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Papua New Guinea

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Background
The 2015 JMP estimates indicate that there has been no change in access to improved sanitation in rural areas of Papua New Guinea since 2000 with the rate remaining at 13 per cent. Open defecation is estimated at 13 per cent while the biggest gap is in the use of unimproved sanitation, which has increased to 71 per cent. There are still 154,000 households (860,000 people) who do not have access to any form of sanitation in rural areas.

CLTS status and geographic spread
CLTS was introduced by Oxfam in 2008, with implementation expanded by ChildFund and Live and Learn in 2009. By 2012 CLTS was being implemented in 19 provinces, largely  through the efforts of an EU-Rural Water Supply and Sanitation Program. Currently CLTS is supported in around 12 of the 22 provinces in Papua New Guinea, but only in selected districts within those provinces. The widest reach is by local NGO Touching the Untouchables (TTU) who is working in two districts of Eastern Highlands province, and in one district covering 30 wards, but altogether covering 12.5 per cent of the entire province.

CLTS implementation is led by NGOs including WaterAid, ChildFund, World Vision and TTU in the Eastern Highlands province. Government involvement is at the local level through partnerships with NGOs, and the training of Provincial Environmental Health Officers at the national level for roll out within provinces. The extent of the roll out by provincial Environmental Health Officers is unknown, but it is believed to be limited. CLTS has only been trialled on a small scale in urban settlements by World Vision, whose staff have been trained to try out the feasibility in WVs urban projects.

CLTS variations and practice
CLTS implementers in Papua New Guinea require that latrines meet two minimum technical criteria: provision of a sealed pit and a vent pipe.

  1. CLTS + Healthy Islands concept: The Healthy Islands concept encourages health promotion in sub-settings such as homes, schools, villages and markets; and covers safe motherhood, child health, immunization, protection against communicable diseases, and quality of life. CLTS fits well with many of the activities and principles of this Pacific-specific approach. Implementation of the concept has lacked finance and support, however a framework of action for revitalizing implementation of the concept was agreed in 2011. Strategy 7.3.1 of the National Health Plan 2011-2020 is to increase the roll out of the Healthy Islands strategy, however the extent to which this approach is utilized in Papua New Guinea is uncertain.
  2. WASH, Community Health and Maternal Health: CLTS is integrated into other programmes of NGOs:
  • •WaterAid integrates CLTS into WASH programmes.
  • TTU has built CLTS into all of its village health worker (VHV), village birth attendant (VBA) and community health worker (CHW) training workshops. ODF villages are selected and presented to Oxfam (PNG) to provide rainwater harvest systems to these villages. So far five villages have benefited from this strategy.
  • World Vision implements CLTS in all (100 per cent) of its WASH projects. Sanitation is linked to the provision of water supply, with water supply hardware being subsidized. World Vision also includes sanitation and hygiene components in its Maternal, New Born and Child Health (MNCH) projects in Bougainville, Port Moresby Urban Settlements and Madang.
  • ChildFund PNG integrates CLTS with hand washing/hygiene, provision of water supply and other projects such as nutrition and livelihoods.

Local modifications of CLTS include: promoting improved sanitation in locations where households already have toilets, adapting to the local context, using local materials as teaching aids during training. TTU also introduces a minimum standard ventilated improve pit latrine structure design during the community engagement so the participants can see what a health promoting toilet looks like.

CLTS scale and ODF success rate
As of 2012 more than 470 villages were reported to have been triggered using the CLTS approach, with a further 189 triggered since then. There is no central register of ODF communities. As of June 2015 an estimated 144 villages have been certified as ODF (123 added since 2012). The success rate of ODF communities from those triggered is 18 per cent. The most experienced NGO (TTU) reports 23 out of 97 villages triggered have been certified as ODF – a success rate of 24 per cent. Other NGOs have not achieved full community ODF but the amount of OD has reduced at the household level. The time between triggering and achieving ODF ranges substantially from three months to as much as 12 months where a community has difficult conditions such as flooding. It has also been observed that the usage of latrines at night is an issue due to fear of being bitten by snakes and sorcery. More typically the average time to reach ODF as reported by World Vision and TTU is five to six months. Successful triggers include: disgust, privacy, convenience, pride and stigma of continuing OD, good health, but also status in terms of wealth and respect.

CLTS capacity
A total of 510 CLTS facilitators and community representatives have been trained in Papua New Guinea. Community representatives are village health promoters, and village birth attendants who are trained for awareness rather than to conduct triggering. It is uncertain how main trained remain active but probably half to one third are still active.

Most significant change since 2012
National WASH Policy 2015: The PNG National WASH Policy 2015 is the first WASH policy in the country. The policy gives official recognition to CLTS as a suitable sanitation approach to achieve the objective of reaching ODF communities. The policy gives clarity about the use of subsidies and only employing them if targeting the very poor, in challenging environments and for other special conditions. The policy development brought stakeholders together and awareness on sanitation to the forefront, and it is hoped that this collaboration and awareness will continue.

Lessons learned
CLTS can reduce conflict: CLTS can be applied in socially challenging environments. TTU has six tribal fighting villages that have been trained in CLTS and now have toilets, animals fenced, rubbish holes, footpaths lined with flowers and drainage. As a result of CLTS the communities have agreed to stop fighting and have reached a ceasefire agreement and are now working towards a peace agreement. These communities were influenced by the sanitary and hygiene transformation that happened in their homes and village.

Self reliance and innovative development: In a country where Government services are poor, CLTS has shown people that they can be self-reliant and improve sanitation for themselves without waiting for the Government. Communities have shown innovation in building VIP toilets, but have also improved their homes and village environments. Collective goals in the CLTS process have also sets a foundation for other developments to build on e.g. literacy, agriculture, tourism, law and order and peace, and gender equity and equality.

Integration supports sustainability: CLTS cannot be a stand-alone activity or programme. It needs projects like safe motherhood, rural water supply system projects and livelihood projects to support sustainability of ODF villages.

CLTS weaknesses and bottlenecks

  • Sanitation is not a government priority: Sanitation has not been a priority for the Government in the past and it has not received any attention. There are misconceptions within the Government about subsidies and the roles of Government departments.
  • Facilitator capacity still weak: Influencing the community mindset leading to behaviour change is not an easy task and needs facilitators who are skillful. It is difficult to cultivate and sustain good facilitators.
  • Subsidies not standard in practise: Subsidies are still given by NGOs for sanitation e.g. ChildFund PNG’s WASH project gives every household in its participating communities hardware materials to self-construct latrines with some community contribution. Hardware material for a standard designed VIP latrine costs about K800.00 (US$ 290).
  • Difficult to scale up without Government: CLTS is entirely NGO implemented, and therefore lacks budget and scale. Without financial support from the Government, INGO’s and the private sector for CLTS in Papua New Guinea it will be difficult to scale up. A consistent and sustained driver (Government at all levels) is needed to drive the progress in scaling up CLTS.
  • Weak sanitation supply chain: Despite community innovation there are few latrine choices, especially low cost toilets for households. The sanitation supply chain in undeveloped.
  • Land issues: Most of Papua New Guinea is customary land. It is sometimes difficult to apply CLTS where there are land issues and disputes. Settlers on other peoples’ land only construct makeshift sanitation facilities for temporary use and these are not sustainable.

CLTS opportunities over the next 3-5 years
WASH policy sets future direction: Approval of the WASH Policy and CLTS being one of the standard approaches to be implemented for sanitation with proper planning that can be taken to scale. The policy will help to create opportunities to make CLTS a standard approach in implementation in Papua New Guinea.

Improve sector practice: The WASH Policy provides the framework to begin strategy development and other enabling environment factors such as standardization of facilitator training, ODF guidelines, verification processes, monitoring, and learning to improve sector practise.

Institutionalize facilitator training: Potential opportunities to improve facilitator training include establishing a CLTS training module through the Environmental Health Department of the Faculty of Health Sciences at Divine Word University; and through the establishment of a CLTS foundation in Goroka, Eastern Highlands province to provide capacity building support for TTU and other organizations that are implementing CLTS. TTU sees the opportunity for CLTS training to be conducted in educational institutions in the district, particularly in lower and upper primary schools and vocational schools, in the church and through youth groups.

Potential for ODF district: Through the NGO TTU, Henganofi district in the Eastern Highlands province may be the first ODF district in PNG by 2016. This could be a potential model and inspiration for other districts to become ODF and integrate CLTS with rural water supply and livelihood projects.

(September 2016)