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

Learning Brief • December 4, 2015

Purpose

This learning brief shares key findings from a case study of community-led total sanitation (CLTS) implementation in Plan International Uganda program areas, focusing on the roles and responsibilities of local actors. Several implications are relevant for consideration by Plan International Uganda 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 28 page Uganda Country Report.

Methods

In November 2013, a researcher from The Water Institute collected data in the capital city, Kampala, and in sub-counties within Tororo district. Data collection consisted of 23 in-depth interviews with government and non-government stakeholders, visits to five triggered villages that had been certified as open defecation free (ODF) across the three sub-counties, and a review of relevant organizational documents and national reports.

Key Findings and Implications

Triggering Activities in Tororo District, Uganda
Photo by Plan International

  1. National government has a policy and budget for sanitation activities that includes CLTS. Monitoring and evaluation guidelines, training guides, and established master trainers help to standardize trainings and improve reporting outcomes across government and other NGO’s CLTS projects.
  2. The national ODF definition and ODF verification criteria are not consistent. Unclear definitions and criteria can lead to different interpretations of ODF status, which makes it difficult to compare CLTS progress across regions.
  3. Village-level volunteers were highly engaged in the CLTS process, but require substantial support from implementers. Additional capacity building support for VHTs and natural leaders via exchange visits and refresher trainings may be necessary to sustain long-term motivation.
  4. Plan International Uganda has trained sanitation entrepreneurs in its CLTS communities, but adequate publicity remained a challenge. The high demand for durable latrines indicates potential for expanding sanitation marketing activities in triggered communities.

Roles of Local Actors

Plan International Uganda established CLTS in Uganda in 2007, and continues to play a supporting role in implementing CLTS. Additional actors involved in CLTS activities are national government, district and sub-county government, village health teams (VHTs), and natural leaders.

The National Sanitation Working Group (NSWG), comprising officials from NGOs, networking organizations, and government, is responsible for coordinating CLTS implementation across ministries and sectors. As a result of the Local Government Act of 2000, district governments are required to provide water and sanitation services at the local level. Thus, Plan International Uganda staff help train health inspectors and sub-county health assistants to oversee activities at the local level. Health assistants then recruit VHTs to trigger communities. These VHTs work with village and parish leadership to promote CLTS with the goal of ending open defecation. The various roles of these actors are illustrated in Figure 1.

CLTS Progress

Table 1 highlights the most recent data obtained from Plan International Uganda’s CLTS projects. As of July 2015, they had implemented CLTS in 173 villages across six sub-counties in two districts. Of all 173 villages, 140 (81%) have been certified as ODF, with latrine coverage ranging from 67% to 100%. Sub-counties with the lowest baseline latrine coverage, Mukuju and Katikamu, had the greatest absolute increase in latrine coverage after CLTS activities. On average, it took communities 12 months to reach ODF status, although this time ranged anywhere from 4 to 31 months.

Table 1. Toilet Coverage and ODF Outcomes in Plan International Uganda CLTS Communities, 2015

District Luwero Tororo Total
Sub-County Luwero Katikamu Mukuju Osukuru Kwapa Molo
Parishes triggered 2 2 1 3 4 4 16
Total parishes 7 (29%) 9 (22%) 6 (17%) 4 (75%) 4 (100%) 4 (100%)
Villages triggered 13 17 12 46 49 36 173
No. of households (HH) 1458 2222 1114 6360 3083 3342 17579
Avg. no. of HH per village 112 131 93 138 63 93 102
Avg. baseline latrine coverage 57% 34% 27% 40% 48% 58% 46%
Avg. end-line latrine coverage 93% 90% 96% 87% 94% 96% 92%
Avg. absolute change in coverage 37% 55% 69% 47% 46% 38% 46%
No. of villages certified ODF 13 (100%) 17 (100%) 12 (100%) 13 (28%) 49 (100%) 36 (100%) 140 (81%)
Avg. months to ODF 4 30 N/A 31 8 4 12
Source: Plan International Uganda, 2015
Note: Endline data as of July 2015. ODF certification dates not available for Mukuju sub-county.

Key Findings

Finding 1: National government has a policy and budget for sanitation activities that includes CLTS.

Uganda’s national sanitation policy is guided by the 2010 National Development Plan, which focuses on both CLTS and social marketing. The government has also developed a set of “golden indicators” which not only cover access to household and school sanitation, but also measure hygienic practices and access to water infrastructure. Districts receive sanitation scores based on these indicators, which then allows the national government to assess progress towards improving rural sanitation. In addition, a national training-of-trainers manual and a facilitator’s field guide were introduced in 2011, both of which were adapted from international guidelines.

Despite having these institutional mechanisms in place for water, sanitation, and hygiene (WaSH), coordination between government ministries remains a challenge. The lack of clear separation of institutional roles is evidenced by reports that the Ministry of Water and Environment may trigger communities, but the Ministry of Health is then responsible for verification, and data is not always shared between ministries. Therefore, despite strong national buy-in for CLTS, the roles and responsibilities of ministries in implementing these projects has yet to be clearly defined.

Finding 2: The national ODF definition and ODF verification criteria are not consistent.

National guidelines provide distinct definitions for total sanitation and ODF status. Total sanitation is defined as 100% use of improved latrines, handwashing with soap, safe drinking water storage, and safe solid waste disposal. ODF is defined as 100% household latrine use, lack of open defecation (OD), by-laws for preventing OD, and mechanisms to track construction of improved latrines. However, the national CLTS training manual does not require 100% latrine coverage for ODF status. Meanwhile, ODF verification and certification criteria require 100% latrine coverage and achievement of total sanitation. Interviews and observations in Tororo district suggest that the definition for ODF is interpreted to falls somewhere between absence of OD and all indicators of total sanitation. These inconsistent definitions make it challenging to compare results across communities, sub-counties, districts, and NGO projects.

Finding 3: Village-level volunteers were highly engaged in the CLTS process, but require substantial support from implementers.

Plan International Uganda and local government engage intensively with community-level volunteers, especially VHTs and natural leaders. Their model involves training VHTs to facilitate and follow-up on CLTS activities, with support from natural leaders. Most natural leaders were identified for this role during triggering events, and all VHTs and natural leaders said that they were selected by their communities. Furthermore, the relationship between natural leaders and VHTs was strong; they recognized each other’s importance in CLTS and contributions toward ODF progress.

However, as volunteers, these community leaders may have limited capacity for intensive participation or throughout CLTS implementation. In Plan International Uganda’s program, it appeared that local government facilitators still took the lead in triggering communities. Furthermore, although VHTs and natural leaders appeared in interviews to be highly motivated, maintaining this level of engagement in the long run remains a concern and may require additional resources. For example, both natural leaders and VHTs wanted to receive refresher trainings and the opportunity to participate in exchange visits.

Finding 4: Plan International Uganda has trained sanitation entrepreneurs in its CLTS communities, but adequate publicity remained a challenge.

A key challenge cited by local government, Plan International Uganda staff, and community leaders was the quality of latrines being built. Dry pit latrines were the most common latrine type in communities visited for this study, and a number of respondents cited latrine collapse due to termites or heavy rains, affecting ODF sustainability. In response to this challenge, Plan International Uganda identified and trained 78 masons in construction and entrepreneurship in Tororo district.

However, despite the high demand from respondents for high quality latrines, it was evident from this study, as well as a prior internal evaluation, that not all communities were aware of these trained masons. A 2011 evaluation of CLTS activities revealed that in Tororo district, only 9 out of 32 people interviewed were aware of skilled masons in the area. While there was awareness of this program, there was much greater demand for these programs than Plan International Uganda had thus far been able to implement. Some community leaders suggested that it would be useful for households to know about these durable latrine materials from the beginning of the CLTS process so that the households are sensitized to this option ahead of time.

Implications

This study documented aspects of Plan International Uganda’s CLTS process that may enable or constrain their ability to achieve and monitor their desired impact. The findings suggest several implications for Plan International Uganda and other sanitation practitioners.

Confusion in roles and responsibilities between national government ministries can lead to inefficiencies in sanitation activities at the local government level. Plan International Uganda can use its influential role in the sanitation sector to improve coordination between key national stakeholders.

Inconsistencies between the national ODF definition and verification criteria can lead to different interpretations of ODF status. Plan International Uganda should advocate for standardization of definitions and criteria to enable comparisons across triggered communities. Progress towards ODF can serve as a tool to motivate communities to improve their sanitation status, as originally intended by national guidelines.

The model of recruiting VHTs may help expand the scope of CLTS activities in Plan International Uganda working areas. However, to sustain long-term involvement of these volunteers, Plan International Uganda can consider providing additional capacity building support of VHTs via exchange visits and refresher trainings for both VHTs and natural leaders.

Encouraging community members to build simple pit latrines is unlikely to lead to sustained progress towards achieving ODF status. Given the demand for durable latrines, Plan International Uganda should consider expanding the scope of training for sanitation entrepreneurs to include more sanitation marketing activities. They could introduce permanent latrine options with the help of trained masons in the earlier phases of implementation.

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 Uganda implements CLTS, which means the study may not fully capture all aspects of CLTS implementation in Uganda.

Acknowledgements

Authors: Vidya Venkataramanan and Alexandra Shannon, 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 Uganda 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. 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.