Integrating Handwashing into Community Approaches to Total Sanitation (CATS)

PPPHW Think Tank, February 2014

Community Approaches to Total Sanitation

What are CATS?
CATS is an umbrella term developed by UNICEF to encompass a wide range of community-based sanitation programming (including CLTS). Community Approaches to Total Sanitation (CATS) aims to eliminate open defecation in communities around the world.

The CATS Essential Elements are the common foundation for UNICEF
sanitation programming globally.

CATS: The Essential Elements

At their core, CATS rely on community mobilization and behavior change to improve sanitation and integrate hygiene practices.

They are demand-driven and community-led, and emphasize the sustainable use of safe, affordable, user-friendly sanitation facilities.

CATS: A Global Perspective

CATS is currently being implemented in 53 countries

How is handwashing being included?

Through new triggering exercises, as part or follow-up to the initial village triggering Interpersonal hygiene promotion, as part of community level followup and school-based activities

Inclusion in national ODF protocols

Example: Creating new HW triggering tools

10 tools field tested in Malawi (UNICEF, Salima District Council, ECB Canada) Handwashing practice increased by 69% and soap availability at handwashing facilities increased by 15% (compared to communities where no specific HW triggering tools were used)

By-laws imposed at Local Government/community level

X X X X

OD be to prohibit must The community visibly clean no garbage or flies

X X X X

All latrines must have sanitary bins

Example: ODF protocols

Additional Indicators

All latrines must have a tight fitting cover

Institutional WASH facilities (schools and health centres)

also be present must Community Committee, WASH Action Plan and/or other community M&E structure present

Each member of the community understands the need to contain excreta

Each household has access to a shared latrine

Childrens faeces are disposed of effectively

Essential Indicators

Each household has access to HWWS facilities

All latrines must be fully functional and clean Each household has access to their own latrine Environment is completely 100% ODF

But a lot of variation in the way HW is included.

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
Mozambique Cote dIvoire Madagascar Sierra Leone Bangladesh Ethiopia Nigeria Ghana Kenya Niger India Chad Syria Mali Togo

X X X X X X X X X X X X X
Zambia

X X

X X X X X X X X

X X X X X X X

X X

X X

Country

X X

X X X X

Example: ODF protocols

Zambia ODF verification form requires visit to each HH in village looks at: Handwashing station (Y/N) Handwashing station with water + soap/ash (Y/N)

ODF certification letter sent to community includes:

Following the ODF verification visit of your village conducted on the XXX month year, I am happy to inform you that the verification team has recognize the achievement of the ODF status of your village. This is no mean achievement and the district team takes this opportunity to congratulate you for your efforts I urge you to continue your effort to ensure that all household use and maintain their latrines appropriately and practice hand-washing with soap/ash. As you know Hand-washing with soap/ash before eating and after using the latrine is key to reduce diarrheal disease and keep you community healthy.

Example: ODF protocols

Ethiopia:
Phase 2 certification (to get white flag) includes:
Handwashing facilities are in working order and have enough water and soap or soap substitute (applies to HHs and institutions, such as schools, health centres) Communal latrines with hand washing facility available for passengers on main routes and public gathering places

Example: ODF protocols

Others are less precise: Ghana Model Clean Community (MCC) criteria includes: An increase in hand washing practice (evidenced by hand washing facilities with soap or other agent) close to toilet facilities, in institutions such as schools and health posts

Immediate impact of including hygiene promotion in CATS:

120% 100% 80% 60% 40% 20% 0%

Roofed toilets

Covered orifices

Smooth and clean squatting surface

Toilets in use

Toilets with superstructures

Zambia 6 month follow-up survey: 76% of toilets had hand-washing facilities (a significant improvement on the initial pilot) - of these, 84% had water, 51% of households were using soap and 34% using ash for handwashing

Toilets with lids

Toilets with handwashing facilities

Some findings from the Global CATS Evaluation

Survey shared with regional and country level staff and partners 218 responses from 45 countries: Broad agreement that hygiene promotion should be integrated into CATS programmes Majority of respondents reported that Handwashing station with water and soap/ash is one of the most difficult results to achieve

Some findings from the Global CATS Evaluation

And hand washing was reported as being the hardest ODF certification criteria to maintain

Some findings from Sustainability Checks:

Increasingly being used by UNICEF (with partners) to ensure that project outputs are sustainable beyond the end of the projects by systematically auditing key sustainability criteria and using the results to make course corrections and as a core indicator for assessing project success: In Mozambique, virtually all ODF communities visited were free of signs of OD, but only 40% met the more stringent ODF+ standards which includes new criteria on latrine quality, handwashing facilities and the presence of soap or ash. A key challenge for ODF sustainability monitoring through the SCs is finding tools nuanced and flexible enough to assess defecation and hygiene practices and behaviour change patterns within the quick in-and-out visits typical of SCs.

Thank you! Any questions?