 One of the reasons why we At least Stockholm environment Institute and I believe also Africa ahead We're interested in holding this the seminar was was to discuss a little bit about the differences between CLTS the community led total sanitation Programs around the world that stop they're aimed to stop something there. They stop open defecation That's through naming and shaming and triggering change compared that with something like the Community-based health health clubs where you're starting to do something or and you've given options and you understand And it's a much more positive Kind of thing. Yeah, it's a really controversial thing UNICEF was invited to participate in the seminar and decided not to This week there are several meetings discussed saying CLTS So keep in mind what you've learned today about CHC's and Bring that back to your workplace as I said earlier the People here today are open for collaboration So we can learn together and I think that's That's what we've been hearing from George as well. I think as a funder. He's looking for for things that work and Things will become fashionable and get funded, but in the long run It's it's the things that work that will will be resilient and so we have about Almost 20 minutes and basically the way to work is is you can all line up here Or you can just put your hand up and come to the front say who you are what you'd like to ask you can ask Any question that you'd like to any of the speakers? So And you did have these little discussions with Your neighbor and that might be something of interest something that may have popped up Okay, Marianne Shalene from Siwi. Thank you very much and also. Thank you for the idea about asking Questions or discussing questions. So that's where I come from and also. Thank you all for really nice presentations I think it's been very informative and valuable My question relates to the to the idea of the approach Of the community health clubs and sort of the also the idea of rolling it out where it sort of has some standardized features in some way And so I'm wondering a little bit how much it changes in the community because there it will meet I mean there are existing maybe religious associations or welfare associations and and these things like how is it Managing to merge with those existing structures or are there like a new power dynamics in the community when you get this sort of new New idea and maybe new people engaged. So how that is being managed and what is your experience in terms of Thank you. We're not going to collect the questions. I particularly don't like that Okay, thanks, Lauren. Yeah, I mean, I think it's it's really you have to sort of tailor it to the local situation You don't want to burden them with all you know an endless extra Institutional things and and make it life complicated. So if they're existing You know mothers clubs women's clubs Existing structures then just bolt onto that if you can and make it and I think that's you know That's how we were discussing it with the DRC Provincial people from from their Ministry of Health was how they've already got the structures in place You know, and they don't want to kind of reinvent the whole thing Trash what they've already been doing for ages and and and and try something new that maybe works for a bit And then it crashes again. So how do we how do we work within the existing structures? So it's very much tailor-made to the local situation, but it's um, that's that seems to be that seems to work, okay you know it's And in terms of you know after the six months what tends to happen is that the clubs I think Julia was referring to it in fact if you look at your um If you look at your little handouts that we've given if you see the kind of this the stages they reach They go from from the initial getting the club started getting this common unity of purpose that we were talking about And then it leads on they've got it You've got now a functioning community that then goes on to the next things that are critical of them so, you know, they've heard about the importance of you know of Safe food chain the safe water chain and so they take those those sort of projects into their into their orbit But the overarching thing is poverty and so, you know, obviously income-generating activities is very much formative in their minds And they and there's developing of social capital and social trust kind of Works in so many ways for for for the mothers to trust their their young kids so that they can go to the clinic They've got a neighbor so that they can trust with that happens with these clubs So you've got you address this whole sort of that side of it But you've also got you've developed trust within the community that they see working together You know, we can we can farm together We can have corporate farming those sort of things and so in whole districts in in Rwanda, for example in Zimbabwe, I mean the one district had got up to 5,000 beekeepers They sort of suddenly worked and then they realized that bees need trees So then they started planting trees everywhere So it's kind of just this whole kind of constructive approach forward But they work with with you know, they make those decisions are made by the the people themselves Long long-winded response. Yeah one of the stroke I'm very interested in learning and One of the strongest learning Initiatives is embarrassment So the naming and shaming a part of CLTS is so effective because it's a very strong learning thing that doesn't mean that it needs to be the only thing but I think it's a very good starting point for bringing change and What I heard about the community health club sounds very interesting as something that could be combined with such an approach but I think that Knowing how learning works is is important and yes, okay It's always nice and to be good and positive, but again the strongest Thing that you remember is when you did something wrong And you don't want to repeat that especially with when other people were seeing that so that is the the the strong part of CLTS I think and it's also the thing that you need to The learning is is understanding. That's that's a thing So I mean when I was a child these we used to get strapped for for doing bad things in school The question is is there any learning? And it will it will be if there's a if it's folded up with something positive and the content of the CHC is there Whereas the name and shame thing is a sensational thing that can actually put the learning to the side Park it a little bit too much, but that's that's the controversy Juliet wanted to say something please come up. I Just wanted to just throw it out to the floor a bit because I think we should open this dialogue a bit to everybody Can you all just put up your hands if you're a parent with children? I mean obviously if you've got a parent you you're gonna have children. Okay, so people with children You're gonna send them to a school, right and you're gonna look around in the neighborhood You're gonna look around for a school that suits the kind of education that you'd like for your children, right? And you're gonna look and you're gonna go. Okay, so here's a comprehensive school These kids when when they do something wrong They they they sent home from school. They don't get a second chance This is an old-fashioned system where if you do something wrong you stand in the corner or you go and write lines I don't know if any of you went to school in those times when we actually used to get beaten We used to get the ruler I went to school with nuns who used to smack me on my hand with a ruler But did something wrong also had to hold up my arms if I had something I had to stand in the corner If I did something wrong those kind that kind of training for children has gone out of fashion. Do we agree with that? I mean do any of you want to send your kids to those kind of schools? No Because the kind of schools now are enlightened schools They're kind of schools where if you do something you might get stars you might get rewards you might There's it's much more to do with incentives to make yourself appreciate things to Encourage people and we're certainly not allowed to beat our kids and we're not allowed to embarrass them We're not allowed to mention the color of their skin or if they're dirty, right? We do not say to the children your dirty you come from a dirty home go home until you watch. We're not allowed to do that Are we? No, so my question is if we in public health Have a choice between two systems We're public health practitioners if we have a choice between two systems Should we go for an enlightened system which allows you to let your people learn your people in your village? Say you there you think of your child now your people in your village you let the people learn You let them then be encouraged by sharing to do something together Is that not a positive way to go and if it achieves the same amount as The punishment or the embarrassment or the shame or the disgust that you use for other triggers which I totally agree work I totally agree they work. I just think it's not the time for that kind of intervention anymore I think as practitioners we've moved into a more benign and we have to do things in an ethical way I'm challenging the process that makes people embarrassed and that's why they should do something I don't think that should should work not in our day and age. I think we've moved beyond that I'd love to hear your opinions But here we are not talking about children that are being that are being named and shamed we're talking about adults that are being named So it's it it is it's and it's all it's all base based also on information. It starts as an approach with Information so I I think that you're putting things against each other that that shouldn't be put against each other It is I think a mix of the two that could work I don't see the reason why you should why you should sort of divide these these these two Approach they are not sort of opposing approaches. I think there is some connection Now we're going to get into the heat of it. I saw three hands, but you were you were talking about the photographer before so I think you have it Because you were disturbed by being Pictured all morning, so please say something about concerning you. Hi, I'm Sam Beckel with the Evaluation Office in UNICEF I'm not going to enter into this polemic. I don't think you're though fairly talking about how cats and CLTS operate There's a trying to trigger a lot of community pride to take charge of the problems that are identified So it's a bit of a straw man that you set up But actually I had different questions one is for mr. Nelson, which I thought was just a terrific presentation I think I would I'm not the one that responds just only to anecdotes and stories I like to sometimes like to see the statistics So are you running some statistics statistical tests on the work? You're doing like when you show the income and the capital spending. Are you showing seeing some? statistical significance in that and in some of the other results and which are the ones that are leaping out is really having a statistical power really showing impact and The second question of maybe a little bit on up left field for miss Nash But in talking to mr. Wolf on the sidelines. He said that you had helped arrange through Notre Dame the Bringing of a an evaluation approach to the work in northern Uganda And I'd like to hear a little bit more about what is being set up there to a match It's not designed as a match, but Along with a good one from the gates is doing with the Africa head programs Yeah, thank you. Yeah, we ran significant tests on on the Gender division of labor and what I showed there was what we had a significant what came out significant That is the fact that men are also involved in cleaning in the eco-sand households or the UD households and then also in cabalé we did a significant test there But it wasn't very Significant, but then we could see from the trends that men are also involved at least more than they are in the pit Latrine households for the costs We are you know getting cost data at the household level is a little bit challenging in rural Africa, so we we had estimates And we used the median value to be able to you take care of outliers because we had some outliers some households actually reported quite high Amounts of money that is spent on the toilets Then we used a medium absolute deviation to be able to present what I showed Thank you in terms of the the randomized controlled trial that we just started about the program H2O plus It's specifically focused on the clean cook stove aspect of it. So within the 75 communities We've divided or noted aim is divided it Randomly into communities that will actually be able to get access to the clean cook stoves and communities that don't and then we will be measuring both at the The chief cooker of the household, which is typically the woman And the entire household what is the impact of having the clean cook stove introduced or not? So the the chief cooker in this case the women will actually have a device Attached to them for 24 hours to measure the level of co2 in In the household as well as with them And then to see how that tracks over time that will be done at certain pre-ordained periods And then measure that against what the levels are in communities that don't have the clean cook stoves And then we will add to that data that we're going to be Collecting from the local health clinics as to what's happening with just Families in the communities because the clinics happen to they don't just serve in survey particular community. They serve Communities all over so we'll be getting their data whatever they have to say how does What's happening in a very controlled environment Compare with what's happening community that has nothing that then compares with what the clinics are getting from a much broader variety so While the the RCT in the will be most classic in terms of the ones that have the clean cook stoves and the ones that don't We also want to overlay the information of what the clinics are getting and see can we make any Connection we may be able to we may not be able to but Yeah, Dan. Is there anything that you would want to add to that? No And I would love to talk to you about you know, how you're doing your studies and see what we can learn from that Thanks Okay, thank you. Thank you for that question to This thanks. Hi. My name is Louise more. I'm a sanitation and hygiene advisor with UNICEF I don't have a question, but I do have a I feel I have to make a little bit of a response about the comments that have been made about our programs We have just undertaken a global evaluation of our cats programming which includes the LTS As well as school-led sanitation and other total sanitation approaches and overall the findings Very positive about the impact that that's having in 53 countries of world around the world Millions of people who are now living in open defecation free communities Because of this approach and I think anybody who's been to see the approach implemented at a community level Would not see it as a naming and shaming event I mean when you take something to scale to the extent that we have across 53 countries often national level programs You get bad examples There are always occasionally poor quality programs and that's something that the evaluation helps us identify and something then we try To follow up and address but I think on the whole CLTS and other community type Approaches really do try to take an empowerment approach when they're engaging with the community One thing that we've found and I mean, I think it's very interesting George's comment That when the community engages in that reaches open defecation free status Often you have then created a space in which to have further ongoing discussions about other hygiene and health issues And a number of our programs are taking that opportunity setting up wash committees Which then have a broader health and what wash and date Because we as an organization have a multi-sector approach some of our health and nutrition Colleagues are very excited about the opportunities that the kind of community Cohesion that has been created at the community level is something in a platform that they can then go and build on so That's my response Thank you. Thank you for that. Is there anyone that would like to say something about the CLTS or CHC models You're left and I'm sadja My name is Kamran I come from Pakistan I work with UNICEF, but I have a very knowledgeable colleague from the government of Pakistan Once we started with the presentation of Benin We were very interested because it looked quite similar to The programs we have UNICEF has its programs and then we have other sector partners and then we have donor funded programs We came across this debate of shaming no shaming pride and dignity Some four years ago after we had big floods in 2010 and we were starting a very large-scale program and as My other colleague has said that the cats community approaches to total sanitation includes different approaches so what we found the right recipe for Pakistan was to Put them in sequence and in synergy so that we can Start the learning process with the community through washclubs in schools And then but there is a power in triggering through CLTS using the Gamal cars that's Output oriented that's quick That's at scale I Had a question also that this can be done by the government itself because it's so simple So we we took one of the provincial government to trigger the communities themselves While the other approaches through wash club in schools Sanitation marketing has its own marketing methodologies to mobilize people And there are other institutions that we were talking about the mosque for example in Muslim areas There are community organizations So once we are working for a change and for development It has to be an all-encompassing approach We cannot Use any one of these approach and think of development Even we had to cross-cut with the other programs like education and so that's my That's excellent. It's good to hear about this There was some Man there yeah with your hand up. Please come up. We were running at 2 30 12 30 now. I think we can take a couple more questions after this Hi, my name is Orlando Hernandez and I'm affiliated with the wash plus project funded by USAID and I was just interested in finding out from the CLTX experience and been in we do have a program and been in the urban areas Can you address the sustainability issues and been in? and perhaps also the minimum standards associated with the types of latrines are being constructed in the CLTX program and well There's no particular Latrine that is being standardized in the in the program. So as far as I know That's that's not that's not there And yet a question Sorry, yeah, yeah Well, I mean one of the big the big problems that you have when you talk about about Sanitation is that in fact you are trying to influence a System within the system because you're trying to influence households and you want people to invest themselves to do something I mean government is not checking at least not in Benin the quality of the toilets in the Netherlands they do but in in Benin they don't and so you you you you are trying to to to To bring people to to do that investment rather than invest in a mobile phone or a scooter or whatever and And use their or use their own labor for creating something. That's what you try so your The the as I said our our program as we run it at the moment in Benin is is the bilateral program is is a And start to sectoral support, so it's really very much a Principle agent problem. Yeah, you know, maybe how you want to do things, but you're not doing it It's the government that's doing it They are the ones and then the government is doing something and then you have talking about central government who are in there In their turn influencing local government and local government is trying to bring people to build toilets in their houses so it's it's it's it's in terms of of Achieving that is is quite a difficult system to influence And that's why this this CLTS where you bring people up to speed about consequences of sense Hygiene behavior is so important because it it Declicks that the their their willingness to to invest in In in sanitation in their own household This sustainability part that we and that's where in particular my colleagues that are supporting the UNICEF program That they introduced is that they say well how in this uncertainty you are still how can you create some certainty and the certainty that they then were looking for was an agreement with the many government that they would push for the community health workers to the governmental community health workers To follow up when there has been a CLTS intervention so it is it's it's it's it's commitments that you are in fact contractualizing they are trying to contractualize and Probably that's the best thing you can do it's it's you're trying to To bring people at least to realize that just doing this this triggering is not enough You need to have subsequent intervention What we have in our program also and that's that is Maybe to to increase the The likelihood of people really doing something is a micro finance part where you make sure that there is When you do want to have something you as a household you can also take a risk you can invest in a in another dream using a Microfinance credit so that those are sort of the elements that that should secure to some extent this Sustainability but it comes to a whole society or a whole community Starting to think differently That's what you trigger with with the first intervention So we have one final question before we break for lunch Thanks. Thank you Just sort of to the panel the first question. What are what are the life cycles of? You know some of these programs that are run I mean I've seen I've heard talk of many different and diverse projects in various areas So, I mean are they one year two years and some of the challenges which threaten their sustainability? And the second question was to Lisa Nash in terms of The collaboration that you have within the various providers Do you guys have a benchmarking system? I know perhaps this is a bit of an idealistic question considering the diversity of challenges around the world But is there some sort of benchmark and I ask this question purely from a sustainable point of view. Thank you So, yes, we all want the magic bullet you know what we've focused on with our members is Saying in terms of the monitoring and evaluation post implementation They obviously have to decide what are the metrics that they they monitor that's most important to them, but we asked for three Generally, and they can customize the first one is Whatever the system is whether it's a water system or sanitation Is it working or not just the basic is the water flowing is the toilet? You know still functioning number two How many people is it serving? Because if you've got some idea about the level of people you know whether it's Only two people are using it. There's something to matter with it If 500 people more are using it than you expect then it's probably just two taxed You've got to do something else about it, and then the third area which is really squishy soft But which seems to be getting the most interest among the members and we're still figuring out Whatever what's your number one quality measurement? So for our member in West Bengal in India It's what's the arsenic level in the water because that's the one thing that's gonna kill everybody for somebody else It may be in a level of community activity in You know making sure that the one pit two pit latrines still function And they they really are used because that's what clearing it out is what's gonna make it sustainable So whatever that one one you know it's just to give standardized it said that's what I'm gonna track And then we asked them to track it and share it on the network, so We're still learning Anybody got any great ideas, please let me know And then you asked about longevity is that right our programs started in the in the early 90s So we've been there for 20 years in Benin The current program that that I'm responsible for starting 2007 It is currently running until the end of 2015, but we are going to make an extension until 2018 So we're talking about an 11-year period of Running that night. I The implicit message is you should be have a long-term engagement in order to really bring change And I think that's that's true, but you need to think together also So you need to sort of continuously see whether your intervention logic, which is what we're talking about all the time is Is is really the most the most effective one when it comes to monitoring? I think this introduction of this aqua system is very interesting because again, it allows a municipality Who should be responsible and feel responsible for something to track what they're doing? But not only can they track what they're doing They can also prove to others that they're tracking what they're doing and that makes them an actor not just to central government But even to outsiders because they can show look if you want to invest in my place. I can show you the results because I can create Credible proof that your money has been used properly. So it's it's it's with the coming off of internet You have and a number of tools that are very interesting and these guys they are here at At Stockholm also, I think that that is I think a very very promising system to have To have available that you you emancipate local government to become a trustworthy actor By allowing them to have an information channel That others can follow also Okay, I'm going to round up this the session here and I'd like to thank you all for coming I think We kind of resolved a little bit of that controversy between CLTS and CHC's there was a There isn't really a controversy I think in fact, it's there's a there's a lot of complementarity were the interesting thing is that this is all about human beings and So when we talk about integrating things Like the this thing about IW RM integrated water resource management, which was like with us for the last 20 years It's really the real integration is with the human with with the and the groups and humans need to work in groups And I think so to change behavior and this is not just an African problem I think it's a global one, you know concerning hygiene and things related to it We need to learn from each other and we need to integrate about the different forces around us So I think you'll be hearing more about these these two or three different kinds of approaches How we organize ourselves and how we learn from each other so you will see that some of these themes will be recurring during the week and It's it's a very nice thing to have a meeting on Sunday like this because then you'll see each other during during the week And you'll know where you've you've you've seen that person and you have something to talk about so again that that little group Function you now have it with you So I do thank you for coming and have a good lunch and we'll see you during the week