CLTS in Malawi has traditionally been implemented through local Health Centre extension agents and supported by resourcing provided by donor partners. With the goal of a 100% Open Defecation Free Malawi by 2015 and the current percentage of ODF villages verified at 4.3%, there is immediate need for more efficient delivery of CLTS. The inability to monitor and verify progress towards ODF presents a critical barrier that jeopardizes the attainability of ODF targets.

Within Malawi there is a movement towards Districts integrating CLTS activities directly into everyday Health Centre work without specific project funding.  A promising innovation is being developed with support from Engineers Without Borders Canada that addresses the need for an effective monitoring system while working within existing resource constraints of local government.  Health extension agents are grouped into ‘blocks’ that cover numerous villages instead of the traditional approach of a lone agent assigned to only a few villages.

This reorganization enhances the ability to plan, facilitate, and monitor activities towards the 100% ODF target. The ‘blocks’ create plans and set realistic CLTS targets with monitoring and service delivery decisions made at the local level. This grouping of extension staff presents an opportunity to improve accountability and accuracy of monitoring for government practitioners.

Drawing on field experiences in Salima and Zomba districts, this paper explores structural challenges impacting Malawi’s rural health extension program, how the innovation emerged, and tools and methods for monitoring using the ‘block’ system.

Download the paper by Michael Kennedy, Engineers Without Borders Canada, African Programs Staff and Ashley Meek, Engineers Without Borders Canada, Sanitation Coordinator which was presented at the IRC Symposium on Monitoring Sustainable WASH Service Delivery in Addis Ababa in April 2013