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