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Untangling complexity: How do we ensure we effectively reach, support and involve the most disadvantaged?

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Have had the great opportunity to take part in a workshop organised jointly by the CLTS Knowledge Hub at IDS and UNICEF, which looked at how best to support the poorest and most vulnerable in sanitation at scale.

The participants included a mix of some of the leading lights and people active in: CLTS and participatory techniques; smart subsidies; and equity and inclusion. It also included representatives of organisations implementing sanitation at scale:

  • Using CLTS with a range of supporting methodologies;
  • Using  approaches other than CLTS;
  • Those that only allow support from within the communities and local businesses and government;
  • Others that allow support from other sources external to the community and local actors.

The workshop was held in Tagaytay in the Philippines, 24 – 28 May and a number of participants took part in a pre-workshop field visit to Tacloban Province. This was hosted by UNICEF and partners to learn about the sanitation efforts that were undertaken in the aftermath of Typhoon Haiyan.   

The purpose of the workshop was to enable discussions around the challenges faced by the most disadvantaged – particularly those least able to construct, maintain and use a toilet and associated facilities; and the solutions which may be possible. This includes individuals and households within communities and those where whole communities are living in complex and challenging situations. The workshop was facilitated to enable frank discussions on sometimes challenging and sensitive issues.

Case studies of programmes shared included: The Community Hygiene Output-Based Aid (CHOBA) programme in Vietnam presented by East Meets West and the Thrive Network; a process to search for and reward communities in the Philippines with the best sanitation practices presented by the Ministry of Health; CLTS programme in Timor-Leste presented by WaterAid; a pro-poor support mechanism and an integrated WASH and agricultural vouchers scheme (NOURISH) in Cambodia, presented by the Institute for Sustainable Futures and SNV;  the Typhoon Haiyan Phased Approach to Total Sanitation (PhATS), presented by UNICEF; the Emergency Food Assistance project (EFAP) in Cambodia presented by Plan International; and the Global Sanitation Fund (GSF) programme in Nepal and the global GSF Equality and Non-Discrimination (EQND) study, presented by UN-Habitat, Nepal and myself.   

Some participants shared examples highlighting that there has been huge and significant progress at scale since the introduction of the Community-Led Total Sanitation (CLTS) approach which is based on community action and behaviour change and collective action, in comparison with what was achieved with the more supply driven approaches as applied in the past.  This in itself has benefitted many poor and vulnerable people across many contexts. But it was also acknowledged that CLTS also faces some challenges and limitations and in the context of Sustainable Sanitation Goals it is no longer acceptable to be only focussing on the easiest to reach communities and households. Also in South Asia, as increasing numbers of people gain access to sanitation on the first stage of the ladder, there is a need to investigate approaches that can support movement up the sanitation ladder to safe and sustainable sanitation, including for the poorest.  

It was also acknowledged that latrines built by or for the poorest and most vulnerable are some of those most likely to collapse and needing to be rebuilt over time; and that certain situations add further complications and challenges to the effectiveness of CLTS in its purest form. For example, this might include high density low income urban-environments, areas prone to disasters or difficult technical conditions such as high water tables or sandy soils, and communities with significant social divisions or internal conflicts. Also a recent study on equality and non-discrimination (EQND) in sanitation programmes at scale supported by the Global Sanitation Fund (expected to be published in July 2017), has also highlighted that whilst many people who may be the most disadvantaged (individuals or groups who may be vulnerable, marginalised, excluded, experiencing inequities, inequalities, or stigma) have benefitted from having gained access to a toilet, they may also be some of those least likely to participate in all the stages of the process. Potential risks were also identified for the poorest and most vulnerable when being pressurised to build a toilet and challenges have also been expressed related to sharing.

The need to strengthen the facilitation of CLTS to ensure that community solidarity mechanisms and support are well utilised and do not miss the most vulnerable or marginalised was highlighted, as it is not clear that this element is working well in all instances and sometimes ‘hidden’ challenges are being faced even where communities have reached ODF status. Whilst I feel that in some instances external support could be appropriate, such as to try and ensure that the poorest and most vulnerable people’s latrines do not keep collapsing over time, I still have concern as to how this could be provided without damaging the community motivation and achievements that have been seen when there is no expectation of external support. In line with this one of the key questions discussed during the workshop was how to ensure that the collective behaviour change that is core to the success of the CLTS approach is not damaged by the input of support from outside of the community in whatever form, for example as rebates, vouchers, material provision or other forms of external support. A study supported by East Meets West, the Water and Sanitation programme of the World Bank and the Thrive Network on the effect of Output Based Aid subsidies combined with sanitation marketing on latrine uptake among rural communities in Cambodia was shared. It showed that the provision of both sanitation marketing and subsidies to the poorest households in this context had a positive impact on the uptake of toilets by households of all wealth groups including the wealthiest, and hence goes against the notion that the provision of external support / subsidy is always counter-productive.    

Boundaries of CLTS were discussed and a range of provisional recommendations were agreed. A set of principles were proposed, research gaps identified and commitments made by the workshop participants, as the first step of a process to continue to investigate and debate these issues.

One point of caution as we move forward on this issue - I think I had been assuming, probably because I have been involved for many years in issues related to equity and inclusion that everyone is used to working on this issue. But on reflection I think that as a sector we need to spend more time sharing good practice and building our own capacities and confidence to know how to work in the most appropriate way on this issue. It is quite easy, and I admit to also slipping into the frame of mind at times, to be working from the mindset of the ‘charity approach’ where we are looking to support people who may be disadvantaged with products, in this case toilets, as an act of charity; when we should be working in a way that is inclusive and respects the skills, abilities, contributions and rights of people who are potentially the most disadvantaged and involving them in all discussions and decisions related to their needs as well as other community priorities. The principle “Nothing about us, without us!” is one that is core to this approach, so I hope that in future discussions people who may be disadvantaged and the organisations that represent them will also be invited and actively involved. 

Through the process of discussion it became apparent that there is unlikely to be a ‘one stop’ answer to the issues noted above, but I came away with a feeling that the complexity was starting to be untangled and the discussions held at this workshop will contribute to being able to move forward on this issue with greater clarity. I look forward to the continuing discussions, with the hope that as a sector and across sectors, we can ensure we more effectively reach, support and involve those who may be the most disadvantaged and who are least able to construct, use and maintain their own latrine to be able to do so.

Sarah House is an independent consultant.

Date: 9 June 2017