Background
The JMP estimate suggests a steady increase in improved sanitation coverage in rural areas since 2000 from 10 per cent to 30 per cent in 2015. Open defecation has reduced from 82 per cent to 60 per cent and estimates suggest that more than 1.6 million rural households (7.5 million people) do not use any form of sanitation facility. National development plans set the goal of 30 per cent rural sanitation coverage by 2015, and 100 per cent by 2025. The JMP estimates for 2015 suggest Cambodia has met its own 2015 goal, however the National Strategic Development Plan goal of 60 per cent by 2018 will still require rapid acceleration.

CLTS status and geographic spread
CLTS was first introduced by CONCERN Worldwide in 2004, but without immediate follow up. UNICEF and Plan Cambodia started to implement at a larger scale in 2006. In 2012, CLTS had spread to 11 out of 23 provinces in Cambodia (introduced in 48 per cent of the provinces), and is now currently in 19 out of 25 provinces and the capital (increasing spread to 76 per cent). Provinces include: Banteaymeanchey, Battambang, Kampong Cham, Kampong Chhnang, Kampong Speu, Kampong Thom, Kampot, Kandal, Mondulkiri, Otdar Meanchey, Pailin, Preah Vihear, Prey Veng, Pursat, Rattanakiri, Siem Reap, Svay Rieng, Takeo and Tboung Khmum.

Major funding through the Global Sanitation Fund (GSF), Cambodia Rural Sanitation and Hygiene Improvement Program (CR-SHIP 2012-2015), and UNICEF’s WASH programme have contributed to expansions in CLTS in both spread in the country and number of implementers. UNICEF’s WASH programme is implemented by the Ministry of Rural Development, through the Provincial Department of Rural Development, and covers 11 provinces. CR-SHIP has reached five provinces but a three year expansion from 2015-2018 will see it reach five more. Under CR-SHIP, the number of national NGOs implementing CLTS has increased. Since 2012, the number of international NGOs has consolidated.

CLTS is not currently implemented in urban areas in Cambodia.

Two main organizations, iDE and WaterSHED, are implementing sanitation marketing programmes in 15 provinces which are designed to generate demand for pour-flush toilets, strengthen the supply of sanitation goods and services, and assist local producers and their sales networks to sell toilets that increase the number of the population using improved sanitation facilities. These programmes have utilized some CLTS inspired tools in demand creation and latrine promotion activities, but the main objective of these sanitation marketing programmes is incremental increases in sanitation coverage through private toilet sales. These programmes do not have collective action goals (ODF community targets) and contain few specific pro-poor or equity objectives. The World Toilet Organization previously piloted a franchise model of Sanishops but is now operating in Kampong Chhnang province only.

CLTS variations and practice
Global Sanitation Fund CR-SHIP: CLTS + Sanitation Marketing: GSF Cambodia Rural Sanitation and Hygiene Improvement Programme (CR-SHIP) phase 1 plans to implement CLTS in 2,020 villages. Sanitation marketing projects are implemented by partners to improve the availability and affordability of sanitation goods and services in the programme provinces. By the end of December 2014, triggering occurred in 1,739 villages (up from 700 at the end of 2013), resulting in a total of 445 villages with ODF status (up from 128 at the end of 2013).

SNV’s Sustainable Sanitation and Hygiene For All (SSH4A): This programme combines sanitation demand creation through CLTS with private sector development for sanitation supply chain and finance, hygiene behavioural change communication, and improved governance to scale up access to sanitation in the rural areas of Cambodia. The SSH4A programme emphasizes the capacity building of partner agencies at provincial, district and commune levels to plan, implement and monitor sanitation and hygiene interventions so that they can continue to promote sanitation and hygiene for the long term. The first ODF commune was declared in Trapeang Sala Khang Lech commune in Banteay Mas District in 2013. In this commune, previously only 25 per cent of households had access to a toilet and now 98 per cent own their own with 2 per cent sharing. The programme now operates in six provinces.

Plan: Sanitation in Emergency Food Assistance Project-Additional Financing (EFAP-AF): Plan supported CLTS, hygiene promotion and smart sanitation financing integrated in the ADB funded, Ministry of Economy and Finance executed, Emergency Food Assistance Project-Additional Financing (EFAP-AF) 2013-2015. This programme improves food security of poor and vulnerable people affected by high food prices. The sanitation component involves CLTS triggering, with targeting of ID Poor 1 and 2 households for conditional cash transfers through an incentive payment of US$25 to buy materials for latrines (50 per cent of the cost), if they have committed to sustainably applying the main hygiene and sanitation messages (e.g., participation in CLTS events, availability of handwashing facilities, availability of potable water, latrine pit dug) for the first 3-4 months of project implementation. Financial incentives are delivered through a microfinance institution. Achievements include 1,083 communities triggered and 22,859 ID Poor households having received incentives, of which 61 per cent built latrines (53 per cent pour flush, 8 per cent dry pit).

USAID NOURISH Program: USAID is funding a five-year, US$16.3 million integrated nutrition, sanitation and hygiene project called NOURISH to address the complex, multi-faceted causes of chronic malnutrition in Cambodia, targeting rural areas in the poorest districts of Battambang, Siem Reap and Pursat provinces. The programme, targeting ID Poor women and their children in the first 1,000 days of life, was launched in late 2014 and is being led by Save the Children, with technical support from SNV. Sanitation activities include productdevelopment and marketing through private sector promotion, as well as strengthening the capacity of local partners to implement and create sanitation demand through CLTS approaches.

CLTS scale and ODF success rate
An estimated 1,494 villages have claimed ODF, although not all have been verified and there is no reliable source of data on this number. Guidelines to define ODF were introduced in 2014. There is no centralized information on the number of villages triggered or ODF status, but estimates are that 6,160 villages have been triggered with 1,494 ODF, giving a rate of 24 per cent achievement.

CLTS capacity
An estimated 260 facilitators have been trained to date. Most (70-80 per cent) trained facilitators are from government (PDRD and DoRD), however only about 30-35 per cent of trained facilitators are still active. Figures from the GSF programme suggests better retention of female facilitators. Only 18 per cent of trained facilitators are women, yet women make up 32 per cent of active facilitators.

Most significant changes since 2012
National CLTS guidelines: Previously there was no official guide for the CLTS implementation process. The National Guidelines have resulted in a common sanctioned approach which is clear and easy for implementers to follow. The Cambodian definition of ODF has been agreed and the verification process is clear. This has brought unity and conformity to the sector.

Improved facilitation: Facilitation has improved through the National CLTS Guidelines selection criteria for facilitators and through clear statement of duties. A core group of master trainers at the national lever has developed their capacity and skills over time. The training of facilitators is more thorough, resulting in improved triggering at community level.

Large programmes scale up CLTS: Major programmes, such as the GSF C-SHIP, have boosted CLTS implementation and driven evolution in Cambodia. The number of national NGOs with CLTS experience has also increased.

Increased access to durable and affordable sanitation products: Coverage of sanitation and the number of ODF villages has increased significantly in the last three years. Much of this increase is in durable and affordable pour flush toilets.

Change in thinking: CLTS is seen as one element in a sustainable, sanitation solution and there is wider thinking about linking LCTS with the need to improve the supply chain, as well as behaviour change communication efforts and the use of pro-poor support mechanisms. National BCC guidelines are in development which recognize various approaches and methods, including CLTS, as one to address collective change.

Lessons learned
Households prefer pour flush toilets: The sanitation ladder concept is not applicable in Cambodia. Households will frequently delay purchase until they have their preferred pour flush latrine. This can delay the achievements of ODF but can lead to improved sustainability of sanitation behaviour.

Triggering: Triggers that work best to mobilize the community include: disgust, shame, self esteem, desire for good health, privacy and convenience. Triggering with children appears effective, resulting in children urging their parents to build a toilet.

District based sanitation is effective and the role of district administrations for rural sanitation should be enhanced: A district-wide, local government-led approach is more effective and sustainable in comparison with targeted support only for a few selected poor communes or villages. Partnership with local authorities and market suppliers increases government capacity to steer and scale up sanitation initiatives, and builds local momentum to reach all with improved sanitation. Commitment and leadership of the provincial and district authorities is important, but can only be achieved when the programme covers a larger area. SNV’s SSH4A approach has led to stronger commitment and ownership in all target districts. In 2013, after introducing the results based sanitation and hygiene planning at district level, the impact and results were more than triple those from the previous year. To strengthen the district-wide approach, a gradual transfer of rural sanitation mandate to district administrations could help to scale-up government-led service delivery.

Local context is important: CLTS demand creation approaches need to accommodate local solutions to local problems, and the solutions depend upon a clear understanding on the sanitation situation and the community’s socio-cultural norms, values and motivations. One size does not fit all.

CLTS and sanitation marketing is a powerful combination: If CLTS and sanitation marketing are integrated, the achievements can be quick and sustainability can be improved.

Share best practices through peer to peer learning to accelerate progress: Learning exchanges between government officials at commune, district and provincial levels accelerate rural sanitation and hygiene achievements. Joint progress review meetings and visits between the districts and provinces create “healthy competition” for increased sanitation coverage.

Diffusion: Neighbouring, non-triggered villages copy sanitation improvements from triggered communities.

Promotion: Publicity on national days/international days (e.g., global handwashing day) is effective at spreading information to communities, including about sanitation.

CLTS weaknesses and bottlenecks
ODF not a key indicator: National level targets and monitoring focuses on sanitation coverage, not ODF achievements.

Continued use of subsidies: Acceleration of progress and effective scaling up of sanitation is undermined by competing or contradictory approaches in the same location, particularly the use of hardware subsidies that are not employed in a targeted manner for the poor and delivered in a smart way. There is more consensus in the sector that a pro-poor mechanism is needed and a guideline will be drafted in 2015.

Lack of national monitoring system: There is no central place for monitoring and tracking ODF statuses of villages, therefore it is difficult to obtain a national picture of the progress of CLTS and ODF status or to identify lagging areas within the country.

No post-ODF monitoring: No procedure for monitoring sustainability and slippage of previously verified ODF communities. Post ODF monitoring is uneven and not formalized.

Limited latrine technologies: There are few latrine options available for households. Affordable technology solutions are yet to be developed for challenging environments i.e. flooding areas, floating areas, mountains.

CLTS opportunities over the next 3-5 years

• National Action Plan:  A National Action Plan to be developed in 2015 will set ODF targets and guide the allocation of government funds, and mobilize funds from other donors to support sanitation. The NAP will be an umbrella to mobilize a common approach.
• Management Information System: An MIS (currently under development) will monitor and capture national progress on ODF achievements. The MIS will be trialled in provinces where GSF is operating. Up until now, CLTS has relied on anecdotal information with market based programmes having much better quantitative dates (e.g., sales).
• Increased funding: Continued support of donors, such as the expansion of GSF programmes to five new provinces, and more funds expected from the Government.
• Improved coordination: More coordination is necessary, particularly at district level, in order to create a synergy and reach the sanitation vision. The existing good collaboration between government and partners can further support governments in developing sanitation in the future. MRD has submitted their functional review document to the Government in which rural sanitation is a proposed function for transfer to district administrations. Piloting of this transfer from 2015-2016 in 10 districts will be foreseen before such transfers would be enacted nationally.
• Sanitation integrated with other approaches e.g. nutrition and early childhood: Nutrition is receiving increasing attention and links with sanitation are much better understood by policy makers. The US-AID NOURISH programme is anticipated to provide learning on links between sanitation and nutrition and how to integrate them. Plan Cambodia has been implementing iNEW for integrating WASH with nutrition and early childhood, and has developed iNEW tools using positive approaches.
• Cost norms: A costing exercise to gather unit costs for implementation of CLTS by different partners could contribute to accurate scaling up and targeting costs for the National Action Plan. Cambodia has a sufficient history of CLTS implementation to provide this information. Plan estimates costs per village for triggering and post-triggering follow up visits to be around US$1,200 to US$1,500, which includes ODF status and staffing costs for implementing partners.

(September 2016)