Community-led Total Sanitation in Lao PDR: Findings from an Implementation Case Study

Learning Brief • August 25, 2015

Purpose

This learning brief shares key findings from a case study of community-led total sanitation (CLTS) implementation in Plan International Laos program areas, focusing on the roles and responsibilities of local actors. Several implications are relevant for consideration by Plan International Laos and other sanitation practitioners.

The brief is part of the CLTS Learning Series, a collection of seven country case studies on CLTS implementation prepared by The Water Institute at the University of North Carolina at Chapel Hill as part of the Plan International USA project, Testing CLTS Approaches for ScalabilityThe 4-page brief is based on the 43-page Lao PDR Country Report.

Methods

In July 2013, a researcher from The Water Institute collected data in the capital city, Vientiane, and Meung and Paktha districts in Bokeo province in the Lao People’s Democratic Republic (PDR). The researcher conducted in-depth interviews and focus group discussions with 31 government and non-government stakeholders and reviewed relevant organizational documents and national reports.

Key Findings and Implications

Open Defecation Signage, Photo by Plan International

  1. Plan International Laos has a comprehensive baseline data collection system, which enables them to track community progress. This system also has the potential to improve the way communities are selected for CLTS.
  2. District government staff had neither the mandate nor the capacity to assume full responsibility for CLTS implementation. Official recognition of their role from national or provincial authorities could help in engaging them more effectively.
  3. A small group of national master trainers provided facilitation training but could not keep up with demand. Many new facilitators have to learn on the job or receive lower quality training, which may affect their ability to trigger communities effectively.
  4. In Lao PDR, CLTS Committees take the place of “natural leaders” in motivating behavior change and monitoring CLTS progress. These committees formalize community involvement in the follow-up process.

Roles of Local Actors

Plan International Laos began implementing and financing CLTS in the country in 2010. The main actors involved are national government (the Ministry of Health’s Centre for Environmental Health and Water Supply, locally known as “Nam Saat”), district government facilitation teams, and community-based CLTS Committees.

Plan International Laos participates in monthly Technical Working Group meetings on water, sanitation, and hygiene (WaSH), which include Nam Saat and other NGOs, with whom Plan International Laos has strong working relationships. Among its activities, this group coordinates the national CLTS training agenda. In the areas where it works, Plan International Laos directly involves district government and community leaders through the creation of District WaSH Teams (DWTs) and CLTS Committees to support community-wide behavior change. Plan International Laos envisions eventually transferring responsibility for CLTS to the government. Figure 1 illustrates the roles of these various actors.

CLTS Progress

Between 2010 and 2013, Plan International Laos reported triggering 46 communities, with 37% declared open-defecation free (ODF) as of July 2013. As shown in Table 1, latrine coverage progressed more quickly in Meung and Phaodom districts as compared to Paktha. One possible reason for this difference is that facilitators found it difficult to frequently follow up with communities in Paktha, which tended to be more isolated.

Table 1. Median Latrine Coverage and ODF Status in Plan International Laos Sites

District
Indicator Meung Paktha Phaodom
Communities Triggered 11 15 20
Baseline Latrine Coverage 59% 53% 32%
Post-Triggering Latrine Coverage 91% 59% 71%
Communities Declared ODF 5 (46%) 5 (33%) 7 (35%)
ODF communities are those with 100% latrine coverage as well as the presence of a CLTS Committee and 80% of households using latrines, practicing hand washing, and using household water treatment and safe storage.
(Source: Plan International Laos, 2013)

Key Findings

Finding 1: Plan International Laos has a comprehensive baseline data collection system, which enables it to track community progress.

The DWTs and Plan International Laos collect baseline data from communities selected for CLTS, which feed into a monitoring system with indicators on latrine use and cleanliness, handwashing, safe water practices, environmental sanitation, and CLTS Committee efficacy. As seen in Table 1, this process enables Plan International Laos to track progress across program areas.

Plan International Laos develops a list of target communities based on desk studies and consultations with DWTs. Communities selected for CLTS must be on a district government list of villages prioritized for development. However, villages targeted by government tended to be remote, had high baseline latrine coverage, and overlapped with latrine subsidy projects, which conflicted with the preferred selection criteria identified by interviewees. As a result, triggered communities may not always be well suited for CLTS and conducting activities there may be a sub-optimal use of resources.

Finding 2: District government staff had neither the mandate nor the capacity to assume full responsibility for CLTS implementation.

Plan International Laos implements CLTS by assembling DWTs representing government officials from health, education, and rural development. The DWTs work closely with Plan International Laos’ District WASH Coordinators to conduct baseline surveys, facilitate triggering, and follow-up with communities.

Although this collaboration reflects a vision of handing over CLTS implementation, at the time of this study, there were no formal arrangements for the involvement of district government. Interviewees revealed that district government lack a mandate for CLTS and perceives CLTS as the responsibility of Plan International Laos. With many competing government duties, DWT members are unable to prioritize CLTS. Plan International Laos may find it easier to transfer CLTS responsibilities to government if district staff were to have an official mandate and were held accountable for implementation.

Finding 3: A small group of national master trainers provided facilitation training but could not keep up with demand.

A small team of CLTS master trainers has the primary responsibility for training CLTS facilitators in the country. Although this may support standardized training, Plan International Laos staff expressed the need for more frequent training by qualified trainers. At times, Plan International Laos staff directly trains DWT members to meet the need. However, as they are less experienced than the master trainers, this may affect the quality of training.

Thus, new facilitators must often learn on the job or receive lower quality training, which may affect their ability to trigger communities effectively. Greater training capacity is also important to meet the demand resulting from high employee turnover in district government. At the time of this study, the WASH TWG was working to develop national training guidelines and certify more master trainers.

Finding 4: In Lao PDR, CLTS Committees take the place of “natural leaders” in motivating behavior change and monitoring CLTS progress.

After triggering communities, Plan International Laos and the DWTs assemble CLTS Committees from a group of five to seven pre-selected community leaders. The members are trained and become responsible for collecting data, promoting behavior change through structured follow-up, and reporting progress to DWTs.

CLTS Committees are a mechanism for communities to self-monitor and track progress during the post-triggering phase, similar to the role of “natural leaders” used in CLTS programs elsewhere. However, whereas natural leaders are rarely organized into formal groups and can be any community member, the CLTS Committee is a structured, formal mechanism within the village leadership.

Implications

This learning brief describes Plan International Laos’ model for CLTS and offers suggestions for strengthening community selection, training, and the role of district government.

First, Plan International Laos can utilize existing baseline data to compare villages and see where CLTS has had greater success. This could help district government improve how it targets communities for CLTS and optimize the use of resources.

Meanwhile, expanding the cadre of master trainers would help to standardize and scale up CLTS. Plan International Laos can train its staff as master trainers in line with national guidelines, which would help in capacity strengthening of DWTs.

District government plays an important part in Plan International Laos’ CLTS activities. Validating their role through a memorandum of understanding or official mandate from higher authorities could help Plan International Laos engage them effectively and promote accountability. In its advocacy efforts, Plan International Laos could create a dialogue by explaining the role of the DWTs, seeking input to improve the process, and illustrating the benefits of their involvement using success stories.

Limitations

This study uses qualitative methods and a small sample size. Researchers did not evaluate program effectiveness. Although readers may connect these findings to their own CLTS experiences, they should be cautious about generalizing the findings. Furthermore, researchers visited a subset of communities where Plan International Laos implements CLTS, which means the study may not fully capture all aspects of CLTS implementation in the country.

Acknowledgements

Authors: Vidya Venkataramanan, Jen Bogle, Alexandra Shannon, and Ryan Rowe, The Water Institute at UNC

This learning brief was made possible through support from Plan International USA, which received a grant from the Bill & Melinda Gates Foundation. The findings in this brief are derived from the Lao PDR Country Report, available in our Resource Library at waterinstitute.unc.edu/clts. Data were collected by the Water Institute at UNC with logistical support from Plan International Laos. The findings and conclusions contained within do not necessarily reflect positions or policies of the funder, Plan International USA, or of The Water Institute at the University of North Carolina at Chapel Hill.

Project Resources

External Resources

The Testing CLTS Approaches for Scalability project involves The Water Institute at UNC working with Plan International USA to evaluate whether capacity strengthening of local actors influences CLTS outcomes. Our activities span 10 countries in Africa, Asia, and the Caribbean. More information, project resources, and news are available at the project website.