility of UP, planning, monitoring and documentation of the project activities.

2.3 Community Engagement Plan International Bangladesh built the capacity of government health workers, Ward representatives and â&#x20AC;&#x2DC;Natural Leadersâ&#x20AC;&#x2122; through need-based training, coaching, demonstration and exposure visits. They played significant roles in the facilitation of community triggering sessions, planning processes, implementing and monitoring sanitation activities at para, village and union levels. Plan International Bangladesh and partner NGO ensured girlsâ&#x20AC;&#x2122; and boys participation in all CATS processes and events. The organisation also provided different training to the children through the Student Councils to act as hygiene change agents in the targeted communities. Plan International sensitised and enhanced the capacity of local private entrepreneurs to promote a range of sanitation technology options with hand washing facilities such as technologies suit with geo-physical situation, gender and child friendliness as well as people with disabilities and easy operation and maintenance. The trained local entrepreneurs were encouraged to introduce and promote multiple and affordable sanitation options for poor households in the community.

Community Approaches to Total Sanitation (CATS) Community Approaches to Total Sanitation (CATS) are an umbrella term used by UNICEF sanitation practitioners to encompass a wide range of community-based sanitation programming. CATS shares the goal of eliminating open defecation; is rooted in community demand and leadership, focused on behaviour and social change, and committed to local innovation. The essential elements of CATS are a framework for action that provides a common foundation for sanitation and hygiene engagement in the sector while allowing for a broad variation in the way programmes are applied and translated locally (as further detailed below). 1. CATS aim to achieve 100 percent open defecation free (ODF) communities through affordable, appropriate technology and behaviour change. The emphasis of CATS is the sustainable use of sanitation facilities rather than the construction of infrastructure including the safe disposal of infant and young children’s faeces in toilets. 2. CATS depend on broad engagement with diverse members of the community, including households, schools, health centres and traditional leadership structures. 3. Communities lead the change process and use their own capacities to attain their objectives. Their role is central in planning and implementing improved sanitation, taking into account the needs of diverse community members, including vulnerable groups, people with disabilities, and women and girls. 4. Subsidies – whether funds, hardware or other forms – should not be given directly to households. Community rewards, subsidies and incentives are acceptable only where they encourage collective action in support of total sanitation and where they facilitate the sustainable use of sanitation facilities. 5. CATS support communities to determine for themselves what design and materials work best for sanitation infrastructure rather than imposing standards. External agencies provide guidance rather than regulation. Thus, households build toilets based on locally available materials using the skills of local technicians and artisans. 6. CATS focus on building local capacities to enable sustainability. This includes the training of community facilitators and local artisans, and the encouragement of local champions for community-led programmes. 7. Government participation from the outset – at the local and national levels – ensures the effectiveness of CATS and the potential for scaling up. 8. CATS have the greatest impact when they integrate hygiene promotion into programme design. The definition, scope and sequencing of hygiene components should always be based on the local context. 9. CATS are an entry point for social change and a potential catalyst for wider community mobilization.

2.4 CLTS: Pre-triggering, triggering and post-triggering The underlying assumption of CLTS is that once women, men, boys and girls are convinced of the need for sanitation they will be self-motivated to construct their own toilets using locally available resources. CLTS focuses on igniting change in sanitation behaviour at the community level rather than on individual behaviours in order to achieve Open Defecation Free (ODF) communities. Plan International Bangladesh used sequential steps of CLTS for community sensitisation and mobilisation to achieve 100 percent ODF status in intervention communities that includes pre-triggering, triggering and post triggering events at the community level. The project followed the principle of CLTS and organized different activities such as organized triggering sessions to demonstrate the effect and consequences of open defecation and using unhygienic latrine. Through this session a group of selves motivated people were come forward (including men, women, youth girls and boys, people with

CLTS convinces Monkhathoai to install an improved latrine Mongbaaung is a para of 110 households situated in Alikadam Sadar Union of Bandarban district. At the time of community situation analysis through CLTS triggering session, more than 52% of the households in Mongbaaung para were without an improved latrine as community situation analysis through triggering session. The common practice of open defecation meant that residents frequently suffered from water and sanitation related diseases. In May 2015, the CATS project organised an awareness-raising session on Community Led Total Sanitation (CLTS) in Mongbuaaung para. Through this session, a social map presenting the sanitation situation of the para was developed, and the para residents were oriented on the consequences of open defecation and the failure to wash hands at three critical times. All the household members in the para were ignited by the project interventions to install hygienic latrines or to upgrade their existing unhygienic latrines. The household of Mongkhathoai Marma was an exception. Although Mongkhathoai had previously received a set of latrine rings and slab from the government, he had opted to sell the materials rather than install a latrine. Mongkhathoai cited several reasons including a financial crisis for not having a hygienic latrine of his own. Meanwhile, his family continued to practice open defecation in places that were very close to the kitchen of his neighbourâ&#x20AC;&#x2122;s house. While conducting regular monitoring visits, project staff and UP representatives tried to convince Mongkhathoai Marma that open defecation harmed both themselves and others. Finally, Mongkhathoai committed to install a sanitary latrine in his residence. In October, 2015 Mongbaaung para was declared as ODF. The people in this locality now live in a healthier environment where nobody defecates in the open. Like other households in the para, Mongkhathoai Marma and all of his household are using their sanitary latrine and washing their hands at critical times. Mongkhathoai Marma says that â&#x20AC;&#x153;the environment of our house and surroundings has dramatically changed after the installation of this hygienic latrine. There is no longer such a bad smell around our house.â&#x20AC;?

disability) to form a community based committee (cluster/sub-cluster action team) and developing an action plan for achieving the ODF. In the process of triggering session social map the women and children indicated the households did not have latrine, place of open defecation, etc. and prepared community action plan (CAP); and updating the social map and Community Action Plan (CAP), mass monitoring and house to house visits. Post-ODF support helped ensure ODF communities are not only maintaining this status but that they are also climbing the sanitation ladder with the installation of improved and more sustainable latrine options with handwashing devices.

2.5 Verification and Certification of ODF status The verification and certification of ODF status was a key area of project support. Following notification by the community sanitation committee and natural leaders, the Union Parishad WATSAN committee verifies whether a community is 100% ODF. Following this, an application is submitted to the Union WATSAN committee chaired by Union Parishad Chairman required to issue a certificate on the open defecation free status of the community.

2.6 Community based monitoring As this project followed a community based approach, Plan International Bangladesh and partner NGO built community capacity, developed necessary monitoring tools and engaged male and female community members for routine monitoring. The organisation used the monitoring capacity of local governments and other partners to validate a certain percentage of data generated from the community based monitoring. In addition, WASH issues were integrated into the para micro plan under the Integrated Community Development Programme (ICDP) activities at para centres of Chittagong Hill Tracts and the Para Workers monitored the progress.

Nolbunia village achieves ODF status North Nolbunia is a small village of 136 households under Sharikkhali union of Taltoli Upazila under Barguna district. Together with the community members, the project conducted a CLTS triggering session and a sanitation situation analysis in the village in April, 2015. During the preparation of a Sanitation Social Map it was found that only 31 out of 136 households had an improved latrine while 102 households had unimproved latrines and 3 had no latrine at all. Village residents were sensitized through the CATS approach and prepared an action plan to make their village ODF. A committee of community members and local government representatives conducted awareness raising initiatives including interactive campaigns, film screenings, house to house visit as well as theatre for development (TfD) shows by adolescent boys and girls, hygiene messages disseminated by mother and adolescent group, monitoring visits by children group and WATSAN committees also established linkages with sanitation entrepreneurs in order to make the village ODF. Households with no latrine installed latrine facilities however some of the households with unhygienic latrines claimed that they couldnâ&#x20AC;&#x2122;t afford the cost to upgrade to improved latrines. The committee observed that most of the unhygienic latrines would be improved if a gooseneck or water seal was installed on the ring slab of the unimproved latrines. The committee then appointed a local sweeper named Korshed to install water seals on the 81 unimproved latrines at a cost of 70 taka for each household. Following this, North Nolbunia village was declared ODF by the Sharikkhali Union Parishad.

2.7 Hygiene Promotion by Schools & Health Workers The CATS project aimed to promote good hygiene behaviour through building the capacity of professional health workers to ensure the greater participation, ownership and awareness of the community in hygiene behaviour change. The project targeted different health workers including health assistants, family welfare assistants, health and family planning inspectors, sanitary inspectors, NGO health workers, village doctors and skilled birth attendants. Trained health workers and school teachers facilitated interactive sessions in communities, health centres and schools. Four sessions in three waves (ODF, hand-washing and clean latrines) were conducted in each of the EPI clusters of the selected 20 Union Parishads. Trainings were also provided to the children to act as hygiene change agents in their own communities through the Student Council. Adolescent girls and boys also received training and participated in different events such as visit household latrines, checked cleanliness of the latrines, availability of hand washing device, soap and water and discussed with household members regarding benefit of good sanitation & hygiene practice, consequence of open defecation and using unhygenic latrine in relation of health, economic, social etc.

2.8 WASH in school (WinS) The UNICEF-promoted ‘Three Star’7 approach (daily supervised hand washing, supervised cleaning of toilet, monitoring of open defecation, improved sanitation and hygiene facilities) was deployed in the 200 target schools. The rehabilitation / installation of WASH facilities was targeted in the schools that scored two stars or less. The ‘Fit for School’8 approach prioritizing local solutions to improve hand washing was adopted to complement the ‘three star’ approach. Training and coaching sessions were conducted for teachers, SMC members, student council, parent teacher associations and Upazila Education Officers to facilitate hygiene behavioural change. These sessions were focused on hand washing and the School Led Total Sanitation (SLTS) approach which adapts the CLTS methodology to the school setting. The project organized different types of mobilization and awareness activities including art competitions, debates, rallies, role-play, games and the celebration of hand washing day and sanitation month within the schools.

2.9 The Accelerating Action Towards Ending Child Marriage Project In August 2015, Plan International Bangladesh and UNICEF signed a Programme Cooperation Agreement (PCA) for the implementation of project titled “Accelerating action towards ending child marriage (AECM)”. The project was two phases, the first ended on 31 March 2016 then extended for six months from April –September 2016. This project included both entrepreneurship and social skills building of targeted adolescent girls and the establishment and operation of four “SaniMarts” where local sanitation entrepreneurs partnered with adolescent girls groups to produce low-cost sanitary napkins as well as provide income generating opportunities for group members. The Three Star Approach is a means of benchmarking WASH service delivery performance in schools in a progressive manner to meet national WinS standards. 8 The Fit for School approach applies school-based management to implement simple evidence-based interventions that address key health determinants (i.e. appropriate sanitation, washing facilities and clean water) in a single package that prioritizes simplicity, scalability and sustainability. 7

2.10 Establishment of SaniMart As part of the Accelerating Action towards Ending Child Marriage (AECM) project, four SaniMarts have been established in Bhola Sadar and Charfashion Upazila. These SaniMarts seek to reduce the risks of child marriage by supporting girlsâ&#x20AC;&#x2122; economic and social empowerment along with addressing the barriers they face to equally participating and learning in schools due to the personal challenges they experience during menstruation. The creation and supply of affordable and easily accessible sanitary napkins by and for girls helps girl clients and teachers improve their menstrual hygiene management to then be better able to participate in school. The social and entrepreneurial skills-building is two-fold. Girls are trained and encouraged to take active roles in hygiene education promotion in schools and in communities. They are also trained in production and sale of sanitary napkins including in entrepreneurship. This opportunity to become active agents in their own communities and to be self-employed further enables them to stay in school, thus reducing risks of early marriage. Adolescent girls aged 14 -18 groups started the production of sanitary napkin pads in March, 2016. In this short time span, important activities have been realized. In partnership with local sanitation entrepreneurs, these adolescent girls groups established retail outlets and are communicating and developing linkages with shopkeepers, pharmacies, Community Clinics, schools and colleges to encourage them to purchase their sanitary napkin pads. They are also involved in awareness raising for other pre-adolescent girls and women on the benefits of using the sanitary napkin as part of safe menstrual hygiene management. Complementing the sanimarts, awareness raising and sensitization sessions on MHM in schools and communities were also conducted which engaged boys and men as well as girls and women.

What is a SaniMart? The global concept of SaniMart is to bring together in one place all the various components required to construct and maintain a latrine, as well as other personal hygiene items. It is a small shop located in an accessible bazaar or community. A SaniMart is both a shop and production centre sanitation items of materials and manufacture of sanitary napkins. Under the AECM project local sanitation entrepreneurs along with adolescent girls groups were established and trained on the production of sanitary napkins. These groups were then provided with machines and raw materials, introduced to the suppliers of the raw materials and several clients such as the Upazila health complex and pharmaceutical shops for the bulk purchase of sanitary napkins as well as individual to purchase napkin and other goods. The production of sanitary napkins involves 4 types of machines as further detailed below: 1. Raw Materials: Local cotton fabric, medical cotton & cotton net suppliers are identified 2. Refining: Collected local fabric (Jhut) is processed in a cotton refining machine. 3. Rolling & Cutting: The refined cotton is rolled with medical cotton layer by layer, covered with netting and cut to the prescribed size. 4. Sewing: Each piece of napkin is then sewn adding a cotton loop. 5. Sterilizing: Finished napkins are placed in an auto-clave machine for dis-infection. 6. Drying: After disinfection the napkins are placed in a dryer to remove all moisture. 7. Packing: 8-10 napkins are then bundled together in a sealed package. 8. Marketing: Napkins are sold either directly to women or via pharmacy/health outlets

raw cotton

refining

rolling + cutting 03

sewing + loop

marketing

packaging

drying

sterilizing

Financial viability: During the training on the production of sanitary napkins, the analysis of costs is discussed. At current prices, one packet consisting of 8/10 napkins costs BDT 32/40 to produce and sells at BDT 40/50. This is a profit of roughly 1 BDT per napkin. Supply and Production: As revolving fund the AECM project provided machineries and raw materials (cotton, cloth, rapping packet, etc.). Adolescent girls groups are primarily producing these napkins at the site of the SaniMart in addition to their study and other activities. With each member spending 1-2 hours per day producing napkins, an average 400 - 550 packets (3,200 - 4,500 pieces) are produced each month. Marketing: Most napkins are supplied to medical shops, Community Clinics, Schools/colleages and the demand is relatively high as compared to other napkins due locally available with comparatively low prices and good quality. Group members sell napkins in their schools and colleges and the Health Complex supplies these napkins to the upazila hospital and union health complex. In addition local sanitation entrepreneur and girls groups are selling other sanitary goods (toiletries, handwashing devices, etc.). SaniMarts enable adolescent group members to generate some income that is proving useful in the battle against early marriage and school dropout. At the same time it is increasing awareness and access to safe menstrual hygiene products particularly in the rural and hard to reach areas. Strong linkages between the education and health departments at the Upazila level increase the sustainability and effectiveness of SaniMarts in improving menstrual hygiene, improving the school attendance of adolescent females and resisting early marriage.

2.11 Market Facilitation The CATS project established various linkages with local sanitation entrepreneurs, hardware shopkeepers, masons and plumbers to facilitate the access of project beneficiaries to sanitation facilities. In some of the project areas where other major WASH programs were being conducted, the project assisted male and female community members to access supply chains and market financing developed through these interventions.

2.12 Advocacy Local Government Institutions played a key role in the advocacy for improved sanitation and hygiene. Union Parishads were strengthened to improve the coordination of all sanitation and hygiene activities within their jurisdiction. In addition, Union Parishads were encouraged to allocate a portion of their local budget for sanitation and hygiene interventions. Through open budget processes communities were involved in the budget planning discussion especially in regards to the allocation of any sanitation subsidies. Communities were also encouraged to engage in the targeting of subsidies in the ODF targeted areas.

2.13 Linkage to UNICEFâ&#x20AC;&#x2122;s Monitoring Results for Equity Systems (MoRES) A sanitation tracer developed by Plan International Bangladesh at the household and community level sought to track the progress of individual and collective behaviour change in ODF target areas. The indicators adopted in the sanitation tracer were selected to align with the UNICEF monitoring results for equity systems (MoRES).

Sanitation Tracer Framework Coverage level

Frequency

Assessment criteria

Sample Survey for Baseline, midline & Endline

6 months, Baseline, Midline & Endline