Learning What Works Sanitation Partners Workshop Phnom Penh

Learning What Works: Sanitation Partners Workshop, Phnom Penh, January 2013 Demonstration by the football player Frederic Oumar Kanouté Overview of the CLTS Impact Study in Mali Nicolas Osbert, UNICEF, nosbert@unicef. org

CLTS Impact Study Mali– CLTS Mali 11/12 Study takes place in 120 villages of Koulikoro Region (pop. : 2, 4 million)

CLTS Impact Study Mali – WHAT IS IT? q Randomized controlled trial (RCT) allow: comparison of relevant indicators between “treated” and “control” communities better estimate of the causal effects (having a randomly selected control group allows observing the outcomes that would have been experienced in the absence of the intervention)

CLTS Impact Study Mali – WHAT IS IT? q Randomized controlled trial (RCT) design – implying random selection of communities: 60 communities to receive the “treatment” (CLTS intervention) + 60 Control communities. q An international and multidisciplinary team of 10 scientific experts + Local team of more than 60 enumerators q Funding from the Bill & Melinda Gates Foundation: $ 900, 000 q UNICEF coordinates the study with the government + partners q 2 comprehensive household and community surveys, q Water quality testing, 2 campaigns (baseline / final) q Observational data collection on sanitation practices, health indicators and community decision-making.

CLTS impact study Mali - INDICATORS q Psychological outcomes: knowledge, risk perceptions, self-efficacy; q Community outcomes: level of cooperation, level of trust, social cohesion, wealth disparities, leadership, speed of diffusion of latrine use within social networks; q Intermediary sanitary outcomes: building latrines, quality of latrines built, usage frequency of latrines, building of hand washing stations, hand hygiene behavior, water quality, quantity of flies, outdoor presence of fresh feces; community status towards becoming ODF; q Final sanitary outcome: q Health outcomes: diarrheal illness for children under 5, child anthropometrics (stunting and wasting), reports on community disease rates by traditional healers and health clinic staff, out-of-pocket health expenditures, etc. ; q Non-health outcomes: school attendance, time use, women's safety

CLTS Impact Study Mali – PURPOSE 1. Understand the determinants of behavioral change • social dynamics, leadership, social cohesion or pressure, adoption of better sanitation practices – • understand the sustainability of impact (whether the ODF status and positive outcomes are maintained over time), • cost-effectiveness, potential scalability and spillover effects (in neighboring communities) of the CLTS program. 2. improve the future of sanitation programs • Identify bottlenecks that may impede adoption of better sanitation practices; • Identify the most relevant strategies to develop in ODF communities in order to sustain the results achieved, as well as community engagement in improving sanitation practices 3. Transparency, accountability show that we try sound evidence analysis, neutral/external monitoring 4. If possible: show the positive impacts of Sanitation on health and other outcomes and advocate

CLTS impact study Mali – 1 st RESULTS from baseline SANITATION (JMP 2012, Rural Mali: access 14% / OD = 20%) q 93% of children under five, 62% of children age 5 -10 years, 56% of adult women and 44% of adult males practice OD. q 34% with access to a private latrine (improved or unimproved) and 29% with access to a neighbor’s latrine q On average, households have to walk 3. 6 minutes to the location where they most often practice open defecation. q 54% of respondents: OD area was located outside the village. q 28% of respondents reported that women do not have privacy when practicing OD + 4% reported harassment/assaults q Most latrines were unimproved pit latrines. q 85% of households reported that they did not have a specific place in their household to wash their hands. ;

CLTS impact study Mali – 1 st RESULTS from baseline WATER SUPPLY (JMP 2012, Rural Mali: access 51%)

CLTS impact study Mali – 1 st LESSONS LEARNT q Great Buy-in from government: § Crucial: Gov. involved since early start of the study; creation of a technical working group (Mo. S, Mo. H, Mo. WS, WHO, UNICEF, INGOs…) § Sees opportunity: (i) to increase visibility of sanitation sector / of Mali, (ii) to improve efficiency of interventions (iii) to build capacities (implementing surveys, water quality monitoring, statistic calculation…)

CLTS impact study Mali – 1 st LESSONS LEARNT q Improve CLTS strategy: § Follow-up phase between triggering and certification: understand all the areas on which de teams can focus to achieve better results: ü Hand Washing, ü Household water storage and use, ü community empowerment, ü latrine construction, ü institutional framework ü waste management…

CLTS impact study Mali – 1 st LESSONS LEARNT q Improve CLTS strategy: monitoring per village now per household (with focus on hand washing, water and food storage and use) identification of efficient leaders and formalizing hygiene committees improve construction techniques and how to promote them (without breaking the ownership / creativity of communities) : site selection, coating of slabs, roofs, lateritic mud walls … Improving the institutional framework: intensification of follow-up by districts and communes and establishing post-certification follow-up § Learn from external experts; i. e. have more focus on children who more persistently practice OD Mobilize the schoolteachers: involve them to involve the children

Cleansing of public spaces by the women in Konosoro, Koulikoro Region (next step: put men on board) Lateritic mud wall consolidated by adding straw (Sallé Village, Koulikoro Region)

Latrine in the Village of Touloumadjo Villagers digging pits, the day of the triggering

“This is the Family Coulibaly; Nothing is better than sanitation; Cleanliness protects us” Certificate given to the hygiene committee + Certification board at the entrance of Tienra village inaugurated on 14 August 2012