GOVERNMENT OFLIBERIA

Guidelines forCommunity-LedTotal Sanitation

Implementation in Liberia

NATIONAL TECHNICAL COORDINATING UNIT

SEPTEMBER 2015

ACRONYMS

AMCOWAfricanMinisterialCouncilon WaterandSanitation

CLTS Community-LedTotalSanitation CSC CountySteeringCommittee

DEOHDivisionofEnvironmentalandOccupationalHealth

DSCDistrictSteeringCommittee

gCHVsGeneralCommunityHealthVolunteers

GOLGovernmentofLiberia

IYSInternationalYearofSanitation

MOEMinistryof Education

MOHMinistryofHealth

MIAMinistryof InternalAffairs

MLMEMinistryofLandsMinesandEnergy

MPWMinistryofPublicWorks

NLNaturalLeader

NTCUNationalTechnicalCoordinatingUnit

NSCNationalSteeringCommittee

NWSHPCNationalWater,SanitationandHygienePromotionCommittee

NWSSPNationalWaterSupplyandSanitationPolicy

ODOpenDefecation

ODFOpenDefecationFree

RWSSBRuralWaterSupplyandSanitationBureau

SOMSectorOperatingMatrix SSPSectorStrategicPlan TOTTrainingofTrainers

WASHWater,SanitationandHygiene

Updated September 2015

Table of Contents

1. Community-Led Total Sanitation

2. Guidelinesfor Community-Led Total Sanitation in Liberia

3. InstitutionalStructure of CLTS in Liberia

3.1National Level

3.1.1 NationalSteering Committee

3.1.2 NationalTechnical Coordinating Unit

3.2 CountyLevel

3.2.1 CLTSCounty Steering Committee

3.3 DistrictLevel

3.4 Natural Leader Network

3.5 CommunityLevel

4. RequirementsandStepsinCLTSImplementation

4.1 RequirementsforImplementers

4.2 StepsinCLTSImplementation

5. CapacityDevelopment

5.1 Training of Leaders and WASH Entrepreneurs

5.1.1 Facilitators

5.1.2 NaturalLeaders

5.1.3 WASH Entrepreneurs

6. Post-ODF Scale-Up

6.1 Setup natural leader network (NLN) through the DSC Structure:

6.2 Natural Leader Training

6.3 Improved Sanitation and Sanitation Marketing through the Natural Leader Network and WASH Entrepreneurs

6.4 Sanitation Marketing Centers

6.5 IntroducePHAST in CLTS/ODF Communities:

6.6 Providingother WASH support to ODF Communities:

6.7 Enforcing Public Health Law

7. Reportingand Documentation

8. Miscellaneous

8.1 Advocacy and Awareness

8.2 Resource Mobilization

Annexes

Annex 1: BackgroundtoSanitationinLiberia

Annex 2: Global Context

Annex 3: HistoryofCommunity-LedTotalSanitationinLiberia

Annex4:HumanitarianSituationandCLTS

Annex 5: CLTSImplementationActivities

Annex6:Triggering Activities

Annex7:ExampleofBudgetLineItemsforImplementingCLTSat CommunityLevel

Annex8:MonitoringForms

Annex9:ODFCertificateTemplate

Annex10:StandardODFBillboard

Annex11:ODFCelebrationSampleProgram

ACKNOWLEDGEMENT

I am pleased to sign and enact into official Government of Liberia public health policy, the “Guidelines for Community-Led Total Sanitation Implementation in Liberia,” revised and validated in October 2015. The Government of Liberia’s Ministry of Health recognizes the importance and the critical health benefits of CLTS, sanitation and hygiene in reducing the incidence of fecal-oral disease as well as the documented reduction in Ebola Virus Disease (EVD) transmission as a result of CLTS.

The Government of Liberia’s Ministry of Health further recognizes that this revision of the “Guidelines for Community-Led Total Sanitation Implementation in Liberia,” describes the successful methodology to cost effectively bring CLTS implementation to scale by using Natural Leader Networks. Using this model,more communities have achieved open defecation-free (ODF) status in the past six (6) months than in the previous five (5) years and the first ODF Health District (Vahun District, Lofa County) is within our grasp.

By signing below, on behalf of the Government of Liberia’s Ministry of Health, I do hereby approve this document in its entirety.

______

Francis Kateh, MD, MHA, MPS/HSL, FLCP

Deputy Minister/Chief Medical Officer, RL

1.Community-Led Total Sanitation

CLTSis an innovative methodology for mobilizing communities to conduct their own appraisal and analysis of open defecation (OD), stimulating a collective sense of disgust and shame among community members as they confront the crude facts about mass OD and its negative impacts. The basic assumption is that no human being can stay unmoved once they have learned that they are ingesting other people’s feces. Communities generally react strongly and develop action plans to become open defecation free (ODF) through their own effort based on different motivations. CLTS focuses on behavior change, triggering the community’s desire for change and encouraging innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability. It accomplishes all of this without external subsidies. Facilitators and natural leaders in more than 25 countries now enable this process, developed by Kamal Kar in Bangladesh in the year 2000.

2.Guidelinesfor Community-Led Total Sanitation in Liberia

Since its introduction to Liberia in 2009, CLTS has been implemented by a number of actors in an uncoordinated manner; partners have used different criteria for community selection and post- triggering monitoring has been weak in most instances. It is essential to avoid variations in community support and to maintain uniformity and standards in program implementation, which will in turn solve the problems of resource constraints and give an impetus to sanitation promotion. To make the program result-oriented, Government of Liberia (GOL) and WASH partners have agreed to develop and adopt the guidelines contained herein as the standard for the country, to be adhered to by all partners implementing CLTS directly or indirectly throughout the Republic of Liberia. Full justification for the development of these guidelines can be found in Box 3 below.

This document aims to achieve the following objectives for CLTS implementation in Liberia:

  • To set standards for the implementation of CLTS;
  • To enhance coordination and regulation of CLTS activities among stakeholders at all levels; and
  • To clearly define processes, procedures and practices for CLTS implementation in Liberia.

Box1.Justificationfor LiberiaCLTSGuidelines

3.InstitutionalStructure of CLTS in Liberia

TheCLTS re-engineering process led to an institutional structure for CLTS in Liberia, led by the National Steering Committee (NSC). Management structures at national and county level have been established and modified. Community management is handled mostly by general community health volunteers (gCHVs) and natural leaders coming forth during the triggering process. There remains opportunity to strengthen institutional structures at all levels, especially district. The figure below shows the CLTS structural arrangement in Liberia as of September 2015.

Figure1.Structureof NationalCLTSManagementinLiberia

3.1
National Level

3.1.1NationalSteering Committee

Description

This is the highest decision making body for CLTS in the country.

Composition

Chair:Ministry of Health, Deputy Minister for Public Health Emergencies

Co-Chair:Ministry of Public Works, Deputy Minister for Community Services

Members:Chairpersons (Senate/Representatives) of Health

Ministry of Internal Affairs, Deputy Minister of Internal Affairs

Ministry of Finance and Development Planning

Ministry of Education

Ministry of Gender

Ministry of Information

Ministry of Lands, Mines and Energy

LISGIS

Ministry of Agriculture

Ministry of Planning & Economic Affairs

Monrovia City Corporation

The Head of Civil Society Organizations

Leading WASH Donors

Responsibilities

  • Policy formulation
  • National decision making
  • Commission a national CLTS research initiative to determine the status in country; and
  • Meet semi-annually, or more often in case of emergency, to review programmatic progress, constraints and make recommendations to improve implementation.
  • NationalTechnical Coordinating Unit

Description

TheNational Technical Coordinating Unit (NTCU) will have a dedicated office within the DEOH of the MOH. In addition to the Coordinator and supervisor , designated staffs of four (4) people (2 from MPW and 1 each from MIA and MOE) as well as three (3) dedicated staff (Administrative Assistant, GIS Specialist, Database Manager) from MOH will be stationed in the NTCU to provide support to partners as well as manage CLTS implementation in Liberia. The NTCU will provide briefings to the NSC and support county-level steering committees in CLTS coordination and management.

Composition

Chair:Ministry of Health, DEOH

Co-Chair:Ministry of Public Works, Community Services

Responsibilities

  • Mobilize resources for CLTS scale-up in Liberia;
  • Standardize and regulate training procedures and content for national partners;
  • Ensure documentation and sharing of CLTS best practices and lessons learnt, for policy decision-making and replication in other countries;
  • Coordinate all CLTS activities in Liberia;
  • Set-up and manage CLTS database;
  • Ensurethe effective implementation of CLTS strategy in keeping with these guidelines and the Handbook on CLTS by Kamal Kar;
  • Regulate the process of triggering, monitoring of ODF verification, declaration and certification;
  • Report to the National Water, Sanitation and Hygiene Promotion Committee (NWSHPC) on a monthly basis;
  • Conduct CLTS research in collaboration with stakeholders;
  • Lead the process of developing and reviewing guidelines on CLTS;
  • Lead orientation sessions for NSC members on CLTS;
  • Through the CSCs and DSCs ensure strict adherence to these guidelines and the Handbook on CLTS by all stakeholders;
  • Authorize and revoke authorization of partners to implement CLTS in Liberia;
  • Validate all in-country CLTS training;
  • Organize semi-annual review meetings;
  • Conduct regular monthly meetings;
  • Supervise the activities of all County Steering Committees;
  • Plan and conduct periodic monitoring of CLTS in Liberia in consultation with the NSC;
  • Establish independent ODF verification and certification teams at the county level and support these teams to validate ODF status and provide certification to communities
  • Perform other duties and tasks as assigned by the NSC; and
  • CountyLevel
  • CLTSCounty Steering Committee

Description

TheCounty Steering Committee is the highest decision making body at county level; its role is to support communities in every aspect of the sanitation ladder. The CLTS Focal Person, who is an EHT at the county level, is responsible for overall implementation of CLTS, monitoring implementing partner activities and reporting to the CSC.

Composition

Chair:Ministry of Health, EHT Coordinator

Co-Chair:Ministry of Public Works, WASH Coordinator

Members:Ministry of Internal Affairs, Superintendent’s Office

Ministry of Education

Ministry of Gender

LISGIS

NGO Representation

Community-Based Organizations

Responsibilities

  • Conduct assessment and mapping for proper targeting of communities for intervention;
  • Assign areas to CLTS implementing partners;
  • Identify core staff and non-staff to be trained and serve as resource group;
  • Identify and train emerging and active natural leaders to support their own communities and neighboring communities to maintain and improve ODF status;
  • Collect data and share all CLTS information at county level;
  • Submit monthly reports to NTCU and share copies with WASH stakeholders;
  • Carry out CLTS verification and submit documentation to NTCU;
  • Monitor, supervise and report on CLTS activities at the district level using minimum data collection standards as detailed in the CLTS Guidelines;
  • Develop CLTS county plans and meet monthly at county level;
  • Assist the districts in developing CLTS district plans and have quarterly meetings with Districts regarding CLTS planning
  • Integrate the CLTS process into existing community structures; and
  • Perform other duties and tasks as assigned by the NTCU.
  • DistrictLevel

Therole of district level stakeholders is vital to the success of the CLTS program. Results can hence be achieved through identification and mobilization of district level stakeholders, establishment and maintenance of effective coordination mechanisms, mobilization of available resources, and capacity development initiatives. The District Steering Committee (DSC) is the highest decision making body at district level; its role is to support communities in every aspect of the sanitation ladder.

Composition

Chair:Ministry of Health, District EHT

Co-Chair:Ministry of Internal Affairs, Office of the Commissioner

Members:Ministry of Education, DEO

NGO Representation

Natural Leader Network

Community Health Development Council

Community-Based Organizations

Responsibilities

  • Conduct assessment and mapping for proper targeting of communities for intervention;
  • Identify and train emerging and active natural leaders to support their own communities and neighboring communities to maintain and improve ODF status;
  • Collect data and share all CLTS information at district level;
  • Submit monthly reports to CSC and share copies with WASH stakeholders;
  • Monitor, supervise and report on CLTS activities at community level using minimum data collection standards as detailed in the CLTS Guidelines;
  • Actively participate in monthly WASH coordination meetings;
  • Assist communities to develop scale-up plans for post-ODF activities that will lead to improving sanitation facilities and ODF certification;
  • Develop CLTS district plans and meet monthly at district level;
  • Integrate the CLTS process into existing community structures; and
  • Perform other duties and tasks as assigned by the NTCU.
  • Natural Leader Network

The Natural Leader Network (NLN) is comprised of NLs, who emerge initially during the triggering process in their own communities, who bring his or her communities to ODF status. The NLN is organized at the district level and below that into clusters at the clan level. Furthermore, clan clusters are divided into teams of NLs from 3-10 communities, depending on geographic proximity of communities. Communities can only have a maximum of two NLs per 50 households and members of the NLN who trigger and bring three or more other communities to ODF status are Natural Leader Champions and receive a financial incentive or “bonus” of $65 USD for each community they bring to ODF status. In addition, other officials or individuals who have worked closely with communities and/or Steering Committees during the CLTS process can be recognized as CLTS Ambassadors who then engage other counties and districts to improve CLTS implementation.

Figure 2. Structure of Natural Leader Network

The main role of the NLN is to promote and scale up CLTS and improved sanitation at the community-level, coordinate CLTS and other development activities of the NLs with partners and governmental actors.

Responsibilities

  • Engage communities and gather letters of interest from interested communities and submit them to DSC;
  • Trigger communities and monitor them to reach and maintain ODF status;
  • Participate in ODF verification alongside the NTCU and DSC;
  • Promotion of new and improved sanitation technologies and marketing of sanitation products and services;
  • Advocate for governmental and private sector support for CLTS and improved sanitation;
  • Participate in CLTS fora, monthly WASH coordination meetings and District and County Steering Committees;
  • Assist gCHVs in mobilizing community participation in health and other campaigns; and
  • Reporting data on diseases under surveillance to gCHVs for onward reporting to OICs.
  • CommunityLevel

Stakeholders at this level will work with Community Development Committees, Natural Leaders and Town Chiefs. CLTS recognizes communities as an entry point for sanitation and hygiene promotion, so all community members should be oriented and trained to be able to identify and exercise their full rights, roles and responsibilities, including mobilizing resources, coordinating with other community members, and promoting action or mutual help. The capacity development of sanitation volunteers, known as general Community Health Volunteers (gCHVs), and natural leaders, women groups, user committees, social mobilizers, local leaders, etc., also holds significance in keeping community commitment for action at all phases of the project. These individuals can be inspired through exposure and visits to nearby programs or projects, returning with enthusiasm and ideas for action.

4.RequirementsandStepsinCLTSImplementation

4.1RequirementsforImplementers

The NTCU has devised the following list of requirements for those partners wishing to implement CLTS in Liberia. Partners must:

  1. Be registered and accredited by the GOL (MOH and MPW) to engage in WASH activities;
  2. Apply to the NTCU and be granted a permit to implement CLTS in Liberia;
  3. Have staff with CLTS knowledge and be willing to go through NTCU prescribed training;
  4. Have a functional office in Liberia and a field base in the county(ies) of interest;
  5. Have commitment to implement CLTS project within target for at least six months.
  6. The NTCU is required to provide a baseline data to implementing partners as it relates to counties of interest
  7. StepsinCLTSImplementation

Thegeneral steps for CLTS implementation are below. For additional idea of what activities to include along the way, refer to the Annexes.

StepI:Develop a general CLTS implementation work plan with the NTCU: This plan will outline initial key activities to be completed before actual community implementation. These initial activities will facilitate more detailed activities at the county and district levels.

Step II:Conduct county-level consultative meeting with local county authorities, CSC, DSC, NLN and WASH implementing partners: The implementing partner is required to support the NTCU to hold a consultative meeting with the relevant stakeholders to focus on the details of CLTS implementation and role of county officials in the project.

Step III:Support NTCU to train DSC (and CSC) on CLTS facilitation: Implementing agencies in collaboration with NTCU should train a team of district-level facilitators who will lead the triggering and monitoring exercises in communities.

Step IV:Liaise with DSC to identify target communities (pre-triggering): It is strongly recommended that criteria (see Box 2 below) for community selection for CLTS implementation is followed. The implementing partner should also ensure that they visit communities to determine feasibility given their logistics.

Step V:Mobilize and work with district-level facilitators for community triggering: Plan a working session with district facilitators in order to validate their skills in the facilitation of triggering

Step VI:Conduct community triggering exercises in line with the CLTS Handbook: It is strongly recommended that the principles and approaches in Kamal Kar’s CLTS Handbook are strictly followed. Refer to Annexes 5 and 6 for an in-depth look at triggering.

Step VII:Conduct regular monitoring of triggered communities pursuing ODF status: Monitoring of CLTS communities should utilize the natural leaders’ model. Partners should support the DSC (weekly), CSC (monthly) and NTCU (monthly) to visit and monitor ongoing activities and progress. Refer to CLTS Handbook for guidance.

Step VIII:Link communities to ODF verification process: Communities will request ODF status verification from the DSC who will visit and approve. The DSC will then request ODF status verification from the CSC who will also visit, approve then request final verification from the NTCU. NTCU representatives will visit, inspect and declare communities ODF.

Step IX:Conduct celebration session for qualified communities upon NTCU validation: Celebration of CLTS communities is based on a declaration by the NTCU. All ODF communities should be provided sanitation start-up kits. During the celebration, extraordinary individuals from the community will be honored through awards and special recognition. Communities will be given a standardized and sustainable ODF signboard (e.g. Metal Sign board preferred). Trained WASH Entrepreneurs will also be introduced during celebrations.