Toilet touring in Uganda: experiencing the true spirit of Community-Led Total Sanitation

Date: 27th October 2015

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Patrick England, who recently joined the Global Sanitation Fund secretariat, travelled to Uganda to participate in a learning exchange mission. The mission turned out to be a unique opportunity to experience the true spirit of community-led total sanitation (CLTS). Read about his experiences below.

Visitors from Madagascar and Canada with ‘Natural Leaders’ in Amuria District – enthusiasts who volunteered to help others in their community make their latrines ODF. That’s me to crouching in the middle. Credit: Ronnie Rwanwanja

Visitors from Madagascar and Canada with ‘Natural Leaders’ in Amuria District – enthusiasts who volunteered to help others in their community make their latrines ODF. That’s me crouching in the middle. Credit: Ronnie Rwanwanja

When I first entered the field of international development, I had no idea that ‘shit’ would become a standard part of my professional vocabulary. But as a Portfolio Support Analyst with the WSSCC’s Global Sanitation Fund (GSF), my mission is to discover and document everything about shit: how communities are dealing with it, and how to support our programme partners to tackle the world’s growing sanitation and hygiene crisis. So in June 2015, I received my first opportunity to become a professional toilet tourist with the GSF during a cross-programme exchange to Uganda.

Community member from Koboko District working to make his latrine open-defecation-free (ODF). Credit: Patrick England/WSSCC

Community member from Koboko District working to make his latrine open-defecation-free (ODF). Credit: Patrick England/WSSCC

Just prior to my Ugandan journey, I was working with Concern Universal, the GSF Executing Agency in Nigeria. I supported the development of case studies and lessons learned for the GSF-supported Rural Sanitation and Hygiene Promotion in Nigeria programme, which carries out Community-Led Total Sanitation (CLTS) activities in the south-east of the country. Similar to Uganda, Nigeria’s GSF-supported programme is fully owned and implemented by government agencies. However, for local officials and civil servants, the participatory, spontaneous, and dynamic ethos of CLTS often runs in direct contrast to decades of enforcing toilet construction. Not only must CLTS trigger improved sanitation and hygiene behaviour in communities themselves, but it must also trigger government authorities to create enabling environments for communities to climb the sanitation ladder.

CLTS learning journeys converge: the GSF cross-programme exchange
Dazed after two days of travel from Calabar to Kampala, I met my new Uganda colleagues in the rural district of Pallisa. Accompanying them was a delegation from Madagascar’s GSF-supported programme. While much could be written on this band of Malagasy medical doctors-cum-sanitation crusaders, let’s just say that they definitely know their ‘shit’. For them, CLTS isn’t just an approach to increase sanitation coverage and reduce under-five mortality; it’s an action-affirmative philosophy that underpins a movement to improve the health of entire countries. Most importantly, this movement must be wholly owned by communities themselves – a point continuously emphasized throughout our district visits in Uganda.

Map of districts visited in Uganda, based on image retrieved on d-maps.com.

Map of districts visited in Uganda, based on image retrieved on d-maps.com.

Our exchange crossed the entire country – from the shores of Lake Victoria to the jungles along the border with the Democratic Republic of the Congo – working alongside District Health Office staff to improve their CLTS approach. Led by the Malagasy doctors, each visit comprised a systematic review of existing practices, a hands-on demonstration of best-practice triggering and follow-up, and a critical self-analysis by health staff to enhance their community engagement. As was the case in Nigeria where decades of latrine enforcement and health sensitization failed to achieve any notable impact, this intensive learning process focused on ‘de-programming’ the old behaviours of local government facilitators.

Representatives from Madagascar’s Fond d’Appui pour l’Assainissement (FAA) programme demonstrating CLTS facilitation in Amuria District. Credit: Patrick England/WSSCC

Representatives from Madagascar’s Fond d’Appui pour l’Assainissement (FAA) programme demonstrating CLTS facilitation in Amuria District. Credit: Patrick England/WSSCC

Compared to Nigeria, where 25 percent of the population practices open defecation, Uganda has a relatively high level of sanitation coverage (where seven percent practice open defecation)[1]. This was made evident by the number of well-built latrines I observed during our visits to rural communities. Until then, I never entertained the notion that a toilet could be beautiful: walls carefully smoothed and polished, meticulously patterned with charcoal and red mud paint, all topped with round thatch roofs. One elderly woman in Koboko District proudly demonstrated how she used a local weed to give her latrine’s mud floor a glossy sheen. However, the presence of toilets – even those ornately designed – did not mean that these communities were open defecation free (ODF). These latrines frequently went unused, especially during planting and harvesting seasons, while a lack of adequate fly-proof covers and handwashing facilities meant that these community members were still unintentionally eating their own, and others’, shit.

The crux of the issue was that facilitators conceptualized the three ODF criteria – no open defecation, fly-proof latrines, and handwashing with soap/ash at critical times – purely as a matter of infrastructure. Although households nominally met the ODF criteria, latrines that were dirty, or had drop-hole covers that did not prevent flies from entering/exiting the pit, meant that sanitation hardware acted more as ceremonial items rather than blocking the fecal-oral transmission chain.

Painted latrine in Kumi District. Credit: Patrick England/WSSCC

Painted latrine in Kumi District. Credit: Patrick England/WSSCC

A local artist painting the Ugandan coat of arms on his kitchen wall using charcoal and red mud. Credit: Patrick England/WSSCC

A local artist painting the Ugandan coat of arms on his kitchen wall using charcoal and red mud. Credit: Patrick England/WSSCC

ODF ‘in the heart’: beyond the hardware
In some cases, an engrained focus on sanitation hardware on the part of government health workers doomed the dynamic behaviour change process before it even began. In one district, where a sanitation programme recently concluded a pilot sanitation marking project, we were informed that improved latrine designs were introduced immediately following the initial triggering session. The rather naïve assumption behind this approach sounded like it came straight out of a neoclassical Intro to Microeconomics textbook: “triggering has shifted the demand curve for sanitation products to the right, so the supply-side of sanitation products should be introduced immediately”. Apart from the fact that generating demand for improved sanitation does not stop with the initial triggering exercise, the prohibitive cost of these improved facilities ($120 per toilet in some cases) discouraged communities to step on the first rung of the sanitation ladder with simple pit latrines. Moreover, instead of being grounded in local technologies, these toilets were created from designs piloted in Asia and shipped from a latrine design centre in Kampala! Despite this, the rationale for promoting costly infrastructure was conceived in order to meet the government’s own understanding of ODF, which included preventing the collapse of latrines in waterlogged areas.

As explained by the Madagascar team, the prescription of hardware or behaviour transfers the onus of responsibility of achieving ODF to outsiders rather than the community themselves. But once triggered, the community will always come up with the most novel solutions. The ‘triggering’ moment for the Amuria District staff came when a community member named Peter explained how his ODF latrine endured despite heavy seasonal rains. When asked how it was constructed, he explained that he built his latrine over a year ago with a wider superstructure, supported by a raised mound of earth, in order to prevent it from collapsing. And voilà! Here was a bonafide community engineer! At practically zero cost and with no outside assistance, Peter had built a durable, ODF latrine. What mattered was not so much the availability or affordability of external sanitation infrastructure, but the unremitting desire to not eat his, or anyone else’s, shit. Godfrey, the focal Health Inspector for Amuria District, summarized what his team had learned: “we now know that ODF isn’t just about the facilities… it’s about a mindset for both ourselves and the communities. You must have ODF in the heart!”

Singing, dancing and ‘Cotton Eye Joe’: building community trust
Another significant challenge faced by local government CLTS facilitators is their often tenuous relationship they have with communities. This is especially the case where transparent and accountable governance is particularly weak, and public service delivery is prone to abuse. In Nigeria, local environmental health officers would routinely threaten court action, solicit bribes, or issue beatings on the spot if a household did not have a toilet. In response communities would offer officials palm wine and food to avoid these heavy penalties, thereby institutionalizing graft, creating resentment, and failing to improve sanitation and hygiene. However, as the participatory CLTS approach began to transform the social contract between sanitation officers and community members, former enemies have now become allies in the mission to end open defecation. In many parts of Uganda, arrests for failing to construct toilets are still common. One community in Amuria remarked that whenever they hear a motorcycle coming from the direction of the district headquarters, they all run into the bush!

‘Community Engineer' Peter (left) signing a ‘friendship contract’ with the Amuria District Health Office staff. Credit: Patrick England/WSSCC

‘Community Engineer’ Peter (left) signing a ‘friendship contract’ with the Amuria District Health Office staff. Credit: Patrick England/WSSCC

Community members and District Health Office staff in Amuria District. Credit: Joelina Ratefinjanahary

Community members and District Health Office staff in Amuria District. Credit: Joelina Ratefinjanahary

Trust building is therefore one of the most important components of CLTS, especially when facilitated by government agencies. To help build constructive partnerships with communities, the Malagasy crew shared their own essential CLTS tool: ‘follow-up Mandona’. Mandona – meaning ‘to push’ in Malagasy – replaces traditional house-to-house inspections by bringing the entire community together to re-trigger and carry out small, independent, do-able actions creating model ODF latrines. Not only does Mandona reinvigorate collective action towards ending open defecation, but because it thrives on energy, excitement, and participation, it offers a crucial opportunity to deconstruct power dynamics and build a strong rapport with community members. Learn more about this approach and other innovations from the GSF-supported programme in Madagascar.

One of the most memorable moments was when the Madagascar team, Amuria district health workers, and one awkward Canadian built a lasting bond with a community during a Mandona demonstration. Throughout our visit, our gracious hosts welcomed us with several songs and dances. Upon request, the Malagasies happily performed a lively rendition from their own country, and soon enough, everyone was singing, dancing, and laughing together. But then they wanted a ‘muzungu’ song. The pressure was on; after the community proudly presented us with their traditional songs and dances, I needed a tune that would equally capture the infinite richness and depth of Canadian culture. It also needed to be catchy, simple, and involve some sort of interactive dance. Bryan Adams? I didn’t think ‘air guitar’ classified as a dance. Shania Twain? I unfortunately lack the vocal range. Justin Bieber? I prefer forgetting he’s even Canadian. Frantically, I racked my brain for a suitable song. I ultimately decided to go with an ice hockey game staple: ‘Cotton Eye Joe’. And there, in the middle of rural Uganda, an entire community came together with local government officials to clap hands, lock arms, and swing around in a barnyard jig.

Community members singing and dancing during a CLTS facilitation visit in Amuria District. Credit: Patrick England/WSSCC

Community members singing and dancing during a CLTS facilitation visit in Amuria District. Credit: Patrick England/WSSCC

This was of course a great deal fun, but highlighted how invaluable trust building is to effective CLTS facilitation. Immediately following our song and dance session, four Natural Leaders volunteered to assist elderly members of their community to upgrade their latrines. With smiles on their faces, the community eagerly welcomed the return of the Amuria District Health Office in two weeks when they would be completely open defecation free.

Talking about shit is always funny: District Health Office staff and community members in Koboko District. Credit: Patrick England/WSSCC

Talking about shit is always funny: District Health Office staff and community members in Koboko District. Credit: Patrick England/WSSCC

After visiting each district, the mentality of District Health Office was visibly transformed. Each internalized the ‘spirit’ of CLTS as a community-owned movement, and developed their own action plans to improve their engagement with communities. In many cases, our exchange inspired leadership. Jurna, the articulate focal Health Inspector for Koboko District, pledged to personally facilitate five communities to achieve ODF to set an example for his team.

It’s this intensive learning process that sets the Global Sanitation Fund apart. Rather than a donor-driven approach which remotely dictates programmes through rigid targets, logframes and spreadsheets (increasingly run by the burgeoning world of private development consultancies), the GSF promotes hands-on learning, sharing, and support to achieve sustainable outcomes. The organizations and agencies who work with the GSF are therefore not seen as contractors – or as ‘suppliers’ in the new and alarming development discourse – but are instead considered as partners who are afforded flexibility to adapt their programmes to their own context. Learn more about what makes the GSF stand out.

[1] See the latest data from the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation: http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-Update-report-2015_English.pdf

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