CLTS in Himbirti
March 2012
Asmara, Eritrea
Background
Himbirti is a peri-urban town located 30 km away from Asmara, the capital city of Eritrea. Administratively Himbirti is in Maekel region. It has a population of around 10,000 and 2197 households.
The economic activities are agriculture, irrigation farm, trade, daily labours, in the capital city. There are 42 shops, 11 bars, 2 bakery and 4 snack bars in Himbirti town. There is one fuel station, one police station, communal judicial office, micro credit office and office of the national union of Eritrean Youth and Students and there is youth club.Himbirti has two kindergartens, one elementary and Junior and one high school. There is a central market for cattle and vegetables serving more than 15 villages.
Himbirti is connected with the urban water supply system and it has electricity 24 hours a day. There is transport connection with the capital city and there are 7 buses that make more than six trips every day.
With respect to sanitation, there are 25 household latrines constructed by an NGO in 1997 using the subsidy approach. There are two blocks of public latrine separated for male and female (5 squat holes +3 showers for male and 3 squat holes and two showers for female). The latrines have a hand washing facilities and water reservoir. These latrines are managed by the village water committee and the community use the latrines for free. There is a health station with maternity and vaccination services.
Himbrit is classified into 3 zones and each zone is classified into sub zones or block of 50 households.
CLTS process in Himbirti
Methodology
CLTS was introduced in April 2009 by Ministry of Health Maekel region and at that time 113 people participated in the triggering session. The report of the local health facility shows that around 40 households from the triggered people built their latrines and started using it within 10 days of triggering. Initially it was started like a rural CLTS.
There was a joint monitoring done by UNICEF and Ministry of Health in April 2009 and it was realized that the town is too big and the characteristic is a combination of urban and rural. Therefore it needs different approach and handling and the following were recommended:
-Initially assessment of existing situation and people’s attitude towards the environmental sanitation to take place.
-In the triggering the majority were not present therefore the whole community was not triggered. It was suggested that each block to be triggered in a convenient time to the people. (more triggering sessions were needed to cover such big community)
-The town administrator to settle the issue of land conflict in some areas and the issue of households who rented a house.
-Households located in the rocky area if they couldn’t manage to dig their own latrine they use shared latrine.
-Continuous follow up to take place by the Ministry of Health Maekel Region.
Therefore the steps which have been followed from triggering up to ODF declaration can be summarized as below:
Step 1. Assessment of current situation
The public health officers did pre-assessment on the environmental sanitation situation of the village. A household questionnaire was developed and every household was assessed. The questionnaire includes the source of water, availability and usage of latrines, disposal of solid and liquid wastes. In addition the common diseases for children less than 5 years were also assessed.
While the assessment was taking place in June 2009 a national ToT on CLTS was carried out by Dr. Kamal Kar and 50 facilitators were trained. Two facilitators were trained from Maekel region where Himbirti is located.
Step 2. Selection of health promoters
There were 112 very active natural leaders or health promoters who were selected from the three zones of Himbirti. Each zone has 10 blocks and each block has 50 households. There were 3 or 4 natural leaders selected per block. Their main role is to promote latrine use in their block and give technical guideline on how to build the latrine that is the depth of the pit, diameter of the pit and others. In addition they report the progress on their block on the use of the latrines and hygiene promotion.
There was agreed structure line of accountability developed by the health promoters, Ministry of Health Maekel region and Himbirti town administration. This structure consists of that in each zone there is one zonal coordinator, 3 sub-zone coordinators and health promoters.
The organogram/structure used in Himbirti for the CLTS implementation
Step 3. Training of health promoters
The health promoters were trained using PHAST tools on health promotion and the technical requirements in building latrine, monitoring and supervision (follow up techniques). In addition the health promoters were trained on how to trigger a community. 90% of the health promoters were females and this was a deliberate strategy with the reason for that being it is convenient for women to promote stopping open defecation in their neighbouring households since the whole day they are around, they can transfer the messages when they fetch water and they have dedication. In addition they can easily influence the women who in turn can influence their husbands to build latrine. One health promoter was responsible for 15-16 households.
Step 3. Triggering sessions
As it was clear that such a big community could not be triggered in one session, multiple triggering sessions were needed to ensure the coverage of the whole community.
Ministry of Health Maekel region arranged a one day triggering demonstration for the health promoters sothat they could be able to trigger their own community block by block.
The health promoters did triggering on some blocks with the support of the facilitators from Ministry of Health Maekel region. Later they started doing it themselves and the whole community was triggered within one month time. The triggering session was done in September 2010 and the whole town was covered.
Step 4. Monitoring,
The health promoters/natural leaders together with zone and block coordinators, public health officers from Ministry of health Maekel region, head of the health facility in Himbiti town and the town administrator were meeting every 3 week. In the meeting the health promoters report the progress in their block and the challenges that they have faced were discussed and they share experience and they were developing action plan for the next step.
The head of the health facility and the town administrator worked closely. Together they developed a clearance form to be attached in the file of each resident. This form captures the status of the household on whether they have built and are using a latrine or not. To speed up the ODF of the village they agreed that if each household is not having and using a latrine, he/she will not get service (eg issuing ID cards, licence renewal, getting mobile phone simcard, etc.) in the admin office. This was agreed and implemented by the health promoters. When the household starts to use the latrine the public health officer visits and certifies to give the clearance form. The clearance form is attached in the Annex.
In addition every month the administrator and public health officer inspects the whole village and this has continued to give moral/maintain the momentum among the families.
Step 5. ODF verification and ODF declaration
The ODF verification was done by Ministry of Health Maekel region in 2011. The ODF verification looks to the following:
-Latrine constructed and used continuously.
-Hand washing facility is done near the latrine and hand washing with soap is practiced.
Himbirti was verified/ready to declare ODF in August 28, 2011. However the ceremony was postponed because of the uniqueness of the area (being a peri urban) and is the first experience in Eritrea, it was given much emphasis to make a colourful ODF ceremony for the following reasons:
-Higher government officials were convinced that their presence during ODF ceremony would vice the CLTS progress in the region and nationwide momentum.
-The ODF ceremony would serve a double purpose of ODF ceremony and advocacy to all village administrators in Maekel region.
-Since there are other peri-urban areas in the region ready to be triggered in 2012 the administrators of such areas would be convinced of the feasibility of CLTS in peri-urban areas.
With the above reasons Himibiti has declared ODF on 25th February 2012. In the ceremony the Minister of Health and Governor of Maekel region were present. It was first time higher government officials to attend ODF declaration ceremony. In addition village administrators from most of the villages and peri urban places attended the ceremony.
Photo: Governor of Maekel region Mr. Kahsai Ghebrehiwet followed by Minister of Health Ms. Amina Nurhussien.
Children played great role in the ceremony in stressing the messages especially on open defecation, hand washing and dignity through dramas and songs. The governor of the region also gave very touching and triggering message for villages who haven’t started CLTS within the Maekel region. In addition he gave prize for 10 villages which have declared ODF in 2011 in their region.
Challenges
-Big size and heterogeneity of the village.
-Majority of the area is very rocky and it took them so long to dig the pits.
-Scarcity and high price of construction materials like cement and iron bar
-Shortage of locally available construction materials (wood and stone) for casting and superstructure of latrine
-Hesitation of the sustainability issues about constructing latrines using locally available materials-basically residents were looking for construction materials to be available in the market at reasonable price. The people want to build sustainable latrines-being a peri urban area.
-Around 160 latrines were destroyed by rain and they were replaced quickly by households.
-Termites’ problem, they destroyed many latrines. In order to control the termites the community started to paint the wood with motor oil and some raised the slab with stone wall from the surface of the ground.
-There are pour flash toilets built in some households and the owners were undermining the latrines built from locally available materials.
Lessons learned
Introduction of CLTS and subsequent ODF status has been a good experience on how to introduce CLTS in peri-urban areas. During the entire process, the following are some of the key lesson learnt:
-CLTS has to contextualize to the local condition especially in peri-urban areas it needs reinforcement.
-Determination of the community and focus by implementers without sending mixed messages. If the community are convinced about an issue, they will come up with their own indigenous ways to ensure they achieve what they want. For example,the residents of the rock area they were using different indigenous practices to break the bedrocks and they managed to dig 2 m deep latrines. Some of the practices they were using were filling the pit with water; they burn plastic materials in the pit …etc.
-Continuous health education/promotion is very helpful especially for the health promoters because it helps them to convince and further elaborate the benefits to community.
-Training/capacity building of human resource-at all levels-ensuring that trainings/skills development of the various cadres of staff is done at the start and during the implementation and post implementation process is a key to success.
-Engagement with the local administration is crucial for success-Govt/local admin owns and champions the process-they can use the carrot and stick approach!!Working hand in hand with administrators is very helpful.
UNICEF’s role
UNICEF Support to the Ministry of Health in the CLTS intervention includes:
-Technical support
-Financial support for the triggering sessions, training of health promoters, monitoring and ODF declaration ceremony like car rent and Billboards
-Capacity development of Ministry of Health staff
Conclusion
From the experience of Himbirti it can be concluded that despite the big population if organization, dedication of implementers and continuous follow up are done ODF declaration can be reached in peri urban areas. This is a starting point to scale up CLTS in Urban areas in Eritrea.
The form attached in the file of each household
The state of Eritrea
Galanefhi sub zone
Maekel Region
Date:______
Household Head Name______
The above stated name who resides in sub zone______block ______has constructed and is using a household latrine.
Victory to the Mass!!!
______
Head of the health center
Annex: Some photos from Himbirti
Photo: children doing rehearsal of songs in the ODF Photo: ODF Ceremony gathering place
Photo: participants of ODF ceremony Photo: Billboard showing Himbirti is ODF
Photo: latrine slap made from wood and stones is Photo: walled pit constructed in the church
done using a mad mixed with cow dung