Urban Community-led Total Sanitation in Kenya: Realising the Right to Total Sanitation

                                                              

Urban Community-led Total Sanitation in Kenya: Realising the Right to Total Sanitation

Practical Action
Solution proposed by: 
The Realising the Right to Total Sanitation project in Nakuru’s Low Income Settlements was designed by Practical Action Eastern Africa and funded by Comic Relief.
In a Nutshell: 
Practical Action, with Umande Trust, and in collaboration with the County Government of Nakuru (Department of Health) worked on a 39-month project to adapt CLTS approaches to the sanitation needs of a growing urban informal population. It aimed at achieving ODF status in two informal settlements, Rhonda and Kaptembwo.
Where and When: 
The project was carried out in Kenya in two of Nakuru’s informal settlements, Rhonda and Kaptembwo with a population of around 190,000, over a period of 39 months between January 2012 and March 2015.
Challenges: 
In Kenyan towns, housing is generally grouped on plots where rooms are rented by landlords. In Nakuru, we found that although almost every plot had at least one toilet, provision was nowhere near sufficient for the number of people. Toilets were poorly designed, constructed and maintained, and with rampant misuse. Most people had to use neighbouring toilets or defecate in the open or in plastic bags on some occasions. Access to handwashing facilities was also very low (15%). Sanitation interventions in the town have been piecemeal and scattered with little noticeable difference being made to the overall situation.
Innovation: 
CLTS approaches have been widely adopted with success in rural contexts, but there are almost no instances where urban slum communities have been declared open defecation free. The innovation in this project was to find ways of adapting the standard CLTS methodology to fit with urban realities such as the need for high-quality solutions, how to incorporate handwashing, how to engage the multiple stakeholders. The project also used participatory technology development to agree six new low-cost toilet designs which were pre-approved by the government, so building work could be more readily approved.
Concept: 
CLTS is an innovative methodology for mobilising communities to completely eliminate open defecation using their own resources. It focuses on collective hygiene behaviour change, involves no hardware subsidies and does not prescribe latrine models. It works through communities being involved in assessing the levels of open defecation (or in an urban context: faeces openly in the environment), and then planning actions to address it. It aims to achieve change in a particular geographical area. The project team realised that many interventions attempted so far have failed to achieve sufficient coverage in a given area to make any meaningful difference to public health. The Kenyan Ministry of Public Health and Sanitation formally approved and recommended the CLTS approach for improving sanitation coverage in the country by including it in its national strategy towards the end of 2009, but progress has been slow and it has been barely used in urban areas. A number of adaptations to the process would be needed to deal with, for example, the need for a minimum quality of latrine, the majority or residents being tenants, the presence of multiple local institutions, and the imperative of ensuring adequate pit emptying.
Description: 
The CLTS approach four main stages. These have all been tailored to fit the urban environment as part of the project. The process has been fully documented with the support of the Indian CLTS foundation. Pre-triggering; we used GIS monitoring to map the availability and quality of toilets in the two settlements. This helped raise awareness of the inadequacy of current sanitation provision among landlords and residents, and to identify particular ‘open defecation hotspots’ that would need particular attention. Landlord forums were then held to discuss the best strategy for creating collective behaviour change, and to discuss some of the challenges faced by landlords in investing in improved sanitation. Participatory technology development was also employed for toilet designs to be pre-approved by the local authority. Triggering: using a range of techniques including street theatre and powerful demonstrations to convey messages about the levels of open faeces and their health risks. Post-triggering follow-up: A small army of community health volunteers (CHVs), working under the Public Health Officer, were already active in the community visiting house-to-house to identify needs and sign-post people to available services. They followed up on the triggering activities to try to ensure action was happening. Natural leaders also emerged, working alongside the CHVs. Village chiefs and elders were also mobilised. School sanitation campaigns were run. Smart-phone monitoring was used to track and celebrate progress. Supporting activities: in addition, the project supported the creation of an urban sanitation credit line with a local bank, building capacity to deal with safer pit emptying and disposal, and supporting artisans who can construct toilets to the agreed designs. A ‘bio-centre’ sanitation block was constructed at one of the markets to help address sanitation needs there.
Impacts: 
The sanitation situation has improved dramatically and areas would have been declared ODF were it not for technicalities around the location of handwashing facilities. 135,431 people had been engaged in the CLTS process. 2,204 sanitation facilities were built or improved, benefitting 58,260 people. 17 landlords took out sanitation loans and 464 invested in sanitation from their own resources. Informal pit emptiers are now formally recognised, trained and have established a social enterprise, and 120 artisans were trained in toilet construction. The process has been adopted by the County for wider uptake beyond these two settlements.

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Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa
Credit to Practical Action - Eastern Africa