CATS project brief November 2016
Project brief
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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abstract Plan International Bangladesh implemented the “GoB-UNICEF Community Approach to Total Sanitation (CATS)� 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.
01
The CATS Project
hygiene
Sanitation
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. 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.
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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
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
wash in school Others
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. 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
Activities
Project context 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. %OD
Proportion of Households 30.00% 24.20% 22.50%
15.00%
24.30%
25.10%
26.60%
28.20%
21%
20.30% 13.60%
14%
7.50%
0.00%
28%
7%
Barisal
Khulna
Rajshahi
Chittagong
Sylhet
Rangpur
Dhaka
Proportion of households where soap and water were observed
0%
Bhola Sadar
char Fashion
Taltoli
Alikodom
Laxmichari
Open defecation status in CATS project areas
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.
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CATS Activities > Baseline and KAP study > Capacity Building of LGIs > Community Engagement > CLTS triggering > Verification and Certification of ODF > Community based monitoring > Hygiene Promotion by Schools & Health Workers > WASH in school (WinS) > The AECM Project > Establishment of SaniMart > Market Facilitation > Advocacy > Linkage to UNICEF’s MoRES > Sustainability of Results
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Achievement of cats against target Project target
Achieved
Pre-triggering and triggering communities
500
762
152%
Post-triggering
791
845
107%
4,342
8,473
195%
17,373
36,571
211%
100,000
221,457
221%
Number of communities declared ODF
500
762
152%
ODF post-certification periodic monitoring
500
762
152%
200,000
330,078
165%
100
100
100%
279
296
106%
3,600
3,619
101%
333,000
400,793
120%
Major activities
% of target
CLTS - new latrines (100,000 people in 500 communities)
Number of new improved latrines constructed Number of latrines upgraded to improve from unimproved Number of people gaining access to improved latrines CLTS - 500 communities declared and 200,000 people ODF
Number of people living in ODF communities Sanitation- 100 local sanitation entrepreneurs established Number of local sanitation entrepreneurs established
Hygiene promotion- 333,000 people reached with hygiene education Number of health workers trained on hygiene promotion Number of Natural Leaders trained on CATS Number of people reached with hygiene education
Hygiene promotion- 85,000 people practice hand-washing with soap Available handwashing facilities / devices in use at HHs
17,000
20,860
123%
Number of people practicing handwashing with soap
85,000
104,300
123%
Rehabilitation of hand washing facilities in 200 schools
200
200
100%
Rehabilitation of sanitation facilities in 100 schools
100
100
100%
28
28
100%
WinS- 200 schools have rehabilitated WASH facilities
Installation of water facilities
WinS - 45,000 students have access to WASH facilities with water and soap Number of teachers trained on hygiene promotion
400
402
101%
SLTS sanitation and hygiene sessions plans at schools
200
200
100%
2,000
2,690
135%
45,000
53,142
118%
100
200
200%
Number of SMC members trained Number of students that have access to soap and water at school for handwashing Establish a mechanism for O&M of WASH in schools
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What is 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. raw cotton
01
refining
02
rolling + cutting 03
sewing + loop
04
08
marketing
07
packaging
julia, the changemaker Julia is 15 years old and is a class nine student of Gungerhat Secondary School. Previously she used to miss 4-5 days of her classes each month during her menstrual period. After joining the SaniMart she now earns BDT 700-800 per month, continuing her school. She has become a female change agent by using these sanitary napkins and raising awareness on benefits of hygienic sanitary napkins and disposal systems. She says “I safely manage my period and go school regularly. I work at SaniMart during my leisure time and earn some money towards the cost of my education. I work to raise awareness of women on the benefits of using sanitary napkins. My dream is to become a successful women entrepreneur.�
06
06
drying
05
sterilizing
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 couldn’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.
public screening of wash film
triggering community to end opendefecation
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CATS Project Results wash improvement at Households and in School
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According to the donor-commissioned endline survey completed to evaluate CATS project, there were significant increases in 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.
CATS project sanitation & Hygiene achievements Indicators
% Baseline (Mar 2015)
Access to improved latrine- owned by the households
% End-line (Oct 2016)
24
82
No latrine access for the households (OD)
22.5
0.69
Households had access to a functional latrine and the latrine was within 20 meters from the household
66.8
68
Household had year round access to a functional latrine
54.1
92
Visible faeces were notices over latrine slab and/or floor
72
15
Handwashing location <5 meters from the latrine
27
76.1
HW location was in <5m from latrine and water was available
20
72.8
Respondents hands appeared visibly clean
28
90
Observed handwashing: before eating washed with soap
1.8
89
Observed handwashing: after defecation washed with soap
17
94
CATS project WASH achievements in school % Baseline (March 2015)
Indicators Water points available at school
% End-line (October 2016)
88
94
Schools had improved latrine access for students
63.9
100
Visible faeces were noticed over pan or slab or floor
50.8
11.1
31
100
32.8
100
Solid waste disposal places/facilities available at schools One or more teachers received training related to school sanitation and hygiene education
CATS project sanitation tracer achievements
% of Households
90
82
67.5 45
Baseline 2015 Endline 2016
57 31
22.5
23
26
22
16 6
0
Availability
Accessibility
Utilization
Adequate Coverage
17 2 Effective Coverage
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Challenges and Mitigation 10
Challenges and mitigation Struggling with organizing Health Workersâ&#x20AC;&#x2122; training as Upazila Health and Family Planning Officer are not agreeing to organize training without authorization letter from health department. Mitigation: Negotiated with local health offices; especially with Civil Surgeon (district level) and with UNICEF office and managed to organize training for Health Worker in Alikadam, Bhola Sadar, Charfasion and Taltoli Upazila.
Installation of hand washing devices and rehabilitation of WASH facilities of schools have been bit delayed due to receiving authorization letter from education department. Mitigation: Maintained continuous communication with education department at central and local offices, UNICEF offices, school authorities to get the authorization and started hand washing devises installation and WASH rehabilitation activities at soonest possible time.
Coordination among the multi stakeholders (LGIs, Government Departments, NGO, etc.) and building common understanding on the implementation of project activities. Mitigation: Activation/reactivation of WATSAN committees at different levels and mobilization of key actors to play the leadership role such as UP Chairman to play the coordination role at Union level.
As end of March, 2016 10% payment is not paid for a number of schools due to incompletion of defect liability period (DLP) of those school. As per agreement partnership with DAM will be finished in March, 2016 and the vendors (with 10% unsettled payments) were not allowing DAM to leave station without making their payments. Mitigation: This issue has been discussed in a meeting at Upazila level with the vendors and agreement were signed with the vendors and Plan International Bangladesh. The vendors were assured to be paid their owing by Plan International Bangladesh after end of DLP.
11
key lessons learned
12
Key Lesson Learned Paradigm shift has been noticed in relation to the changes of orientation of the local government representatives from hardware to software interventions. It has been noted that the UP chair and members play critical roles in community mobilization for achieving ODF community. As the key agents of changes, boys and girls children/adolescents use different modalities to advocate and influence the adults for stopping open defecations. Hygiene promotion is an integral part of total sanitation and facilitate hygiene promotion sessions by Health Worker, effectively functions to promote hygiene practices among the community people Hygiene promotion in school programs through School Led Total Sanitation approaches effectively functions to promote hygiene practices among the school children. The SaniMart centre producing and marketing low cost sanitary napkin, and sensitizing women and adolescents girls at community and school level for safe management of menstrual hygiene through using sanitary napkins, which is effectively integrating gender equality. The adolescentâ&#x20AC;&#x2122;s girls are developing the linkage with schools, shop keepers, pharmacy and schools and encouraging them for purchasing their product. Promoting gender responsive entrepreneur development for ensuring menstrual hygiene management at school and community level for accelerating towards ending child marriage initiative Women are great champions of WASH and are very active in effectively promoting sanitation and hygiene in their respective communities. Enabling environment is critical for achieving the project result and sustainability. Partnership with LGIs contribute to sustainability of the program.
students at khagrachari observes global handwashing day
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Conclusion
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Conclusion Despite increases in awareness, access and practice of sanitation and handwashing behaviours, effective coverage as defined in the sanitation tracer matrix, was much lower. Although it was notably higher than the baseline, this suggests there remains room for improvement. With regard to open defecation, the sustainability survey at both community FGD participants and individual householdsâ&#x20AC;&#x2122; respondents reflected that communities are ODF. However, it is in the early stage of ODF. To sustain results, continuous follow up by community leaders and local government officials is needed. Girls still do not have access to facilities for MHM in school. Although CATS project rehabilitated the existing sanitation facilities at school, few measures to make them MHM friendly were under taken. It seems there is scope to improve further with respect to equity and equality issues to reduce gender disparities and to respond to the specific barriers girls face because of MHM and risk of gender based violence in not having access to appropriate safe and private sex-segregated latrines. The end-line study showed that the latrine to student ratio was 1: 89, which was nearly two times more crowded than the Bangladesh National WASH standard though an improvement from the baseline (1:118).. Increase of school latrine chambers proportional to students is highly recommended. Installation of group handwashing devices at schools was associated with better availability of water and soap at handwashing locations after defecation and or other related personal hygiene purposes. End-line study found formation and activation of student council acted well in order to maintain the cleanliness of school latrines. Sourcing out money from SLIP fund or SMC for ensuring continuing WASH related O&M was something new, since the baseline. In respect to O&M of school WASH facilities and services, it is noticed that improvements with regards to funding, caretaking, monitoring cleanliness, and availability of cleaning materials in schools. However, there are rooms available to improve further. Studentsâ&#x20AC;&#x2122; reported latrine use at schools increased which could be attributable to high level of awareness, greater level of availability and accessibility of latrine facilities including water and soap. Lastly, sustainability indicators suggested 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 intervention in schools.
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Reflection of Stakeholders “Plan International Bangladesh engaged community people following PRA method and took robust initiative to stop open defecation. The percentage of open defecation is now zero in the project areas. Achievements of stopping open defecation are being displayed through billboard at public places.” Rashidul Haque, Project Director, GoB-UNICEF WASH project, DPHE “Adolescents is the transitional stage in which a child takes into an adult turn. It is necessary to discuss with adolescents on menstrual hygiene management. Thanks to CATS Project as they do the same activities to help girls for growing positive attitudes about menstruation, which will have a great impact on the girls’ ability to take an important decision about their health and well-being.” Dr. Farid Ahmmed, Civil Surgeon of Bhola “DPHE, UNICEF and Plan International Bangladesh have been successfully implemented a large-scale WASH programmes in Bhola. We further replicate its learnings in a wider area to make it ODF.” Kazi Tofayal Ahmad, Upazila Nirbahi Officer, Sadar Upazila, Bhola “I started to motivate the villagers to create demands for improved latrine as well as installation. I expanded my business for meeting the growing demand of ten neighboring villages. I also gained popularity in the market as well as in the community.” Nasir Shikdar, Local Sanitation Entrepreneur, Sadar Upazila, Bhola “Leaded the planning process at my territory and reviewed the progress with stakeholders. We encouraged to households and community people for installation of hygienic latrine to achieve open defecation free community. After predicating significance of the improved sanitation, people thought that they have no longer chance to go back for open defecation” Ukkojay Marma, Headman, Alikadam, Bandarban. “The CATS project created an innovative example on WASH in school for the establishment of child friendly and gender sensitive WASH facilities, good hygiene promotion through group hand washing station and menstrual hygiene management. It plays as model, we hope to replicate this learning in all school” Mr. Mohibur Rahman, Secondary Education Officer, Sadar Upazila, Bhola.
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