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Myanmar

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Background
UNICEF and Save the Children introduced the concept of CLTS to the WASH Thematic Group in Myanmar in 2010, and invited Dr. Kamal Kar and Dr. Brigitta Bode to conduct the first CLTS training in Pyay district of Bago region in July 2011. Eleven local and international NGOs and three government departments participated and nine villages were triggered during the training itself. UNICEF conducted a second training in September 2011, and convinced one of its donors, Danida, to adopt the CLTS approach in their current sanitation programme.

In late 2011 Save the Children, the International Rescue Committee and Partners International all piloted CLTS in villages in three different regions of Myanmar. In 2012 the Government of the Republic of the Union of Myanmar began to introduce CLTS in fifteen townships across the country with UNICEF support. UNICEF is also supporting Myanmar Health Assistance Association, a local NGO to introduce CLTS in two more townships with funding from Danida and in the first training township, where 15 villages are now triggered and approaching ODF status.

Current

UNICEF and the Department of Public Health in Myanmar are now experimenting with increasing the sustainability of ODF through a two-stage certification process. The idea is to have a warranty or probationary period of 12 months, during which time an ODF village is supported and monitored to keep its ODF status. However, the village also risks losing its hard won ODF status if it is not careful.

Myanmar’s ODF criteria
In Myanmar the ODF criteria includes:

  • No evidence of open defecation in the whole village.
  • Every latrine has a proper lid over the latrine pan and a cover on the ventilation pipe of the pit to prevent flies.
  • Children’s faeces are disposed in the latrine pit or properly covered.
  • Everyone must wash their hands with soap or other soap substitutes such as ash or sand after using the toilet, as indicated by presence of soap and water at the latrine.

The community should also prepare a strategy for sustaining the 100 per cent ODF status and an action plan to carry this out, such as how it will mobilize and support the community to continue using latrines and reduce the number of shared latrines. In many countries, getting to this ODF point is achievement enough, and follow-up beyond 100 per cent ODF status is left to Government health staff, with little in the way of formal monitoring and  rectification of any slippage.

Building in a post ODF process
Myanmar is trialling a process that shows promise for strengthening ODF sustainability, by closer monitoring during the post ODF period and then rewarding the community for sustaining the status. The theory is that a community can be supported and encouraged to adopt and continue positive sanitation and hygiene practices through this additional step.

The timeline of the ODF process involves:

  1. Village self declares ODF. Approximately six to eight months after triggering, if a community believes it has reached ODF status, members of the village WASH committee check against the ODF criteria by visiting all the households. When they are satisfied the criteria is met the committee contacts the township (district) health office and requests an official independent verification.
  2. External verification. An external verification team checks the compliance of the village with the ODF criteria. Members of the verification team include: representatives from the Department of Public Health (Central Health Education Bureau, and Environmental Sanitation Division) in collaboration with the state/regional health education bureau, township medical officers, basic health staff, other local governmental officials who are already trained as CLTS facilitators, and natural leaders from nearby villages. The verification protocol involves sampling 15 per cent of households, carrying out physical checks of latrines, interviewing households, and a transect walk through the village.
  3. Interim ODF certification. If the village complies with the verification protocol then an interim ODF status is awarded. This involves ODF declared villages attending a special ceremony at the Township  Medical office, which is also attended by the township authority, parliamentarians, township education officer, basic health staff, CLTS triggered (but not yet ODF) villages and other ODF villages. This ceremony is an opportunity for the sharing of lessons learned by ODF villages and non-ODF villages, encouragement from the Town Medical Officer to non-ODF villages to become ODF, and for ODF declared villages to maintain their ODF status. ODF villages also receive large signs that they can display in their villages. ODF status is probationary for one year, during which time it can be revoked if slippage occurs. For national monitoring purposes, villages are officially counted as being ODF at this point.
  4. Probationary ODF status. As part of their regular monthly visits to villages, Public Health Supervisors and midwives include ODF follow-up. They encourage the community to continue using latrines and maintaining other behaviours, build new latrines for those who are using shared latrines and avoid reversion to open defecation. The maintenance of the ODF status is monitored and recorded on a quarterly basis by the township authority and township medical officer. If they find non-conformance with ODF requirements then the community status is revoked. A full award of ODF is granted after maintaining ODF status for one year.
  5. Full ODF certification. After one year of sustaining ODF, a village is certified as achieving full ODF status.

Key issues

  • This process is yet to be adopted by Government and is only being trialled. In fact CLTS is not yet part of the Government’s approach to increasing sanitation and there are no authorized guidelines on CLTS and ODF.
  • Implementers find that village ODF acknowledgement ceremonies should be held as soon as the villages are declared ODF to keep community enthusiasm high. However, this requires strong planning and coordination by township officers to ensure timing is suitable for ceremonies for batches of ODF villages.
  • As yet, no village has implemented CLTS long enough to get to the full ODF status after the 12 month probationary period.
  • The process has not been developed and described in detail beyond the probationary period. For example, exactly how the full interim ODF status is verified and awarded is yet to be finalized, as is the monitoring system for full ODF villages.
  • Regular follow-up by basic health staff is still weak because staff are overloaded with many tasks.
  • Implementers also do not have funds to conduct continuous monitoring after villages achieve ODF.

The trial of this approach will continue to be monitored by CLTS implementers and may soon find its way into the Government’s official CLTS approach. One question remains – what happens after full ODF status is achieved? Indications so far are that once a community reaches ODF status that using a latrine becomes a social norm for villagers, and close monitoring is not necessary. The key challenges are to move households away from using unsanitary latrines to sanitary latrines, and to improve the sustainability of latrines in flood prone and sandy soil areas where toilets are not durable and need to be frequently replaced. In these conditions, better technical solutions and sanitation marketing could improve sustainability.

(September 2016)