Context

The Central Pacific nation of Kiribati, comprises 33 low lying coral atolls stretching along the equator. The majority of the population of Kiribati lives in the Gilbert Group of 16 atolls in the west of the country. The Gilbert Group includes the so-called Outer Islands, and the capital, South Tarawa where nearly half of Kiribati’s population lives. 
With lagoons and white-sand beaches, the country’s 103,000 people appear to live in paradise. But Kiribati has one of the highest rates of infant mortality in the Pacific region, at 47 deaths per 1,000 live births. This shocking statistic is mainly due to diarrhoeal disease, caused by inadequate access to clean water and appropriate sanitation.
Open defecation rates in Kiribati are some of the highest in the Pacific sub-region. According to the UNICEF/WHO Joint Monitoring Programme data in 2015 just 40 per cent of the population of Kiribati has access to improved sanitation, with 36 per cent defecating in the open. In rural areas and the outer islands the rates are even higher – open defecation is practiced by nearly half of the rural population (49 per cent) and by more than 70 per cent in some outer islands. 

History of CLTS in Kiribati
CLTS was only introduced in Kiribati in 2013 by UNICEF and the Ministry of Public Works and Utilities (MPWU) through the EU-funded KIRIWATSAN 1 Project, but in a short space of time it has rapidly changed behaviour and reduced open defecation on Kiribati’s Outer Islands.30 Early efforts at adopting the approach were boosted by a visit from Kamal Kar in 2013, during which training and demonstration triggerings were held in North Tarawa. Very quickly the 13 villages on this island became ODF and on 11 May 2013 North Tarawa was declared the first ODF island; not just in Kiribati but in the entire Pacific region. Previously about 64 per cent of its 6,000 people used the beaches and mangroves for defecation.
The success of the CLTS approach in North Tarawa led the President to set the goal of an “Open Defecation-Free Kiribati by 2015”. Following the success in North Tarawa, the MPWU and UNICEF planned to roll out CLTS to all 139 villages throughout the 16 Outer Islands, and included in the KIRIWATSAN Phase 1 Project, complemented with funding from the Government of Kiribati. One year later, over 70 communities on six Outer Islands had declared themselves to be free of open defecation.
By October 2014 the number had increased to 90 villages on 10 outer islands with the involvement of a total of 30,054 people representing 84 per cent of the triggered population and 29 per cent of the total population of Kiribati. The shift from open defecation to ODF communities, has driven a large household latrine building effort. Pit latrines and pour-flush toilets with concrete slabs and pedestals are popular. Island councils even subsidized the cost of a concrete slab for pour-flush toilets as encouragement for island residents to improve sanitation and stop open defecation. Under the KIRIWATSAN Phase 1 Project, chainsaws were purchased for each island so these can be used to sustainably cut down coconut trees to make platforms and slabs. Molds are also available on islands and pedestals can be made locally, which is critical for success and sustainability of remote Outer Islands that lack even the most basic supply chain.

Scaling up
This speed and scale of achievement is impressive. Part of this is due to a high level of commitment from the President of Kiribati and Cabinet, who promoted CLTS as the main approach for increasing sanitation coverage in line with the National Sanitation Policy. The massive mobilization to Outer Islands to launch the ODF campaign was due to efforts of people on the ground. UNICEF’s WASH Community Development Officer Beia Tiim has organized and cultivated a Core Technical Group of 73 people from the Ministry of Health, MPWU, Ministry of Environment, Ministry of Internal Affairs, Women’s Federation, and other organizations to lead the CLTS roll out. Beia trained the core technical group, together with Kamal Kar, in CLTS facilitation skills. They are now community champions who go to the Outer Islands and work with Island Councils on triggering and changing
sanitation and handwashing behaviours. The strength of this cross-sectoral facilitation team has been a cornerstone of the successful triggerings on Outer Islands.

Challenges

If open defecation is being eliminated and people are using toilets, then where is the problem? Kiribati has unique challenging physical and social environments which significantly affect achievement and sustainability of ODF status. For one, open defecation in the ocean or on the beach is a deeply entrenched social norm on all Outer Islands. In the village lifestyle, open defecation is not only socially acceptable but it is a social activity. There are also the issues of distance and remoteness. The country is made up of 33 small islands and coral atolls spread out across a distance greater than the width of India. Simply getting the Core Technical Group to the Outer Islands is a major challenge due to their remoteness, infrequent boat and flight schedules and the cost and time required to visit these islands. Continuous monitoring, follow-up and verification are critical to sustaining behaviour change and ODF status, however this is not easy to do in Kiribati. As a result, a key lesson learned has been that building capacity for CLTS facilitation and follow up on each Outer Island through the Island Council, Medical Assistant and staff, is critical to sustainability.

The most serious challenge is posed by the relationship between sanitation and drinking water. The usual logic in CLTS is that stopping open defecation helps protect drinking water sources, but in Kiribati stopping open defection by building and using toilets can actually harm drinking water sources. Many people living in coral atolls rely on shallow groundwater reserves, referred to as freshwater lenses, to provide drinking water. These lenses are very fragile and with porous coral soils, pollutants from human waste and other sources easily enter the groundwater lens, threatening public health.

Kiribati’s environmental constraint turns conventional logic on ‘improved’ and ‘unimproved’ sanitation options on its head, as improved facilities such as pour-flush and flush latrines harm people’s health as much as unimproved options like pit latrines. As the demand is created throughout Kiribati for households to build their own toilets, it becomes critical to develop a supply chain that gives people safe sanitation options that will not contaminate their drinking water. There are few sanitation options to protect these groundwater lenses, and suitable technical options are not low cost. Neither of the current sanitation options – pit latrines and pour-flush toilets – protect the ground water, even though they have stopped open defecation. Households prefer simple pit latrines because they are cheap and can be built quickly, but these can do more harm to public health than the original practice of open defecation if they contaminate a freshwater lens that people depend on for drinking water. Flush toilets are inappropriate for Outer Islands since they require scarce water for flushing and costly septic tanks are prone to leaking.

To raise awareness of the impacts of sanitation on water supply, the New Zealand-funded Kiribati WASH In Schools Project is introducing WASH safety planning to be used with CLTS triggering techniques. WASH Safety Planning, similar to water safety planning, is an approach that schools and their communities can use to identify the risks to their health from WASH practices, and take steps to reduce their risk. Participatory mapping during CLTS triggering can be an entry point for identifying and discussing health risks not only from open defecation, but also from poorly built latrines, pigs, and household waste. Through this risk mapping process, the community identifies the risks and threats to water supply and is ‘triggered’ to modify what it does, in particular where people defecate.

The KIRIWATSAN 1 Project provides guidance to island communities on latrine construction – for example where to build toilets to protect the ground water table, safe distances of latrines from wells, and identification of coastal areas suitable for building toilets where there is much less risk of polluting ground water. Once people understand the risks to groundwater they accept the loss of convenience in having toilets away from where they live. Through the CLTS process and WASH safety planning, people are realizing the importance of maintaining water quality and protecting water supplies. Reinforcement from Island Councils is important, but is most effective where there is Sanitarian Aid to advise communities on toilet locations and enforces Island Council by-laws on sanitation; and where there is a very active mayor. Currently, most Island Councils do not have Sanitarian Aid.

Raising awareness of the risks of pit latrines and pour-flush toilets has had an unintended consequence. The people who built toilets in the early stages of CLTS in Kiribati have since learnt that they are contributing to ground water pollution. Many stopped using their toilets and reverted to open defecation, but they do this covertly by hiding in the bushes. Although the extent is not yet measured, the wrong sanitation solution has caused slippage in ODF achievements. In Kiribati there are few right choices for sanitation. According to Marc Overmars from UNICEF, dry latrines are the only option but finding a technology that is affordable, and acceptable to communities’ demands and preferences is problematic. There is an interest in composting toilets as a solution, especially from the Ministry of Environment, Land and Agricultural Development which sees that there could be ways of using sanitation technology to improve agriculture through composting.

Ways forward

A search is on for the most suitable technology, yet everyone agrees that there is no perfect technology and a balance needs to be found between cost, environmental protection and user preferences. Currently there is a coalition of partners working on developing suitable sanitation options – New Zealand’s Ministry of Foreign Affairs and Trade (MFAT), Australia’s Department of Foreign Affairs and Trade (DFAT), Asian Development Bank, NGOs, and research partners New Zealand Institute of Environmental Science and Research – are all looking at technical options which are acceptable, feasible, affordable, and use locally available products.

The researchers want to avoid past mistakes. Trials of composting toilets in Kiribati’s Kirimati Island 20 years ago were largely unacceptable to the community, as the approach was primarily a technology-driven solution without considering community preferences or taboos around handling waste. Unless there is in-depth community engagement and decision-making, together with WASH safety planning, the communities cannot grasp why they have to use composting toilets. The coordinator for KIRIWTSAN Phase 2, Pauline Komolong, is also looking to Kiribati’s Pacific neighbours in Tuvalu for inspiration. A composting toilet project there was successful at gaining public acceptance and there could be lessons learned to help Kiribati’s problem. Under KIRIWATSAN Phase 2, implemented by the Secretariat of the Pacific Community, two demonstration toilets of the Tuvalu design will be provided in each community. While the composting toilet designs used by KIRIWATSAN 2 are environmentally acceptable, they are financially out of reach for households on Outer Islands.

Another approach is to change the behaviour of the younger generation first. Under the Kiribati WASH in Schools Project, UNICEF and its partners will trial composting toilets in schools on four Outer Islands in 2015. The premise is that children can easily adapt to new behaviours, and that schools are a catalyst for change and a suitable place to trial new technologies. If the trial proved successful it can be rolled out to other schools in the Outer Islands and increase exposure to new technology on a wide scale. “Solving the issue of water and sanitation in Kiribati is one of the most difficult issues in the world. There are no golden solutions, only compromises” according to Marc Overmars from UNICEF. There may not be a golden solution but it is clear that a range of solutions need to be developed collectively by Government, development partners, NGOs, researchers, Island Councils, and most importantly, the communities themselves. A stepwise approach is needed, which includes a strong enabling environment and partnerships, and cost-appropriate solutions in the context of WASH risk plans. CLTS will continue to play a key role in community mobilization and behaviour change, but achieving sustainable and healthy ODF communities in Kiribati is a continuing process.

(September 2016)