1. Sustaining and Scaling-up the Social Norm of not defecating in the open in Ghana Lorretta Roberts WASH Specialist UNICEF Ghana

2. Ghana is on Track for MDG Target for Water But NOT for Sanitation 86

3. 20 Year Trend in Sanitation Progress - 1990 to 2010 Source: WHO/UNICEF Joint Monitoring Programme Data for the 2012 JMP Report

4. Open Defecation rates per region in Ghana

5. Why Open Defecation is a problem - The Northern Region with 73% of OD accounts for 33% of under -5 diarrhoeal cases - Cholera is an annual occurrence in Ghana. In 2012 alone, 4443 cases and 24 deaths

6. Government Response Adoption of CLTS approach in 2010 Revised Environmental Sanitation Policy CLTS seeks to stop the practice of open defecation and promote the use of latrines using a Social Norms approach CLTS is a non prescriptive approach in which householders adopt their own preferred solutions of improved sanitation options 152 communities currently ODF in Ghana

7. Focus of Analysis Focus is on new collective behaviour of not defecating in the open using the CLTS approach and the analysis of the approach using the SN framework Focus is not on the old custom of open defecation Focus is on how this new behaviour can be sustained and scaled up

8. Process for creating a new norm

9. Application to CLTS Process of ending OD Creating common knowledge on extent of open defecation in the community through defecation map and transect Walk Evoking collective emotions of disgust and shame at OD practice Demonstration of faeco-oral routes using the glass of water, food and flies and shit and shake tools Changing beliefs and attitudes Fines Community pride as they celebrate ODF status Community Sign board / Flag system Collective Discussion and Decision to enact a new practice Analysis of the quantity of faeces deposited in the environment through Shit Calculation Analysis of the health care and other costs of open defecation Collective commitment to end OD and preparation of community action plan Introducing Sanctions Collective Pledge to become ODF signals norm change Individual Commitment to construct latrines and sharing with others Sanctions have a signaling effect Creation of Normative Expectations Construction and use of Latrines Visibility of Community Based Monitoring and Evaluation using Community Action Plan Community Certification as ODF provides public knowledge Creation of Empirical Expectations

10. Changing of Factual Beliefs “….it is bad enough that one eats one’s faeces but it is unthinkable to know that one eats the faeces of one’s enemy”

11. Key Challenges Identified Sustainability : New norm in a community surrounded by other non conforming communities Continued Effectiveness of Approach : Social Networks ensure information diffuses to surrounding communities through markets, churches etc. Scaling up: MDG target to be met in 2015 and MAF developed. Scaling up one community at a time may not work

12. Make empirical expectations visible throughout the country through the publication of the ODF league and other communication channels Introduce legal norm supporting the social norm Scaling and Sustaining CLTS Recommendations

13. Making use of Religion Designate a place outside the camp where you can go and relieve yourself. As part of your equipment, have something to dig with and when you relieve yourself, dig a hole to cover up your excrement. For the Lord your God moves about in your camp to protect you and to deliver your enemies to you. Your camp must be holy so he will not see anything indecent and turn away. Deuteronomy 23: 11-14

14. Thank you!