Eliminating open defecation is increasingly seen as a key health outcome, with links to reduced stunting, improved educational and positive health outcomes for children. In Sub Saharan Africa, over 35 countries are implementing some form of CLTS, ranging from TATS in Tanzania to CLTSH in Ethiopia. Since the introduction of CLTS in 2005 in the region, rapid scale-up has been achieved with suggested numbers of ODF communities in the range of 30,000 affecting over 15 million people in Sub-Saharan Africa. Several countries have set aggressive targets for
elimination of Open Defecation in rural areas for the next five years which often include not only safe disposal of faeces but hand washing facilities, cleanliness and solid waste management. Sustaining the progress made through the application of the CLTSprocessisemerging as a challenge with experience suggesting that sustainability is determined by the process followed to achieve ODF. Rapid scale up in SSA is arguably linked to the fact that CLTS is based on the concept of triggering community-wide behavior change, requires no subsidies and integrates easily into existing health programming structures. Current focus is on ‘triggering’ communities into action; while considerably less resources and emphasis on following up and mentoring of communities ‘post-triggering’.
This paper reviews process and protocol for defining, reporting, declaring, certifying ODF and sustaining ODF,highlighting where the process varies between countries and potential determinants of sustainability within the process itself. Critical questions include what elements (should) constitute an ODF protocol, what are the determinants of sustainability and what impact does target-setting have on achievement of ODF goals in country? Equity of Access to WASH in Schools: A Comparative Study of Policy and Service Delivery. Emory University; UNICEF Understanding the mechanisms by which children are excluded from WASH in Schools is essential to ensuring adequate and equitable access for all school-aged children. ‘Equity of Access to WASH in Schools’ presents findings from a six-country study conducted by UNICEF and the Center for Global Safe Water at Emory University.
This research was carried out in collaboration with UNICEF country offices in Kyrgyzstan, Malawi, The Philippines, Timor-Leste, Uganda and Uzbekistan and their partners. The six case studies presented together contribute to the broader understanding of inequities in WASH in Schools access by describing various dimensions that contribute to equitable or inequitable access across regions, cultures, gender and communities. The researchers identified key dimensions of equity through formative investigations that included discussions with service delivery providers and policymakers. In
some countries, inequity existed but was found to be linked to poverty and the prioritization of other health and development objectives, rather than a specific policy. In other cases, some dimensions could not be fully investigated, usually due to lack of data. Because it was not feasible to explore every equity dimension in each of the six countries, focus areas were prioritized for each case study. Some dimensions were found to be relevant acrosscountry contexts.
Limited access to WASH in Schools compromised children’s health, educational attainment and well-being, and exacerbated already existing inequities and challenges in each of the countries. Gender was identified as a key aspect of inequity in allsix countries, but the mechanisms and manifestations of gender inequities varied within each context. Menstruating girls in Malawi and Uganda faced consistent challenges in obtaining adequate access to WASH in Schools facilities, preventing them from comfortably practicing proper hygiene. In this context, a lack of access to school WASH facilities is a potential cause of increased drop-out rates. Girls in Kyrgyzstan and Uzbekistan were affected by the poor maintenance of facilities and lack of privacy, rather than by overall lack of basic access. In these settings, lack of doors and private latrine stalls, coupled with proximity to boys’ latrines, led to girls avoiding the use of school WASH facilities, which may have deleterious health
effects. Accessibility of WASH facilities for children with disabilities was identified as an issue in all countries. In Malawi and Uganda, concerted effort has been made to include school sanitation, water and hand-washing facilities appropriate for children with disabilities. Thedesigns for facilities, however, were often found to inadequately address students’ needs, and hand-washing facilities remain largely inaccessible, compromising students’ health.