Interview: Changing the sanitation mindset

12 September 2011

Approximately 20% of the population of Nepal does not have access to safe drinking water. And sixteen million people (more than half the population) do not have toilets. The result is regular and massive outbreaks of water-related diseases that cause thousands of deaths annually.

The Millennium Development Goal targets are that by 2015, 68% of the population should have access to safe drinking water, and 53% should have access to sanitation services. These goals are modest, but seem attainable. By contrast, Nepal’s own national goal of universal water and sanitation coverage by 2017 is far more ambitious, and it is a challenge that some are determined to take on.

In 2008, Abadh K. Mishra became the Director of the Regional Monitoring and Supervision Office (RMSO) in the Midwestern Development Region of Nepal. Here, he successfully mobilised all stakeholders – including the government, development agencies and the local communities – behind one coordinated approach to improve access to sanitation. In June 2011, he was transferred to the Western Development Region to begin replicating his approach there.

Capacity.org asked him about water and sanitation in Nepal.

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What did you encounter when you started out in the Midwestern Development Region?

Soon after I arrived I was confronted with an outbreak of diarrhoea. Over the course of a month, more than 300 people died. Most of the deaths occurred in two districts, Rukum and Jajarkot. The outbreak was caused when people used contaminated water – and this was directly linked to a lack of adequate sanitation. The villagers did not realise that defecating in the open contaminated drinking water. They just did not make that connection.

It was the responsibility of my office to supervise all water, sanitation and hygiene (WASH) activities in the region, so the onus was on me to do something about this outbreak and to prevent further outbreaks. I started talking to all stakeholders including development agencies, district governments, village governments and community-based organisations.

The first thing I discovered was that although development agencies had been working on various water and sanitation projects over the years, very little headway had been made. All these organisations had their own models and approaches, but there was no coordination between them, and each was convinced that their model was the best. They never worked jointly at any level or pursued a common goal. Even though significant resources were available for sanitation, we were not achieving results.

The second discovery I made was that WASH activities were implemented only in certain villages, and the selection of these villages was not coordinated. All the resources were being spent in some villages, while others received no funding.

The third aspect of the problem that became clear was that there was virtually no community participation. The projects were being implemented by government and development organisations, and the Village Development Committees (VDCs) were not actively involved.

What did you do to change this?

We needed to change the mindset of everyone involved in WASH. Because sanitation is heavily dependent on changing behaviour, we felt that a social movement would be more effective than a series of projects. So we shifted our focus away from implementing projects and launched a social campaign.

The core values that drove this movement included health, self-respect, prestige and the formation of a civilised society. We developed a network of platforms from the regional to the village level. We did this by setting up ‘coordination committees’ at the regional, district and village levels, called respectively, RWASH-CC, D-WASH CC and V-WASH-CC.

The R-WASH CC brought together the main development agencies and the regional directors for education, health and forestry. We held a two-day workshop in June 2010, with the slogan, Aligning the action to make diarrhoea epidemics history’. The members signed a declaration and a pledge to collaborate, and to manage the resources in accordance with local needs. Actually, it was not so difficult to achieve consensus at the regional level about collaboration. They were quite forthcoming. All they needed was a legitimate government agency to take the lead.

At the district level, the Water Supply and Sanitation Division offices set up the D-WASH CCs along the same lines. These coordination committees met regularly and prepared district strategic plans for sanitation, to which all stakeholders at the district level were committed.

Finally, the V-WASH CCs were set up in the villages. Our aim was to start working with all the VDCs, not just with a few, as had previously been the case. Of the 575 VDCs in the region, 300 managed to establish V-WASH-CCs. But the process was far too slow to allow us to expect to achieve our 2017 WASH targets.

At the district and village levels, we invested a great deal in training and raising the awareness of local government staff, the media and political party leaders. There was general consensus that sanitation required a movement, not a project or programme, and that this movement should start in the villages and be led by the V-WASH CCs. And this is how it works in practice. Whatever happens in the village that is related to WASH is started by the V-WASH CCs. The VDC chairman is in charge of coordination – and they are doing a good job.

No social movement is complete without the involvement of politicians. It was not easy to get the political leaders to buy in though. Many of them thought that it was not possible to organise a movement for the construction of toilets. We managed to convince them by pointing out the numbers of lives that would be lost if we did nothing, and the huge economic disadvantages.

How did this network of politicians and platforms trigger a social movement?

The people spearheading this movement are the sanitation facilitators in the villages. When we train the people in the V-WASH CCs, we ask them to select sanitation facilitators to work at the village level. They choose energetic, dedicated and self-motivated people who are able to devote time to the society. They are given four or five days’ training at the district level, after which they return to their VDCs and start the work of training the local people and raising awareness of the importance of water and sanitation.

Village sanitation facilitators generally work on a voluntary basis and are usually given some modest incentives such as food, lodging or transport allowances – or sometimes simply recognition by the VDC or the V-WASH CC. Sometimes the regional office gives a nominal payment of US$1.5 to US$3 for raising people’s awareness and for the monitoring of every toilet that is constructed. This is in acknowledgement of the long hours that some village volunteers put in – sometimes working from first light until dusk. It is an arrangement that has worked very well and we have decided to replicate the model in the other regions.

Where do the resources come from and how is allocation organised?

Our regional office is funded by central government. We also have a budget for promoting sanitation activities. This is complemented by local government contributions and the support of development partners working in WASH. The VDCs have their own budgets and we are asking them to set aside a portion of these especially for water and sanitation. They used not to do this, but the training sessions we ran for the VDCs persuaded them to start allocating funds for WASH.

We try to bridge the gap where the VDCs don’t have the resources to set anything aside for WASH. We have also decentralised budget allocation to the villages. This approach has generated a feeling of local ownership of sanitation, and local groups have assumed responsibility for hygiene promotions aimed at stopping defecation in the open.

Local bodies and local politicians influence local people and help to form local opinion. As a result, sanitation coverage is scaled up and there is a visible impact within a short period. In addition, competition is also created between the VDCs to declare themselves ‘open-defecation-free zones’ or ‘ODFs’. This became a matter of pride at district level. One thing we have stopped doing is subsidising the construction of toilets. It obstructs the whole movement approach.

Because government is not providing enough funding to accelerate this movement, we need outside support. Two development partners, UNICEF and SNV, have a very important role here. Over the past 15 years, UNICEF has been involved in sanitation in eight of the 15 districts in the Midwestern Region. In the other seven, UNICEF and SNV are taking care of what is called the ‘soft’ part, which includes capacity development training and workshops.

SNV does not donate funds directly. Rather it provides personnel who have expertise in the water sector and in sanitation engineering, etc. To develop the capacity to fight diarrhoea epidemics effectively and to make this movement a success, we need both financial aid and technical support.

We use a mixture of techniques to promote sanitation in the communities. These include mobilising definable groups such as youth clubs, mothers groups, culture groups, journalists, community health workers and political parties. We try to promote awareness through reward and recognition schemes, through community pressure and ‘blaming-and-shaming’ campaigns, and by encouraging local bodies to enforce restrictions. We have also discovered that infotainment – using entertainment to disseminate information – is an effective way of getting the message across.

What results have you seen so far?

Sanitation has become an important topic. Political leaders, the media and people in the villages are talking a lot about it. The D-WASH CCs and V-WASH CCs take their responsibilities seriously and develop and implement their own strategies and action plans. Sanitation coverage is increasing day by day. According to the Midwestern Regional Health Directorate’s 2009–2010 annual report, the number of deaths caused by diarrhoea is decreasing steadily.
 

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Interview conducted by Heinz Greijn, Editor-in-chief, Capacity.org

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