They are doing a fine job of crowd control here in Chapel Hill today. Despite all the organisers’ concerns about huge numbers overburdening the venue, they’re taking good care of us all. Breakfast sweets and coffee, midmorning snacks, big lunches, end-of-day snacks big enough for dinner, on and on. Poster presenters wait eagerly in the lobby for people to stop and talk with them.

I had lunch with a young woman working on new WHO sanitation guidelines that will be comparable to the drinking water guidelines. She said they expect to finish up in January 2017. This is separate from the JMP indicator-development work I wrote about yesterday. I asked her if her group is thinking about latrine sharing, which is not getting much attention on any front but is the dominant mode in slums and extended family compounds. She said they are thinking about shared facilities, but there aren’t any decisions about them yet. She had not yet heard that the JMP’s new definition of an ‘improved’ toilet now includes safe sludge management.

And, speaking of sludge management, someone in one of the sessions mentioned that in southern Madagascar it’s considered wrong to bury faeces, because the underground space is the resting place for the dead. It is necessary for field-level workers to be sensitive to this cultural concern, she said, but didn’t explain how to get around it and also comply with sanitation standards. Jamie Bartram commented that he had heard the same issue mentioned in Latin America.

Most of my day was spent on CLTS. There was a long morning session on scaling-up, a paper on CLTS during one of the sessions, and a plenary talk by Dr. Kamal Kar of the CLTS Foundation in the late afternoon. The Session on Scaling-up CLTS was a report-back on a group of evaluation studies done jointly by Plan International USA and the UNC Water Institute in ten countries. Both organisations agreed that it had been very challenging to combine field-level implementation with rigorous research study design. But this group of studies raises important issues that need attention as sanitation programmes expand to national-scale. Each country programme, while calling itself “CLTS,” had its own approach and definitions. Even “ODF” means different things in different programmes. Some are working with government officers. Other stay at the village community level.

Like the plenary speaker yesterday, researcher Jonny Crocker (UNC) talked about the actual costs of social mobilisation programmes, specifically CLTS – costs borne either by donors (external agents), by NGOs, by local governments, or by households. He said the study team had gone to great pains to figure out just how much money all aspects of the CLTS process had cost. One comment by Prof. Jamie Bartram, head of the Water Institute, was, ‘We’ve been too simplistic about costs’. The no-subsidy concept isn’t helpful, he said. There are costs borne by different actors. This matter turned into a theme of sorts through the day. Later in the day, after Kamal Kar’s presentation, Jamie Bartram asked Kamal Kar this question: ‘What do you call a subsidy?’ Dr. Kar answered, ‘Just up-front giving toilets or money to buy them to individual households’. Other facilities, such as schools, obviously need funding, Dr. Kar said.

Another theme of the day was government action and actors, who will be more in the forefront of programme implementation in the future. A Kenya programme evaluation focused on local government. In 2011 Kenya shifted responsibility over to government away from NGO’s, whose work was considered ‘not scalable’. So Plan trained government officers from multiple ministries in some skills needed to do participatory planning and social mobilisation for total sanitation. Researchers followed the trainees for 18 months, to see if/how they benefitted from the training. They also were eager to see what enabled or constrained the officers when they set out to apply what they had learned. They found their teamwork skills improved, but community-level data collection was not strong, so monitoring skills might not be good enough. ‘Supervisor inflexibility’ and differences among the rules and procedures of different ministries also were problematic. But Plan’s training was found to have encouraged the trainees to ‘sensitise their supervisors’ and to advocate for county governments to change policies.

Peter Lochery, of CARE, observed that the tendency has been for NGOs to create programmes and hand them over to government, rather than working along with government from the start and thus strengthening government’s capacity. (This assumes that government wants advice from NGOs, which probably isn’t always true.)

The potential of government officers to play a direct role in scaling up came up in Kamal Kar’s presentation. The CLTS Foundation, he said, is now developing a method called ‘institutional triggering’. Institutionalisation and scaling-up, he said, are more challenging than introduction, because ‘other actors must trigger at different levels’, if whole districts, regions, and nations are to become ODF. He showed a picture of some district officers going through a new version of the shaming exercise. A map of the country was drawn on the floor. Each district officer stood on the part representing his or her district. Each called out how many (or how few) ODF villages there were in the district, and the differences among them became evident.

In an afternoon presentation Aftab Opel, working in Lao PDR with SNV, talked about CLTS programmes being implemented entirely by government officials. As he put it, ‘There is no space for social mobilisation in Laos. Government remains the main driver’. SNV supports government’s work with various kinds of capacity-building activities (training?), at monthly meetings o a national-level WASH technical group, and by working with latrine parts suppliers to arrange group discounts for customers. The National Center for Water and Sanitation is under the Health Ministry in Laos, but provincial governments do the actual sanitation promotion work, pulling in government officers from various other ministries as needed.

Vidya Venkataramanan is a UNC researcher working on the Plan-UNC study in seven countries (Haiti, Niger, Uganda, Nepal, Cambodia, Laos, and Indonesia). She urged us to think of CLTS as part of a larger toolkit and to target communities where this method is appropriate. This suggestion makes sense to me too. As many now recognise, the social processes on which CLTS depends presume some degree of social cohesion; but this is not found in all ‘communities’. 

At the end of the day there was a reception, where we played a bowling game, knocking down myths about menstruation and leaving bottles with accurate information standing. Before we could play, we had to write ‘myths’ on pink sticky-notes and ‘facts’ on blue notes.

Suzanne Hanchett is a consultant and a partner in Planning Alternatives for Change.