1. This presentation will probably involve audience discussion, which will create action items. Use PowerPoint to keep track of these action items during your presentation In Slide Show, click on the right mouse button Select “Meeting Minder” Select the “Action Items” tab Type in action items as they come up Click OK to dismiss this box This will automatically create an Action Item slide at the end of your presentation with your points entered. Sanitation for All: New Marketing and Community Approaches Julia Rosenbaum and Orlando Hernández USAID Hygiene Improvement Project Global Health Council May 2008

2. Outline Two complementary approaches - Negotiation - Community Led Total Sanitation (CLTS) Integrated HIP model for sanitation coverage HIP field applications

3. Individual household level List of small doable actions individuals may adopt to address a health issue List may be generated by households or by program One size does not fit all Incremental steps to move in the right direction Potential reliance on private sector to deliver one preferred option Negotiation

4. What is Acceptable? Not Acceptable Open Defecation Fixed Place Defecation Improved pit Simple pit WC KVIP Pour flush Ecosan

5. Achieves 100% sanitation coverage in one community Uses increased community action and collective decision for improved sanitation behavior Draws on Participatory Rural Appraisal (PRA) methodologies Instills a sense of disgust and shame at collective level Community Led Total Sanitation (CLTS)

6. CLTS: Settle Only for 100% Defecation Free Communities Getting a few individuals to have latrines is not enough

7. Traditional and Total Sanitation Approach: A Comparison ElementsPrevious ApproachNew Approach: CLTS Starting Point LatrinesUsers MessageLatrine construction by householdsCollective behavior change by entire community TechnologyFixed model & few optionsMenu of options MotivationIndividual subsidyThreat, fear and self respect Time frameUnknown6-9 months Monitoring# of latrines constructed# of ODF communities

8. Steps in Implementing CLTS Mapping of defecation areas Transect walk Excreta calculation Flow diagram, dangers of open defecation Photo: Julia Rosenbaum

9. Lessons and Challenges from CLTS in Asia and Africa Increased cleanliness, safety, perception of dignity Effective for increasing sanitation coverage where only approach used Villages not interested when they are close to other villages where subsidies were available Difficulty reaching the very poor, some households not ‘complying’ What actions are needed to make initiatives sustainable? How much does it cost? Too slow to implement consecutively in many villages? Only rural based? Nigerian evaluation showed effectiveness in town with < 3000 residents

10. CLTS Triggers Disgust Shame Threat (sanctions, disease) Community incentives after the fact

11. BCC Effectiveness Negative appeals + response and self efficacy

12. Levels of Negative Appeal Low Disgust/Shame /Threat High Disgust/Shame/ Threat Levels of Efficacy (Response + self) Low Efficacy No responseControl of negative emotions -> maladaptive behavioral outcome High Efficacy No responseThreat control -> adaptive behavioral outcome

13. Balanced fear appeal, has both threat and efficacy with explicit conclusion. Source: Kim Witte, Fear Messages: Their Use in Behavior Change Communication Programs. HCP Presentation, 2003

14. Balanced fear appeal, threat + response efficacy with explicit conclusion. Source: Kim Witte, Fear Messages: Their Use in Behavior Change Communication Programs. HCP Presentation, 2003

15. Ignition Districts in Amhara Region in Ethiopia 150 districts covering 19 million 90 districts with donor presence and reached by different partners 07-08, 20 districts 08-09, 30 + districts

17. HIP Sanitation Marketing Opportunities in Uganda BCC helps to increase demand Must ensure sustainable supply options Have to ensure that the marketplace will respond: –Masons have to be able to build what consumers want –Cement must be available to build wanted slabs

18. Balanced Approach Demand Supply Sanitation Marketing CLTS Negotiation

19. Sources An Introduction to CLTS: Is CLTS a Feasible Option for Scaling Up Sanitation Delivery in Rural Areas? CLTS Workshop. 33 rd WEDC Conference. Accra, Ghana, 2008. Burton, Salma. CLTS: An Evaluation of Wateraids’s CLTS Programme in Nigeria. Wateraid, August 2007. Verhagen, Joep. Applying Local Lessons Learned. CLTS Workshop. 33 rd WEDC Conference. Accra, Ghana, 2008. Witte. K. Putting Fear Back Into Fear Appeals: The Extended Parallel Process Model. Communication Monographs. Vol. 59, December 1992, 329-349