nemap

Abstract

In order to support the government target on Total Sanitation at Surkhet District, ENPHO initiated WASH promotion programs at Surkhet from 2011-March 2014 with the support of USAID and EAWAG. As the name of the project itself indicates, the main approach of Su-Swastha Project was School Led Total Sanitation (SLTS) with the focus on all the 58 schools within the project areas as entry points. Apart from SLTS, the project embraced multi-tier approaches and methods to engage locals at household, community and institutional level to speed up the process of community mobilization for effective WASH promotion throughout the VDCs, taking on consideration with the local level of understanding and interest.

Strategy used on one cluster/ tole did not work in other due to their geographical condition, ethnic background, changing livelihood, cognitive behavior, conservative thoughts, educational standard, interest, and profit-making mind-set. Throughout the project intervention period, combination of two or more approaches along with multiple front line workers were the foundation to convince the community towards applying WASH interventions and ensuring gradual transformation. It has been observed that minimum three working team was required to make any approach or strategy successful.

The main motivation for the team on engaging throughout the project duration were exposure visits, recognition and appreciation. In order to attain the sustainability of the project, four major aspects were focused on. This included; 1. Social/ Environmental aspect; 2. Institutional aspect; 3. Technical aspect and 4. Financial aspect. It is deemed necessary that post-project evaluation to be conducted in order to maintain sustainability so that project experiences could benefit other similar projects in Nepal.

Introduction

Access to safe water and sustainable sanitation is a major challenge in Nepal. According to the Government of Nepal (2011)[1], water supply coverage has been substantially improved and currently stands at 80%. However, surveys showed that more than 80% of the drinking water supplies in rural areas are contaminated. As stated by Ministry of Health and Population (2007)[2], only 15.3% households (HHs) are practicing household water treatment methods before drinking. The report further assessed that more than 2 in 5 HHs in urban areas treat water prior to drinking, while that in the case of rural areas showed that only 10% of the total households practiced household water treatment and safe storage (HWTS). As for NMIP (2011)[3] stated that only 43% of the people have access to basic sanitation while the paper presented during SACOSAN-V (2013)[4] reflected the coverage to be 63%, whooping increase of 20% within a short frame of two years.

Lack of safe drinking water and poor sanitation and hygiene are the major causes of morbidity and mortality, particularly among young children. In Nepal, a major cholera epidemic in 2009 affected over 70,000 people in 27 districts out of total 75, killing almost 380. Since then, it has been reported that an average 3,500 children under five are hit by diarrhea outbreaks every year, resulting in 50 deaths (1.4% fatality rate) (The Guardian, 2013)[5] and an economic loss of around 10 billion rupees.

The challenges on safe water, sanitation and hygiene are prominent in the mid-western region of Nepal. According to Nepal’s Human Development Report, the Human Development Index (HDI) for the Mid-Western Region is 0.452, which is the lowest among the five development regions of Nepal. Similarly the Human Poverty Index (HPI) for the region is 38.7 which is much higher than 35.4 for Nepal (UNDP, 2009)[6].

According to the nation-wide water and sanitation surveys of 2010; the region’s water and sanitation access coverage is 76% and 31% respectively, which is less among all the other regions. Similarly, the data showed that the diarrheal cases under five years were found to be 260 in 1000 children, while underweight children under the age of five was 43.5% with infant mortality rate of 97, which are the highest among all the regions. The poor situation of sanitation and health in the region was exposed in 2009 which showed only 55.90% use of soap with only 1.80 frequency of hand washing cases (MoHP, 2007; MoPPW, 2010 and NMIP/ DWSS, 2010[7]).

Su-Swastha Project – A case on multi-tier approaches

In order to support the government target on Total Sanitation at Surkhet District, ENPHO initiated WASH promotion programs at Surkhet since 2011 with the support of USAID and EAWAG. With the fact on mind that improved water sources reduce diarrheal morbidity by 21%; improved sanitation reduces it by 37.5%; and the simple act of washing hands at critical times can reduce the number by as much as 35%; improvement of drinking-water quality, such as point-of-use disinfection, would lead to a 45% reduction of diarrheal episodes (United Nations Millennium Project, 2005)[8] and 1 in 5 new born deaths can be prevented with safe water, sanitation and clean hands (Water Aid, 2015)[9]; ENPHO targeted on sustained improvement in water, sanitation and hygiene (WASH) at five VDCs (Ramghat, Kalyan, Mehelkuna, Sahare and Kaprichaur VDC) and three wards (ward no. 1, 2, and 11) of Birendranagar Municipality of Surkhet District through the project “School-Led Safe Water, Sanitation and Hygiene Improvement in Mid-Western Nepal”, also termed as Su-Swastha Project from January 2011 to March 2014.

As the name of the project itself indicates, the main approach of Su-Swastha Project was School Led Total Sanitation (SLTS) with the focus on all the 58 schools within the project areas as entry points. However, it was deemed necessary on adopting other strategic approaches by the start of 2012 due to below the average results. An observational study at the project areas suggested that successful motivational factor for one ward was not same for the other. For instance, locals of ward 1 of Sahare VDC might be inspired by FCHVs while ward 5 might be convinced by the child club members while ward 8 got motivated by the high level political leaders and VWASHCC members. At most of the cases in Surkhet, WASH messages delivered by children were either neglected or taken for granted at both the community and household level.

As per the experience of Su-Swastha project, the approaches differed according to the working area and knowledge, attitude and practice of the community people. Apart from SLTS, the project embraced multi-tier approaches and methods (Table 1) to engage locals at household, community and institutional level to speed up the process of community mobilization for effective WASH promotion throughout the VDCs, taking on consideration with the local level of understanding and interest.

Table 1: Multi-tier approaches and methods to engage locals of different levels

Approaches/ methods	Household level	Community level	Institutional level
School led total sanitation (SLTS) approach		√	√
Community led total sanitation (CLTS) approach	√	√
Provision of partial subsidy/ support	√		√
Focus Group Discussions (FGD)		√
WASH intervention		√	√
WASH supply chain and entrepreneurship development	√	√
Advocacy campaigns	√	√	√
Behavior Change Communication (BCC) campaign		√	√

Throughout the project intervention period, combination of two or more approaches along with multiple front line workers were the foundation to convince the community towards applying WASH interventions and ensuring gradual transformation. Figure 1 below reflects the major focus during the project intervention.

Figure 1: Conceptual framework of the dynamic of water security and sustainable growth

Process to attain sustainability

The main aim of the project was to achieve sustained improvement in water, sanitation and hygiene (WASH). In order to achieve the WASH improvements, a list of activities were successfully conducted within the project areas as listed in table 2 below.

Table 2: Project Achievements

Hardware Interventions and achievements	Software Interventions and achievements
· Regional Resource Centre establishment - 1 · BSF entrepreneurship established – 1 · WASH-Mart establishment – 6 · Household toilet construction (improved permanent latrines) – 6108 · Public toilet construction and maintenance – 6 · Construction of 29 ECOSAN, 4 ECOSAN with biogas attached and 332 biogas attached toilets · Demonstration plot for urine application – 2 · WATSAN improvement in Health Posts – 3 · WATSAN improvement in schools – 58 · Rehabilitation of Water Sources using WSP– 6 · Ramghat Water Supply Scheme – 1 · Promotion of PoU options in school catchment areas – 3480 · Construction of Waste burning chamber – 2 · Declaration of SWASTHA communities – 10 communities in 5 VDCs · ODF declaration – 5 project VDCs and 3 wards of Birendranagar Municipality along with facilitation on ODF declaration at Maintada VDC	· Project launching workshop (6 times) · Awareness raising campaigns (86 events) · Documentary Shows (20 times) · Drama (28 times) · BCC trainings (12 times) · SLTS trainings (8 times) · WASH training for local stakeholders (17 times) · WASH training for school children (58 times) · WASH orientation at school (167 times) · District WASH Conference – support to DWASHCC · Post ODF workshop (12 times) · Training on WASH-Mart (2 times) · National conference of Junior circle of Nepal red cross society- support to NRCS	· District WASH exhibition (2 events) · ICS training (2 times) · Mason training (2 times) · O&M training (7 times) · WSP training (3 times) · ECOSAN trainings (6 times) · HWTS training (1 time) · WASH training for HHs (82 times) · Community mass meetings/ FGD (266 times) · BSF training (2 times) · Refresher trainings (23 times) · School review program (6 times) · Project closing and dissemination workshop (6 times)

At the completion of the project, it has been recorded that total 39,391 people benefitted from the software intervention programs while around 47,000 were benefitted by the hardware interventions. Among the total, it was found that around 48% of the benefited individuals were female.

In order to attain the sustainability of the project, four major aspects were focused on. This included; 1. Social/ Environmental aspect; 2. Institutional aspect; 3. Technical aspect and 4. Financial aspect. Under each aspect, following mechanism (Figure 2) were undertaken to achieve the expected results and maintain sustainability.

Figure 2: Aspects focused by Su-Swastha project to attain sustainability

Challenges

The major challenges identified during the project implementation were:

- Due to scarcity of water, local people were demanding large scale water supply schemes.

- Local people practiced using household water treatment options such as Piyush, Water guard when there is epidemic. Otherwise, they consumed water directly from the source without any treatment options.

- Emphasis on sanitation overshadowed safe water promotion.

- Decreasing participation on V-WASH-CC meetings due to long distance and lack of financial benefit.

- Unhygienic toilet conditions due to lack of water.

- Frequent transfer of VDC secretaries and CEO of municipality.

- Frequent strikes and unsustainable political situation.

Efforts on Overcoming Challenges

The challenges were jointly overcome in coordination with RMSO, DWASHCC, VWASHCC, entrepreneurs, institutions and local community. Few challenges like lack of water, flood, transfer of government officers, unstable political situations were outside the reach.

For the demand of large water supply schemes, ENPHO facilitated the VDC to coordinate with RMSO and DDC on meeting their needs. RMSO and DDC were reached with the problems on water supply during the ODF declaration events and through formal letters. VDCs have initiated on separating certain budget for small water supply schemes and sanitation activities. Even RMSO separated budget for water supply schemes for Mehelkuna VDC at the end of 2013.

Safe water promotion at the Su-Swastha communities reached 100% coverage as per the project target. However, in order to overcome the challenges on safe water promotion at non-Su-Swastha communities, SWASTHA approach on cluster basis could be influential. Water users’ committees are cooperating and have taken the responsibility on information dissemination towards safe water promotion.

Learning/ Strategy on WASH Improvement

WASH has been the visible issue in rural Nepal; directly affecting human health and livelihood. Throughout the project implementation, various strategies have been applied to change the behavior of local people towards achieving safe water consumption, better sanitation and improved hygiene. Strategy used on one cluster/ tole did not work in other due to their geographical condition, ethnic background, changing livelihood, cognitive behavior, conservative thoughts, educational standard, interest, and profit-making mind-set.

It has been observed that minimum three working team was required to make any approach or strategy successful. As per the experience of Su-Swastha Project, the following team listed in table 3 below has supported on achieving success of the project. The main motivation for the team on engaging throughout the project duration were exposure visits, recognition and appreciation.

Table 3: Collective Team Effort Engaged in Su-Swastha Project

S.N	VDC/ Municipality	Effective Working Team
1	Ramghat VDC	Mothers’ Group, WWASHCC, FCHVs and youth clubs
2	Kalyan VDC	Child clubs/ school teachers, FCHVs, Mothers’ Group
3	Mehelkuna VDC	FCHVs, Child clubs/ school teachers, Mothers’ Group
4	Sahare VDC	Child clubs/ school teachers, WWASHCC, FCHVs, Mothers’ Group, VWASHCC core team and youth clubs
5	Kaprichaur VDC	Mothers’ Group, WWASHCC, Child clubs/ school teachers and VWASHCC monitoring team
6	Birendranagar	WWASHCC, Child clubs/ school teachers, TLOs, FCHVs and Mothers’ Group

- Safe water promotion

Safe water promotion has been effective at the schools, its catchment areas, WSP implemented communities and Su-Swastha Communities. It has been found that 100% households within the Su-Swastha Communities and 100% schools within the intervention areas have awareness on PoU options and were using filters before consuming water. The major reasons behind this were:

1. Provision of filters

2. Free supplies and distribution of Chlorine solutions during monsoon

3. Agreement binding the committees on providing safe water

4. Demonstration of P/A vial water quality tests

5. Adopting the lessons learnt

Though similar approaches were applied at the HHs of non-Su-Swastha communities, the promotion were limited due to the lack of committee formation, lack of regular monitoring and no provision of filters; as done in the above mentioned focused areas.

It was found during the impact survey that among 43.7% HHs that did not treat their water, only 27% of them had lack of knowledge on getting access of PoU options. However, it has been found that they knew about the consequences of drinking untreated water. It has been observed that neighborhood and presence of at least four to five active and influential social workers, political leaders and youths inclined towards WASH promotion supported on bringing change in the community.

It has been clearly detected through the health post records that the use of PoU options was one of the major reasons behind the significant reduction on water borne diseases. Apart from that the initiation of Water Safety Plan for local sources has helped local people on understanding the need of hygienic condition of the water sources. The best learning among all was the increase in awareness among the people of Su-Swastha community on adapting the behavior of safe water consumption from source to mouth.

The struggle did exist while changing the behavior at the local community level and organizational level on not promoting subsidy for the distribution of filters and chlorine solution. It has been experienced that free distribution halted the behavior change process, making the community more dependent on external financial sources. The change came with time. However, the conditions applied were the compulsory contribution or involvement of the community/ household and giving them responsibility towards the operation and management (O&M).

- Better Sanitation

Toilet promotion without subsidy at the areas lacking water supply was a challenge in itself. However, government pressure, achieving total sanitation targets and motivation to the VWASHCC after the declaration by the GoN were few factors initiating the top-bottom approach. Among all, one of the strict method was sanitation card promotion which was distributed to the household with improved latrines. VWASHCC and MWASHCC published pamphlets and announced through local radios that all facilities and citizenship cards provided by the VDC and municipality offices would be halted to those not having the sanitation card.

The interest on biogas toilet was tremendous due to the increased government subsidy (up to NRs 30-35,000). This interest was huge at Ramghat VDC while only selected farmers preferred ECOSAN. Gender friendly urine diverting toilets and urine application on different vegetables were experimented at two schools of the project areas. This initiation is expected to have tremendous increase on the interest of local farmers on using urine as fertilizers.

It has been experienced that making latrines sustainable required firstly the ownership, secondly the responsible unit on monitoring the system and thirdly the school assistant with hands-on competency on dealing with minor technical problems and maintaining the hygienic conditions on a regular basis. It has been found during the observation of the school latrines that accumulation of minor negligence has resulted in closing out or not using the latrines.

Apart from toilet promotions, solid waste management and waste water management have been achieved through the involvement of Su-Swastha Community Promotion Committees and community mobilizers. Solid waste management have also been focused at the school through School Management Committee (SMC) and child club members. The most effective awareness material on promoting sanitation has been documentary shows. Mason trainings and refreshers have added the value on further supporting the promotion.

- Improved Hygiene

Hygiene improvement has taken speed due to school children and child club members. Continuous hand-washing trainings, school cleanliness and installation of child friendly hand-washing provision have resulted in the increased hand-washing behavior. It was also found that 100% hand-washing facilities was available at Su-Swastha Community due to the active involvement of the committee.

Conclusion

In order to overcome the issues raised at the project VDCs, various strategies have been adopted – these include making the voice of the community heard, effective involvement of influential political leaders, mobilizing diverse staff, organizing refreshers training, O&M training, exposure visits wherever required and conducting mass orientations from motivational experts and regular coordination meetings with VWASHCC.

Community contribution, involvement of committees/ institutions on fund mobility and their participation on decision making have resulted on speeding up the WASH improvements with high level of transparency. On top of that regular meetings, refresher training and exposure visits have motivated the committees to support the project selflessly for the community benefit. Fund management and use of collected fund for the community were the best examples set by the project.

The guidelines, strategies, policy formulation, plans and manuals prepared through the project are expected to achieve project sustainability and long-term benefits for project areas. For the sustainability of safe water consumption practice and improved sanitation and hygiene behavior, it is essential that post-project evaluation should be conducted so that it’s the project experiences could benefit other similar projects in Nepal.

[1] GoN (2011) Water Supply, Sanitation and Hygiene: Sector Status Report, May 2011. GoN: MoPPW, DWSS and SEIU.

[2] MoHP (2007) Nepal Demographic and Health Survey, 2006. New Era and Marco International Inc. Kathmandu: New Era, Nepal.

[3] NMIP/ DWSS (2011) Nationwide Coverage and Functionality Status of Water Supply and Sanitation in Nepal: Final Report. Kathmandu: NMIP/ DWSS

[4] SACOSAN-V (2013) Country Paper on Sanitation. Kathmandu: SACOSAN

[5] The Guardian (2013) Nepal Focuses on Management of WASH Project to Tackle Child Diarrhea. Accessed from http://www.theguardian.com/global-development/2013/jan/04/nepal-improved-management-projects-diarrhoea [Accessed on 11th March 2015]

[6] UNDP (2009) Nepal’s Human Development Report. Kathmandu: UNDP

[7] NMIP/ DWSS (2010) A Survey Report on Nation-Wide WATSAN Coverage and Functionality. Kathmandu: NMIP/ DWSS

[8] UN Millennium Project (2005) Health, Dignity and Development: What will it take? UNDP

[9] Water Aid (2015) Healthy Start. Published on March 17, 2015. [Accessed from http://www.wateraid.org/us/news/news/one-in-five-newborn-deaths-in-developing-world-could-be-prevented-with-wash Accessed on March 26, 2015]