Ending open defecation and building household toilets

Community-led approaches that foster positive hygiene and sanitation behaviours lead to sustainable health and reduced incidence of water-related diseases, such as diarrhoea.

WHY: 2.4 billion people globally lack access to improved sanitation, and nearly a billion people practice open defecation (OD). Disparities between people with access to sanitation and those without are driven by socio-economic inequalities. NCA’s WASH interventions focus on rural, poor populations with little access to sanitation. A clean environment is a pre-condition to health and development, and poor sanitation stunts growth and limits productivity. Unhygienic living conditions mean that people, particularly children, are at risk of contracting preventable, water-related diseases such as diarrhoea, which is the cause of death for over 500,000 children annually. In some settings, OD is an accepted practice, so merely building latrines will not solve the problem. NCA integrates awareness raising about proper hygiene practices, such as hand washing at critical moments, and the link between sanitation and health risks, to promote sustainable behaviour change.

Photo: Jim Holmes / Norwegian Church Aid, Afghanistan.
Photo: Jim Holmes / Norwegian Church Aid, Afghanistan.

WHAT: Mobilising women, men, girls and boys through Community-Led Total Sanitation (CLTS) and similar participatory approaches. Six countries with household sanitation programmes used CLTS. NCA provided technical assistance and financial support to local partners, who in turn, raise awareness through “triggering” which is a participatory process whereby people become aware of the transmission of faecal material to their food, agree collectively to end open defecation and develop an action plan to become Open Defecation Free (ODF).

One fundamental rule of the CLTS is not to subsidise household toilet construction; householders must build latrines with their own means. CLTS has been very successful in fostering ownership and creating demand by raising awareness about open defecation. In fact, NCA replaced the “demonstration toilet” approach with CLTS in Afghanistan, which proved to increase demand for latrines at the household level. 43 communities (40,911 individuals) are now declared ODF. In Ethiopia, the CLTSH approach was a method adapted to include a stronger hygiene (H) component, focusing on washing hands with soap at critical moments. NCA and local partners facilitated 129 Ethiopian communities in in Tigray and Amhara Regions areas to become ODF in 2016. In Burundi, NCA, tailored the CLTS approach to schools (SLTS), which resulted in 1,674 household toilets.

RESULTS: 507,552 women, men, girls and boys gained access to toilets in their homes in 2016 in eight countries where Norwegian Church Aid operates. Most of these people moved from practising OD to using toilets they constructed in their household. The remaining people benefitted from rehabilitating an existing household toilet, which had not previously guaranteed sanitary conditions. NCA’s local partners measured the satisfaction of individuals who gained access to sanitation in Afghanistan, Pakistan, Ethiopia and the DRC. Between 75-87% women, men, girls and boys reported that they are satisfied with sanitation services, indicating an increased demand for household sanitation.

As NCA focuses interventions on society’s most vulnerable people, there are competing demands on limited financial resources for these populations, thus building a toilet is often under-prioritised. The high percentage of people expressing satisfaction means that NCA’s intervention was able to bring the under-prioritised issue of household toilets to the top of the agenda for many families. Moreover, these families better understand the link between a clean environment and the benefits of sanitation, such as health. In Afghanistan, for example, local partners in the Ashtarly, Kejran and Trinkoot districts, reported a 72% decline in diarrhoea episodes of children under five years.