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SOUTH ASIA REGIONAL LEARNING EVENT SYNTHESIS REPORT

8-11 NOVEMBER 2016 | KANDY, SRI LANKA

The CS WASH Fund is supported by the Australian Government and managed by Palladium International Pty Ltd.

Thinking beyond Open Defecation Free towards safely managed sanitation for all

Civil Society Water, Sanitation and Hygiene Fund

ii

Acknowledgements

Thanks to all the contributors to the CS WASH Fund

South Asia Regional Learning Event particularly: CSOs for their

preparation and participation, their project partners, and

numerous guest speakers and rapporteurs. Thank you to World

Vision Lanka as the hosting partner and the International Water

Management Institute (IWMI) for logistics support. Thank you

to the organising committee made up of representatives from

the Australian Red Cross, Habitat for Humanity, International

Rescue Committee, Plan International Australia, SNV, World

Vision Australia, the CS WASH Fund Monitoring, Evaluation and

Review Panel and Fund Management Facility.

The authors of this report are Mark Ellery, Paul Tyndale-Biscoe,

David van Eyck and Bronwyn Powell. This activity is supported

by the Australian Department of Foreign Affairs and Trade and

managed by Palladium International Pty Ltd.

Recommended citation:

Civil Society WASH Fund (2016) Thinking beyond Open

Defecation Free towards safely managed sanitation for all.

Synthesis Report of the South Asia Regional Learning Event.

Kandy, Sri Lanka, 8-11 November 2016

Cover: Toilets installed adjacent to barracks-style housing

for tea estate workers. These pour-flush latrines were built

as part of RIWASH-2 project with World Vision Lanka funded

by Australian Aid (then AusAID, now DFAT) completed in 2013.

Photo credit: CS WASH FMF / Dazzle Images

Partners:

iii

Contents

Acronyms and abbreviations iv

Executive summary 1

1 Chapter 1: Background 3

1.1 Purpose of this document 3 1.2 The Civil Society Water, Sanitation and Hygiene Fund 3 1.3 The CS WASH Fund in South Asia 4 1.4 Knowledge and Learning and the South Asia Regional Learning Event 4

2 Chapter 2: CSO projects, contexts and strategies 6

2.1 CSO project approaches 6 2.2 Project context and strategy mapping 9

3 Chapter 3: Status of sanitation in South Asia 11

4 Chapter 4: Moving from ODF to safely managed sanitation for all 15

5 Chapter 5: What is safely managed sanitation? 22

5.1 Managing faecal waste 23 5.2 Handwashing with soap 26 5.3 Menstrual Hygiene Management 28

6 Chapter 6: Ensuring equitable sanitation for all 29

6.1 Government roles and financing 29 6.2 Sanitation marketing 32 6.3 Disability inclusive WASH 33 6.4 Reaching women and girls and the underserved 33

7 Chapter 7: Priority SDG sanitation responses in South Asian countries 36

8 Chapter 8: Conclusion 39

Annex 1: References 40 Annex 2: Program 42 Annex 3: CSO projects 48 Annex 4: Latrine options 49

Partners:

iv

Acronyms & abbreviations


ARC Australian Red Cross

BDRCS Bangladesh Red Crescent Society

CLTS Community Led Total Sanitation

CS WASH Civil Society Water, Sanitation and Hygiene

CBO Community Based Organisation

CSO Civil Society Organisation

DFAT Department of Foreign Affairs and Trade

EED Environmental Enteric Dysfunction

GDP Gross Domestic Product

GESI Gender Equality and Social Inclusion

GO Government Organisations

HfH Habitat for Humanity

iDE International Development Enterprises

IRC International Rescue Committee

JMP Joint Monitoring Programme

K&L Knowledge and Learning

LSHTM London School of Hygiene and Tropical Medicine

MDG Millennium Development Goal

MERP Monitoring, Evaluation and Review Panel

MFI Micro-Finance Institute

MHM Menstrual Hygiene Management

MOU Memorandum of Understanding

NGO Non-Government Organisation

NPCODA Northern Province Consortium of Organisations for Differently Abled

ODF Open Defecation Free

PATS Pakistan Approach to Total Sanitation

PHED Public Health Engineering Department

RLE Regional Learning Event

SanMark Sanitation Marketing

SDG Sustainable Development Goal

SNV Netherlands Development Organisation

UNICEF United Nations Children's Emergency Fund

WASH Water, Sanitation and Hygiene

WHO World Health Organization

WSP World Bank Water and Sanitation Program

WV World Vision

1 1

This challenge was the focus of the South Asia

Regional Learning Event (RLE) held in Kandy, Sri Lanka

by the Civil Society Water, Sanitation and Hygiene

Fund (CS WASH Fund, ‘the Fund’) from 8-11 November

2016. The event was part of the Fund-wide Knowledge

and Learning; a component of the Fund that fosters

evidence-based WASH knowledge and innovations

within, between and beyond projects and the Fund.

It consisted of four days of facilitated interactive

learning, key content delivery, peer-to-peer learning

and a field trip.

The South Asian region achieved significant

improvements in sanitation coverage within the

Millennium Development Goal (MDG) period. Near total

Open Defecation Free (ODF) status was achieved in

Bangladesh and Sri Lanka; with Bangladesh, Nepal and

Pakistan achieving more than 30% reduction in open

defecation between 1990 and 2015. Moving beyond ODF and working towards the targets set by the Sustainable Development Goals (SDGs) increases the challenge to not only reach improved sanitation but to achieve safely managed sanitation for all.

Executive Summary

Child at a Sri Lankan tea estate washing her hands. Photo credit: CS WASH FMF / Dazzle Images


2

This report is a synthesis of the presentations

and discussions of the event whose 98 participants

included Civil Society Organisations (CSOs) in the

Fund, government partners and WASH sector

stakeholders. In South Asia the CS WASH Fund

supports Australian Red Cross (ARC), Habitat for

Humanity (HfH), International Rescue Committee

(IRC), Plan International Australia, Netherlands

Development Organisation (SNV) and World Vision

Lanka and Australia (WV) undertaking eight projects

in Bangladesh, Bhutan, Nepal, Pakistan and Sri Lanka.

These projects include direct support for up to 425,000

poor and vulnerable people to access basic sanitation

for improved health.

Meeting the new targets set by the SDGs, particularly

target 6.2, requires addressing the challenges

which sit beyond the ODF ‘finish line’: to not only

‘declare’ ODF, but to verify and maintain it, and move

households and communities to improved sanitation

with safely managed faecal waste treatment and

disposal. Different countries face different challenges

in climbing up the sanitation ladder. Participants

explored the application of the SDGs to their context

identifying a diversity of priority issues depending on

the country. In Bangladesh, for example, the emptying

of faecal sludge from direct pit latrines is a major issue

while in Sri Lanka the failure to contain the faecal

effluent released from septic tanks is the primary

public health risk associated with faecal

waste management.

‘Safe sanitation’ requires a holistic approach to

WASH including hygiene, especially hygienic

sanitation, handwashing with soap and Menstrual

Hygiene Management. CSOs are working to break the

silence surrounding Menstrual Hygiene Management:

this is critical in Nepal and Bangladesh if the needs

of women and girls are to be properly understood

and met. In Bhutan, SNV is trialling innovations in

behaviour change communication aiming to translate

handwashing knowledge into handwashing practice.

The SDG targets of ensuring that no-one is excluded

from safely managed sanitation services and

progressively eliminating all inequalities are areas

where CSOs make strong contributions to the sector.

For example, WV Lanka facilitated a field visit to

tea estates, exposing participants to the complex

realities of providing sanitation services for hard

to reach groups such as plantation workers where

the ownership of the land, assets and liabilities are

not clear. WV Lanka also contributed expertise on

strengthening disability inclusive WASH

in conjunction with their partner organisations that

work with people with disabilities.

The sanitation targets identified by the SDGs and

possible approaches to reach these were discussed

during the learning event. This was elaborated in a

workshop session designed to map the sanitation

service status, its institutional context within each

country, identify major bottlenecks and establish

priorities necessary to meet the rural sanitation SDG

target. The teams then worked to identify appropriate

social, legal and financial instruments to ensure safely

managed services for all that could be supported by

CSOs. Participants were also engaged in mapping their

project and the extent to which they can influence the

larger institutions of service delivery. In both cases, the

goal was to give participants the tools and reflective

space to engage with strengthening the enabling

environment within which their projects are situated.

3

CHAPTER 1

Background

1.1 Purpose of the document

This report provides a synthesis and summary of the

South Asia Regional Learning Event (South Asia RLE)

held in Kandy, Sri Lanka by the Civil Society Water,

Sanitation and Hygiene Fund from 8-11 November

2016. It seeks to capture the key content delivered by

topic experts and Civil Society Organisations (CSOs)

at the event, record important areas of discussion

by participants and direct practitioners to useful

resources. The intended audience is the CSOs within

the Fund, government partners and other WASH sector

stakeholders. This report may be read in conjunction

with the supporting resource materials available

online and linked in this document.

1.2 The Civil Society Water, Sanitation and Hygiene Fund

The CS WASH Fund is an Australian Aid initiative

funded by the Department of Foreign Affairs and

Trade (DFAT). The Fund resources 13 international

CSOs selected through a competitive grants program

to deliver 29 WASH projects over a four-year

implementation period in Southern Africa, South

Asia, East Asia and the Pacific. The ‘Theory of Change’

for the Fund is for CSO delivery teams to effectively

influence change agents, such as government, private

sector and local water authorities to scale-up and

sustain the improved delivery of water, sanitation

and hygiene services. A recently completed mid-

term review consisted of two parts: a review of

management arrangements by DFAT’s Office of

Development Effectiveness, and a review of projects’

progress by the Monitoring Evaluation and Review

Panel (MERP) in South Asia and globally.

Participants of the South Asia Regional Learning Event. Photo credit: CS WASH FMF / Dazzle Images

http://www.cswashfund.org/learning-events/events/south-asia-regional-learning-event

http://dfat.gov.au/aid/how-we-measure-performance/ode/other-work/Pages/evaluation-of-the-management-arrangements-for-the-civil-society-water-sanitation-and-hygiene-fund.aspx

http://dfat.gov.au/aid/how-we-measure-performance/ode/other-work/Pages/evaluation-of-the-management-arrangements-for-the-civil-society-water-sanitation-and-hygiene-fund.aspx

http://www.cswashfund.org/our-work/highlights-from-fund/mid-way-review-see-how-are-we-doing

http://www.cswashfund.org/our-work/highlights-from-fund/mid-way-review-see-how-are-we-doing

http://www.cswashfund.org/sites/default/files/Day1.8 MERP CS WASH Fund progress and trends.pdf


4

1.3 The CS WASH Fund in South Asia

The CS WASH Fund is supporting five CSOs in

South Asia to undertake eight projects at a value of

approximately AUD 17 million expected to directly

support 425,000 poor and vulnerable people gain

access to basic sanitation for improved health in

the region. The five CSOs are Australian Red Cross

(ARC), Habitat for Humanity (HfH), International

Rescue Committee (IRC), Plan International Australia,

Netherlands Development Organisation (SNV) and

World Vision Australia (WV), managing projects in

Bangladesh, Bhutan, Nepal, Pakistan and Sri Lanka.

Further information on the CSO projects is in Annex 3.

1.4 Knowledge and Learning and the South Asia Regional Learning Event

The CS WASH Fund incorporates a Fund-wide

Knowledge and Learning (K&L) component which

fosters and shares good practice, evidence-based

WASH knowledge and innovations with Fund CSOs,

their partners and the global WASH sector to improve

projects and service delivery. Learning events are a key

opportunity for peer-to-peer learning across CSOs as

well as from sector specialists and researchers1.

Ninety-eight participants attended the South Asia RLE.

The objectives of the event were to:

• Improve the effectiveness and sustainability of

WASH projects within the Fund by facilitating

knowledge exchange and learning;

• Strengthen relationships between CSOs, local

government and other change agents to extend

specific areas for collaboration and sharing; and

1 Research by the Fund revealed that face-to-face learning is not only the preferred method of learning for CSO WASH professionals

but it is also the most effective means for improving WASH practice (CS WASH Fund/ISF-UTS 2016).

• Provide a forum to learn from and share with the

wider WASH sector, including CSOs that cannot

attend the event, and strengthen communities

of practice within the Fund.

The overarching topic was thinking beyond Open Defecation Free (ODF) towards the Sustainable Development Goals (SDGs) and safely managed sanitation for all (elaborated further in

Chapters 3 and 4). Specific objectives agreed by

CSOs were to:

• Improve the understanding of CSO approaches

to embedding and strengthening government/

change agent systems at multiple levels for

demand and supply-side sanitation and

monitoring, including supportive financing and

incentive schemes, and systems for monitoring

changes in access to sanitation;

• Explore approaches to ensure total sanitation

for all, particularly poor and disadvantaged

households, women and girls, people living with

disabilities and to increase sanitation access in

remote and challenging environments; and

• Improve understanding of effective integrated

hygiene behaviour change activities to ensure

maximum health benefits are achieved from

sanitation and water initiatives.

This topic is within the broader context of the overall

approach of the Fund, which is to tackle WASH

holistically, including a focus on crosscutting elements

such as hygiene, gender, environment, K&L, disaster

risk reduction and climate change.

The event deployed an Integrated Learning Platform

approach offering a series of sequential learning

opportunities. This format promotes continual

http://www.cswashfund.org/our-work/cswash-projects

http://www.cswashfund.org/sites/default/files/Day1.7 Powell_B_COPs and Learning for WASH_SthAsiaRLE.pdf

http://www.cswashfund.org/research-wash-communication-maximum-impact

5

engagement, supports remote participation and

consolidates learning over time. This integrated learning

platform included:

• An e-discussion on the changing roles and

responsibilities in response to the different

challenges posed by the different steps in climbing

the sanitation ladder. This e-discussion focused on

the role of CSOs and others to assist communities

to move from the eradication of open defecation2

to improved sanitation for all.3 It explored total

sanitation including the management of faecal

sludge, drainage and solid waste services and

achieving improved health outcomes such as

regulation and enforcement of environmental

health sanitary standards.

• A webinar on the role of government in ensuring

versus providing safely managed sanitation, and

how CSOs can support government to perform

these two different roles. The webinar included an

introductory presentation distinguishing between

the roles played by government either through

short or long routes of accountability drawing on

the World Bank report, Making Services Work for

Poor People (2003). Plan International Pakistan and

SNV Bhutan presented case studies on their systems

strengthening work with government to eliminate

open defecation, promote the use of improved

sanitation for all and achieve total sanitation.

• The face-to-face Regional Learning Event which

commenced with an open day including WASH

sector stakeholders from Sri Lanka in addition to

Fund participants. This was followed by three days of

facilitated interactive learning, including key content

delivery, peer-to-peer learning and a field trip. A

guided learning tool enabled participants to capture

and reflect on their personal and team objectives

over the course of the event. A high representation

of people with disabilities was a feature of the event,

and their full participation was aided by guidelines

provided by CBM Australia on facilitating inclusive

meetings and events. The learning event was also

an opportunity for CSOs to utilise and develop their

skills with nine presentations given and five thematic

workshops led by CSOs.

2 Moving communities towards the eradication of open defecation involves triggering the behaviour change of individuals within communities to achieve

collective ODF status. 3 Sanitation for all includes proximate, sufficient, affordable and hygienic sanitation facilities for all including for children, women and girls, the poor and people

with disabilities.

Marcus Howard and Nilupuli Pethiyagoda participate in lighting the traditional Sri Lankan oil lamp – a ceremoney to mark the beginning of the learning event.


http://www.cswashfund.org/learning-events/e-discussion/moving-beyond-odf-safely-managed-sanitation

http://www.cswashfund.org/learning-events/webinars/ensuring-vs-providing-safely-managed-sanitation-services-all-roles



http://www.cswashfund.org/shared-resources/references/six-tips-planning-and-running-inclusive-meetings-and-events

http://www.cswashfund.org/shared-resources/references/six-tips-planning-and-running-inclusive-meetings-and-events


6

CHAPTER 2

CSO projects, contexts and strategies

This chapter sets the context of the CSO projects and approaches implemented in South Asia, which include attention to water, sanitation and hygiene and various crosscutting issues, with a particularly strong emphasis on sanitation. This chapter also summarises each project context and the strategy mapping process.

2.1 CSO project approaches

The approaches taken by Fund CSOs in South Asia vary

depending on their context, organisational philosophy

and guidelines. Some approaches are described

below, along with selected highlights from project

posters and ‘bringing the field to the room’ sessions

at the South Asia RLE.

Anowara Begum smiling with her husband in front of her latrine bought with a CBO loan. Photo credit: Habitat for Humanity Bangladesh

7

Habitat for Humanity is working at a community level

in three Districts of Bangladesh. While official figures

suggest high latrine coverage, household access to

hygienic toilets is low. HfH is strengthening community

organisations to provide affordable credit to poor

households to upgrade their toilets.

Plan International Pakistan’s approach is

to strengthen the Punjab Provincial Government’s

capacity to implement the Government’s own Pakistan

Approach to Total Sanitation (PATS 2011). The project

is training community mobilisers and community

development officers from the Public Health

Engineering Department (PHED), and women health

workers from the Health Department Union Council

Secretaries at the district and village level. A focus of

the project is the establishment and support of formal

government-led WASH Core Groups at District level

that will develop WASH road maps to achieve ODF

certification.

The International Rescue Committee is working

in three districts of Khyber Pakhtunkhwa Province in

Pakistan to develop and implement environmental

health plans in 120 villages. The aim is to achieve ODF

through participatory village planning processes that

proactively involve both women and men in setting

environmental health priorities such as water supply

schemes, drainage and pavement, handwashing

facilities and solid waste management.

Thanujiya and Thamilperiyan, both affected by a nerve condition leaving them unable to walk or balance, are pictured in front of their completed disability

inclusive toilet. Photo credit: World Vision Lanka


8


IRC team members explain their project to South Asian colleagues during the

poster marketplace session. Photo credit: CS WASH FMF / Dazzle Images

Building on past successes the Australian Red Cross/Bangladesh Red Crescent Society project

in Bangladesh enables vulnerable individuals and

communities in targeted areas to address their WASH

related needs as part of a broader resilience focused

program that includes other components such as

shelter, livelihoods, education and disaster risk

reduction. WASH activities include hygiene promotion,

water-testing training, and sanitation marketing

activities leading to latrine construction, water supply

provision and water resources management. The

project is working with key government departments,

community radio, public schools, madrasahs, student

and community leaders and commercial and finance

service providers.

SNV’s Sustainable Sanitation and Hygiene for All

(SSH4A) projects in Bhutan and Nepal accelerate

progress in sanitation and hygiene by strengthening

professional and organisational capacity of local

governments, private sector and stakeholders to

develop a sustainable service delivery model at scale.

They integrate sanitation demand creation, supply

chain development, behaviour change communication

and governance. In Bhutan, the programme provides

technical support to the lead government agency

nationally and at a district level to further the

development and scaling up of the national Rural

Sanitation and Hygiene Programme based on the

SSH4A approach. In Nepal, the project builds on the

successes of the first phase of the CS WASH Fund by

deepening and expanding activities in the Mid-Western

Region with a focus on strengthening post ODF

support mechanisms and sustainability. The project is

also responding to the Government’s priority districts

in the Terai by adapting the approach to this new

context.

World Vision is working in rural areas in the Northern

Province of Sri Lanka where up to 96% of households

in the targeted villages are collecting water from

unprotected wells. WV is supporting national and local

government, and Community Based Organisations

(CBOs) to implement water supply projects in

communities and schools, and to provide financial

support to the most vulnerable members of the

community to construct latrines. Improved dialogue

between communities and government is achieved

through the project’s ‘Citizen Voice in Action’ initiative.

The project has a strong focus on vulnerable groups

and directly involves disabled persons organisations in

the design and implementation of project activities.

Figure 1: Engagement strategy spectrum

STRENGTHENING THE SECTOR /

GOVERNMENT / PRIVATE SECTOR

SUPPORTING THE SECTOR /

GOVERNMENT / PRIVATE SECTOR

COLLABORATING WITH SECTOR /GOVERNMENT

IMPLEMENTING THROUGH A

PARTNER

IMPLEMENTINGDIRECTLY

9

The strategy mapping tool requires teams to rate their

project deliverables according to the same spectrum and

component structure. The tool also allows mapping of

the kind of actor (or change agent) that comprises the

primary focus of the project deliverables (government,

private sector, community or a combination), which in

turn allows the project’s strategy to be mapped by these

classes of change agents.

A project context and strategy mapping session at

the event enabled project teams and their participating

change agents to reflect on their projects and the

context in which they are implemented. Using an

Excel-based tool, project teams first mapped the WASH

context in which their projects operate, and then

mapped their project strategies. The tool generates

two spider-graph ‘maps’ which can be overlain and

compared for relative alignment (see Figure 2). This

activity has been run at each of the Fund’s RLEs.

The mapping processes are based on a strategy

spectrum consisting of five stages (see Figure 1) and

incorporates engagement with government, community

and the private sector. The context mapping uses a

Likert scale that allows the country or regional context

to be placed on a spectrum from fully enabled to not

enabled in terms of delivery of WASH services, and

is done by component (WASH infrastructure; WASH

behaviour change; gender and social inclusion;

environment, climate change and disaster risk

reduction; policy and governance).

2.2 Project context and strategy mapping

Central Province Chief Minister, the Hon Sarath Ekanayake, welcomes participants.


http://www.cswashfund.org/sites/default/files/Day4.4 Strategy Mapping Presentation %28SARLE%29.pdf


10

The large number of RLE participants

from Sri Lanka meant that the context and

strategies for WV’s project were mapped

by three different groups (see Figure 2).

Interestingly the three maps generated

were not the same. While all three groups

mapped the infrastructure component

similarly, the other components diverged

for both the context and the project’s

strategic approach to the components.

While the three groups were mapping the

same project, they were all looking at it

from a slightly different perspective: one

group was predominately project staff, the

second predominately government change

agents and the third were staff from Plan

Sri Lanka (who were participating in

the event but are not part of the Fund).

This variation highlights the importance

of a collaborative approach to project

design and the need to ensure that all

stakeholders are involved in analysing

needs and defining the most appropriate

project approach. It also highlights the

subjectivity of mapping results and

its usefulness in triggering discussion,

particularly where views on strategies

and contexts diverge.

The session stimulated robust discussion

within project teams and their counterpart

change agents, which teams found useful.

Project teams were encouraged to take

the tools back to their project offices

and conduct the exercise with the whole

project team in a less time-constrained

environment.

Infrastructure

Behaviour ChangePolicy and Governance

Environment, Climate Change and DRR Gender and Social Inclusion

Infrastructure



Infrastructure



Country Context Map

Project Strategy Map

Figure 2: Three graphs produced for Sri Lanka showing variable results from differnent groups.

Newly constructed toilet. Photo credit: CS WASH FMF / Dazzle Images

11 11

CHAPTER 3

Status of sanitation in South Asia

South Asia has secured significant

improvements in sanitation over the

Millennium Development Goal (MDG)

period. While only the Maldives, Sri

Lanka and Pakistan achieved the MDG

target of halving those without access

to improved sanitation, all countries

saw improvements in the percentage

of their population with access to

sanitation over the MDG period

(see Figure 3).

Figure 3: Sanitation progress during the MDG period in South Asian countries (JMP, 2015)

34%

61% Bangladesh

19%

50% Bhutan

4%

46% Nepal

24%

64% Pakistan 71%

95% Sri Lanka

17%

40% India

21%

32% Afghanistan

68%

98% Maldives

0%

20%

40%

60%

80%

100%

120%

1990 1995 2000 2005 2010 2015

Popu

latio

n us

ing

impr

oved

sani

tatio

n (%

)

Sanitation MDG Progress JMP 2015

34%

1% Bangladesh 11% 2% Bhutan

88%

32% Nepal

49%

13% Pakistan 13%

0% Sri Lanka

75%

44% India

34%

13% Afganistan23%

0% Maldives

0%

20%

40%

60%

80%

100%

1990 1995 2000 2005 2010 2015

Popu

latio

n de

feca

ting

in th

e op

en (%

)

Year

Open Defecation Reduction

0

200

400

600

800

1,000

1990 2015 1990 2015

Mill

ions

of p

eopl

e

# People without Sanitation Facilities in SAR JMP 2015

-161 million

+29.6 million

Maldives Afghanistan Bhutan Sri Lanka

Nepal Bangladesh Pakistan India

Without any latrine (open defecation) Without improved latrine


12

34%

61% Bangladesh

19%

50% Bhutan

4%

46% Nepal

24%

64% Pakistan 71%

95% Sri Lanka

17%

40% India

21%

32% Afghanistan

68%

98% Maldives

0%

20%

40%

60%

80%

100%

120%

1990 1995 2000 2005 2010 2015

Popu

latio

n us

ing

impr

oved

sani

tatio

n (%

)


34%


88%

32% Nepal

49%

13% Pakistan 13%

0% Sri Lanka

75%

44% India

34%

13% Afganistan23%

0% Maldives

0%

20%

40%

60%

80%

100%

1990 1995 2000 2005 2010 2015 Po

pula

tion

defe

catin

g in

the

open

(%)

Year


0

200

400

600

800

1,000

1990 2015 1990 2015

Mill

ions

of p

eopl

e


-161 million

+29.6 million




Globally, South Asia has made the most

significant improvements in reducing

open defecation with Bangladesh,

Nepal and Pakistan having all reduced

open defecation by more than 30

percentage points since 1990 (WHO

and UNICEF, 2015). During this time,

the Community Led Total Sanitation

(CLTS) approach of triggering ODF

communities was developed in South

Asia (Kar and Chambers, 2008).

Figure 4: Reduction in open defecation in South Asia over the MDG period (JMP, 2015)

The progress of South Asia in reducing

open defecation has exceeded the

increase in access to improved

sanitation: while the number of people

defecating in the open in South Asia

declined by 161 million over the MDG

period, the number of people without

improved latrines actually increased by

29.6 million (see Figure 5). This is due to

the access to improved latrines failing

to keep up with population growth

(i.e. while fewer people are defecating

in the open, an increased number still

use unimproved latrines).

Figure 5: Progress of sanitation versus open defecation in South Asia over the MDG period (JMP, 2015)

34%

61% Bangladesh

19%

50% Bhutan

4%

46% Nepal

24%

64% Pakistan 71%

95% Sri Lanka

17%

40% India

21%

32% Afghanistan

68%

98% Maldives

0%

20%

40%

60%

80%

100%

120%

1990 1995 2000 2005 2010 2015

Popu

latio

n us

ing

impr

oved

sani

tatio

n (%

)


34%


88%

32% Nepal

49%

13% Pakistan 13%

0% Sri Lanka

75%

44% India

34%

13% Afganistan23%

0% Maldives

0%

20%

40%

60%

80%

100%

1990 1995 2000 2005 2010 2015

Popu

latio

n de

feca

ting

in th

e op

en (%

)

Year


0

200

400

600

800

1,000

1990 2015 1990 2015

Mill

ions

of p

eopl

e


-161 million

+29.6 million




13

The reduction of the number of people defecating in the

open within a given area of a country can be represented

as a decrease in the density of open defecators. This

decrease in open defecation density (i.e. the number

of people open defecating within a particular area)

has a surprisingly high correlation with the average

height for children4 under the age of five (Spears, 2013).

The Demographic and Health Survey data for South

Asian countries shows that as the number of people

defecating in the open declines (i.e. the size of the bubble

decreases), the density of open defecation declines (i.e.

the bubbles move to the left) and the average height of

children increases (i.e. the bubbles move upwards) (see

Figure 6). This high correlation is particularly surprising

because of the difficulty that researchers have faced more

broadly in establishing a significant correlation between

access to improved sanitation and acute undernutrition

(i.e. abnormally low weight-for-age), let alone chronic

undernutrition (i.e. abnormally low height-for-age).

-2.4

-2.2

-2

-1.8

-1.6

-1.4

-1.2

-1

-0.8

1.2 1.4 1.6 1.8 2.0 2.2 2.4

Child

hei

ght f

or a

ge

Open defecation per square km

Bangladesh DHS Pakistan DHS Nepal DHS Sri Lanka DHS India DHS Maldives DHS

Open Defecation Density vs Stunting vs # Open Defecators

Bangladesh 1996-97

Bangladesh 1999-2000

Bangladesh 2004

2005-06

Nepal 2006

Nepal 2001

Nepal 2011

Pakistan 1990-91

Bangladesh 2007

Bangladesh 2014Sri Lanka1987

Maldives 2009

1998-99

Bangladesh 2011

Pakistan 2012-13

India

4 Child <5 height-for-age >2 SD below the normal representing chronic undernutrition or stunting

13

Source: ICF International, 2015. The DHS Program STATcompiler. Funded by USAID.

Figure 6: Correlation of open defecation density and chronic undernutrition of infants in South Asia. The graph shows open defecation density versus stunting (child height for age) versus number of open defecators using Demographic and Health Survey (DHS) data.


14

Figure 7: Influence of faecal ingestion on chronic undernutrition

Uninfected Intestine

Constant exposure to fecal bacteria

Food Healthy villi Food Unhealthy villi Stop exposure to fecal bacteria

No diarrhoea

No diarrhoea

Environmental Enteric Dysfunction

Significance of Faecal Ingestion on Undernutrition

Good absorption of nutrients

Infected intestine

Poor absorption of nutrients

While exposure to faecal contamination has

traditionally been associated with acute symptoms

(i.e. diarrhoea and fever characterised by low weight-

for-age), recent research suggests an association of

faecal contamination with chronic symptoms (i.e.

lack of absorption of nutrients characterised by

low height-for-age or stunting) that is independent

of acute symptoms (i.e. not necessarily associated

with a prolonged bout of diarrhoea). Environmental

Enteric Dysfunction (EED) is one such condition

where the regular ingestion of faecal matter can

lead to the blunting of intestinal villi resulting in the

malabsorption of nutrients (Korpi and Petri, 2012;

Crane et al., 2014) (see Figure 7).

This clear correlation of open defecation density with

child height for age, along with the recent research on

the association of EED with chronic undernutrition in

children (Mbuya and Humphrey, 2016) suggests that

eradicating open defecation remains an important

goal for South Asia.

14

15

District ODF ceremony in Jumla District. Photo credit: SNV Nepal

CHAPTER 4

Moving from ODF to safely managed sanitation for all

While some countries in South Asia

still have a significant problem with

open defecation, the challenge is

shifting to the quality of sanitary

containment. The scale, scope and

resources required to move beyond the

eradication of open defecation varies

significantly across the CS WASH Fund

countries in the South Asia Region (see

Figure 8). Countries with a higher Gross

Domestic Product (GDP) per capita

and smaller population have a greater

capacity to bear the financial costs

associated with higher quality sanitary

containment (WSP, 2013).5

Figure 8: Sanitation and economic status of CS WASH Fund countries in South Asia

Bangladesh 62,560,290

Bhutan 388,000

Nepal 15,358,140

Pakistan 67,731,840

Sri Lanka 1,080,600

0%

20%

40%

60%

80%

100%

0 1000 2000 3000 4000

% A

cces

s to

Impr

oved

San

itatio

n

GDP per capita (current US$)

# People without Improved Latrines JMP 2015

Improved facilities Shared facilities Other unimproved Open defecation

5 www.wsp.org/content/economic-impacts-sanitation

Source: World Bank Data Bank, WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP)

http://www.wsp.org/content/economic-impacts-sanitation


16

Figure 5: Rural sanitation coverage in the South-East Asia at 2015 (WHO/UNICEF 2015)

TARGET 6.2

Language In proposed targets Normative interpretation

By 2030, achieve

access Implies facilities close to home that can be easily reached and used when needed

to adequate Implies a system which hygienically separates excreta from human contact as well as safe reuse/treatment of excreta in situ, or safe transport and treatment off-site

and equitable Implies progressive reduction and elimination of inequalities among population subgroups

sanitation The provision of facilities and services for safe management and disposal of human urine and faeces

and hygiene The conditions and practices that help maintain health and prevent spread of disease including handwashing, menstrual hygiene management and food hygiene

for all Suitable for use by men, women, girls and boys of all ages including people living with disabilities

and end open defecation

Excreta of adults or children are: deposited (directly or after being covered by a layer of earth) in the bush, a field, a beach, or other open area; discharged directly into a drainage channel, river, sea, or other water body; or are wrapped in temporary material and discarded

paying special attention to the needs of women and girls

Implies reducing the burden of water collection and enabling women and girls to manage sanitation and hygiene needs with dignity. Special attention should be given to the needs of women and girls in ‘high use’ settings such as schools and workplaces, and ‘high risk’ settings such as health care facilities and detention centres

and those in vulnerable situations

Implies attention to specific WASH needs found in ‘special cases’ including refugee camps, detention centres, mass gatherings and pilgrimages

Figure 9: SDG Target 6.2 definition.

The framing of the SDG for sanitation (Target 6.2)

helps to put the challenges of moving beyond ODF in

South Asia within a broader context. The specific SDG

sanitation targets and their interpretation are included

in Figure 9, and how these vary to the MDGs described

visually in Figure 10.

‘By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.’ (UN Water, 2016)

17

Figure 10: Key shifts from the MDG to SDG definitions of sanitation access showing the move from MDG definitions (improved, shared, unimproved, OD) to SDG definitions (safely managed, basic, shared, unimproved, OD).

Sustainable Development Goals (SDGs)

Open defecation

Other unimproved

Basic

Safely managed

Shared

Millennium Development Goals (MDGs)

Eradicate all open defecation

Faecal sludge & menstrual hygiene management, handwashing & hygiene

Open defecation

Other unimproved

Shared

Improved

No targets for open defecation

Improved facilities are not necessarily safe

Shared facilities are not necessarily unsafe

Halving those

without access is

biased against

the hard to reach

(i.e. poor, disabled)

Target the universal access to sanitation

and the progressive elimination

of all inequalities

Add a ‘safely

managed’ category

Specifically, the SDGs have prioritised the eradication

of open defecation, where the MDGs did not have any

target for open defecation. In addition, the shift in the

SDGs towards universal access reflects the learning

that halving the numbers of those without access can

leave the poorest and most vulnerable behind. The

SDGs have therefore also prioritised the progressive

elimination of inequalities in all population sub-groups

and prioritised the needs of women and girls. A safely

managed category has also been introduced to ensure

that faecal waste from improved latrines is safely

emptied, transported, treated, disposed of and/or

re-used. Hygiene has also given priority to maintaining

health and stopping the spread of disease through

handwashing, food hygiene and menstrual hygiene

management practices

(WHO & UNICEF, 2015).

Moving beyond the eradication of open defecation

towards safely managed sanitation has been

conceptualised with a ladder progressing from lower-

cost sanitation options with lower health benefits to

higher-cost options with higher health benefits (see

Figure 11). SNV’s work in Nepal addresses the post-

ODF challenge of sustaining ODF on the sanitation

ladder, and they have prepared post ODF sustainability

tools and processes to assist with this (Regmi, 2016).

There has been a strong ODF movement in Nepal and

building on the momentum from this, there is growing

recognition of the need to avoid complacency by

targeting higher sanitary standards. To this end the

government and partners have drafted total sanitation

guidelines that also recognise the need to secure the

existing gains through processes designed to verify

and sustain ODF behaviours.

http://www.cswashfund.org/sites/default/files/Day3.3 SNV Nepal_PostODFTools_AnupRegmiFinal.pdf

http://www.cswashfund.org/sites/default/files/Day3.3 SNV Nepal_PostODFTools_AnupRegmiFinal.pdf


18

Thinking beyond the Finish Line

Figure 11: SNV’s ladder identifying intermediate steps between 100% ODF and total sanitation (SNV, 2016)

100% ODF STATUS

100% ACCESS TO IMPROVED SANITATION

100% HYGIENIC USE OF IMPROVED SANITATION AND HANDWASHING FACILITIES

SAFE MANAGEMENT OF WASTEWATER (GREY AND BLACK WATER)

UNIVERSAL ACCESS TO ENVIRONMENTALLY SAFE SANITATION

Vision for 2030

Intermediate milestones

Other dream elementsthat came up:

• Safe drinking water• Solid waste management• Safe food handling

Community members describe World Vision Australia and Lanka’s work at MacDuff estate. Photo credit: CS WASH FMF / Dazzle Images

19 19

The notion of a sanitation ladder implies a shift in the

types of approaches deployed to move up the ladder. For

instance, the sanitation ladder developed by the World

Bank proposed that collective mobilisation approaches

such as CLTS were more effective in moving households

away from open defecation, while sanitation marketing

approaches were more effective in assisting households

to move up the sanitation ladder (WSP, 2012). SNV

described how they have been ‘thinking beyond the

finish line’ and engaging stakeholders in creating a

vision towards the SDG goals of universal access to safely

managed sanitation and seeing ODF as one of a series of

milestones. This approach requires ongoing engagement

in addressing the challenges that householders face

on the demand side in making informed choices when

purchasing latrines as well as addressing the supply side

challenges of providing appropriate technology options.

It also requires understanding the ‘last mile’ (i.e. what

is required to meet SDG Target 6.2), local leadership

and the public finance available to adequately

resource required activities. The sanitation ladder

developed by SNV (see Figure 12) proposes that the

shift from milestones related to improved sanitation to

safely managed systems will need to be accompanied

by a change in roles and responsibilities, including

regulation of compliance.

Figure 12: Sanitation ladder proposed by SNV to ensure health outcomes (SNV, 2016). Different milestones require different roles and responsibilities.

Open Defecation Free (ODF)

Total Sanitation

Healthy Village

Use of Improved Sanitation by All

- CLTS - Steering multi-stakeholder

coordination - Technical guidance - Informed Choice

- Supply Chain facilitation - Pro-poor strategies - Strategy for disabilities

- Solid waste management - Much stronger BCC - Drainage solutions

- Better sta�ed inspection

- Environmental standards and guidance

Thinking Beyond the Finish Line

Thinking beyond the Finish Line

http://www.cswashfund.org/sites/default/files/Day1.3 Halcrow_G_SNV_Thinkingbeyondfinishline.pdf

http://www.cswashfund.org/sites/default/files/Day1.3 Halcrow_G_SNV_Thinkingbeyondfinishline.pdf


20 20

The generic representation of a

sanitation ladder and the changes in

approaches that the major steps imply

does not, however, give any sense of the

relative size of the different steps of the

ladder. To understand the relative scale

of the steps in the sanitation ladder,

and thus the scale of the challenge to

be addressed, a rural sanitation ladder

was developed using Joint Monitoring

Programme (JMP) data. By inverting

the MDG monitoring data for 2015 and

splitting the sanitation status into

sanitation ladder steps it was possible

to visualize the relative size of the steps

necessary to move up the sanitation

ladder in the five relevant countries

(see Figure 13).

Although this seems to suggest that

some countries in the region, such

as Sri Lanka, have almost completely

addressed the challenge of sanitary

containment, it is not true that

improved facilities are always operated

and maintained in a safe manner.

For this reason, the sanitation SDGs

have introduced an additional safely

managed target beyond the improved

sanitation target.

As communities move up the sanitation

ladder (see Figure 14), there is a greater

need for private sector involvement

(e.g. to supply improved latrines) as

well as public service provision (e.g.

handwashing and menstrual hygiene

management facilities in healthcare

centres and schools). There is a need

for public regulation of compliance to

sanitary codes, infrastructure standards,

sanitary behaviour, and clarity of

institutional roles and separation

at all steps of the ladder.

Figure 13: The three tables above show the three steps in developing a sanitation ladder in CS WASH Fund countries in South Asia based on JMP (WHO and UNICEF 2015) data.

Source: WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP)

32

4

18

46

0

20

40

60

80

100

2015

Cove

rage

(%)

Open defecation Other unimproved Shared facilities Improved facilities

10

28

61

2015

20

28

50

2015

13

14

9

64

2015

1 4

95

2015

Rural sanitation status upside down Nepal Bangladesh Bhutan Pakistan Sri-Lanka

46

18

4

32

0

20

40

60

80

100

2015

Cove

rage

(%

)

Improved facilities Shared facilities Other unimproved Open defecation

61

28

10 1

2015

50

28

20

2

2015

64

9

14

13

2015

95

4 1

2015

Rural sanitation status Nepal Bangladesh Bhutan Pakistan Sri-Lanka

32

4

18

46

0

20

40

60

80

100

Cove

rage

(%)

Open defecation Other unimproved Shared facilities Improved facilities

1 10

28

61

2

20

28

50

0 1 4

95

13

14

9

64

Rural sanitation status as a ladder Nepal Bangladesh Bhutan Sri-Lanka Pakistan

2 1

28

21 21

Mr Najeeb Aslam inspects a water meter at a tea plantation estate. Photo credit: CS WASH FMF / Dazzle Images

Basic

Safely managed

Health Benefits

Cost

s

Supply Chains - Appropriate technologies - Access to finance - Poor/disable inclusive - Gender equitable

Public Services - Fecal e�luent &

sludge management - Handwashing

facilities & hygiene behaviour

- Menstrual hygiene management

Public Regulation - Sanitary behaviour - Sanitary codes - Environmental standards - Quality tradespeople - Institutional separation

CLTS - Coordination - Behaviour Change - Informed Choice

Unimproved

Shared

Open Defecation

Adapted from: SNV (2016), Thinking Beyond the Finish Line: Sustainable Sanitation Services for All; Asia Regional Learning Event

Changing roles in response to the SDG sanitation ladder

Figure 14: Changing responses to the differing challenges presented by the SDG sanitation ladder. This illus-trates how with increasing complexity (increasing costs and health benefits) there is increasing private and public sector involvement.


22

CHAPTER 5

What is safely managed sanitation?

To measure the achievement of SDG Target 6.2 an additional indicator of ‘safely managed sanitation’ has been added to the MDG monitoring of access to improved sanitation. The SDG 6.2 definition of ‘safely managed sanitation’ includes the safe management of faecal waste and the washing of hands with soap. This requires that all faecal waste is safely contained, transported and treated and that all of the risks of faecal exposure are managed in a safe manner.

Improving faecal waste management contributes to

other SDG6 targets, including reducing volumes of

untreated wastewater to improve water quality (6.3),

contributing to water-related ecosystem health (6.6)

and working towards Integrated Water Resources

Management by placing WASH in the broader water

cycle (6.5). Recognising these broader contributions

of safely managing sanitation, this section identifies

the challenges in achieving safely managed sanitation

as well as handwashing with soap and menstrual

hygiene management (MHM).

To measure the achievement of SDG Target 6.2 an

additional indicator of ‘safely managed sanitation’

has been added to the MDG monitoring of access to

improved sanitation. The SDG 6.2 definition of ‘safely

managed sanitation’ includes the safe management

of faecal waste and the washing of hands with soap.

This requires that all faecal waste is safely contained,

transported and treated and that all of the risks of

faecal exposure are managed in a safe manner.

Improving faecal waste management contributes to

other SDG6 targets, including reducing volumes of

untreated wastewater to improve water quality (6.3),

contributing to water-related ecosystem health (6.6)

and working towards Integrated Water Resources

Management by placing WASH in the broader water

cycle (6.5). Recognising these broader contributions

of safely managing sanitation, this section identifies

the challenges in achieving safely managed sanitation

as well as handwashing with soap and menstrual

hygiene management (MHM).

These young Bangladeshi masons have been trained to make concrete

latrine rings with support from Bangladesh Red Crescent Society/Australian

Red Cross. Photo credit: Bangladesh Red Crescent Society

22

23 23

5.1 Managing faecal waste

The inclusion of the faecal waste management

within the safely managed sanitation SDG requires

that sanitation facilities are not only safe but that

the disposal of the faecal sludge and effluent is also

safe. This not only requires the hygienic containment,

emptying, transport, treatment, disposal and re-use of

faecal sludge but it also demands greater understanding

of the faecal digestion process in order to know the

environmental and health risks associated with

different faecal containment options.

The use of anaerobic and aerobic digestion processes

in wastewater treatment plants have been extensively

studied and their application refined over time, however

the study of the anaerobic and aerobic digestion

processes within pit latrines and septic tanks has

been the subject of less attention. While there are well

defined parameters for what constitutes improved

latrines, safely managed sanitation requires assessing

the whole sanitation service chain and is yet to be

globally defined.6

The digestion of faecal sludge and effluent generally

comprises of both anaerobic (without air) and aerobic

(with air) processes. As anaerobic and aerobic bacteria

cannot co-exist in the same space and the transition

between these processes is vitally important to the

stability of faecal digestion.

Anaerobic digestion processes are more efficient

than aerobic processes in reducing the Biological

Oxygen Demand7 of faecal sludge and effluent (i.e. the

solid content including nitrogen and phosphorous).

Anaerobic digestion is efficient in reducing the

environmental loading of faecal sludge in addition to

reducing solids that hamper the aerobic digestion of

faecal effluent. Anaerobic processes are not as efficient

as aerobic processes in reducing pathogens that have

already survived the anaerobic processes within the

gut of humans and animals. Anaerobic chambers

only require a vent pipe if they aren’t connected to an

aerobic system allowing the gas pressure to build up to

a point where the latrine won’t flush.

Aerobic digestion processes are more efficient than

anaerobic processes in reducing the pathogen content

of faecal sludge and effluent (i.e. bacteria, viruses,

parasitic protozoa and helminths). Aerobic digestion

processes are most effective when solids have been

removed from faecal effluent, or when liquids have

been removed from faecal sludge. For this reason,

aerobic processes are most effective in reducing the

pathogens in clear faecal effluent or dry faecal sludge.

Safely managed faecal waste (as defined in the SDGs)

will generally require faecal sludge and effluent to be

exposed to both anaerobic and aerobic processes.

The exposure of faecal sludge and effluent to anaerobic

processes for reducing environmental health risks, and

aerobic processes for reducing public health risks, can

assist practitioners in understanding the point at which

sanitation can be considered to be ‘safely managed’.

The perceived safety of the faecal waste management

options based on the exposure to aerobic and

anaerobic processes to major sanitation technology

options in South Asia has been summarised in Figure

15 and further detailed in Annex 4.

During the South Asia RLE, country teams identified

the need to ensure that the contents of septic tanks

are subject to some form of aerobic process as a

major issue. In the short term the absence of leach

pits results in the release of faecal effluent with high

pathogen levels and in the long term this can lead to

a loss of retention time in septic tanks if they are not

pumped out periodically. This can result in both faecal

effluent and sludge being discharged directly into the

environment from septic tanks without any treatment.

6 The WHO Sanitation Safety Planning Toolkit (2015) provides guidelines on how to assess risk and manage sanitation waste treatment (WHO 2015). 7 Biological Oxygen Demand (BOD) is a measure of the amount of oxygen used by microorganisms to degrade organic matter over time (expressed in mg/L). A high

BOD can be caused by high levels of organic pollution or high nitrate levels.


24 24

Given this risk, twin pit latrines may be a superior

option for the safe management of sanitation as

compared to septic tanks, particularly in rural areas

where equipment for safely emptying and treating

faecal sludge is difficult to access. Switching between

twin pit latrines can safely treat faecal sludge and

effluent to a point where pit contents are safe to

handle. Sealed septic tanks or pits will continue to be

more viable for high faecal loads (i.e. schools) or in high

water table areas.

In Bangladesh and other countries where direct

pit or single offset pit latrines are the common

rural sanitation solution, the handling of the faecal

sludge was identified as major area of risk. The safe

management of faecal sludge by sweepers8 and their

role in promoting the upgrade to technologies that

enable the safe management of faecal sludge was

also discussed. The experience of Welthungerhilfe

in developing desludging enterprises in small urban

centres in Zimbabwe was presented to illustrate the

issues in developing viable sludge enterprises. This

included the testing of the Technology Applicability

Framework (Potter et al., 2015) to assess the viability

of a proposed faecal sludge management approach

on six dimensions of sustainability (i.e. technological,

economic, social, environmental, institutional/legal,

skills/know how) from three different perspectives

(i.e. user/buyer, producer/provider, regulator/investor/

facilitator). The experience in the application of the

Technology Applicability Framework established that

this is a useful tool to guide discussion between users,

operators, authorities and regulators on the planning of

faecal sludge management operations.

The use of three rings can significantly reduce the costs of a septic tank for high loads

Aerobic Anaerobic

Septic Pits

Handle faecal sludge with care

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Fecal sludge is safe if dry

Water kills aerobic bacteria = unsafe

Anaerobic

Aerobic

Effluent Sludge

O�set Pit

Remove faecal sludge with care

Live pit is anaerobic so pathogen content is high

Sludge

Aerobic

Anaerobic

Twin O�set Pit

Faecal sludge is safe if le� for 1 year

Switched pit will shi� from anaerobic to aerobic

Anaerobic

Sludge

Direct Pit

Hard to empty faecal sludge

Superstructure makes it di�icult to empty

Aerobic Effluent

Rural Faecal Sludge Ladder Fecal sludge & faecal e�luent are most e�iciently digested by anaerobic + aerobic processes

Anaerobic digestion: is more e�icient in reducing solids (incl.nitrogen & phosphorous) Environmental Health Aerobic digestion: is more e�icient in reducing pathogens (i.e. fecal bacteria & viruses) Public Health

Scum

Sludge

Effluent

Anaerobic Aerobic

Septic Tank & Leach Pit

Handle faecal sludge with care • A septic tank without a leach pit will discharge both

fecal e�luent & sludge to drains • Septic tanks lose the retention time to treat

e�luent if they are not routinely pumped out

Effluent

Aerobic processes are e�ective when; - solids have been removed from liquids - liquids have been removed from solids

Anaerobic chambers only require a vent pipe if they aren’t linked to an aerobic process and if the latrine doesn’t flush

Incr

ease

d sa

fety

Increasing cost

Incr

ease

d sa

fety

Figure 15: Exposure to aerobic and anaerobic processes associated with different faecal waste management options

8 Sweepers are one of the lowest Hindu caste communities historically employed in the disposal of the solid and liquid waste.

http://www.cswashfund.org/welhungerhilfe

http://www.cswashfund.org/welhungerhilfe

25 25

Participants engaging in discussion during the field trip at the South Asia RLE. Photo credit: CS WASH FMF / Dazzle Images

Pour flush latrine. Photo credit: SNV Nepal


26 26

The classification of safely managed sanitation

identified within the SDGs includes the provision of

handwashing facilities close to a latrine. The provision

of handwashing facilities in rural areas requires the

provision of sustainable access to soap or detergent,

water and drainage. The failure to secure access to

either water or soap or drainage fails to offer a safe

handwashing option for households.

During the workshop a range of low cost handwashing

options were created by the participants to

demonstrate that access to a handwashing devices

is not necessarily costly. Various options for recycling

various sizes and shapes of plastic bottles were

showcased that enable detergent and water to be

available close to latrines. Participants demonstrated

that hot nails heated with a candle can puncture

lids and bases of plastic bottles. The proximity of

handwashing facilities to dining areas and latrines was

prioritised. Figure 16 offers a range of handwashing

options to make soap and water, drainage and re-use

facilities available proximate to latrines as well as the

dining locations in rural areas.

Recognising that the burden for carting water falls

most heavily on women and girls, the water SDGs

prioritise the supply of water via piped networks to

the household. The re-use of water transported to

the household within the household also reduces

the burden on women and supports the integrated

management of water also prioritised by the SDGs.

Access to water, soap and drainage facilities does not

necessarily mean that people will practice handwashing

with soap at critical times. SNV Bhutan is innovating

in Behaviour Change Communications and shared

the process and the learning of developing a national

approach for handwashing with soap. Working with

the London School of Hygiene and Tropical Medicine

(LSHTM), a creative agency and the Ministry of Health,

SNV are testing the potential to improve handwashing

with soap in Bhutan at scale. The ‘Super Amma’

Figure 16: Options to make handwashing facilities available in rural areas

5.2 Handwashing with soap

Drain

Soap

Soap on a rope

Soap in a net

Detergent in a bottle

Bottle Tap

Tippy Tap

Soap

Water

Concrete Drain

Water point

Crushed bricks

Bucket

Tap

Bowl

Plastic vessel

Rural Handwashing Ladder From pipe

Basin

Garden Soakwell loti Re-use


27 27

(or ‘Super Mum’) approach originally developed in

India, tested different emotional drivers of nurture,

social affiliation and disgust based on the LSHTM

Evo-Eco9 behaviour change communication approach.

The formative research found that a farming metaphor

(i.e. nurturing the health of children like seeds) to be

most effective in evoking emotions associated with

hygienic behaviour to which families could relate.

Figure 17: Super Amma

9 For more information on the Evo-Eco approach see ehg.lshtm.ac.uk/the-evo-eco-approach

SNV’s materials showing invisible germs and encouraging handwashing with soap through disgust messagaing. Photo credit: SNV Bhutan

http://ehg.lshtm.ac.uk/the-evo-eco-approach


28

MHM impacts on women and girls’ health, right to

work, education and ability to engage in society.

The explicit mention in SDG Target 6.2 of the need for

access to sanitation for women and girls to manage

sanitation and hygiene needs with dignity implies,

amongst other things, the safe management of

menstrual hygiene. This requires sanitation facilities

to have the provisions that potentially enable:

• changing (i.e. space for changing menstrual

products within the latrine facility)

• washing (i.e. water and soap for changing

and washing oneself and the cleaning of

menstrual rags)

• drying (i.e. a place for drying of menstrual rags)

• storage (i.e. a place for keeping spare emergency

menstrual products)

• disposal (i.e. a means for disposing of used

menstrual products)

SNV’s work in MHM has highlighted the catalytic role

played by various communication strategies aimed

at ‘breaking the silence,’ which often surrounds this

taboo issue. SNV’s work on integrating MHM within

ongoing country programmes in Asia as part of SSH4A

and five countries in Africa as part of the Girls in

Control projects has aimed to strengthen demand

(through behaviour change communication) and

supply (through supply chain interventions) as well as

working to advocate for and to improve governance

and enabling environments for MHM. SNV found that

underdeveloped supply chains were challenged to

meet consumer preferences for menstrual products in

rural areas and impacted by subsidy practices. Linking

various actors from health, education, WASH, women

and economic empowerment at the district and

national level to bring different activities to bear on

menstrual hygiene matters was considered essential

to breaking the silence.

5.3 Menstrual Hygiene Management

Learning event participants reflected similar

experiences to those of SNV, identifying a range of

issues for girls both ‘in’ and ‘out’ of school, and women

in workplaces. Participants identified particular action

points that included advocacy for a government

budget line for MHM (i.e. specific budget allocations

for improving menstrual hygiene), advocacy against

white secondary school girl’s uniforms and advocacy

for waste bins in toilet facilities to prevent blockages

associated with flushing menstrual pads down toilets.

The strong taboos around menstruation lead to

inadequate menstrual hygiene facilities. Additionally,

the re-use of unclean or damp rags is a significant

health issue for adolescent girls and women in

Bangladesh. HfH Bangladesh is working on MHM in

schools, and has activated School Hygiene Groups

(teachers and selected students) as change agents

responsible for delivering hygiene messaging in

schools. The provision of facilities for changing and

disposing of menstrual hygiene products within

adolescent female facilities is complemented by

increased hygiene awareness.

http://www.cswashfund.org/sites/default/files/Day4.3 SNV MHM Halcrow.pdf

29

CHAPTER 6

Ensuring equitable sanitation for all

In moving beyond ODF to safely managed sanitation,

it is important to ascertain what systems need to be

retained, upgraded or changed. One important lesson

from the success in eradicating open defecation is that

an area that is ODF provides a pure public good (i.e. it

is both non-rival and non-excludable). It is non-rival

because one person enjoying an ODF area does not

reduce the availability for anyone else to enjoy. It is

non-excludable because it is not possible to include

some while excluding others from the benefits of an

ODF area. The provision of public goods are the raison

d’être of government.

Almost all of the other aspects of sanitation are private

goods (i.e. they are rival and excludable). Latrines

and sewers, masons and pit emptiers are rival and

excludable. Rival, because one person using a toilet or

a sewer, a mason or a pit emptier means that there is

less for others to use. Excludable because one can be

excluded access while others use that good. Private

goods are most efficiently dealt with by market forces,

irrespective of whether the front-end provider is public

or private.

6.1 Government roles and financing

Sanitation entrepreneur in Punjab Pakistan. Photo credit: Plan Pakistan


30

This delineation of public versus private goods through

CLTS supports the understanding that a primary role of

government is to ensure that no one (including future

generations) is excluded from a safe sanitation service.

This is separate from and above the role of providers

(public and private, community and household) that

deliver services to the underserved. This distinction is

particularly important for government as it typically

plays both roles (see Figure 18).

In the same way that local governments have

established certified ODF jurisdictions by deploying

social instruments preventing citizens from practising

open defecation, local governments can also deploy

legal instruments to ensure that the sanitary facilities

in all households, public buildings and utilities are

safely managed. This is most efficiently pursued

by government entering into quality of service

agreements with all of the providers of sanitation

services (i.e. public and/or private, community and/or

household providers) within their jurisdiction.

Another lesson from the CLTS approach to eradicating

open defecation is the notion that household latrines

should not be subsidised (Kar and Paster, 2005). While

there are instances where subsidies for sanitation can

be effective, the risk of creating perverse incentives

suggests that such subsidies need to be approached

with caution. Although a ‘no subsidy’ mantra

promoted by CLTS is oversimplified it was effective in

maintaining an important principle of retaining asset

ownership and financing liability together.

Provision of an ‘open defecation free’ jurisdiction

Non-Rival + Non-excludable

Public Good Government

Provision of latrines,

masons, sewers & emptiers

Rival + Excludable

Private Good

Market Forces

Public and Private Sanitation Goods Separate the primary role of government of ensuring that no-one is excluded from a minimum sanitation service above all of the agents (including government agents) that provide services to the underserved

Figure 18: CLTS untangling of public and private goods

Mr Najeeb Aslam from the Government of Punjab, Pakistan, is welcomed with a wreath in Central Province, Sri Lanka. Photo credit: CS WASH FMF / Dazzle Images

31

When asset ownership and financing liability are

retained together and when the responsible tier of

government enters into quality of service agreements

with all providers of sanitation services there can only

be one of two options for the ownership of sanitation

assets. That is, either the ownership of sanitation

assets lies with the responsible tier of government,

or it doesn’t.

These two options for asset ownership then translates

into two different means by which government can

ensure a minimum safety of sanitation services.

• If the responsible tier of government owns

the assets; then it can ensure a maximum

quality of sanitation services through the

letting of competitive contracts (i.e. service or

management contracts, leases or concessions).

• If the responsible tier of government doesn’t

own the assets; then it can ensure a minimum

quality of sanitation services through social/legal

licensing of the market (i.e. planning approvals,

no-objection certificates, trade licenses).

It is proposed that these two key principles of

ensuring that no one is without access to a sanitary

facility and retaining asset ownership and financing

liability together have underpinned the success of

the movement to secure ODF jurisdictions in South

Asia. These two principles are worthy of being retained

as countries shift from community-based to market-

based approaches to reach the SDGs and safely

managed sanitation for all.

This is illustrated in Box 1 by the example of Pakistan

which was presented by the Government of Punjab

and Plan Pakistan.

Following the 18th Amendment to the Constitution

of Pakistan in 2011, which devolved some federal

powers to the provinces, the government of Punjab

adopted the Pakistan Approach to Total Sanitation

(PATS). The PATS builds on the experiences of

government and non-government organisations

who were working together on sanitation demand

creation and recognised the need for these

activities to be complemented by facilitation of

supply through market-based options. Where

applicable, any sanitation subsidies were limited

to the provision of community infrastructure

as a reward to communities that achieved ODF

status. Sanitation and hygiene, which had formally

lacked any provincial mandate, was prioritised

through the Local Government and Community

Development Department. This was supported

by the strengthening of interdepartmental

coordination particularly at the district level,

between the Local Government and Community

Development Department, and between the PHED,

primarily responsible for water and the Health

Department, responsible for health promotion. The

government has welcomed the contribution of non-

government organisations (NGOs) to support the

identification and addressing of critical gaps within

the government system. The Local Government and

Community Development Department presented

the experience of a government department

working together with NGOs to enable wider

replication. By starting small, working together

and building/scaling-up as capacity develops it has

been possible for government organisations and

NGOs in Punjab to garner significant momentum

around sanitation in the province.

Box 1: Pakistan Approach to Total Sanitation

31

http://www.cswashfund.org/sites/default/files/Day3.8 Plan Pakistan_Working of NGOs togather with Government for WASH Scale up.pdf

http://www.cswashfund.org/sites/default/files/Day3.8 Plan Pakistan_Working of NGOs togather with Government for WASH Scale up.pdf


32

In Bangladesh, less than one percent of the population

is now practicing open defecation but only 61%

of the population uses an improved facility. The

leading sanitation challenge for Bangladesh is thus

to improve the quality of latrine facilities. Moving

from a basic latrine to an improved latrine is most

efficiently supported by market instruments when the

requisite technologies and their compliance, finance

and affordability are readily available. In seeking to

address some of these bottlenecks in the markets for

sanitation in Bangladesh, HfH and the Bangladesh

Red Crescent Society (BDRCS, with iDE) showcased

their projects with sanitation markets to reach the

‘ultra-poor’ in Bangladesh. Where HfH have supported

financing via the introduction of a revolving fund

managed by CBOs, BDRCS and iDE have supported

a financing system via vouchers and access to

micro-finance institutions (MFIs).

Habitat for Humanity is supporting the training of

sanitation entrepreneurs on the supply of hygienic

latrine options and community WASH committees to

raise demand and enable access to finance for their

members through the establishment of a revolving

sanitation fund. On the other hand, iDE and BDRCS

have a project approach of providing vouchers

to ‘ultra-poor’ households to access a discount on

the sanitation options offered by various trained

sanitation entrepreneurs. As the vouchers can be

claimed from any sanitation entrepreneurs, the

onus remains on the entrepreneurs to market their

sanitation products. The next step of the project

is to seek to replace the vouchers with loans from

micro-finance institutions.

Plan International Pakistan is similarly supporting

market-side sanitation as Pakistan has transitioned

from a context of low demand to high demand

for sanitation. Plan’s experience highlighted the

importance of timing in the staging of support for

demand creation before extending support in the

supply of sanitation technologies and finance. In the

Pakistan context, a wide range of affordable sanitation

options and the diversification of local service

provision fostered greater viability in the provision

of sanitary products. In the future, Plan is seeking to

ensure the availability of comprehensive business

support to sanitation entrepreneurs (i.e. counselling,

market linkages, finance, banking and market

solutions).

6.2 Sanitation marketing

Demostrating handwashing methods in Kalikot District. Photo credit: SNV Nepal




http://www.cswashfund.org/sites/default/files/Day1.5 Plan Pakistan_Supporting Market-Side Responses_Presentation_FINAL 4 Nov.pdf

33

6.3 Disability inclusive WASH

World Vision Lanka has partnered with The Northern

Province Consortium of Organisations for Differently

Abled (NPCODA) for the delivery of its WASH work

in Jaffna, Sri Lanka to strengthen disability inclusive

WASH. They highlighted the following barriers that

inhibit WASH access for the differently abled10 during

their presentation at the learning event:

• Physical: rough pathways, steps, narrow

doorways, insufficient room, no handle, facilities

too low or high, etc.

• Attitudinal: within communities (i.e. ‘they don’t

need to collect water – someone else will do it

for them’, ‘they shouldn’t collect water – they are

unclean’) and within implementing NGOs and

partners (i.e. ‘we don’t ‘do’ disability’ or ‘it is too

hard’).

• Communication: can’t find the toilet/water

point, can’t read/access hygiene promotion

materials, can’t participate in community

planning.

• Institutional and Policy barriers: lack of

funding for accessible/universal design, building

codes don’t consider universal accessibility, no

accessibility requirement in public places.

While there are now national regulations and Ministry

of Health guidelines for universal accessible latrines in

Sri Lanka, local governments and contractors were still

largely unaware of these requirements.

6.4 Reaching women and girls and the underserved

The impact of WASH on the lives of women and

girls is immense as women predominantly carry

the household burden for water-related tasks yet

are excluded from decision-making forums. Many

Fund projects already include a strong gender focus

including the South Asia projects as illustrated by the

IRC project in Pakistan.

In Khyber Pakhtunkhwa, Pakistan, the role of women

in decision-making is hampered by a conservative

religious culture, male dominance, a lack of education,

a lack of confidence and disagreement about the role

of women in society. In this situation where women

and men are unable to meet together, discussions

must take place separately for men and for women.

IRC undertook a study to ascertain the impact that

improved tools and approaches on women’s decision-

making had on securing their priorities in approved

local development plans. IRC’s work translating

gender-disaggregated environmental health needs

into village decision-making analysed gender

segregated planning to assess the extent to which

men’s and women’s priorities were included

in planning.

10 The UN Convention on the Rights of Persons with Disabilities defines: “Persons with disabilities include those who have long-term physical,

mental, intellectual, or sensory impairments which in interaction with various barriers may hinder their full and effective participation in

society on an equal basis with others.” (Article 1)

http://www.cswashfund.org/sites/default/files/Day1.4 SthAsia RLE_CS WASH_2_WV Lanka_Partnering with DPOs to Strengthen Disability Inclusion in WASH.pdf

http://www.cswashfund.org/sites/default/files/Day1.9 Gender study_IK_DC_0.pdf


34

The multiple challenges that such cultural norms raise

were discussed, where even the recruiting of female

staff to facilitate local planning processes is extremely

difficult. This requires the project to recruit paired

male and female activists (brother and sister, husband

and wife, etc.) to find women who are able to spend

time working with women’s groups (i.e. able to spend

time away from their family or able to gain permission

from their husband). By being respectful of local

customs and blending these with the project priorities,

IRC has been able to improve local government

planning processes sufficiently to improve the extent

to which they are able to incorporate the priorities of

women in a context where women are generally not

permitted to meet with men outside of their family.

World Vision Lanka is also working to improve the

lives of women workers and their families in the hard

to reach and underserved communities of tea workers

(see Box 2).11

Have you ever wondered who picked the tea leaves in your morning brew? The first thing to know about

your morning brew, especially if it is mixed with Sri

Lankan premium blend, is that it was picked by a

woman on high, steep muddy slopes on an isolated

tea estate many hours from a town. During the day she

works in the field with no access to a toilet, and at the

end of the day carries anywhere between 10-15kg of

leaves on her head back home, to a home that more

than likely also doesn’t have a toilet.

Participants of the South Asia RLE visited Sri Lankan

tea estates on a field trip hosted by WV Lanka. Until

recently many tea workers did not have the most

basic of services, including toilets and access to

water. In these elevated green mountainous areas of

the Central Province, the local people are Sri Lankan

and, after a long history of colonial intervention from

the Portuguese and Dutch, finally succumbed to the

British in 1815. The proud people refused to work as

labourers on the tea estates. With a booming demand

for tea and plants to be picked, the British brought

over Tamils as indentured labourers from India in the

early 1800s. Generations have now grown up, married,

raised families, and died, on the tea estates, which still

bear their colonial masters names such as MacDuff, St

Clair and Mayfield Estates.

Plantation workers rely on the tea estate companies

for their wages, housing and public services including

water and sanitation, schooling and healthcare.

While these workers have been reliant on plantation

companies ‘from the womb to the tomb’, their rights

have been gradually recognised over time. From 1988

they received Sri Lankan citizenship and recently

received an increase in their daily wage from Rs. 700 to

Rs. 1,000 per day. The government and tea plantation

companies have also started enabling the workers to

own the houses and land on which they live.

Sophia Cooke and Towfika Khatun from Habitat for Humanity.


11 Note that the project activities described in Box 2 are not

CS WASH Fund projects.

Box 2: Toilets and jobs: tea workers in Sri Lanka

34

35

The low standard of sanitation and water facilities in the tea workers residences is in stark contrast to the generally high quality of water and sanitation services throughout Sri Lanka. WV Lanka has

worked with tea plantations in Nuwara Eliya District

to improve the WASH conditions of plantation

workers. This work was completed as part of the Rural

Integrated Water, Sanitation and Hygiene (RIWASH)

initiative supported by the Australia Government and

implemented by WV Lanka between 2010 and 2013.

The project provided WASH facilities to over 23,000

people – including 7,500 school children – spread over

a number estates, schools and rural villages. Visits to

the sites where WV Lanka has been working with tea

plantation owners and local governments to improve

the water and sanitation facilities for tea estate

workers included:

1. MacDuff estate where WV Lanka provided

subsidised household toilets attached to

each household, and connected to a central

treatment filtration system. This filtration

system discharged treated effluent to a wetland

downstream of the village.

2. Lindula estate where WV Lanka negotiated land

allocation from the estate to build integrated

housing for families with children. Through a

grant from WV Lanka and the support of the tea

estate, families enter an agreement to pay off

the financing gap through their salaries over a

period of ten years at which point they will own

their house and the land. Sanitation and water

is built into the house design with a pour-flush

toilet connected to a leach pit the location and

design of which were approved by the local

municipal government sanitary inspectors.

WV Lanka has started tackling the challenge of water, sanitation and housing rights for estate workers crucially opening the dialogue between estates, workers and local governments. While

Lanka is using advocacy and cost-sharing mechanisms

to leverage WASH service improvements for tea estate

workers, the scale of the challenge is well beyond

their resources. As the plantations are state owned,

but operated by companies, individual owners or

cooperatives, the responsibilities to safeguard the

rights of the workers are complicated. While the local

government act requires tea estates to meet water

and sanitation quality for workers, and while some tea

buyers require estates to meet environmental health

standards (including housing standards for workers),

the reality is that the water and sanitation rights of tea

estate workers have not been guaranteed. WV Lanka

is seeking to bring options to the table to highlight an

urgent need among this underserved group.

Left: Water tank – part of a community-managed water scheme. Right: Clarence Sutharsan, Program Manager, World Vision Lanka explains a centralised

community multi-chamber treatment to learning event participants at MacDuff Estate. Photo credit: CS WASH FMF / Dazzle Images

35


36

CHAPTER 7

Priority SDG sanitation responses in South Asian countries

This chapter summarises the results of country-focused sanitation analyses and planning activities and presents the outcomes of group discussions, agreed priorities and issues and potential future actions. During the whole-day workshop at the South Asia RLE, country-based groups assessed their country’s sanitation context in light of SDG6 and considered what is needed to work towards safely managed sanitation.

Led by the Topic Expert Mark Ellery, teams utilised

a range of tools to identify the major sanitation

bottlenecks within their country contexts, identify

priority sanitation targets and develop scenarios for

how these could be addressed to meet the sanitation

SDGs. The country profiles described here have applied

the bottleneck analysis to estimate the size of the steps

of the safely managed component of the sanitation

ladder.12

Hand washing in Rolpa, Nepal – with plate drying rack, water bucket and waste collection pit present. Photo credit: SNV Nepal

12 A more detailed description of the analysis for the five CS WASH Fund countries are available online.

http://www.cswashfund.org/sites/default/files/20170301%20SthAsiaRLE_CountryProfiles_GroupWork_Day3.pdf

37

For rural Bangladesh, addressing the risks of

faecal sludge management associated with the high

percentage of direct pit latrines, could be improved if

union parishads are supported to issue a quality mark

to sweepers and masons that have been trained in the

safe management of faecal sludge and the upgrading

of latrines from direct pit to offset pit. The upgrade

to an offset pit latrine offers the opportunity to

introduce the functionality for safe changing, washing

and drying (or disposing) of menstrual pads and the

washing of hands with soap in addition to the safe

emptying of faecal sludge from pits.

In rural Nepal, there is both a need and an opportunity

to fill the void left by the success of the movement

to eradicate open defecation. With a shift of targets

to secure total sanitation, it will be incumbent on

Village Development Committees (VDCs) to monitor

this achievement. This can be achieved through the

passage of by-laws requiring households to comply

with total sanitation standards. Given the high rates of

chronic undernutrition, VDCs could also pass by-laws

requiring the registration of births and monitoring

of growth of all children, thus measuring any

improvement to child stunting.

In rural Pakistan, where cultural patriarchy and

religious fundamentalism reduce the ability of

women to engage in planning processes, the greatest

bottleneck in reaching the sanitation SDG is most

likely going to be the access to hygienic menstrual

management facilities in rural areas. With the

assignment of the responsibility for sanitation service

provision to union (and village) councils, councils

could ensure the provision of facilities for women

through by-laws making it mandatory for households

to install latrines and bathing facilities. The provision

of facilities for women to dispose of sanitary napkins

should be an essential planning approval requirement

for all places of work and restaurants, all public

buildings and secondary schools attended by girls.

Raising the issue of MHM through local legislation

could also contribute to ‘breaking the silence’ through

Figure 19: Bangladesh rural SDG sanitation ladder

Figure 20: Nepal rural SDG sanitation ladder

Figure 21: Pakistan rural SDG sanitation ladder

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities

Safe (wrt. soap for hands)


Safe (wrt. fecal

sludge)Safe

(wrt. fecale�luent)

0

20

40

60

80

100

Cove

rage

(%)

21

18

106

10

2015

33

1 1

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)Safe


12

1 14

Safe (wrt. fecal

sludge)Safe


12

Pakistan

Other unimproved

Opendefecation

BasicfacilitiesShared

facilities

Safe (wrt. mentrual

hygiene)


Safe (wrt. fecal

sludge)

Safe (wrt. fecale�luent)

0

20

40

60

80

100

Cove

rage

(%)

0 0 3

19

2015

16

16

Sri Lanka

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

37

713

8

22

2015

11

Nepal

Other unimprovedOpen

defecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

431

32

26

2015

3

Bhutan

Bangladesh


defecation

Basicfacilities

Sharedfacilities0

20

40

60

80

100

Cove

rage

(%)

2 7

28

9

2015

8

16

31

1

25

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)


1 2

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities



Safe (wrt. fecal

sludge)Safe


0

20

40

60

80

100

Cove

rage

(%)

21

18

106

10

2015

33

1 1

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)Safe


12

1 14

Safe (wrt. fecal

sludge)Safe


12

Pakistan

Other unimproved

Opendefecation


facilities

Safe (wrt. mentrual

hygiene)


Safe (wrt. fecal

sludge)


0

20

40

60

80

100

Cove

rage

(%)

0 0 3

19

2015

16

16

Sri Lanka

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

37

713

8

22

2015

11

Nepal


defecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

431

32

26

2015

3

Bhutan

Bangladesh


defecation

Basicfacilities

Sharedfacilities0

20

40

60

80

100 Co

vera

ge (%

)

2 7

28

9

2015

8

16

31

1

25

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)


1 2

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities



Safe (wrt. fecal

sludge)Safe


0

20

40

60

80

100

Cove

rage

(%)

21

18

106

10

2015

33

1 1

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)Safe


12

1 14

Safe (wrt. fecal

sludge)Safe


12

Pakistan

Other unimproved

Opendefecation


facilities

Safe (wrt. mentrual

hygiene)


Safe (wrt. fecal

sludge)


0

20

40

60

80

100

Cove

rage

(%)

0 0 3

19

2015

16

16

Sri Lanka

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

37

713

8

22

2015

11

Nepal


defecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

431

32

26

2015

3

Bhutan

Bangladesh


defecation

Basicfacilities

Sharedfacilities0

20

40

60

80

100

Cove

rage

(%)

2 7

28

9

2015

8

16

31

1

25

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)


1 2


38

official channels that are potentially less subject to

cultural restrictions.

In rural Bhutan, where open defecation rates are

low and access to water and sanitation facilities are

relatively high, the prevalence of diarrhoea and the

incidence of stunting are still unacceptably high. In

addition to targets to secure 100% access to basic

sanitation facilities there is a growing recognition of

the need to improve hygiene behaviours to secure

health benefits for all. The responsibility of the

Gewog (elected rural village government) for ensuring

sanitation service provision could be strengthened

through the drafting of national model by-laws on

handwashing and hygiene. These by-laws could then

be amended by Gewogs according to their context

with the goal of making access to handwashing and

hygiene facilities a necessity for all households and

restaurants.

In rural Sri Lanka, to address the unsafe containment

of faecal effluent and sludge the central government

may update the building code to include leach pits

with septic tanks and draft model sanitation by-laws

for local governments to ensure that this code is

applied. This would involve the pradeshiya sabha

council (local authority) passing the sanitation by-law

and licensing the compliance of all sanitation facilities

(i.e. through planning approvals and No Objection

Certificates) and sanitation providers (i.e. trade

licenses against certificate of competence of masons,

plumbers and sweepers).

Figure 22: Bhutan rural SDG sanitation ladder

Figure 23: Sri Lanka rural SDG sanitation ladder

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities



Safe (wrt. fecal

sludge)Safe


0

20

40

60

80

100

Cove

rage

(%)

21

18

106

10

2015

33

1 1

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)Safe


12

1 14

Safe (wrt. fecal

sludge)Safe


12

Pakistan

Other unimproved

Opendefecation


facilities

Safe (wrt. mentrual

hygiene)


Safe (wrt. fecal

sludge)


0

20

40

60

80

100

Cove

rage

(%)

0 0 3

19

2015

16

16

Sri Lanka

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

37

713

8

22

2015

11

Nepal


defecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

431

32

26

2015

3

Bhutan

Bangladesh


defecation

Basicfacilities

Sharedfacilities0

20

40

60

80

100

Cove

rage

(%)

2 7

28

9

2015

8

16

31

1

25

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)


1 2

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities



Safe (wrt. fecal

sludge)Safe


0

20

40

60

80

100

Cove

rage

(%)

21

18

106

10

2015

33

1 1

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)Safe


12

1 14

Safe (wrt. fecal

sludge)Safe


12

Pakistan

Other unimproved

Opendefecation


facilities

Safe (wrt. mentrual

hygiene)


Safe (wrt. fecal

sludge)


0

20

40

60

80

100

Cove

rage

(%)

0 0 3

19

2015

16

16

Sri Lanka

Other unimproved

Opendefecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

37

713

8

22

2015

11

Nepal


defecation

Basicfacilities

Sharedfacilities

Safe (wrt. mentrual

hygiene)


0

20

40

60

80

100

Cove

rage

(%)

431

32

26

2015

3

Bhutan

Bangladesh


defecation

Basicfacilities

Sharedfacilities0

20

40

60

80

100

Cove

rage

(%)

2 7

28

9

2015

8

16

31

1

25

Safe (wrt. mentrual

hygiene)

Safe (wrt. fecal

sludge)


1 2

39

CHAPTER 8

Conclusion

The South Asia RLE enabled participants to reach

a new level of understanding in regards to the key

topic of moving beyond ODF to the SDGs and safely

managed sanitation for all. CSOs with differing

approaches had the opportunity to discuss and

debate the pros and cons of these approaches, such

that all participants could reach a more informed

understanding. Participants also left with a renewed

appreciation of the differing contexts within South

Asia in regards to the current status of progress in

sanitation and the challenges associated with meeting

the SDG targets for sanitation. From the strategy

context mapping exercises, the participants gained a

greater understanding of the role that the CSO projects

are already playing in respect to the context of the

current status of the country in the sanitation sector.

Participants also left with a greater understanding of

the potential instruments that could be deployed by

governments to assist countries to move beyond ODF

and towards the SDGs and safely managed sanitation

for all.

The statement from one participant in the concluding

session of the workshop indicated that the primary

goal of the workshop of moving beyond ODF toward

ensure safely managed sanitation for all had aligned

with the Fund’s primary goal of strengthening the

institutions of service delivery. “In many instances, the

laws and regulations that can support us to deliver on

our own WASH interests and desired outcomes already

exist and there’s something about us understanding

what those are and working with them, rather than

thinking about they don’t exist.”

Understanding the country context and strengthening

the licensing instruments already assigned to local

government institutions is central to enabling

countries to move up the sanitation ladder to ensure

safely managed sanitation for all. After attending the

South Asia RLE, CSO staff and partners returned to their

projects equipped with a more in-depth understanding

of the challenge set by SDG Target 6.2, priority issues

for their country and actions on how to tackle these.

World Vision Lanka presenting on Plantation Sanitation Model . Photo credit: CS WASH FMF / Dazzle Images


40

ANNEX 1

References

Crane, R.J. et al. (2014) Environmental enteric dysfunction: An overview, Community-based Management of Acute Malnutrition (CMAM) Forum. www.ncbi.nlm.nih.gov/pmc/articles/PMC4472379

Hanchett, S. et al. (2011) Long-Term Sustainability of Improved Sanitation in Rural Bangladesh, WSP World Bank. www.wsp.org/sites/wsp.org/files/publications/WSP-Sustainability-Sanitation-Bangladesh-Report.pdf

Kar, K. and Pasteur, K. (2005) Subsidy or self-respect? Community Led Total Sanitation – An update on recent developments, IDS Working Paper 257, Institute for Development Studies. www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/ wp257_0.pdf

Kar, K. and Chambers, R. (2008) Handbook on Community Led Total Sanitation (CLTS), Plan UK and the Institute for Development Studies at the University of Sussex. www.communityledtotalsanitation.org/page/clts-approach

Korpe, P.S. and Petri, W. A. Jr. (2012) Environmental enteropathy: critical implications of a poorly understood condition. Trends in Molecular Medicine June; 18(6): 328-36.

Mbuya, M. N. and Humphrey, J. H. (2016) Preventing environmental enteric dysfunction through improved water, sanitation and hygiene: an opportunity for stunting reduction in developing countries, Maternal Child Nutrition. www.ncbi.nlm.nih.gov/pubmed/26542185

Potter, A., Nothomb, C. and Tuffuor, B. (2015) Technology Applicability Framework (TAF) questions: mobile desludging units. IRC: The Hague, Netherlands. www.ircwash.org/resources/technology-applicability-framework-taf-questions-mobile-desludging-units

Regmi, A. (2016) Tools for embedding post-ODF sustainability: experiences from Nepal. In Bongartz, P., Vernon, N. and Fox, J. Sustainable Sanitation for All. Warwickshire: International Development Studies, CLTS Knowledge Hub. dx.doi.org/10.3362/9781780449272.000

SNV (2016) Thinking Beyond the Finish Line: Sustainable Sanitation Services for All; Asia Regional Learning Event. www.cswashfund.org/shared-resources/references/thinking-beyond-finish-line-sustainable-sanitation-services-all

Spears, D. (2013) How much international variation in child height can sanitation explain? Policy Research Working Paper 6351, World Bank. elibrary.worldbank.org/doi/abs/10.1596/1813-9450-6351

UN Water, The United Nations Inter-Agency Mechanism on all Freshwater related issues, including sanitation. www.unwater.org/sdgs/from-mdgs-to-sdgs/en

UN Water (2016) Integrated Monitoring Guide for SDG 6 Targets and global indicators. www.unwater.org

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472379

http://www.wsp.org/sites/wsp.org/files/publications/WSP-Sustainability-Sanitation-Bangladesh-Report.pdf



http://www.communityledtotalsanitation.org/sites/communityledtotalsanitation.org/files/wp257_0.pdf



http://www.communityledtotalsanitation.org/page/clts-approach

http://www.communityledtotalsanitation.org/page/clts-approach

http://www.ncbi.nlm.nih.gov/pubmed/26542185

http://www.ircwash.org/resources/technology-applicability-framework-taf-questions-mobile-desludging-units



http://dx.doi.org/10.3362/9781780449272.000

http://www.cswashfund.org/shared-resources/references/thinking-beyond-finish-line-sustainable-sanitation-services-all



http://elibrary.worldbank.org/doi/abs/10.1596/1813-9450-6351

http://elibrary.worldbank.org/doi/abs/10.1596/1813-9450-6351

http://www.unwater.org/sdgs/from-mdgs-to-sdgs/en

http://www.unwater.org

41

World Bank (2004) World Development Report 2004: Making Services Work for Poor People. World Bank. openknowledge.worldbank.org/handle/10986/5986

WHO (2015) Sanitation Safety Planning: Manual for safe use and disposal of wastewater, greywater and excreta. France: World Health Organization. www.who.int/water_sanitation_health/publications/ssp-manual/en

WHO and UNICEF (2015) WASH Post-2015, Proposed indicators for drinking water, sanitation and hygiene. www.wssinfo.org/fileadmin/user_upload/resources/JMP-WASH-Post-2015-Brochure.pdf

WHO and UNICEF (2015) Drinking Water Supply and Sanitation Joint Monitoring Programme (JMP). www.wssinfo.org

WSP (2012) What Does It Take to Scale Up Rural Sanitation, World Bank. www.wsp.org/sites/wsp.org/files/publications/WSP-What-does-it-take-to-scale-up-rural-sanitation.pdf

WSP (2013) Economics of Sanitation Initiative for South Asia, World Bank. www.wsp.org/content/south-asia-economic-impacts-sanitation

http://openknowledge.worldbank.org/handle/10986/5986

http://openknowledge.worldbank.org/handle/10986/5986

http://www.who.int/water_sanitation_health/publications/ssp-manual/en

http://www.who.int/water_sanitation_health/publications/ssp-manual/en

http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-WASH-Post-2015-Brochure.pdf

http://www.wssinfo.org/fileadmin/user_upload/resources/JMP-WASH-Post-2015-Brochure.pdf

http://www.wssinfo.org

http://www.wsp.org/sites/wsp.org/files/publications/WSP-What-does-it-take-to-scale-up-rural-sanitation.pdf



http://www.wsp.org/content/south-asia-economic-impacts-sanitation

http://www.wsp.org/content/south-asia-economic-impacts-sanitation


42

ANNEX 2

South Asia Regional Learning Event Program 8 – 11 November 2016, Kandy, Sri Lanka

Thematic objectives of the event include to:

1. Improve the understanding of CSO approaches to embedding and strengthening government/change agent systems at multiple levels for demand and supply-side sanitation and monitoring, including supportive financing and incentive schemes, and systems for monitoring changes in access to sanitation;

2. Explore approaches to ensuring total sanitation for all, particularly poor and disadvantaged households, people living with disabilities and to increasing sanitation access in remote and challenging environments; and

3. Improve understanding of effective integrated hygiene behaviour change activities to ensure maximum health

benefits are achieved from sanitation and water initiatives.

Learning objectives of event include to:

1. Improve the effectiveness and sustainability of WASH projects within the Fund by facilitating knowledge exchange and learning;

2. Strengthen relationships between CSOs, local government and other change agents to extend specific areas for collaboration and sharing; and

3. Provide a forum to learn from and share with the wider WASH sector and strengthen communities of practice

within the Fund.

Theme: Thinking beyond Open Defecation Free (ODF) towards the SDGs and safely managed sanitation for all

DAY 1: Open DayTime Tuesday 8 November

8:00 – 9:00 Registration

9:00 – 9:10 Welcome and Lighting of the LampDavid van Eyck, National Facilitator and Master of Ceremonies

9:10 – 9:20 Welcome by World Vision Dr Dhanan Senathiraja, National Director, World Vision Lanka

9:20 – 9:30 Welcome to Central Province The Hon. Sarath Ekanayake, Chief Minister, Central Province, Sri Lanka

9:30 – 9.40 Australian Aid and WASH in Sri Lanka Charlotte Blundell, Counsellor, Development Cooperation, Sri Lanka and Maldives, DFAT, Australian High Commission, Sri Lanka

9:40 – 9:50 Official Opening Representative of The Hon. Rauf Hakeem, Minister for Water Supply and City Planning, Ministry of Water Supply and City Planning

9:50 – 10:10 Current status of sanitation and water in Sri Lanka Representative of Eng. G. A. Kumararathna, General Manager, National Water Supply and Drainage Board

43

DAY 1: ContinuedTime Tuesday 8 November

10:10 – 10:40 Break

10:40 – 10:50 Introduction to the learning event program and objectivesBronwyn Powell, Knowledge and Learning Manager (KALM), CS WASH Fund Management Facility

10:50 – 11:15 Keynote Presentation – Moving beyond ODF to safely managed sanitation for allMark Ellery, Topic Expert/Facilitator of South Asia Regional Learning Event

11:15 – 12:00 Presentations and panel discussion 1) Beyond the finish line and total sanitation – Gabrielle Halcrow, SNV Netherlands Development

Organisation2) Partnering with Disabled Peoples Organisations to strengthen disability inclusive WASH – Vellayan

Subramaniam (President of Northern Province Consortium of Organization for Differently Abled (NPCODA) and Jeyald Rasaratnam, Operations Manager, World Vision Lanka

3) Supporting market-side responses to demand generated by CLTS activities – Asim Muhammad Saleem, Plan Pakistan

12:00 – 1:00 Lunch

1:00 – 2:00 “Marketplace” of CS WASH Fund project posters in South Asia

2:00 – 2:05 CS WASH Fund video

2:05 – 2:20 Australian Aid support to WASH and the Civil Society WASH Fund Marcus Howard, Water, Sanitation and Hygiene Section, Australian Department of Foreign Affairs and Trade

2:20 – 2:35 Communities of Practice and innovation for CSOs and WASH sector learning Bronwyn Powell, KALM

2:35 – 2:50 CS WASH Fund progress and trends Dr Paul Crawford, Monitoring, Evaluation and Review Panel (MERP)

2:50 – 3:00 Question and answer session

3:00 – 3:30 Break

3:30 – 4:45 Thematic sharing sessions 1) Sanitation marketing and financing amongst poor communities in Bangladesh – Habitat for Humanity

Bangladesh and iDE 2) Decision-making at the village level and ensuring women’s voice in decision-making – lessons from

Khyber Pakhtunkhwa – IRC Pakistan3) Behaviour change communications and hygiene cost effectiveness – SNV BhutanThese are parallel sessions with brief presentations, group activities and discussion

4:45 – 5:00 Day 1 Wrap-up session

Briefing for field visit

5:15 – 6:30 Welcome function at Earl’s Regency

ANNEX 2 continued


44

ANNEX 2 continued

Time Wednesday 9 November

7:00 am Depart Earl’s Regency – Packed breakfast provided

7:00 – 9:30 Travel to Hatton

9:30 – 10:00 Morning tea

10:00- 11:00 • Security and child protection briefing by World Vision • Welcome by plantation management, Local Authority and Provincial Government representatives • Split into two groups for Gallery Walk

11.00 – 12.30 Group 1 – Mayfield Estate – Site 1 This project was completed two years ago and is now operating as a community managed scheme. It provides a good example of partnerships with community, private sector and government. Communities are ODF. Visitors will see sanitation projects and learn how WV works with partners and CBOs to achieve ODF.

Group 2 – Lindula EstateThis estate has new housing estates with integrated housing. This estate provides an example of different institutions have partnered (microfinance organisations, government, WV) to meet the basic needs of the community. Visitors will see the technical challenges of supplying services to and emptying septic tanks in hilly areas.

12.30 – 1:30 Lunch at Tea Estate Lunch at Lindula Estate Bungalow

1:30 – 4:00 Mayfield Estate – Site 2 • Visit a gravity-fed water project for

household water supply scheme and meet user groups.

• Inspect handwashing stations and household latrines

• Learn about Operation and Maintenance, user fees and how plantations support sustainability

MacDuff EstateThis is a privately owned estate that had been neglected and had no basic facilities for workers. With the RIWASH DFAT grant, a central sewerage system connecting all plantation workers houses to a central system was built. This was a pilot test and now provides a model for community-managed systems that will be rolled out to other areas. Improvements to the estate included electricity, sanitation and water connections. The communities have been ODF certified for 5 years.

4:00 – 4:30 Evening Tea at Hotel Asvika – Group 1 and 2 meet for debriefing

4:30 – 7:00 Travel back to Earl’s Regency

Group 1 – Mayfield Estate

Focus on sanitation advocacy, gravity flow water projects with private-public partnership, and the institutional

arrangements for CBOs for operation and maintenance (O&M) of infrastructure.

Group 2 – Lindula and MacDuff Estates

Lindula Estate – Focus on integrated housing projects that were part of a water and sanitation program with different stakeholder partnerships to meet the basic needs of plantation communities.

MacDuff Estate – This estate has been certified ODF for five years. The visit will focus on how the community is maintaining centralised sanitation infrastructure (sewerage).

DAY 2: Field Trip to tea plantation estates with World Vision Lanka

45

ANNEX 2 continued

DAY 3: Workshop: Beyond ODF towards safely managed sanitation for all

Time Thursday 10 November

9:00 – 9:30 Field trip debriefing

9:30 – 10:15 SESSION 1: Sanitation status and mapping bottlenecks by country

1) Introductory presentation to sanitation status in the South Asia Region – Mark Ellery

2) Activity In 5 country groups, CSOs and change agents will be issued with a PowerPoint presentation that contains a graph of the rural sanitation status in their country and a graph of the major rural sanitation bottlenecks in their country. The groups will be asked to annotate this PowerPoint to identify the dimensions (i.e. the scope, scale, type) of the bottlenecks in rural sanitation.

3) Post-ODF tools presentation – Anup Regmi, SNV Nepal

10:15 – 10:45 Break

10:45 – 12:30 SESSION 2: Sanitation ladder analysis

1) Presentations

• Introductory presentation on sanitation ladder in the South Asia Region – Mark Ellery

• Challenges and approaches to addressing water contamination – Nazmul Azam Khan and Biplob Kanti Mondal, Bangladesh Red Crescent Society

• Developing a mobile desludging business: lessons from Zimbabwe – Bronwyn Powell for Welthungerhilfe

2) Activity In 5 country groups, the CSOs and Change Agents will be issued with a PowerPoint presentation that contains a graph of the size of the steps in the rural sanitation ladder in their country. The 5 country groups will be asked to annotate this PowerPoint presentation to identify the priority interventions necessary to assist the different households to move up the different steps in the rural sanitation ladder.

12:30 – 1:30 Lunch

1:30 – 3:00 SESSION 3: Roles and responsibilities for sanitation

1) Presentations • Assigning roles and responsibilities for sanitation – Mark Ellery

2) Activity In 5 country groups, CSOs and change agents will be issued with a generic PowerPoint presentation on the vertical and horizontal assignment of roles and responsibilities for rural sanitation in their country. The 5 country groups, will be requested to identify the vertical and horizontal assignment of responsibilities to the different government agents associated with the 4 major sanitation steps necessary to achieve the SDGs (versus an assessment of their capacity).

3:00 – 3:30 Break


46

Time Thursday 10 November

3:30 – 4:45 SESSION 4: CSO priorities to strengthen national sanitation institutions

1) Presentations

• Working with government at scale – wider replication of project approaches – Najeed Aslam, Director (Community Development and Training), Local Government and Community Development Department, Government of Punjab

• Menstrual Hygiene Management – Towfika Khatun, Habitat for Humanity

• Levers of change in sanitation – Mark Ellery

2) Activity In the 5 country groups, CSOs and change agents will identify the short, medium and long term priority actions for CSOs to support the government institutions in each country.

4:45 – 5:00 Day wrap-up

6:15 – 9:30 Conference Dinner

ANNEX 2 continued

DAY 3: Workshop continued

47

Time Friday 11 November

9:00 – 10:15 Thematic sharing sessions

1) Strengthening disability inclusive WASH – NPCODA and World Vision Lanka2) Learning for impact in WASH – CS WASH Fund K&L Component/ISF UTS3) Menstrual Hygiene Management – SNV

These are parallel sessions with brief presentations, group activities and discussion

10:15 – 10:45 Break

10:45 – 11:00 Context Mapping Exercise – Paul Tyndale-Biscoe and Paul Crawford (MERP)

• Activity to place your project on the strategy spectrum (direct delivery through to strengthening the enabling environment)

11:00 – 12:15 Context Mapping Exercise

• ‘Mapping the Context’ overview• Group work activity

12:15 – 1:15 Lunch

1:15 – 2:45 Strategy Mapping Exercise continued

• Introduction to the Strategy Spectrum• Strategy Mapping – Overview and the mapping process• Strategy mapping activity in project teams

2:45 – 3:15 Break

3:15 – 5:00 Workshop closing session

• Team action planning • Activities for synthesising and consolidating learning

ANNEX 2 continued

DAY 4


48

ANNEX 3

CSO projects The following table list CSOs working in South Asia in the CS WASH Fund and links to project profiles and materials

available on the CS WASH Fund website.

CSO Country Project title

Australian Red Cross and Bangladesh Red Crescent Society

Bangladesh CDI 2 – WASH Program (Community-based Development Initiative – Water and Sanitation Hygiene Promotion)

Australian Red Cross and Nepal Red Cross

Nepal Sanitation, Hygiene and Water Management Project

Habitat for Humanity Bangladesh Supporting the Enabling Environment for better WASH services in Northern Bangladesh

International Rescue Com-mittee

Pakistan Community Driven Environmental Health Program in KP Province, Pakistan

Plan International Australia Pakistan Scaling Up Pakistan Approach to Total Sanitation in Punjab

SNV Bhutan Sustainable Sanitation and Hygiene for All (SSH4A)

SNV Nepal Sustainable Sanitation and Hygiene for All (SSH4A)

World Vision Sri Lanka Learning from the past, leading into the future. Saving lives through inclusive WASH. (Rural Integrated Water, Sanitation and Hygiene Project – 3 (RIWASH-3)

http://www.cswashfund.org

http://www.cswashfund.org/our-work/cswash-projects/cdi-2-wash-program-community-based-development-initiative-%E2%80%93-water-and

http://www.cswashfund.org/our-work/cswash-projects/cdi-2-wash-program-community-based-development-initiative-%E2%80%93-water-and

http://www.cswashfund.org/our-work/cswash-projects/sanitation-hygiene-water-management-project-0

http://www.cswashfund.org/our-work/cswash-projects/supporting-enabling-environment-better-wash-services-northern-bangladesh

http://www.cswashfund.org/our-work/cswash-projects/supporting-enabling-environment-better-wash-services-northern-bangladesh

http://www.cswashfund.org/our-work/cswash-projects/community-driven-environmental-health-program-kp-province-pakistan

http://www.cswashfund.org/our-work/cswash-projects/community-driven-environmental-health-program-kp-province-pakistan

http://www.cswashfund.org/our-work/cswash-projects/scaling-pakistan-approach-total-sanitation-punjab

http://www.cswashfund.org/our-work/cswash-projects/sustainable-sanitation-and-hygiene-all-ssh4a

http://www.cswashfund.org/our-work/cswash-projects/sustainable-sanitation-and-hygiene-all-ssh4a-nepal

http://www.cswashfund.org/our-work/cswash-projects/learning-past-leading-future-saving-lives-through-inclusive-wash-rural



49

ANNEX 4

Latrine options Dry Pit Latrines: The digestion of fresh faecal matter

is primarily aerobic but anaerobic at greater depths

due to an increasing moisture content from urine

seeping to the bottom. In temperate climates most

bacteria will be destroyed within 3-4

months and faecal sludge can be safely

handled. Small amounts of carbon (i.e.

leaves) increase the pit temperature

and ash raises the pH to assist in

destroying pathogens. The introduction

of any water into the pit will kill the

aerobic bacteria making faecal sludge

unsafe.

Direct Pit Latrines: The digestion process within

the pit is primarily anaerobic. As the bottom of the

pit quickly becomes blocked with faecal sludge, the

effluent primarily leaches through the

walls of the pit where it is exposed

to an aerobic digestion process. In

addition to the risks associated with

broken water seals and/or platforms,

the faecal contents of the pit are

unsafe to handle in addition to being

difficult to access to empty.

Offset Pit Latrines: Similar to the direct pit latrine

the digestion process within the pit is anaerobic while

the effluent is subject to an aerobic digestion process.

In many cases, the absence of sufficient holes for the

effluent to leach through the sides of the pit means

that the pit fills up relatively

quickly with a mixture of faecal

effluent & sludge. This means

that the pit contents are generally

highly liquid and unsafe for

handling. It also means that when

the pits are emptied the contents

need to be buried.

Twin Offset Pit Latrines: The introduction of a twin

offset pit means that the ‘on-line’ pit will be anaerobic

while the ‘off-line’ pit will gradually become aerobic.

This means that the off-line pit

will become safe for handling

after a period of 1 year or

more. In those cases where pits

are slow to leach, it should be

possible to switch between the

two pits several times before

emptying.

Septic Tank & Leach Pit: Faecal sludge within a septic

tank is subject to anaerobic digestion, while the faecal

effluent is subject to aerobic digestion. The contents

of the septic tank need to be emptied about every

five years and are never safe to handle. A septic tank

without a leach pit doesn’t treat pathogens within

the faecal effluent

and as the faecal

sludge builds up

within the tank, the

retention time is

lost and the sludge

is discharged with

the effluent.

Septic Pits: The high cost of septic tanks, the poor

performance of leach drains (associated with high

density soils in South Asia that don’t leach) and

the risks associated with the handling of the septic

sludge has resulted in the development

of a lower cost option

comprised of septic pit.

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Anaerobic

Aerobic Effluent

Sludge

O�set Pit

Anaerobic

Sludge

Direct Pit

Effluent

Scum

Sludge

Effluent

Anaerobic Aerobic

Septic Tank& Leach Pit

Anaerobic

Septic Pits

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Effluent

Sludge

Aerobic

Anaerobic

TwinO�set

Pit

Sludge Aerobic

Effluent

Aerobic

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Anaerobic

Aerobic Effluent

Sludge

O�set Pit

Anaerobic

Sludge

Direct Pit

Effluent

Scum

Sludge

Effluent

Anaerobic Aerobic


Anaerobic

Septic Pits

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Effluent

Sludge

Aerobic

Anaerobic

TwinO�set

Pit

Sludge Aerobic

Effluent

Aerobic

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Anaerobic

Aerobic Effluent

Sludge

O�set Pit

Anaerobic

Sludge

Direct Pit

Effluent

Scum

Sludge

Effluent

Anaerobic Aerobic


Anaerobic

Septic Pits

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Effluent

Sludge

Aerobic

Anaerobic

TwinO�set

Pit

Sludge Aerobic

Effluent

Aerobic

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Anaerobic

Aerobic Effluent

Sludge

O�set Pit

Anaerobic

Sludge

Direct Pit

Effluent

Scum

Sludge

Effluent

Anaerobic Aerobic


Anaerobic

Septic Pits

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Effluent

Sludge

Aerobic

Anaerobic Twin

O�setPit

Sludge Aerobic

Effluent

Aerobic

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Anaerobic

Aerobic Effluent

Sludge

O�set Pit

Anaerobic

Sludge

Direct Pit

Effluent

Scum

Sludge

Effluent

Anaerobic Aerobic


Anaerobic

Septic Pits

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Effluent

Sludge

Aerobic

Anaerobic

TwinO�set

Pit

Sludge Aerobic

Effluent

Aerobic

Aerobic

Anaerobic

Vent pipe

Urine

Dry Pit

Anaerobic

Aerobic Effluent

Sludge

O�set Pit

Anaerobic

Sludge

Direct Pit

Effluent

Scum

Sludge

Effluent

Anaerobic Aerobic


Anaerobic

Septic Pits

Anaerobic Scum

Effluent Effluent

Sludge Sludge

Aerobic

Effluent

Sludge

Aerobic

Anaerobic

TwinO�set

Pit

Sludge Aerobic

Effluent

Aerobic

Level 7, 307 Queen Street

Brisbane Qld 4000, Australia

+61 7 3025 8500

[email protected]

http://www.cswashfund.org

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