By Hangi Bashir
Community Led Total Sanitation (CLTS) is an innovative methodology for mobilizing communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free).
At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease.
In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilization instead of hardware, and shifting the focus from toilet construction for individual households to the creation of open defecation-free villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for collective change, propels people into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.
Since the Global Sanitation Fund introduced this approach in Uganda six year ago, a number of lessons have been learned. In the link below is a publication highlighting eight lessons from Community Led Total Sanitation at Scale in Uganda.
By Hangi Bashir
We have lamented the death of many Ugandans to several causes such as accidents, murders and diseases both communicable and none communicable.
The undisputed fact is that whatever the cause of death, we lose lives as a country some whose potential has been exploited and others we haven’t even seen (children under five years) The country loses on the much needed contribution of these two categories who would otherwise play a role in national development.
However, we have in our midst preventable diseases that are killing people and this trend has been taken as something acceptable that we should live with. Diarrhea kills many children in Uganda and has won itself a position among the top infant mortality causing diseases. Open defecation is the leading cause of diarrheal deaths especially among children under the age of five.
According to the World Health Organization, Uganda lost 7001 children in 2015 due to diarrhea making it the second highest killer to Malaria. Additionally, Sanitation related diseases also claim the lives of adults; diseases such as dysentery, typhoid and cholera among others often leads to many deaths as witnessed in the frequent cholera outbreaks that happen in different parts of the country. These cholera outbreaks claim lives including breadwinners leaving their dependents to suffer. Therefore diarrhea is a silent killer that lives within communities and has been accepted as a community member.
That aside, the productivity sectors such as agriculture, industries, trade and the economy including all the government sectors are often affected leading to lower productivity as many affected persons are unable to go to work and instead spend time at home; this does not spare the caregivers who too have to stay home or in health facilities attending to the sick.
In Uganda, latrine coverage stands at 79% which means 21% of the households still practice open defecation, this is a big population that should worry us as a country. As they practice open defecation, even those who use toilets and latrines are affected through contamination of water, utensils, foods and drinks. That notwithstanding, hand washing stands at a paltry 36% which also aggravates the situation, we shake hands on a daily basis with people whose behaviors we don’t know. This further exposes us to the risk of getting in contact with germ carrying humans.
Primary health care is important if we are to have a healthy population that works towards self-sustenance. Good sanitation is one of the critical pathways to keep our communities healthy. It is through building resilient communities and a productive population that Uganda shall be able to focus on achievement the middle income status by 2021.
Using Community Led Total Sanitation (CLTS), the Ministry of health has promoted sanitation in 30 districts under the Uganda Sanitation Fund programme with outstanding achievements of results. Coverage of latrine and hand washing in the programme area stands at 96 % and 46% respectively and this can be replicated in other districts to take sanitation to scale.
Contrary to the conventional methods of compulsion i.e using law enforcement, CLTS is an innovative methodology that mobilizes communities to completely eliminate open defecation by facilitating them to conduct their own appraisal and analysis of open defecation and take their own action to become open defecation free. CLTS triggers the community’s desire for collective change, propels people into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.
The Uganda Sanitation Fund has demonstrated that if communities are empowered to be in charge of their sanitation, they observe high standards of hygiene, keep healthy and productive. Therefore, we should consider putting communities at the forefront of sanitation and hygiene promotion to order to achieve total sanitation at scale.
MAKE PEOPLE RESPONSIBLE FOR THEIR HEALTH FIRST
The media in Uganda is awash with stories of poor services in different health facilities in the country with people bashing Government for the poor state of health services in total disregard of even the visible countrywide achievements in the health sector.
Additionally, some leaders have abdicated their responsibilities and joined the league of critics instead of playing their roles of mobilizing and sensitizing communities about disease prevention.
People go to health facilities when they are sick meaning that if they are healthy, they don’t go there. It is vital to note that a number of diseases that people suffer from are preventable but they continue being tortured by these diseases because of either ignorance about preventive practices or laxity.
The Ministry of Health has sensitized people about disease prevention using a behavior change approach but to sustain behavior change require support from all stakeholders since changing behavior cannot be done overnight. However, some leaders both at national and local levels have left this responsibility solely to the Ministry of Health which has negatively affected the sustainability of interventions aimed at changing people’s behavior.
For example since 2011, government has distributed about 29 million mosquito nets in a a bid to fight malaria but these have been misused and wasted hence not serving the intended purpose. It is common to see in the countryside people using mosquito nets freely distributed by government as door curtains and in fishing communities they are used to dry silver fish (Mukene) let alone being used at weddings. This coupled with the appalling sanitation and hygiene conditions in different parts of the country only serves to expose people to preventable diseases.
This year the Ministry of Health is going to distribute 24 million mosquito nets and chances are high that a big number of these nets will find their way to Mukene drying racks while others are scheduled to serve as curtains and at weddings if leaders don’t amplify on the efforts of the Ministry of Health.
Some people live a laissez-faire lifestyle and don’t care what happens to their lives and the intervention of leaders in this case is critical but they have largely been absent when needed most. They should be at the forefront of sensitizing people to live healthy lives but they have largely not supported these efforts and are instead dancing to the gallery condemning government over poor health service delivery even when some of them participate in appropriation of resources and know how much they give the health sector.
Recently, President Yoweri Museveni came up with seven tips on how to live a healthier life, these are; Nutrition, Immunization against 11 killer diseases, Observing personal hygiene and Sanitation, Fighting common infections like malaria, TB, etc, Avoiding alcohol, drug abuse, tobacco smoking and accidents, Avoiding irresponsible sexual behavior and Having regular medical checkup.
These seven tips squarely rest on an individual and indeed if properly followed, a large of number of people would be living healthy and therefore would have no need of going to health facilities. This would in turn save government the resources spent on treating preventable diseases and instead invest in enhancing high tech equipment for complex cases that require specialized treatment. Therefore other leaders should emulate the President in sensitizing people on living healthy.
We need to ensure that people don’t go to health facilities by investing in disease prevention, this does not only require financial resources but largely commitment and good will from Political, religious cultural and all other leaders at different levels so that synergies are galvanized and communities mobilized and sensitized on basics of sanitation and hygiene as well as other disease prevention practices.
Good citizenry goes with responsibility and as Ugandan citizens; we should be responsible for our health first before government comes in. Our leaders should be at the forefront of this endeavor by prioritizing a preventive approach as opposed to a curative one and ensure that people are responsible for their health first.