An Assessment of clts projects and Formulation of the Strategy on Sanitation Promotion

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An Assessment of CLTS Projects and

Formulation of the Strategy on Sanitation Promotion

Final Report

Submitted to:

Nepal Water for Health (NEWAH)

Lohasal, Kathmandu


Prepared by:

Centre for Economic and Technical Studies Pvt. Ltd.

Dhobighat, Lalitpur



In Nepal, sanitation is a major challenge. Only 39% of the population has access to sanitation. A lot has to be done to meet the Millennium Development Goal (MDG) by 2015 and to achieve universal sanitation two years later by 2017. Many national and international organizations, including the Government of Nepal (GON) have been trying to increase coverage in sanitation sector. But to achieve the MDG or universal sanitation within the stipulated time is a major challenge.

Over the years, NEWAH has developed strong network for promoting sanitation, apart from providing drinking water facility to the needy people. Realizing the urgency to achieve quick and yet more sustainable result, NEWAH piloted Community Let Total Sanitation (CLTS) approach in Karkidada in Dhading in 2003 and in Dumre Ekata Chowk of Morang in 2004. Subsequently, this approach was spread to over five districts including in Dhading, Morang, Sunsari, Banke and Kailali. However, the non-CLTS approach is also continuing.

We are pleased that the Centre for Economic and Technical Studies (CETS) was asked to make assessment of the CLTS and give strategic recommendations. The CETS study team members has been involved in the assessment of CLTS since 1 January 2007. In conducting this work, we received major assistance particularly from NEWAH and other concerned people and for this we are highly indebted to them.

More specifically, we are indebted to Mr. Umesh Pandey, Director, NEWAH and Sanjaya Adhikary, Country Representative, Water Aid Nepal (WAN) for their guidance to the assessment work. Our obligations are also due to Oliver Jones and Rabin Lal Shrestha of WAN for their valuable inputs to the study.
Muhammod Abdus Sabur, Country Representative, Water Aid Bangladesh deserves special thanks from us not only for giving distant input but working together with the study team members in the field during the most turbulent period.
Our gratitude is due to Bipul Gyawali, Laxmi Paudyal and Ratan Budhathoki of NEWAH headquarters for providing us valuable inputs and support at different stages of the assessment. In the field, Himalaya Panthi, Regional Manager, NEWAH ERO, Kumar Silwal, Regional Manager, NEWAH MWRO and Manoj Jung Rayamajhi, Regional Manager, CRO provided all necessary cooperation to our study team members and for this we would like to express our sincere thanks to them. We would also like to thank Bharat Bhatt of NWEAH ERO for his briefing about the CLTS activities.
Our thanks are also due to Nawal Kishor Mishra, Chief, ESS, DWSS and Namaste Lal Shrestha, UNICEF for sharing with us issues related to strategies for further growth of CLTS in Nepal
We are obliged to Md. Zahid Parwez , sociologist for working so hard for the study. Our thanks also go to Madhav Bhattarai, Hari Krishna Adhikari, Krishna Khanal and Shyam Sundar Shah for conducting the field work in so adverse conditions.

Dhobighat, Lalitpur Hari Bansh Jha

30 March 2007 Team Leader










Chapter One


    1. Sanitation Status 1

    2. CLTS Approach 1

    3. Objectives of the Assessment 2

    4. Expected Major Outputs 2

    5. Methodology 3

      1. Secondary Source Information 3

      2. Primary Source Information 4 Orientation Meeting 4 Site Selection and Survey 4 Interview 5 FGD 5 Checklist/Observation 5

1.6 Case Studies 6

1.7 Strategic Inputs 6

1.8 Data Processing 6

1.9 Draft Report 6

1.10 Final Report 6

Chapter Two

    1. Background 7

    2. Process 7

      1. Knowledge about the Project 7

      2. Ignition Process 7

      3. Committee Formation 8

      4. Social Mobilization 9

      1. Tubewell/tap Functioning 12
      2. Capacity Building Training 12

    1. Reaching the poor and socially excluded 12

2.3.1 Dalits/Janajatis and Poor People in Programme 13

2.3.2 Women in Programme Implementation 13

2.3.3 Benefits 13

2.3.4 Support 13

2.3.5 Social Harmony 14

2.4 Sustainability 14

2.4.1 Cost Effectiveness 14

2.4.2 Technological Options 14

2.4.3 Hygienic Latrines 14

2.4.4 Hand washing Practices 16

2.4.5 Scalability 16

2.4.6 Impact on Disease Pattern 16

2.5 Major Challenges 17

2.5.1 Community or Committee Led 17

2.5.2 Geographical Consolidation 17

2.5.3 Too Hurry in Declaring NOD 17

2.5.4 NOD to Total Sanitation 18

2.5.5 Poor and socially excluded 18

2.5.6 Subsidy Approach 19
Chapter Three
3.1 Conclusion 20

3.2 Recommendations 21


Annex 1 Study Team Members 25

Annex 2 An Assessment of Community Led Total 26

Sanitation in Selected Districts in Nepal

(Questionnaire for Household Heads)

Annex 3 Guidelines for Interview with Resource Persons/ 32

NEWAH Staff/Local Partner Staff/Health Post


Annex 4 Guidelines for Focus Group Discussion 33

Annex 5 Guidelines for Checklist/Observation of the 34


Annex 6 Itinerary for Muhammod Abdus Sabur in Nepal 35



Table 1: Condition of the Tubewell/tap 12

Table 2: Benefits to Socially Excluded Groups 13

Table 3: Support for Poor and Excluded Groups 14


Box 1: Compelled by Grandchildren Dhan Bahadur Constructed Latrine 9

Box 2: Video Succeeded when social mobilization techniques failed 10

Box 3: "Khutruki" brings a change 11

Box 4: Hygienic latrine changes behaviour 15



CETS Centre for Economic and Technical Studies

CHV Community Health Volunteer

CLTS Community Let Total Sanitation

CRO Central Regional Office

DDC District Development Committee

DWSS Department of Water Supply and Sewerage

ERO Eastern Regional Office

ESS Environmental Sanitation Section

FGD Focus Group Discussion

GON Government of Nepal

MDG Millennium Development Goal

MWRO Mid Western Regional Office

NEWAH Nepal Water for Health

NGO Non Governmental Organizations

NOD No Open Defecation

NSW National Sanitation Week

SACOSAN South Asian Conference on Sanitation

SCNSA Steering Committee for National Sanitation Action

UN United Nations

VDC Village Development Committee

WAN Water Aid Nepal


Overall Assessment

  • Sanitation coverage in the CLTS programme areas was 6% before the declaration of NOD, which increased to nearly 100% after the declaration of NOD.

  • Permanent latrines formed 96% in CRO, 80% in MWRO and 79% in ERO, which averaged 85%.

  • 94% of the latrines in the project areas were clean.

  • Latrines were largely upgraded in CRO and ERO, but they were hardly upgraded in MWRO.

  • Hand washing practices with soap substantially improved during critical junctures such as before eating, after defecation, after cleaning child's bottoms and before child feeding.

  • Per household cost in CLTS amounted to NRs. 1,689; whereas it was NRs. 2,626 in non-CLTS project. CLTS project proved to be more cost effective than the non-CLTS project.

  • CLTS was largely sustainable. It helped expand sanitation coverage within the shortest period of time.

  • There was drastic reduction in the intensity of diseases like diarrhea, dysentery, skin diseases, and fever due to CLTS project

Major Challenges

  • In CLTS project, the committee and not the community was the driving force.

  • CLTS was just an "island" of success as only "too small clusters" were selected for the programme.

  • Too hurry in declaring NOD.

  • NOD and not hygiene and sanitation were the priority.
  • Lack of "no cost" or "cheaper cost" technological option for latrine construction for the socially excluded groups.

  • Except a "few," all the family members used latrines. But even a "few" was a threat to the rest as one fly is deadlier enough than 100 tigers.

  • Subsidy approach was treated as untouchable even for the poor and socially excluded groups.

  • As certain pit latrines were damaged by rats and through rains in the Terai region, people in certain clusters again resorted to the practice of open defecation, which posed a major threat to the success of CLTS.

  • Virtually CLTS programme had hardly any linkage with local government bodies such as VDCs and DDCs.

  • Complacency developed after a community was declared NOD. Least of efforts were made to move a community from NOD status to totally sanitized one.

Strategic Recommendations
Ending Dual Approach

  • NEWAH should stop its dual approach of running both the CLTS and non-CLTS projects at the same time. Of these two approaches, CLTS is a better option as it is more cost-effective, sustainable and gives more of ownership feeling. Therefore, in future NEWAH should "adopt" modified CLTS approach.

Priority to Hygiene Education

  • Hygiene has to come "first" and be given "top priority" while introducing CLTS programme. NOD should come later. It should not be other way round.

Promotion of Hardware Subsidy

  • Subsidy should be provided to the disadvantaged groups in the form of sanitation materials if that helps promote the purpose of CLTS. In this respect, wealth ranking should be performed before CLTS activities begin so that economic status of different groups of people is identified and necessary "subsidy" support is extended to them.

Increase in Sanitation Coverage

  • There should be geographical consolidation of CLTS project for which the project area coverage should be expanded to the entire VDC or a district and not just selected clusters comprising only a "limited" number of households. In order to increase this coverage, networking should be promoted with the government, INGOs, bilateral and multilateral agencies working in sanitation field and collaborate with them to use their resources and work together to give drive to CLTS approach in far more effective way.

Further Motivation to use hygienic latrines

  • Even those "few" who avoid going to latrines for whatsoever reasons should be further motivated to use hygienic latrines as they are threat to even those who use hygienic latrines.

Adequate Technological Options

  • The poor people should be given adequate technological options for which R&D activities should be promoted and the private sector entrepreneurs should be encouraged to build and market "low cost" latrines. Among the landless groups, the community latrine instead of individual latrine should be promoted such as in Paribartan Tole of Urlabari VDC in Morang district or in Khatwe Tole of Babiya VDC of Sunsari district.

Avoidance of Complacency in post-NOD stage

  • There should be no complacency even after achieving NOD status till the community totally sanitized; for which monitoring and supervision activities should be further intensified.

Total Sanitation

  • The community should be declared totally sanitized not haphazardly but based on certain criteria like the presence and proper use of sanitary latrines on the one hand and the change in behaviour of people in regard to personal, household and environmental sanitation on the other.


  • Sustainability is guaranteed when a project is community led, not committee led. The committee in a community should be formed in a way that it represents all the groups of people and allows the "community" to be in the "driving seat." In the place of a paid-facilitator, there should be a provision whereby the committee performs its activities not through a single facilitator but through more effective groups of extension and development workers including the CHVs for better anchoring in total sanitation.


  • For the scaling up of CLTS activities effectively, NEWAH should go for "joint action plan" with all the organizations working or believing in CLTS model by including governmental agency such as VDCs, DDCs, NGOs, INGOs, bilateral and multilateral agencies. For this, what is also essential for NEWAH is to go for frequent discussion meetings with such organizations and making advocacy for joint action.

Chapter One


1.1 Sanitation Status
In Nepal, the importance of sanitation was not well realized until 1970s. The traditional and modern latrines until that time were mostly confined to the urban areas. Latrines were almost non-existent in the rural areas. Even there was no national plan and programme till that period to improve the sanitary condition.

It was first of all in 1981 that the GON intervened in the sanitation sector by launching UN Declaration of International Drinking Water and Sanitation Decade. Accordingly, a number of measures were announced in 1987 for the improvement of water supply and sanitation situation in the country. Furthermore, in 1991 increased role of the NGOs and other private sector agencies in sanitation sector was perceived. The Environmental Sanitation Section (ESS) was established in Department of Water Supply and Sewerage (DWSS) in 1992. Another major development in sanitation sector was the approval of National Sanitation Policy in 1994. In order to plan and support sanitation promotion programmes through the joint efforts of the stakeholders, the Steering Committee for National Sanitation Action (SCNSA) was set up in 1998.

An era of observing National Sanitation Week (NSW) began in 2000, which is continuing uninterruptedly each year. It has played key role in the promotion of sanitation both in the rural and urban areas.
A number of provisions were made in the Eighth Plan (1992-97), Ninth Plan (1997-2002) and the Tenth Plan (2002-2007) to increase the sanitation coverage in the country. The Tenth Plan targeted to achieve 50% coverage in latrine coverage (Tenth Plan, 2002).
As a result of certain measures adopted by the GON and other agencies, the sanitary condition in Nepal improved. Only 2% of the Nepalese had access to latrines till 1980, which increased to 6% in 1990, 15% in 1997, 25% in 2001 and finally to 39% in 2004 (SACOSAN I).
Nepal's participation in SACOSAN I and SACOSAN II demonstrated the country's further commitment to reduce the gap in sanitation by 50% to meet the Millennium Development Goal (MDG) by 2015. The Rural Water Supply and Sanitation Policy 2004 further committed to achieve universal sanitation coverage by 2017.
1.2 CLTS Approach

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