Session on Community Approaches to Sanitation and Hygiene
Seven country reports summarised histories of sanitation programming. Some highlights are these:  Bhutan -- Until 2008 we did top-down programming, but we shifted to community-based approaches. We are now in the 7th year of this phase. Our approach has four components: governance, demand creation, establishing a supply chain (training village masons), and behaviour change. We are not ‘naming and shaming’. Villages in Bhutan are very far from cities, so local services are important. India – We are trying for ‘really good, sustainable sanitation’. We are trying to understand how to do that. We are using social media, forming networks of champions. We are trying to educate key stakeholders, especially DC’s, District Collectors, and other administrators and leaders about what it means to use ‘community approaches’. We need to define what a minimally ODF community is. We are trying to be sure that what we claim is closer to the truth this time than in former campaigns. India doesn’t have the NGO’s that Bangladesh has. We are asking ourselves, ‘How can government staff serve as foot soldiers’? Two possibilities are: set up trainings and enroll people, and link performance to incentives of some sort. Nepal – ‘Sanitation commandos’ are selected by government WASH coordination committees. Striving for urban ODF is a big challenge. A lesson we have learned is to ‘recognise local energy’. Afghanistan – In 2004 there was the first government endorsement of a sanitation policy. Large-scale implementation is yet to occur, but communities are not just sitting and waiting for the government to do something for them. They are taking initiatives on their own. ‘Traditional gardens’ using human waste as compost are being revived. Pakistan – This report was provided by Tanya Khan, the WSSCC representative, not by a government official. Our seven provinces are diverse. Unimproved sanitation is still a big challenge.  The Public Health Engineering Department has formed a Community Development Unit. We are making the shift from hardware to software (messaging). It is happening. The policy in Pakistan is to invest in training public sector government workers – teachers, nutrition workers, female health workers, and so on. Each village is visited by teams including both women and men. Reaching men is necessary, because they do the financial decision making.

Session on Innovations
Bangladesh Department of Public Health Engineering representative described five technologies proven effective in flooded, water-logged, and erosion prone areas: combined offset and single-pit latrines, urine diversion systems, eco-san, drum latrines, and clay pots (motka). The clay pots are not recommended.

Session on Sanitation in Hard to Reach Areas
A Sri Lanka sociologist, N.I. Wickramanasinghe, discussed a case of a hepatitis-A outbreak in the town of Mahapola. The cause of the problem was lack of sanitation facilities in tea plantations upstream on tributaries to the Mahawali river. 245 families were not using toilets, and awareness of WASH was very low. Medium-term solutions were handled by the Health Department. Long-term, the National Water Supply and Sewerage Board. A water safety plan was developed. 50 toilets were installed. A housing development cooperative society was established on every estate. This case shows the need to consider the impact of poor sanitation on whole watersheds.

Presentation by Dr. Seetharamji, of the Swami Vivekananda Youth Movement, a group of doctors doing health, education, and social empowerment programs in Karnataka State, India
They worked with a population of displaced scheduled castes and indigenous people who had been moved out of their forest homeland after the government designated it as a ‘forest-protected area’. They were suddenly exposed to modern life. Their old system of rituals (getting ‘permission from gods’) was totally disrupted. ‘We spent time with the tribal people, in order to understand their customs. Then we did behaviour change communication in ways that suited them. Committees were formed. We introduced the concept of ‘child rights’. We did water testing and showed them the results. We showed them a variety of toilet models, all made with local or recycled materials. There is a state rule setting side 3% of [revenue] for the use of people with disabilities. We helped get some of those funds to them.

Session on Community Approaches to Sanitation
Nipun Vinayak, Government of India: We don’t want to force ‘community approaches’ – i.e., self-help, no incentives, etc. People are used to getting help. Poor people need help. In stage-2 of our Swachh Bharat Mission we are asking the state to roll out programmes at the sub-state levels. We are constantly cautioning states not to go after numbers. We are trying to ‘share their burden’, help them to perform rather than having them chase targets. Robert Chambers raised the point and the question: Every country, any campaign, has exaggerated top-down targets, despite the fact that local processes work best without them. What is the best way to navigate this inevitable tension?