Eritrea is a country with low improved sanitation coverage according to the Joint Monitoring Programme and is currently not on track to meet the MDG sanitation target of 54 % by 2015. A survey carried out in 2011 by the Ministry of Health in partnership with UNICEF showed the improved sanitation coverage (one that hygienically separates human excreta from human contact, such as flush/pour to piped sewer system, septic tank or pit latrine, ventilated improved pit (VIP) latrine, pit latrine with slap and composting latrines) in rural areas is only 16.3 %. Therefore, in order to meet the MDG sanitation target, an estimated 448,000 Eritrean households in rural areas will have to cease open defecation and construct and use their own latrines between 2011–2015.

Out of this recognition and the need to nationally scale up sanitation coverage, the Government of the State of Eritrea, with the support of UNICEF, adopted the Community Led Total Sanitation (CLTS) approach in late 2007.

Prior to the introduction of CLTS, sanitation interventions carried out in the country were focused on producing “high end” toilets with a subsidy that included five bags of cement, iron bars for reinforcement, vent pipes and re-useable moulds for the floor slab. Almost all of these were built using Government and/or donor funds as most families in the rural areas could not afford to build these types of toilets without support due to the high costs. As funds were limited and families were waiting for subsidies, very few toilets were built and the actual usage of the constructed latrines was not clear.

The adoption of the CLTS approach entailed a paradigm shift in hygiene and sanitation promotion. Consequently, it demanded a considerable amount of capacity building of all stakeholders and social mobilization at various levels. Therefore, the Ministry of Health, together with UNICEF (engaged an international consultant) conducted a training of trainers (ToT) on CLTS for 30 people in December 2007. CLTS was introduced in 2008 and in March of the same year, the Ministry of Health focused activities in the two pilot villages of Adi-Habteslus and Halibmentel.

To further entrench the programme, regional advocacy workshops on CLTS were carried out in six regions between July 2008 and February 2009. These were attended by more than 400 participants (including regional governors, sub-regional administrators, higher government officials, religious leaders, regional assembly members and implementers of sanitation programmes). These workshops helped generate much needed interest and created awareness of the CLTS approach, and as a result sub-regional administrators committed themselves to introduce CLTS in one village of each sub region.

In October 2008, the first pilot village (Adi Habteslus) achieved 100 % sanitation coverage with every household having and using a toilet. It declared Open Defecation Free (ODF) status during the National Sanitation and Hygiene Week (2008). The declaration ceremony was widely covered by the national media and this created further interest in the other regions. Additionally, the entire ceremony was documented and used in the advocacy workshop in one region, and in the subsequent nationwide training of 250 Public Health Technicians and implementers of CLTS prgoramme at sub regional level.

In early 2009, the Ministry of Health, through their Environmental Health Unit, was ready to go to scale with CLTS and launched a nationwide sanitation programme with the assistance of UNICEF in 46 villages. UNICEF in partnership with the Ministry of Health, facilitated the visit of Dr. Kamal Kar to Eritrea in June 2009 during which he carried out a review of the programme as well as advocacy to strengthen CLTS in the country. He supported the development of the necessary framework, implementation guidelines and training for enhanced and coherent implementation of CLTS. During his mission, a week-long national “hands-on” CLTS ToT training for 46 participants (Public Health Technicians, Sanitarians, community Integrated Management of Child Illnesses (IMCI) focal persons and nurses) from all over the country was conducted.

The Ministry of Health and UNICEF continue to partner to scale up CLTS interventions and to build the capacity of implementers in each region. As of May 2014, 869 villages out of 2,644 have been triggered in the six regions of the country with 489 villages (18 % of the rural villages) already declared Open Defecation Free. Since 2007 when the CLTS programme started in Eritrea, 146,700 households (or an estimated 733,000 people, 31 % of the rural population) have stopped open defecation in all the six regions of the country. More than 7,000 village health promoters have been trained. The National Rural Sanitation Policy and Strategy Direction was launched in October 2009 and this policy fully supports the CLTS approach.

(July 2014)