Promising Pathways

By Milward, Pradhan and Pasteur

What does it take to address poor sanitation, and the multiple health and livelihoods issues associated with it, at a large scale? How can Community Led Total Sanitation (CLTS) be operationalized at national and subnational levels? What do the strategies for achieving exponential growth of Open Defecation Free (ODF) communities look like?

CLTS is a rapidly growing approach to solving the widespread sanitation challenges of the developing world. It is an approach that is proving to be effective in country after country, but most experience with the approach to date has been in a relatively bounded, project-based framework. This book looks at a particular experience in Madagascar of taking CLTS to a much larger scale. The Global Sanitation Funds program in Madagascar, the Fonds dAppui pour lAssainissement (FAA), is in the midst of a remarkable process currently producing thousands of ODF villages, which combine to make ODF communes and ODF districts.

Promising Pathways describes some of the mechanisms that have evolved to put this process into action, focusing on innovative strategies and models for scaling up. It identifies and highlights features of the actors and the institutional environment that are key to emerging successes. And it pulls out the lessons that can be applied in other settings where MDG targets for sanitation have not yet been achieved. These lessons are clearly situated in the framework of the bottom-up and community-led principles underpinning the CLTS process. Based on fieldwork conducted at community and national levels in Madagascar during 2013, the research for this publication was guided by Kamal Kar, founder and pioneer of CLTS, and conducted by a CLTS Foundation team.

CLTS Foundation is an association of like-minded development professionals and practitioners, focusing on issues around rural and urban sanitation globally. It strives to create a world free from open defecation by means of collective behavioral change of the empowered local communities through capacity building, providing technical support, and influencing national strategies and policies of the countries. The foundation also undertakes research and action-learning initiatives focused toward poverty reduction, rural and urban livelihoods, and governance issues, with CLTS as an entry-point strategy. It is a trust (trust registration no. 03956) being managed by a board of trustees and headed by a chairman with headquarters in Kolkata, India.

CLTS Foundation
CB 88, Sector 1, Salt Lake
Kolkata Pin 700064
India
www.cltsfoundation.org

• Language: English
• Publisher: Partridge Publishing India
• Release date: Oct 10, 2016
• ISBN: 9781482873948

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Copyright © 2016 Milward; Pradhan; Pasteur. All rights reserved.

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CLTS Foundation

Registered Office:s

R 109, The Residency, City Centre

Salt Lake, Kolkata, Pin - 700064

India 

Operational Office:

CB 88, Sector 1, Salt Lake

Kolkata, Pin - 700064

India 

Website: www.cltsfoundation.org

Email: [e-mail]

© CLTS Foundation

This book has been published by CLTS Foundation jointly with CLTS Foundation Global and Fonds d’Appui pour l’Assainissement a (FAA) Madagascar.

All rights reserved. No part of this publication may be reprinted or reproduced or utilized in any form or by any electronic, mechanical or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system without the written permission of the publishers.

Cover Photo: Kamal Kar

The Global Sanitation Fund (GSF), a programme of the Water Supply and Sanitation Collaborative Council (WSSCC), supports the Ministry of Water policies and makes efforts to improve sustainable access to basic sanitation and good hygiene practices. The GSF focuses on promotion, social marketing and awareness building, particularly for women, girls and the poor in rural and informal settlements. In Madagascar, Medical Care Development International (as the Executing Agency) manages GSF implementation through grants to NGOs. The Executing Agency monitors and reports on implementation and impact on behalf of WSSCC. Australia, the Netherlands, Sweden, Switzerland, and the United Kingdom have contributed to the Global Sanitation Fund.

CLTS Foundation (based in Kolkata, India) strives to create a world that is free from the problem of open defecation and works toward a zero contamination target through the introduction of improved hygiene practices. In its work, CLTS Foundation focuses on collective behaviour change with the aim of realizing a clean and healthy environment for all, while also empowering local communities. The Foundation believes that this process has bearing on the sustainable improvement of living standards and supports a system that offers dignity for all, including safer conditions for women.

CLTS Foundation achieves its work through an international team of professionals, practitioners, researchers and policy experts in order to build capacity and influence policy for enhancing access to sanitation through CLTS.

This publication was made possible through support provided by the Fonds d’Appui pour l’Assainissement a Madagascar, a sanitation programme funded by the Global Sanitation Fund.

The opinions expressed herein are those of the authors and do not necessarily reflect the views of the GSF or WSSCC.

CONTENTS

Authors

Acknowledgements

Acronyms

Foreword

Executive Summary

1. Introduction

1.1 Why Madagascar?

1.2 How can the FMM Madagascar experiences be used?

1.3 Research methodology

1.4 Structure of the document and reading guide

2. Establishing an enabling institutional environment

2.1 Effective structures for programme implementation

2.2 The Diorano WASH

2.3 Evolving role of the Programme Coordinating Mechanism

2.4 Strengths of the Executing Agency

2.5 Capacity building for sub-grantees

2.6 A learning environment

3. Dynamic strategies and innovative models for achieving change at scale

3.1 The U approach: Systematic leveraging of institutional advantage for scale

3.2 Institutional Triggering

3.3 Direct support from the sub-grantee in the scaling up process

3.4 Expanding the base of implementing actors

3.4.1 Natural Leaders

3.4.2 Community Consultants

3.4.3 Champions

3.4.4 BCC experts, local technicians, masons

3.4.5 Monitoring committees and the follow up ‘push’ (mandona)

3.5 Collaborations amongst a range of actors to reach scale

3.5.1 Collaboration between sub-grantees and Diorano WASH

3.5.2 Collaboration between sub-grantees and other implementing actors in sanitation

3.5.3 Collaborations between SGs and the regional and district administration

3.5.4 Collaboration with schools, churches and other local actors

3.6 Leveraging traditional structures and cultural processes

3.6.1 Active involvement of traditional leaders

3.6.2 Understanding the authority structure - the Ampanjaka

3.6.3 Working to change custom

3.6.4 Using songs as a vehicle for spreading the message

4. Participatory technology development and challenging the prototypes

4.1 The FAA approach to technology improvement and the sanitation ladder

4.2 Building on available technology options

4.3 Innovations for technology adaption

4.4 Breaking the inertia caused by subsidy

5. Building a learning organisation

5.1 Mechanisms for systematic sharing of best practices

5.2 Creating model villages as local knowledge hubs

5.3 Recognising and creating space for exchange of technological knowhow

5.4 Capturing and communicating health outcomes

5.5 Tracking knock-on effects beyond sanitation

5.6 Use of media tools for wider outreach

6. Working Towards Sustainability

6.1 Recognition of the programme benefits by the community

6.2 Building on Community Consultants, Natural and Traditional Leaders

6.3 Capitalizing on institutions and their actors at local level

6.4 Advocacy at local level

6.5 Creating robust institutional arrangements to ensure sustainability

6.6 Working through Diorano WASH

6.7 Continued decentralisation of Diorano WASH.

6.8 Establishing widespread knowledge and commitment to ensure quality at scale

7. Conclusion

Annex

SPOTLIGHTS

Spotlight 1: Community Led Total Sanitation

Spotlight 2: Extending the reach of the Diorano WASH

Spotlight 3: The changing role of coaches

Spotlight 4: Picture of a local level Institutional Triggering

Spotlight 5: Sub-grantee MA RINTSOA NGO's direct support inputs in the scaling up model

Spotlight 6: Success strategy in Vatovavy Fitovinany - AINGA MADAGASCA NGO

Spotlight 7: Actor conflicts and the magic of the Diorano WASH: MAMIZO collaborates in Antsinanana Region

Spotlight 8: School sanitation links in Itasy Region

Spotlight 9: Key strategy: Triggering the Tangalamena

Spotlight 10: Reinventing tradition: The Diorano WASH argues the case for latrines

Spotlight 11: Challenges of scaling the sanitation ladder: a picture from Antsinanana

Spotlight 12: Solving technology problems: Designing a light and strong model in Itasy Region

Spotlight 13: CLTS success where subsidy failed: Manakakora village, Ifanadiana District

Spotlight 14: Women, men and children catalogue the benefits of ODF in Vatomandry District

Spotlight 15: Soanambo the wonder fruit to mitigate hunger during food scarcity periods

Spotlight 16: From OD zone to eatery

Lessons

Lesson 1: Establishing an enabling institutional environment

Lesson 2: The WASH Coalition

Lesson 3: A national decision-making body: the PCM

Lesson 4: The role and features of the Executing Agency

Lesson 5: Responsive capacity building

Lesson 6: Using a culture of shared learning to solve problems

Lesson 7: Applying a scaling up strategy

Lesson 8: Institutional Triggering

Lesson 9: Direct and indirect interventions and support

Lesson 10: Facilitating large numbers of actors

Lesson 11: Local and regional collaboration

Lesson 12: Engaging with the resources of culture

Lesson 13: Realities of the sanitation ladder

Lesson 14: Local approaches to the sanitation ladder

Lesson 15: Working with communities which received free sanitary hardware

Lesson 16: Sharing and learning

Lesson 17: Model villages

Lesson 18: Local innovation for adaptation

Lesson 19: Monitoring health outcomes

Lesson 20: Tracking knock-on effects

Lesson 21: Maximizing communication

Lesson 22: Enhancing sustainability

PROFILES

Profile 1: Profile of Angela, a Natural Leader

Profile 2: Profile of a Community Consultant: Etienne andriarison, Vakinankaratra

Profile 3: Donatien: Leader of the co-operative of Community Consultants in Analanjirofo

Profile 4: Picture of a Champion: Benjamin Zafinaly, Fokontany Chief, Salehy Commune, Antsinanana Region

Profile 5: Better collaboration would benefit everyone:

Profile 6: A new FamoPlat© user: Fidy in Itasy Region

Profile 7: Migrant farmer to settled farmer: the case of Remi

FIGURES

Figure 1:Figure 1: Madagascar in relation to the African continent, and Madagascar’s 22 Regions

Figure 1:Figure 2: Key structures of the GSF programme in Madagascar

Figure 3:Figure 3: Evolution of the FAA programme for scaling up CLTS in Madagascar

Figure 1:Figure 4: Structure of the Diorano WASH in Vatovavy Fitovinany Region

Figure 1:Figure 5: The dynamic role of the PCM

Figure 6:Figure 6: The declining need for coaches for achieving ODF status

Figure 1:Figure 7: Summary of phased changes in the coach system

Figure 8:Figure 8: The institutional scaling up process of sub-grantee MIARINTSOA NGO

Figure 1:Figure 9: Multi-actor collaboration and action framework in Vakinankaratra Region   38

Figure 9:Figure 9:Figure 10: Figure 10: ODF Villages, Natural Leaders and Community Consultants

Figure 11: Figure 11: Schematic example of Ampanjaka hierarchy in Vatovavy Fitovinany Region

Figure 12: Figure 12: Figure 9: Cases of diarrhoea in Ampefy Health Centre, ltasy Region

Figure 13: Figure 13: Cases of diarrhoea and dysentery, Sahamatevina Commune, Antsinanana 2011-13

Figure 14: Figure 14: Actors involved in various phases of CLTS facilitation: an example from ASOS

Figure 15: Figure 15: Steps towards sustainability evident in the FAA programme

TABLES

Table 1: Table 1: Ranking of institutional actors in Ampasime Manantsatrana Commune

ANNEXES

1. LIST of FAA Key Persons

Authors

This study has been carried out and written by Kirsty Milward, Sisir Pradhan and Katherine Pasteur of CLTS Foundation with guidance and inputs from Kamal Kar. Written inputs were also made by several key members of the FAA team and sub-grantee representatives in Madagascar during a face- to-face meeting to finalise the findings of the study in February 2014.

Acknowledgements

The authors sincerely acknowledge the valuable contributions made by Dr Josea Ratsirarson, Dr Rija Lalanirina Fanomeza, Dr Joelina Ratefinjanahary, Dr Fano Lovatiana Randriamanantsoa, Dr Jeremia Rakotozafy, Dr Onisoa Rindra Ralidera, Dr Aime Randriamanalina and all MCDI staff. Special thanks to Mrs Michele Rasamison, Chairperson of the PCM of FAA programme in Madagascar, to all PCM members, and to the Ministries of Water, Health, Education, Decentralisation and Environment for their valuable contributions. We also thank Clara Rudholm, Matilda Jerneck and Mark Willis of GSF for their consistent support, and MCDI home office staff.

Special thanks go to all respondents to this research at local levels who hosted our visits with such warmth and endurance: thanks to sub-grantee staff at MIARINTSOA NGO, MAMIZO NGO, AINGA Madagascar, ASOS NGO, ADEMA NGO, FAMONJENA NGO, and to all of those many community members who welcomed us into their villages and answered our many questions. Lastly, we are grateful for all support and information given by Jean Herivelo Rakotondrainibe, Diorano-WASH National Co- ordinator and to the Regional WASH coalition teams in Vakinankaratra, Antsinanana, Analanjirofo, Vatovavy Fitovinany and Itasy Regions. And finally, we are deeply grateful for Jean Clement Andriamanampisoa, translator and cultural advisor, without whom little of the following would have been understood. We apologise for not being able to mention here the names of many others who contributed directly or indirectly to the study but we thank them for all their efforts and input.

Acronyms

Foreword

Kamal Kar

It is a pleasure to put on record here that the work of scaling up CLTS by a group of committed institutions and individuals under the Fonds d’Appui pour l’Assainissement (FAA) programme in Madagascar, and the progress made over the last three and a half years, is simply outstanding. This work needs to be shared for the benefit of many countries in Africa and Asia.

The publication of this document, Promising Pathway, which shares this recent experience and innovation, is especially timely because there are now less than eighteen months before the MDG time limit is over, and most countries in Africa are off-track on targets for sanitation. I sincerely feel that some of the scaling-up strategies and approaches used in the FAA programme in Madagascar, if backed by a strong political will, offer other countries in Africa the possibility not only of achieving their MDG sanitation target, but also of moving closer to achieving ODF nations.

I was personally involved in the introduction and initial scaling up of CLTS in more than 30 countries in Eastern, Southern, Central and Western Africa, starting with the first pan-African ‘hands-on’ training workshop in Dar es Salaam, Tanzania followed by another in Awasa, Ethiopia in 2007. The spread of CLTS all over Africa has been fascinating and exponential and has overtaken Asia both in terms of area coverage, quality and innovation. Madagascar is one of the few countries in Africa, which I visited more than once and rendered hands-on training, post-training follow-up, advocacy and institutional handholding support. My first visit was in 2011