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Rural: improved sanitation coverage
The JMP estimate suggests a steady increase in improved sanitation coverage in rural areas in the Philippines from 45% in 1990 to 69% in 2010, and 71% by 2015. Open defecation has reduced from 18 to 8 % of rural households between 2000 and 2015, although there are still 5.7 million rural people that do not use any form of sanitation facility. As of 2015, 71 % of rural households use improved sanitation. The National Sustainable Sanitation Plan sets a goal of all barangays or villages being ODF by 2022, in seven years’ time.

CLTS status and geographic spread
CLTS in the Philippines was introduced through the Development of Sustainable Sanitation in East Asia – Philippines programme led by the Department of Health in 2007, with support from WSP. Training of facilitators was given by Kamal Kar in 2010, supported by UNICEF. Since then, CLTS has spread to 15 out of 82 provinces and cities in the Philippines (18 % geographical coverage). In some provinces CLTS has been scaled up throughout the province, e.g. Quezon province, as part of the Department of Social Welfare and Development (DSWD) Pantawid Program and through the Integrated Provincial Health Office (IPHO) in all 39 municipalities. Masbate province recently adopted a Rural Sanitation Graduation Framework, also known as the phased approach, as its strategy – this includes CLTS as an important step to go from Grade 0 (open defecation) to Grade 1 (zero open defecation). The Masbate scale up is being implemented through the Provincial Health Office. In Typhoon Yolanda (Haiyan) affected areas, CLTS is also being implemented widely across a number of provinces, including Leyte and Eastern Samar, as part of the Haiyan recovery programme phased approach to total sanitation (PhATS).Through the National Sustainable Sanitation Plan, the Department of Health (DoH) has supported the roll-out of CLTS in all provinces through capacity building for the 15 Regional DoH Coordinators who are tasked to scale-up CLTS in the respective provinces in their regions. The roll out strategy depends on cascading training for implementers at provincial level who in turn train health staff at municipality and barangay level. However, there is currently no national mechanism to monitor this roll out following the initial training (and no obligation of subnational level to report upwards), therefore the scale of actual CLTS implementation through the DoH programme is unknown. The main implementing agencies prioritization of areas for CLTS is based on various combinations of high open defecation, low health and nutrition status, high poverty rates and vulnerable disaster areas.

CLTS institutional coverage
Two major programmes – both of which aim to support the DoH’s Zero Open Defecation Program – have contributed to the expansion of CLTS – the UNICEF-supported PhATS being implemented in Masbate, Cotobato and in Haiyan-affected areas, and the WSP-World Bank supported Scaling Rural Sanitation Program being implemented in six provinces.

The development of PhATS under the WASH Cluster strategy has led to an increase in the number of international NGOs implementing CLTS, including through the adoption of the approach by traditional humanitarian NGOs. Integration of CLTS in the Department of Social Welfare and Development (DSWD) Pantawid Program has the potential to significantly increase coverage of CLTS messages across the five regions participating in the pilot programme, and eventually beyond.

CLTS is not promoted in Metro Manila since it is a peri-urban region, which implements the National Sewerage and Septage Management Plan. However, as part of UNICEF’s shift from emergency response to development in peri-urban areas such as Tacloban City and Zamboanga City, CLTS is being adapted and included as part of the overall recovery strategy.

CLTS variations and practice
Total Sanitation
In the Haiyan-affected areas, PhATS follows the Rural Sanitation Graduation Framework of three levels of sanitation from G1 Zero Open Defecation to G2 Sustainable Sanitation, and G3 Total Sanitation which includes solid waste management and waste water treatment. The Rural Sanitation Graduation Framework was developed prior to the Haiyan emergency and was being piloted in Masbate and Cotobato (however, this is not yet adopted at the national level as the standard approach). In accordance with national guidelines, ZOD certification (G1) includes handwashing (with one of the indicators for certification being 100 % presence of water and soap in/near toilets), as well as safe disposal of child and elderly persons’ faeces. The approach strictly encourages no external subsidy from G0 (open defecation) to G1 – however the community is encouraged to help each other to be able to build toilets (called ‘bayanihan’ in Tagalog). Collective rewards and incentives are provided after achieving ZOD (G1) status to encourage the communities to move from G1 to the next level of the framework (G2), which includes sustainable sanitation solutions. The incentive system aims to make it possible for everyone to have improved toilets, even the poorest of the poor.
The follow-on stages also address other relevant WASH problems, such as having toilets in government institutions (such as schools, day care centres, rural health units, etc.), solid waste  management and waste water treatment, safe management of animal excreta, protected water sources and water points, and water quality testing.

Social Welfare Programmes
As part of a pilot programme, sanitation has been integrated in the Family Development Sessions (FDS) of the Department of Social Welfare and Development (DSWD)’s Conditional Cash Transfer Program (locally dubbed as the Pantawid Pamilyang Pilipino Program or 4Ps). FDS include hygiene and sanitation messages, and some of the triggering tools used in the CLTS Approach, BCC Campaigns Tools and choice catalogue for low cost sanitation options for rural areas where 4Ps grantees are found and organized as Parents Groups at the barangay level. WSP is assisting the DSWD in the WASH integration within its three core protection programmes – Conditional Cash Transfers, Kalahi CIDSS community driven development programme, and Sustainable Livelihoods Program. WASH Integration in DSWD Programs is piloted in six regions, 14 provinces, 37 municipalities with approximately 80,210 Pantawid grantees to gain access to a toilet by 2016. The 4P programme targets individual households, however DSWD staff have had some success at advocating to local mayors or chief executives to aim for ZOD for whole municipalities with DoH staff triggering non-Pantawid community members.

School/ECCD Hygiene Promotion
The Department of Education implements the Essential Healthcare programme which institutionalizes daily group handwashing and toothbrushing in schools. In UNICEF-supported areas, implementing partners engage schools and Early Childhood Care and Development (ECCD) Centers by providing capacities to day care workers, school health promoters, parents, and caregivers in institutionalizing hygiene promotion for school-aged and under five year old children, in support of the EHCP programme. These activities complement the CLTS approach being implemented at the community level.

Disaster Risk Reduction
The CLTS approach encourages poor communities to build their own toilets without being so
dependent on external subsidies. They realize that they can build their own toilets using indigenous materials which will increase resiliency among families. In this way, they can bounce back immediately after a disaster since they have enhanced their indigenous knowledge and capacities to address their hygiene and sanitation needs without waiting for outside help. The community WASH plan is also integrated in the barangay Disaster Risk Reduction and Management Plans as well as Contingency Plans, giving an extensive reach on WASH-related issues.

CLTS scale
According to development agencies, as of May 2015 an estimated 473 barangays have been certified as ODF (ZOD), however there are more than 42,000 barangays in the Philippines and the national target is for 60% of barangays (25,000) to be ZOD by 2016. There is no centralized monitoring database that records the ODF status of barangays at the national level, while regional DoH offices have different ways of monitoring ODF barangays. Although the number of ODF barangays could be higher than reported, the country appears likely to fall short of its target by 2016.

ODF success rate
As of May 2015 the Philippines has triggered 677 barangays and 473 (70 %) have been certified ODF. Haiyan area has been most successful with 364 barangays so far declared ZOD out of 431 triggered (84 % success rate). UNICEF’s development programme has a 29 % success rate (101 triggered, 30 ODF); and WSP a 54 % success rate (145 triggered, 79 ODF). Average triggering to ODF is two to five months, but longer for ‘difficult’ barangays. Achieving ODF in WSP pilot areas in Sarangani was very slow with five years for some barangays to reach ODF. Achievement was accelerated through the development of sanitation action plans at barangay level and focussing on LGU service delivery. In Haiyan affected areas, where PhATS advocates are appointed in the barangay, triggering to ODF self-declaration can be achieved in 2-6 weeks – but these areas have benefitted from massive investment and support from CSOs (UNICEF implementing partners) to achieve these results.

CLTS capacity
The Philippines has significant CLTS capacity with at least 978 facilitators trained through multiple training courses since 2008. DoH has 30 trained Regional Coordinators (master trainers); UNICEF’s regular programme has trained 403 facilitators consisting of barangay officials, community health volunteers, rural health midwives, rural health nurses, school teachers, and heads of line agencies and community health committees; the UNICEF Haiyan programme has trained 160 facilitators from Region VI to VIII (129 facilitators from the villages and municipalities and 31 NGO partners); with 385 facilitators in WSP-supported areas (Quezon – 163; Negros Occidental – 157; Negros Oriental – 30; and Sarangani – 35). DSWD has conducted additional training on their own through the Municipal Links however the number of facilitators is unknown.

Most significant changes since 2012

National CLTS Guidelines: Previously there was no official guide for CLTS implementation process. DoH has approved the National Guidelines for Verification and Certification, as an Administrative Order in January 2015. The guidelines have to be reviewed to consider feedback from LGUs based on their experiences in verifying and certifying ZOD barangays. A consultation with regional sanitary engineers and partners on the implementation of the guidelines is yet to be conducted.

Need for capacity building: CLTS rollout needs to be more than just a one-time training for potential trainers – but needs to be supported by ongoing capacity building and the development of systems to support and monitor rollout, as well as by more adequate dedicated resources for this programme.

CLTS is one part of the sanitation solution: It is now recognized that CLTS is only one piece of the overall sanitation programming required to ensure that the Philippines reaches its NSSP targets. In addition to behaviour change through CLTS, there needs to be sustained communication to reinforce hygiene and sanitation messages; strengthening of the availability of affordable sanitation products and services for low-income households, and development of the enabling environment for supportive WASH governance and municipal services such as solid waste management and wastewater treatment.

Local government ownership: Local governments now take the ZOD programme to scale by implementing using their own funding. The introduction of CLTS paves the way for conducting a Municipal Sanitation Action Plan in which CLTS is treated as a major component of the action plan.

Integration of CLTS in various programmes: CLTS is integrated with conditional cash transfers, WASH in Learning Environments, and Graduated Rural Sanitation framework (including the PhATS programme). CLTS is seen as one part of a comprehensive WASH programme which can be implemented in a phased approach.

Marrying CLTS with sanitation marketing: Bringing CLTS together with sanitation marketing has helped increase coverage and rate of uptake of hygienic latrines. Lessons have also emerged on efficient sequencing of the two approaches, including the enhancement of the enabling environment.

Improved monitoring: ZOD monitoring has been developed using a participatory approach (e.g. forms) and trying to use real-time monitoring tools (e.g. the use of smartphones using the ODK software) – however, these pilots need to be further developed and integrated into a national system.

Lessons learned
Subsidies undermine CLTS uptake: Initial resistance to CLTS could be expected as it discourages traditional sanitation hardware subsidies. Subsidies continue to be an issue. The Government’s and other major agencies’ commitment to shifting towards a ‘no subsidy’ approach will be a major determinant of the future of CLTS. CLTS will be more effective if communities are not covered by subsidized sanitation programmes or are less exposed to such programmes.

Diffusion is effective for scaling up: LGUs and local sanitation champions are contributing to the spread and success of CLTS. Once they have the idea and skills for CLTS, local leaders and champions see the results of the programme and decide to take it to scale. LGUs have independently triggered barangays, and some villages have declared ZOD without being triggered because the community has heard of the benefits of ZOD that nearby communities have been enjoying e.g. the village is clean and free of diseases. Local chief executives (LCEs) who believe in the ZOD Program and CLTS approach are embracing this and sharing their own stories and narratives with other LCEs from other provinces and towns. The media is also gradually picking up sanitation news.

Sanitation marketing is information important for sustaining change: In areas where OD is still practised, people in general have a notion that the construction of sanitary toilets is costly. CLTS under the concept of TSSM, recognizes that there are low cost and easy-to-construct toilets that could help address OD in communities. CLTS is useful in areas where OD is common. After triggering, addressing the demand for improved sanitation and new positive behaviour has to be sustained through BCC/Communication for Development campaigns (i.e. Unli Asenso Pag May Inidoro; Goodbye Dumi, Hello Healthy) and reinforced
by local ordinance. It has to be embedded in the municipal development plans/annual investment plan.

High quality facilitators are critical: Participants to the CLTS Facilitators’ Training must be strictly pre-qualified in order to ensure effectiveness during rollout. There is a need for cooperation and collaboration among government organizations on sourcing talented facilitators. Experience suggests that quality facilitators are one of the key success factors for CLTS, however facilitators also need support mechanisms in place in order to roll out CLTS e.g. budget, technical assistance, monitoring etc.

Timely monitoring: The monitoring mechanisms and monitoring skills of facilitators and focal persons need to be improved to respond better to issues that the community faces during CLTS implementation. The importance of timely follow-up and partnership of all stakeholders (e.g. formation of WASH Taskforces) for monitoring hastens the process.

Children can influence parents: Children and teachers are important in changing the behaviour towards OD. In UNICEF areas, separate triggering of children at the same time as parents has a strong impact on parents’ emotions and motivations. If children are at school and not present for triggering then one-time real food and faeces demonstration/triggering of children in school can be considered in CLTS. The role of teachers is very important for the follow-up and strengthening the feeling of disgust and the stigma of OD practice.

CLTS weaknesses and bottlenecks

Recurring annual natural disasters: Major natural disasters that annually impact human lives, properties and productivity create
unique challenges and setbacks for sanitation progress.

Continued subsidies: Communities and people are used to highly subsidized programmes and wait for money despite it being made clear in the CLTS triggering sessions that no subsidies would be provided.

Weak human resources: Human resource capacity is lacking in some areas. Quality training and careful selection is needed to ensure appropriate skills for key roles of: DoH regional coordinators, sanitary inspectors, CLTS facilitators, and local actors.

Soil type and toilet construction: The type of soil in areas where toilets are built requires expensive innovation e.g. septic tank, reinforced pits etc. There had been requests to DoH to support technical trainings at the LGU level on the construction of improved toilets over the pit latrines.

CLTS opportunities over the next 3-5 years
Building on success to replicate and scale: Successes of CLTS particularly in ODF communities (sitios/barangays) can be used in replicating CLTS in other rural communities. In particular there is an opportunity for LGUs that have
successfully implemented CLTS to speak up/advocate for the programme to be taken up by
their peers.

Institutionalization: Having an institutional structure and delivery mechanism in place would greatly help – selected and trained CLTS facilitators from within the DoH organization and local level could create a permanent support structure and delivery mechanism that can be utilized in scaling-up CLTS in the country.

National Coordination mechanism: If a national inter-agency committee/platform for coordination could be established, it would help to ensure that the various national programmes that support NSSP are properly aligned and linked, and investments are maximized in terms of impact/results.

DSWD integration scaling up: DSWD programmes integrating WASH in achieving targets for social adequacy can be rolled out
on a large scale.

(September 2016)