The following describes the process used in Community Led Total Sanitation (CLTS).
Pre-triggering activities
The facilitator(s) identify a village with low sanitation coverage and one which has favourable conditions for triggering CLTS. The facilitator enters the village through local leadership, which could consist of village elders, government representatives like chiefs (in Kenya) and opinion leaders. The leaders organise a meeting with the entire community (social mobilisation).
Social Map
The facilitator meets the community at the agreed venue, e.g. a village shopping centre or open public space. S/he introduces her/himself as someone who is interested in learning more about the village – its geographical layout; social profile; resources etc. It is important that s/he does not give impression that s/he is an expert out to educate the community, but rather like a student out to learn from the community.
To understand the village features, s/he proposes a participatory method like social mapping. At first the community may not fully understand the concept but with proper facilitation the community enthusiastically joins in to show what their village looks like. A good point to begin is with the village boundaries, followed by key features like major roads, rivers, hills and social amenities like schools, dispensaries, worship places etc. For this reason the map needs to be big. The facilitator asks community members to agree on a symbol to represent each feature, e.g. a stone to represent hill, a bucket to represent water sources, and these are placed on the map accordingly. The facilitator then asks community members to stand where their houses are located on the map. There is a lot of excitement as people try to locate their houses. A symbol to represent houses is agreed upon and placed on the map.
The facilitator thanks the community for having laid out their village for her/him. S/he proceeds to ask the audience to tell her/him what critical things that a human being needs to do in order to survive. The list usually consists of things like food, water, air, a good environment. If nobody mentions shitting, the facilitator follows up by asking them what happens after eating. When they mention shitting, it is usually in a nice language, like defecation, going to the toilet, helping/relieving oneself etc. The facilitator asks the community what they call shit in the local language. Again they will mention it in the socially acceptable language like stool, faeces etc. S/he asks them what they call it in the not so nice language. When they mention it, s/he sticks to the use of that term and encourages everyone to use it. The same is done for shitting.
S/he asks the community if anyone shitted that morning and where they shitted. Awkward silence normally follows but then someone will eventually say that they shitted in the bush. The facilitator requests the audience to clap for the person for doing a good job (shitting). The idea is to make this as fun as possible. S/he asks where everyone else shitted and they will indicate in the map. It is expected that the majority will indicate that they shit in the bush.
Transect Walk
Now that the ‘shit route’ is known, the facilitator requests the community to go for a transect walk across the village. Whenever they come across shit in the open, s/he stands there asking them where they think the flies will land next (may be your meal, utensils); what about chickens and dogs? This discussion goes on in the vicinity of the shit so that they can inhale the foul smell, to drive home the fact that open defecation pollutes environment.
‘Shit’ and food experiment
S/he scoops some shit on the way and takes it back to the social map. S/he places the shit and local food or bread side by side. In most cases, the community tells her/him that this is wrong. S/he asks them why and they tell her/him that flies are flying from the shit to the food thus contaminating it. They do this without the facilitator lecturing them.
S/he takes clean water and offers it to a volunteer from the crowd to drink. Naturally the volunteer will drink the water without hesitation. s/he then takes a stick, touches the shit and dips the stick in the drinking water and the proceeds to invite another volunteer to drink it. Naturally nobody would drink the water. S/he asks them why they wouldn’t take the water. The answer is always that the water is contaminated. The facilitator refutes that water is contaminated since the water is clear and there is no sign of contamination, like a change of colour or visible impurities. This is critical to drive home the point that regardless of its apparent cleanliness, water can still be full of infectious agents if it is contaminated with shit.
‘Shit’ calculation
The next step involves calculating the amount of shit that the community produces in a day, a week, a month and a year. This is not a scientific calculation. The facilitator asks the community how much human shit weighs and they deliberate on the weight. They might say an adult produces 0.75kg while a child produces 0.5kg. Based on their estimates, the annual amount of shit produced by the community is calculated. To make it dramatic, they are encouraged to convert the weight into locally recognised units e.g. lorry loads or sacks. This is meant to be dramatic for them to realise the amount of pollution in their midst as a result of open defecation. S/he asks them to clap themselves for being very good shitters as part of the humour.
The facilitator asks the audience where all these lorry loads of shit end up. They deliberate on its journey on the map and realise that the shit end up in their water sources; some carried back to their houses by dogs, chickens, and even on their own hands. S/he prods the community to tell her/him what they are basically doing. They will tell her/him that they are eating their own shit. This is an extremely important point. The idea of eating one’s shit must not come from the facilitator but from the community.
Medical cost
The facilitator asks them what the outcome of eating one’s shit is and the audience will probably mention ill health. S/he asks them to calculate the amount of money/resources spent on treating medical conditions brought about by eating shit. The amount is displayed for all to see. This is meant to drive home the point that open defecation has a very high price.
Deciding moment
All along, the community realises the connection between open defecation and ill health, in addition to environmental pollution. They also know that this is not something to be proud of. The facilitator thanks the community for having been generous in teaching her/him about their village but could s/he take picture of the group so that when s/he goes back s/he can inform other people that those in the picture are proud shit eaters? Of course, the community members present would vehemently refuse the request so s/he thanks them for their time and s/he tells them s/he is going back.
Naturally the community would say that they have realised what they have been doing (open defecation) is wrong and they would like to change. The facilitator asks them how they will change. This is a very critical moment and has to be handled well. The first person to mention that s/he will build a latrine is requested to step forward and asked to repeat her/his pledge. Other people usually follow this person to pledge that they will build latrines too. In most cases the first person to pledge ends up being a natural leader who pushes the CLTS agenda in the community.
Sanitation committee
A committee needs to be formed, to follow up on sanitation matters in the village, and they are chosen by the community in this meeting. The committee makes a list of all the households in the village, indicating those with latrines and those without. They note down when the households without latrines have pledged to have finished construction. The role of the facilitator is to remind them that the longer it takes for everyone to build and use latrines, the longer they continue to eat shit.
The committee also transfers the social map onto paper, to use it as monitoring tool. Those who finish construction and begin using their latrine are indicated in the map until the whole village attains Open Defecation Free (ODF) status.
ODF celebrations are organised to mark the achievement for the village. It also serves as an advocacy event to encourage surrounding villages to follow suit. In Kenya, it has been noted that other villages usually trigger themselves as a result of seeing the success (ODF status) of their neighbours, i.e. communities taking charge of their own sanitation and in essence their own health.
Njoroge Kamau, Plan International Kenya
Contact: Njoroge.Kamau@plan-international.org or jonseenjoroge@yahoo.com
http://www.plan-international.org/wherewework/eastafricaeurope/kenya/
Filed under: social determinants of health
