Strenghthening Capacity for Scaling up Community Led Total Sanitation in Ghana

STRENGHTHENING CAPACITY FOR SCALING UP COMMUNITY LED TOTAL SANITATION IN GHANA:

Initiating A National Campaign Towards Achieving Sanitation MDG& More Through Local Empowerment

Dr. Kamal Kar (International Consultant, CLTS Foundation, India)

Bisi Agberemi (WASH Specialist, UNICEF. Nigeria)

March, 2011

Table of Contents

Page

Table of content 2

Acronyms and List of Abbreviations 3

Acknowledgement 4

Executive Summary 5

1.0Introduction

2.0Specific Terms of Reference 8

3.0Structure of Report 9

4.0Review of CLTS Practice in Three Regions 11

4.1Review of CLTS Practice in Eastern Region 11

4.2Review of CLTS Practice in Northern Region 15

4.3Review of CLTS Practice in Central Region 25

4.4Main Blockage of CLTS 28

5.0Training of Trainers’ CLTS Workshop 32

5.1Training of Trainers’ CLTS Workshop – Dodowa 32

5.2Training of Trainers’ CLTS Workshop – Elmina 35

6.0Other Miscellaneous Activities 38

6.1High Level Sensitization Meeting on CLTS 38

6.2Public Lecture on CLTS 38

6.3Northern Region Sensitization Workshop on CLTS 39

6.4National Learning Alliance Platform 40

6.5Meeting with Central Regional Minister 40

6.6Meeting with Hardware Manufacturers and Engineers 40

7.0Recommendations 43

7.1General Recommendations 43

7.2Region and District Specific Recommendations 44

7.3National and Policy Recommendations 46

Annexure 49

Acronyms and List of Abbreviations

APDO-Afram Plains Development Organization

BCC-Behavioural Change Communication

CC-Community Consultant

CDO-Community Development Officer

CLTS-Community Led Total Sanitation

CWSA-Community Water and Sanitation Agency

DEHO-District Environmental Health Officer

DFT-District Facilitation Team

EHA-Environmental Health Assistant

EHO-Environmental Health Officer

EHSD-Environmental Health and Sanitation Directorate

EU-European Union

GoG-Government of Ghana

INGO-International Non-Governmental Organization

I-WASH-Integrated Water, Sanitation and Hygiene

KNUST-Kwame Nkrumah University of Technology

KVIP-Kumasi Ventilated Improved Pit

MDG-Millennium Development Goal

MLGRD-Ministry of Local Government and Rural Development

NGO-Non Governmental Organization

NL-Natural Leader

NTWG-National Technical Working Group

OD-Open Defecation

ODF-Open Defecation Free

REHO-Regional Environmental Health Officer

V.I.P-Ventilated Improved Pit

WASH-Water, Sanitation and Hygiene

Acknowledgement

Special thanks go to UNICEF Ghana and National Technical Working Group (NTWG) on Sanitation for organizing this mission aimed at institutional strengthening and capacity development for scaling up of CLTS in Ghana. The excellent manners in which all the planned trips, meetings and workshops were organized contributed significantly to the successful execution of the assigned tasks. The invaluable contributions of Othniel Habila (Chief, WASH Section, UNICEF Ghana), Lorretta Roberts (WASH Specialist, UNICEF Ghana), Emma-Joan Halm(UNICEF Ghana); Demedeme Naa Lenason (Ag. Director, MLGRD), Kweku Quansah (MLGRD), Theodora Adomako-Adjei (CWSA) and other members of NTWG further made the assignment exciting and very productive.

The participation of Hon.Elvis Afriyie Ankrah (Deputy Minister, Ministry of Local Government and Rural Development), Hon. Moses Bukari Mabengba (Regional Minister of Northern Region) and Hon. Ama Benyiwa Doe (Regional Minister of Central Region) in meetings and workshops organized as part of efforts of strengthening capacity for effective CLTS implementation in Ghana and for agreeing to champion scaling up of CLTS in the country are well acknowledged. The active participation of all relevant stakeholders at national, regional, district and community levelsare also acknowledged.

The release of Bisi Agberemi (WASH Specialist) by UNICEF Nigeria Country Office to participate in the mission is also appreciated.

Executive Summary

Community Led Total Sanitation (CLTS) was first introduced in Ghana in 2006 and the approach was piloted in Eastern, Central, Greater Accra, Upper West, Upper East and Northern Regions by CWSA, UNICEF, WaterAid and Plan. Based on the outcome of CLTS piloting over the past 6 years, the approach has been adopted in the revised Environmental Sanitation Policy (2010) of Ministry of Local Government and Rural Development for rural sanitation thereby providing the necessary policy framework for scaling up of CLTS. As part of piloting, quite a large number of communities were triggered with few communities eventually achieving Open Defecation Free (ODF) status. An assessment of the approach conducted in 2009 highlighted the potentials of CLTS for scaling up sanitation in the country and also identified inadequate and poor quality facilitation as the major challenges confronting effective CLTS implementation.

In recognition of the challenges being confronted in scaling up of CLTS and towards addressing the identified gaps, UNICEF in collaboration with National Technical Working Group on Sanitation invited Kamal Kar and Bisi Agberemi to provide technical supports in strengthening the systems and institutional capacity for speedy scaling up of CLTS in Ghana. This exercise was conducted from February 7 to March 14, 2011and basically involved review of CLTS practice in three regions, Training of Trainers’ workshops on CLTS and sensitization activities for scaling up CLTS in the country.

The review of CLTS practice was conducted in Eastern, Northern and Central regions from February 9 to 18, 2011 with the principal aim of obtaining relevant information for better understanding of CLTS implementation focusing on strategy being adopted, capacity for implementation, institutional arrangement and challenges for scaling up. The review was conducted with active participation of members of NTWG on sanitation and involved extensive consultations with all relevant stakeholders at national, regional, district and community levels. From the review exercise, it could be observed that there are great potentials for CLTS in the country if the identified challenges blocking the scaling up of the approach can be systematically addressed.

Apart from the inadequate capacity for quality training and facilitation of CLTS, the following are the major blockage of scaling up:

• Disharmony among the donors in adoption of core principles of CLTS and tendency to provide hardware household subsidy;
• Old mindset of technology prescription and promotion of V.I.P/KVIP
• Long term promotion of communal latrines by the government and ingrained mindset of communities towards the use of communal latrines.
• Ingrained attitudes of traditional village chiefs towards free communal latrines and subsidy orientation.
• Absolute institutional in-coordination
• Non-existence of technical coordinating mechanism at regional/district level.
• Old mindset of counting toilets instead of ODF villages.
• Inadequate funding of District Environmental Health and Sanitation Department and total dependence of this department on external funding for carrying out basic activities like triggering in communities, follow up visits, conducting ODF evaluations and celebrations etc.

Based on the gaps identified during the CLTS review, two National Training of Trainers hands-on workshops were organized in Dodowa (Greater Accra Region) and Elmina (Central Region) to equip the participants with facilitation skills and strategies for scaling up CLTS. The workshops were organized by Ministry of Local Government and Rural Development with financial and technical supports from UNICEF, Plan and WaterAid. Over 120 participants comprising of national, regional and district senior government officials and representatives of NGOs had their skills enhanced on CLTS facilitation and 24 communities were triggered for CLTS implementation during the workshops. Also, Natural Leaders from the 24 triggered communities made presentations of their sanitation profile and ODF plans at the hotel venues of the workshops to the admiration of all participants reinforcing their commitments to achieve ODF in their communities within a short period as indicated in their plans.

Towards creating mass awareness on CLTS among relevant stakeholders and kick starting the process of scaling up CLTS in the country, the following additional activities were carried out;

• High level sensitization meeting on CLTS involving senior government officials of all relevant ministries, agencies and parastatals as well as representatives of donors, UNICEF, NGOs, media and traditional institutions.
• Public lecture on CLTS in University of Ghana, Legon.
• Northern Region sensitization workshop for all the 20 districts in the region towards achieving the regional set target of achieving ODF by 31st December, 2012. The Regional Minister of Northern Region had made declaration of achieving ODF in the region by end of December, 2012 during an advocacy and sensitization visit earlier made to the minister.
• CLTS presentations at the National Learning Alliance Platform
• Meeting with Hardware manufacturers and engineers.
• High level sensitization meetings and discussions on scaling up CLTS with senior political leaders such as the Deputy Minister of Local Government and Rural Development, Deputy Minister of Ministry of Water Resources, Works and Housing, Northern Regional Minister and Central Regional Minister.

The following are the major recommendations which emerged from the visits to different regions and districts, interaction with officials and staff at different levels and meetings with UNICEF and NGOs staff:

• In view of the fact that there is an acute shortage of well trained facilitators of CLTS in most regions and districts particularly within the Directorate of Environmental Health and Sanitation, a small team of at least 5 facilitators in each district of the country must be developed and trained within the next one year. The planning and organization of these trainings should be facilitated by MLGRD, CWSA, UNICEF, PLAN and WaterAid and the 10 Regional Councils while the resource persons for these workshops should comprise of a team of at least 4 or 5 very good trainers drawn from the participants trained in the two workshops (Dodowa and Elmina). Each training workshop must be hands-on and should trigger 10-12 communities around each training venues in different regions. In other words, roughly 20 of such training workshops (2 workshops per region) should be able to trigger 200 to 240 villages in different regions of the country. This should not be very difficult, as major actors in sanitation sector can pull resources together for the urgent training of required facilitators that would support the scaling up of CLTS in the country.
• All district EHOs, CDOs and other key people in each district involve in CLTS implementation must go through Hands-on training which gives them a total clarity on the approach, facilitation for triggering and essential follow up. In the absence of basic training exposure, different kinds of practices in the field have been noticed, most of which cannot be classified as CLTS.
• Highest priority and focus must be given to follow up the 24 triggered villages (12 around Dodowa and 12 around Capecoast) during the two workshops. In the same version, very strict follow up arrangement must be made to ensure post-triggering follow up of 200/240 villages to be triggered in the next 20 regional training workshops (2 in each region). All the basic trainings should be completed by October 2011. However, utmost precaution must be exercised not to rush through in organizing these training workshops. Quality of training must receive utmost attention and priority.
• Post ODF follow up should be the key in scaling up CLTS country wide. Recommended activities under post ODF follow up are as follows;
• Develop the best ODF villages into training/learning centres for other villages of the district. Continuously bring village leaders and community members to these learning centres (ODF villages) for face-to-face interaction with ODF villages and dissemination of the spirit of collective local actions towards achieving ODF.
• Identify potential Community Consultants of CLTS from among the best Natural Leaders emerging from ODF villages.
• Develop a clear scaling up strategy (with provision of funding) using the Community Consultants. Preferably the scaling up process by the Community Consultants (wherever possible) should begin around end of October 2011. It is interesting to note that the 2 Natural Leaders (Afenyo Ekormend & Ganu Mawuko) from Afram Plains who participated in Dodowa workshop have already triggered four neighbouring communities around them. These two NLs were the first people to put the learning from the workshops into use. This needs to be institutionalized at any cost.

• Focus should be on developing ODF districts and regions rather than focusing on few ODF villages.

• CWSA should extend their direct support beyond the regional level to the districts by participating in the district level sanitation meetings and organizing trainings for the identified National Leaders (NLs) and Community Consultants (CCs) emerging from each districts and thus strengthening community led scaling up of CLTS.
• With the declaration by the Regional Minister of 31st December, 2012 target to achieve ODF in the Northern Region, all efforts must be made to provide the required technical supports to the region in achieving this target. A draft roadmap for scaling up of CLTS in entire Northern region of Ghana has been prepared and shared with all relevant stakeholders.
• Each Region should develop plan for achieving ODF with inputs from all stakeholders including the NGOs. UNICEF should facilitate the finalization of these plans which will guide effective scaling up and coordination of all interventions in the region. In other words, the regional plans are comprehensive plans of all districts in each region. This bottom-up planning process needs to be facilitated by involving DEHO, Community Development Officer, District Planning Officer, District Coordinating Director and Chief Executive Officer of the district with support from REHO and Regional Officer of CWSA. This is one important area where CWSA may extend all necessary help and support.
• It is suggested that before initiating the Regional planning process of all the regions, new learning from the Northern and Central Regions be documented and disseminated to all the other 8 regions.

• It is strongly recommended that the National Sanitation policy of Ghana which has explicitly mentioned the adoption of CLTS approach should be disseminated to all the concerned stakeholders at the regional and district levels. Specific measures need to be taken by national government to bring the NGOs, donors and lenders still implementing subsidy approach on the same page in order to avoid any further confusion and disharmony. Circulars should be issued under the signature of National Minister of Local Government and Rural Development to all implementing agencies on the need to strictly adhere to policy provision of no subsidy on hardware household latrine construction in the country.
• The country wide scaling up strategy should be developed involving large number of natural leaders as community consultants.The process of selection of potential NLs from the existing and emerging ODF villages must begin as soon as possible. A cadre of at least 50 NLs in each district should be developed as Community Consultants (CCs) and a pool of community consultants should also be developed at regional level to support the scaling up efforts. MLGRD should formulate appropriate mechanism to support the CCs and use them as active partners in scaling up CLTS in the country. The NTWG on Sanitation should develop generic guidelines in local languages to guide the operations of NLs/CCs. NTWG should also support basic training materials and guidelines as well as documentaries which could be distributed to the teams of CCs.

1.0Introduction

Considering the access to improved sanitation in Ghana, which is estimated at about 13% with worse situation in rural areas (7%), the country is among those in Sub-Saharan Africa that are presently off-track towards achieving MDG sanitation targets[1]. Efforts have been made in the past by governments and other implementing agencies towards addressing this low level of sanitation development but these have not resulted in large scale implementation required to significantly increase access to improved sanitation. Only a marginal increase of 4% in access to improved sanitation was recorded from 2000 to 2008 and if this trend continues, achieving the MDG sanitation target of 54% will be an illusion.

As part of the measures of addressing the poor access to improved sanitation, Community Led Total Sanitation (CLTS) was piloted in Eastern, Central, Greater Accra, Upper West, Upper East and Northern Regions from 2006 to 2010with a view of scaling up the approach to cover all the regions in the country using the lessons learnt from the pilot. CLTS was first introduced in the country in 2006 and CWSA, UNICEF, WaterAid Ghana, Plan Ghana have been involved in piloting the approach working with EHSD staff, DWSTs, NGOs, Consultants and Community Based Hygiene Promotion Volunteers. An assessment of the approach conducted in 2009 highlighted the potentials of CLTS for scaling up sanitation in the country and also identified inadequate and poor quality facilitation as the major challenges confronting effective CLTS implementation.

Based on the outcome of CLTS piloting over the past 6 years, the approach has been adopted in the revised Environmental Sanitation Policy (2010) of Ministry of Local Government and Rural Development for rural sanitation thereby providing the necessary policy framework for scaling up of CLTS. There is high level of commitments and political will among governments and other stakeholders to scale up CLTS but very little progress has been achieved so far.Although large numbers of villages were triggered in the course of piloting, the emergence of ODF villages in Ghana was dismally low.

1.1Rationale of the Mission

In recognition of the challenges being confronted in scaling up CLTS and towards addressing the identified gaps, UNICEF in collaboration with National Technical Working Group on Sanitation contracted Kamal Kar to review CLTS practice in Ghana and based on the findings of the review; strengthen the capacity of major implementers in effective scaling up of CLTS.

Quite a number of countries in West Africa including Ghana introduced CLTS more than five to six years ago, without much progress in scaling up the approach. Apart from the general reasons of poor quality trainings, follow up and institutional support, other issues related to mixing up CLTS with the earlier approaches contributed to poor scaling up. These second generation challenges of CLTS could not be addressed by providing hands-on training alone.

With a view to addressing some of these challenges, an exploratory review mission supported by UNICEF Nigeria was planned and carried out by Kamal Kar and Bisi Agberemi in Nigeria from July to August, 2010 to have a deeper understanding of the country wide variations of practice of CLTS on the ground.The study led by Kar and Agberemi involved active participation of key government agencies and other sanitation stakeholders. Based on the study findings, a special Hands-on training was designed and conducted in which about 80 participants drawn from different agencies from all over the country were trained. These reconnaissance visit followed by hands- on training workshop resulted in significant improvement in CLTS implementation and rapid scaling up in Nigeria.Bisi Agberemi’s wealth of experience of sanitation in Nigeria contributed in developing and fine tuning the government’s approach in adopting CLTS in the country.