1. Summary of Study Findings Assessment of the Sustainability of Sanitation Behaviors, Facilities and Programs Using Community-wide Open Defecation Free Approaches The Manoff Group Planning Alternatives for Change LLC Pathways Consulting Services Ltd. [ROUGH DRAFT- FOR DISCUSSION -12 May 2010]

2. Goals of This Research • To document the present status of sanitation in unions that were officially declared to be “100%” open defecation free more than 4.5 years ago • To analyze the factors that challenge or contribute to continuation of the ODF achievement: • Programs and institutions • People’s perceptions • Technical issues • Availability of supplies and services • Principal challenges • Main factors and forces contributing to sustainabilty

3. Topics covered in the study • Defecation practice only, not other aspects of sanitation (hand washing, environmental pollution, solid waste management): • LATRINES & OPEN DEFECATION ONLY • The context of latrine use: supply chain (latrine selling businesses, free distribution, installation and pit cleaning services), UP activities, social norms • Nodirect assessment was done of intervention program impacts. No evaluation was done of any specific organization’s work. • Specific unions are not identified by name in this study.

4. Approach Used to Achieve “ODF/100%” in 50 Study Unions* • GOB-only approach: 23 • CLTS approach: 10 (8 ASEH, 2 Dishari) • Non-CLTS/NGO approach: 9 • GOB-donor: 8 (DPHE-Danida/UNICEF) *3 additional: RRA/Reconnaissance only::GOB-only, GOB-Donor, & NGO

5. Follow-up Programs

7. Methodology • Selected 50 unions out of 481 that met the selection criterion: “ODf/100%” declaration >4.5 years ago • Quantitative: Survey of 3000 households in 50 unions • Qualitative: RRA, reconnaissance, and/or in-depth team visits in 18 unions (15 covered by hh survey)

8. Summary of Study Findings

9. The Sanitation Campaign • UP leadership • Numerous others: govt officers, volunteers, women/men • School children active • The campaign was compared to national liberation movement (jagoron) Faridpur District, Bhanga Uz., 2005 Rally for Safe Sanitation and Solving the Arsenic Problem

10. Different Approaches to the San. Campaign • All did: • surveys, • public notices, • general meetings, • religious leaders, • miking, • rallies

11. GOB areas: • strong threats, • some breaking and burning of open/hang latrines, • filing bogus “papers” warning people to stop OD, • distribution of ring-slab sets

12. CLTS areas: • stressed motivation & local donations; • less use of violence and fear Bhola 2002

13. Survey Responses

15. Perceived Benefits of Being ODF: Focus Groups and Key Informants

16. Current Views Regarding “ODF” or “100%” • Focus group participants in 13 out of 18 in-depth study unions were mostly enthusiastic about the idea about their villages being free of open defecation. • In five villages negativity was widespread. Reasons for this were: • Some people are bypassed by development efforts • Insecure land tenure • Mistrust of local leaders • Low motivation to overcome practical problems: flooding, water shortages, very hard soil, & others

17. Perceived Benefits of Latrine Use • Avoid ‘shame’ • Convenient for women • Essential to family status, respectability • Improves marriage arrangement prospects • Enhances spiritual life by ensuring cleanliness and purity • Negatives; Ghosts at night, snakes, bad smells, and danger of injury

18. Institutional Supports • 1. UP current activities • 2. NGO/Other current program • 3. Schools • 4. Latrine parts & Installation services • 5. Funding for latrine purchases • 6. Pit cleaning services

19. Union Parishad: Current Efforts • Out of 53 UP Chairmen interviewed or observed, around 2/3 are still working to improve sanitation in their unions. • UP members also are active, more so than chairmen in some cases • No formal monitoring by UP, but some chowkidars (vill. police) & members check up • Out of 18 in-depth study unions, 10 using ADP funds for latrine distribution, 7 not, one information unclear. • Perceived “rules” against open defecation. • Supported by their UNOs • Work well with NGOs

21. The Role of Schools • Sanitation now established as part of the health & hygiene curriculum • Madrasas also teaching san. • Students are actively interested in the issue • School latrines: problems exist, madrasas better

22. Public Latrines • Observed: ____ • Much money spent to build some of them • Bazaar latrines: • - Only one had a paid caretaker • - None were clean • - [OTHER INFO] • Caretakers are very difficult to hire. Many quit the job. • School and mosque latrines better maintained, but school latrines are over-used.

23. Latrine Parts Sellers • Mass production of latrine rings and slabs now well established, in response to sanitation campaign • Diversification of products is common • Some are former masons or “sanitation engineers” • Costs increasing more than prices • Give discounts to poor buyers

24. Pit Cleaners • Pit cleaning is becoming a well-paying occupation. • Some Muslims are taking up the profession (secretly or openly), competing with Hindu Sweeper caste people • Social stigma exists • Charge by the ring: Cost is Tk. ___ to Tk. ___ & distance to dumping place • Frequency of pit cleaning depends on no. of latrine users and ability to pay.

25. Funding latrine purchases • [Survey data] • In some places micro-credit is not available for this purpose, although most micro-credit organizations did fund latrine purchases when they were starting up.

26. Open Defecation • Some open defecation (OD) persists • OD mentioned in survey responses: 26 out of 50 unions • High (5) / Moderate (6) levels of OD in 11 out of 18 in-depth study unions • Related to: weak enforcement of rules, extreme poverty & crowding • More in CLTS areas

27. Household Latrines

28. “Improved” Latrine • -Enclosed pit, confines contents • (not intentionally broken) • -Slab/Cover over pit, with or without water-seal or vent pipe

29. “Unimproved” • Uncovered pit • Open/Hang latrine • Other type: intentionally drained out to open place

32. Superstructures

34. Latrine Ownership Individual HH ownership percentage increases with economic level.

35. Alternative Technologies & Home-made Types

36. Clay Rings (paat) • Clay rings (paat), or clay + concrete [Kurigram, Bogra, Gopalganj, Naogaon] • GOB, Non-CLTS • Low cost, no need for skilled labor to install, very deep pits, less pit cleaning expense • Believed to last long when combined with one or two concrete rings at top of pit • Rodents & white ants go inside Naogaon District

37. Duli or dongi bamboo pit liner • Duli or dongi bamboo pit liner [four districts, Lalmonirhat, Chapai-N., Naogaon, Kurigram, all with some ASEH/CLTS program/follow-up] • Low cost • No need to empty pit • Does not last a long time • Rodents or tree roots get inside

38. Others • Boitak offset model [Noakhali] • Pit (jar-shape) with narrow opening [Narsingdi & Lalmonirhat, Non-CL & CL) • Motka offset model [CLTS union, Naogaon] • Unlined pits in areas with hard earth [Narsingdi]

39. What is a ‘hygienic latrine’? FGD & Key Informants (104 comments)

40. Maintenance Arrangements • [TO BE ADDED]

41. “Hygienic” vs. “Unhygienic” • Among the 50 unions, only 35% of “improved” HH latrines are “hygienic” in terms of maintenance: • No feces visible on the floor or pan; • No major leakage from the tank/pit; • Pit is not broken to let contents run out into an open place; and/or • No strong, bad smell comes out

42. Sharing a Latrine • 36% of improved latrine owners share with another HH • Sharing HH lower economic level than non-sharing HH • Many types of arrangements: regular share, temporary share, occasional, seasonal

43. Sharing (2) • Problems keeping them clean • Long queues • Sharing pit cleaning costs • Can lead to open defecation • Cancellation of sharing also can lead to OD

44. The “Sanitation Ladder” 47% using the same latrine for the past five years; 41% two latrines during the 5-year period; and 10% had used three or more different latrines. Almost a half of the latrines used by the survey households had been installed within the past four years, and 30 percent within the past 2 years. Changes are mostly made within the same latrine type: for example, adding rings, changing location.

45. Reasons for changing the latrine at any time during the past five year period: • -Latrine damage (39%), • -Wanting or being pressured to install a latrine (39%), • -Filling up of the pit (29.7%), and • -Change of residence (11%). • Latrine damage was the most frequently mentioned reason for first, second, and third latrine changes in GOB-only areas. • In CLTS areas it was filling up of the pit: 1st, 2nd, 3rd. • In GOB-Donor areas and Non-CLTS areas: filling-up of the pit and wanting or being pressured.

47. Shared vs. Not Shared (Improved Only) Improved latrines only

48. Some comparisons relating to ‘hygienic’ latrine findings • GOB-only approach has been most effective in raising the over-all ‘hygienic’ status of latrines • But less effective in improving practices of poor households relative to others in the union • CLTS, Non-CLTS, and GOB-donor approaches have had a greater impact on poor households’ latrine maintenance practices than GOB-only approaches.

50. GOB-donor areas: percentages improved & hygienic latrines relative to union wealth-ranking (most- to least-poor)