CATS Project Report

CATS project report november 2016

Project Report

Community Approaches to Total Sanitation (CATS) november 2016 Published by Plan International Bangladesh Concept Proshanto Ranjan Sharma Roy, Project Manager GoB-UNICEF CATS project, Plan International Bangladesh Content Mark Ellery, Consultant Kazi Rashed Hyder, Consultant Edited and Technical Input Md. Zillur Rahman, Head of WASH Programme, Plan International Bangladesh Michelle MacInnesRae, Programme Manager, Plan International Canada George Yap, WASH Advisor, Plan International Canada Photo credit Plan International Bangladesh Design and Layout ASM Shafiqur Rahman / BCKEND360 Print Execute Printed in Bangladesh

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Contents Acronyms abstract acknowledgement Executive summary

02 03 04 05

1. Introduction 2. Project implementation 3. implementation modalities 4. achievement of targets 5. cats project results 6. challenges with mitigation plan 7. key lessons learned 8. reflection of stakeholders 9. conclusion

07 13 23 26 36 40 42 44 47

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Acronyms AECM BCC BHE CAP CATS CHT CLTS C2C C4D DAM DC DGHS DLP DPE DPHE DSHE EPI FGD GoB HtRAs HP HWD INGO KAP LGI LGSP LSE MIS MoU M&E NGO NL OD ODF O&M PCA SLTS SMC ToR ToT UNICEF UNO UP WASH WATSAN WinS

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Accelerating action towards Ending Child Marriage Behaviour Change Communication Bureau of Health Education Community Action Plan Community Approaches to Total Sanitation Chittagong Hill Tracts Community Led Total Sanitation Child to Child Communication for Development Dhaka Ahsania Mission Deputy Commissioner Directorate General of Health Services Defect Liability Period Directorate of Primary Education Department of Public Health Engineering Directorate of Secondary and Higher Education Expanded Programme on Immunization Focus Group Discussion Government of Bangladesh Hard to Reach Areas Hygiene Promotion Hand Washing Device International Non-governmental Organization Knowledge Attitude and Practice Local Government Institution Local Government Support Program Local Sanitation Entrepreneur Management Information System Memorandum of Understanding Monitoring and Evaluation Non-Governmental Organization Natural Leader Open Defecation Open Defecation Free Operation and Maintenance Programme Cooperation Agreement School Led Total Sanitation School Management Committee Terms of References Training of Trainers United Nation Children’s Fund Upazila Nirbahi Officer Union Parishad Water, Sanitation and Hygiene Water and Sanitation WASH in School

abstract Plan International Bangladesh implemented the “GoB-UNICEF Community Approach to Total Sanitation (CATS)� Project. The project assisted towards 500 communities and 200 schools in five hard-to-reach Upazilas located in the coastal and hilly areas of Barisal and Chittagong Division. The project applied Community Approaches to Total Sanitation (CATS) and achieved a significant outcomes both in community and schools such as 200,000 people living in Open Defecation Free (ODF) environment; 333,000 people have increased their knowledge on handwashing with water and soap and 85,000 people have adopted improved handwashing practices after use of toilets; ensured the access of gender sensitive WASH facilities in 100 schools and handwashing devices in 200 schools and 45,000 students have adopted improved hand washing practices after using the toilet.

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acknowledgement The GoB – UNICEF Community Approach to Total Sanitation (CATS) project implemented during December 2014 to September 2016 which was a partnership initiatives of UNICEF and Plan International Bangladesh. The aim of the project was to achieve open defecation free (ODF) in the hard-to-reach areas of Bangladesh where open defecation was high (22% to 27%) as well as improving hygiene practices among community and school students. The locations of the project was in Taltoli Upazila of Barguna district, Charfashion and Sadar Upazila of Bhola district under Barisal Division; and Laxmichari Upazila of Khagrachari district and Alikadam Upazila of Bandarban district under Chittagong Hill Tracks (CHT). The project has achieved a significant improvement on sanitation and hygiene practices within short period of time by using appropriate approaches and techniques which is briefly documented in this report. The partner NGOs (DAM/Green Hill) and Local Government Institutions (20 Union Parishads) contributed a lot and faced many challenges for achieving this huge progress. The project covered about 330,078 population (96,894 female, 100,849 male and 132,335 children) in 20 Union Parishads and 200 schools in 5 Upazilas.

These achievements would not have been possible without the effective coordination and technical support from the Department of Public Health Engineering at different levels as well as support from the Directorate of Health, Directorate of Primary Education, Directorate of Secondary and Higher Education and the Upazila Administration. Plan International also acknowledged the valuable contribution of various stakeholders such as Local Sanitation Entrepreneurs, Para Workers of ICDP, SMC, Teachers, Student council, Natural Leader, Children, Headman, Karbari, adolescents, etc. I am particularly grateful to the adolescent and children for being a constant source of community motivation and inspiration.

I would like to thanks the WASH Project team of Plan International Bangladesh and partner NGO; especial thanks to the Project Manager for his leadership and hardworking in accomplishing the task. I would like to thanks Md. Zillur Rahman, Head of WASH Programme, Plan International Bangladesh for his supervision and guidance for successful implementation of the project. I wish to acknowledge Mr. Mark Ellery and Mr. Kazi Rashed Hyder, WASH consultant for their valuable time, effort and resources which were channeled into producing this project report. I am thankful to the colleagues of Plan International Canada for their continual follow up, technical and financial support. I would like to thanks the colleagues of Barisal and Chittagong Divisional office as well as the Admin Department for the successful implementation and printing this Project Report. I am very much grateful to the Country Director and the Director Business Development of Plan International Bangladesh for their strategic guidance and inspiration in the implementation of the project.

Finally, we are thankful to UNICEF Bangladesh for this PCA to implement the project; effective coordination both at Central and Regional offices.

Country Director (Acting) Plan International Bangladesh

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Executive summary Bangladesh has made significant progress in reducing the proportion of women, men, girls and boys without access to protected water, sanitation and hygiene facilities. While the majority of these water, sanitation and hygiene facilities are accessible, for the majority of Bangladesh citizens (particularly the poor and other vulnerable groups), these facilities remain insufficient, unaffordable, and low quality, undermining equitable health, nutrition & education outcomes in the country. In rural Bangladesh, the health risks of faecal containment by poorly constructed and maintained latrines and the low use of soap for hand-washing (despite the high availability of latrines and soap) are particularly pernicious.

Plan International Bangladesh has been implementing the “GoB- UNICEF Community Approach to Total Sanitation (CATS)” project. This report seeks to document the accomplishments of this 22 month project which commenced in December 2014 ending in September 2016.

The CATS project reached 762 communities and 200 schools in five hard-to-reach Upazilas located in the coastal and hilly areas of Barisal and Chittagong division. The project applied the Community Approaches to Total Sanitation (CATS) toward the following specific outcomes: • • • • •

200,000 people live in Open Defecation Free (ODF) environment 100,000 people in targeted areas shift from open to fixed place defecation 85,000 people have adopted improved hand washing practices after use of toilets 333,000 people have increased their knowledge on hand washing with water and soap 45,000 students have adopted improved hand washing practices after using the toilet.

A number of training manuals like training for SMC, teacher, student council, para worker, natural leader, adolescents, health worker, local sanitation entrepreneur etc. and IEC/BCC materials were developed under the project. These were important for conducting various awareness campaigns and capacity building activities at community, local government and policy levels to realise the eradication of the practice of open defecation, use of improved sanitation and adoption of good hygiene behaviours.

In August 2015, Plan International Bangladesh and UNICEF signed another Programme Cooperation Agreement (PCA) for the implementation of project titled “Accelerating action towards ending child marriage” (AECM). To help ensure CATS and AECM achieved their goals, the donor granted both projects a six months extension ((April – September 2016).

The AECM project established four SaniMarts in two Upazilas in Bhola District to improve menstrual hygiene management (MHM) among women and adolescents girls, improve income earning opportunities for adolescent girls, improve their attendance at school and reduce the risks of child marriage. With the support of local sanitation entrepreneurs, targeted adolescent girl groups are producing and marketing thousands of sanitary pads per month and using their newly gained entrepreneurial skills to sell them. Awareness raising and sensitization sessions on MHM in schools and communities were also conducted which engaged boys and men as well as girls and women.

According to the donor-commissioned endline survey completed to evaluate Plan International Bangladesh, CARE and Practical Action on, the three main implementing

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INGOs for the CATS project, there were significant increases in the awareness, access and practice of sanitation and handwashing behaviours over the project period. Effective sanitation coverage as defined in the UNICEF tracer matrix also increased significantly over the project period although there remains room for further improvement.

Despite increases in awareness, access and practice of sanitation and handwashing behaviours, effective coverage as defined in UNICEF’s sanitation tracer matrix was still much lower, though notably increased when compared to the baseline.

With regards to the practice of open defecation in assisted communities, the sustainability survey of both community members via FGDs and household survey respondents indicates that communities are in the early stages and that for ODF conditions to be sustained, and to minimize slippage, continued monitoring and follow-up is required by local authorities.

Girls do not have access to proper facilities for menstrual hygiene management in school, i.e. waste bin and clean private space for changing and cleaning, in school. The CATS project rehabilitated existing sanitation facilities at targeted schools but had no scope to provide additional latrine and menstrual hygiene management facilities. This was a key lesson learned of this project as there is scope to improve further with respect to equity and equality issues to reduce gender disparity.

The end-line study showed that the latrine to student ratio was 1:89, which about two times more crowded than the Bangladesh National WASH in school standard though an improvement from the baseline (1:118). This suggests that there is a need to increase of school latrine chambers proportional to students.

With regard to sustainability, sourcing of funds from the SLIP fund or SMC for the O&M of WASH facilities was new since the project baseline. This was consistent with improvements in the O&M of school WASH facilities in regards to the appointment of caretakers, availability of cleaning materials & cleanliness. Further consideration for sustainability that the WASH interventions would be sustained at least as long as monitoring, supervision and support remains active across communities, schools and local government representatives.

Increased awareness of national policy along with budgetary allocations and recall of training knowledge were all positive indications of potential for sustainability of the interventions in schools.

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1. Introduction 1.1 Background 1.2 Context 1.3 The CATS Project

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1.1 Background This report presents the accomplishments of the project “GoB-UNICEF Community Approach to Total Sanitation (CATS)� managed by Plan International Bangladesh which was implemented in five Upazilas under Barisal and Chittagong division since December 2014. It is expected that the experience and learning depicted in this report can inform future WASH programming and project design.

1.2 Context 1.2.1 Sanitation Access to basic sanitation facilities is high in Bangladesh with only 1% of the population practising open defecation in 20151. The affordability of basic sanitation facilities is high with the biggest shift away from open defecation occurring amongst the poorest quintile2.

While the proximity of access to sanitary facilities is high, the sufficiency of latrines is compromised with 26% of the population relying on facilities shared by more than two families. As a result, the use of improved sanitation facilities only increased from 33% of the population to 61% over the MDG period1.

A national hygiene baseline survey finding in 2014 found that the cleanliness of latrines was poor with only 34% of the population having access to hygienic latrines3. An evaluation of the sustainability of sanitation in 2011 found that while the durability of latrines was low (< 5 years) the practice of accessing local markets to replace latrines was high4. Faecal sludge management is poor throughout the country with almost all faecal waste being dumped into open fields, storm water drains or surface waters.

According to a sanitation survey conducted by GoB in 2014 (Divisional Commissioner), open defecation rates in the Upazilas of Char Fashion (Bhola), Laxmichari (Kagrachari) and Alikadam (Bandarban) are 20-25 times higher than the national average of 1 percent.

%OD 28%

21%

14%

7%

0%

Bhola Sadar

char Fashion

Taltoli

Alikodom

Laxmichari

Open defecation status in CATS project areas

WHO & UNICEF (2015). Joint Monitoring Programme for Water Supply & Sanitation for Bangladesh WHO & UNICEF (2015), Joint Monitoring Programme for Water Supply & Sanitation 2015 MDG Update (fig. 32) 3 icddr,b (2014) Bangladesh National Hygiene Baseline Survey, WaterAid and Policy Support Unit, LGD, GoB 4 Hanchett S et al. (2011). Long-Term Sustainability of Improved Sanitation in Rural Bangladesh, World Bank 1 2

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1.2.2 Hygiene According to the Bangladesh National Hygiene Baseline Survey, handwashing stations proximity to latrines were accessible for more than two thirds of the households in Bangladesh however only 40% of these stations had both soap and water available5.

While the general awareness of improved hygiene is high, structured observation revealed that washing both hands with soap was much lower after defecation (30%), before feeding children (3%) and before preparing food (1%)6.

Menstrual hygiene management (MHM) remains a challenge in Bangladesh. Amongst menstruating girls and women, old cloth was the predominant menstruation management material (82-86%) amongst which only 22% of school girls, 21% of girls at home and 21% of women washed and dried cloth appropriately1. Use of unclean materials puts girls and women at increased risk of infections. The lack of MHM-friendly sanitation facilities in schools is can also serve as a disincentive for adolescent girls to attend school when experiencing their period.

As per DHS 2011, the proportion of households with soap and water (in a convenient location) is lowest in Barisal division with only 13.6 percent, indicating that more efforts are needed to ensure handwashing practice.

Proportion of Households 30.00%

22.50%

15.00%

24.20%

24.30%

25.10%

Rajshahi

Chittagong

Sylhet

26.60%

28.20%

20.30% 13.60%

7.50%

0.00%

Barisal

Khulna

Rangpur

Dhaka

Proportion of households where soap and water were observed

1.2.1 WASH in Schools Preventing disease transmission in schools can improve school attendance, cognitive development and educational attainment of girls and boys which in turn has an impact on national development outcomes. According to the Bangladesh National Hygiene Baseline Survey, an improved functional drinking water source was found in 80% of schools and 41% of them appeared to be clean. While the majority of schools (84%) had a functional improved toilet for students, in only 45% of schools were the latrines unlocked. The adequacy of these latrines at an average of 213 students per cubicle was well below the national standard of 50 students per cubicle.

Approximately one-third of all schools had water and soap available inside or near (<30 feet) the improved toilet accessed by students and a quarter of the toilets were clean.

Approximately one-third of school studentsâ&#x20AC;&#x2122; hands appeared to be clean and 28% washed both hands with soap during a handwashing demonstration.

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icddr,b (2014) Bangladesh National Hygiene Baseline Survey, WaterAid and Policy Support Unit, LGD, GoB icddr,b (2014) SHEWA-B Programme Health Impact Study Report, UNICEF and DPHE

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MHM remains a challenge especially in schools. Among menstruating girls and women, old cloth was the predominant menstruation management material with 40% of surveyed girls reporting that they miss school during menstruation for a median of 3 days a month. Almost one‐third thought that menstrual problems interfered with school performance. Just over half of students reported that they were forbidden from religious activities; while 74% of them were forbidden from non‐religious activities during menstruation (National Hygiene Survey 2014). It is understood that inadequate WASH facilities at school contribute to this period of absence from school during menstruation5.

1.3 The CATS Project The initial Community Approach to Total Sanitation (CATS) project commenced on December 2014 implemented by Plan International Bangladesh in 5 Upazilas in 4 Districts and was scheduled to end in March 2016 but was extended until October 31st, 2016, with activities ending September 2016.

Since December 2014, Plan International Bangladesh has been implementing the project titled “GoB UNICEF Community Approach to Total Sanitation (CATS)” in the Barisal and Chittagong Divisions where 500 communities and 200 schools were targeted in 5 Upazilas.

At the completion of the project in September 2016, a total of 762 communities had been identified, triggered, declared and certified as ODF.

1.3.1 CATS Project Goal The CATS project aimed to achieve 100 percent open defecation free status and promote hygiene among the targeted population in 500 communities and 200 schools of 20 Union Parishads in five Upazilas in four districts through Community Approaches to Total Sanitation (CATS).

Sanitation

1.3.2 Project Objectives

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Outcome 1 Improved access and use of good sanitation practices and promotion in 500 communities Results

At least 200,000 people live in an Open Defecation Free (ODF) environment At least 100,000 people in targeted areas shift from open to fixed place defecation 100 Local sanitation entrepreneurs trained, linked with LGIs and targeted communities

Activities

Selection of OD community CLTS: pre-triggering, triggering, post-triggering Development of the potential Natural Leaders Strengthen the capacity of Local Sanitation Entrepreneurs and established linkages ODF declaration & certification Spreading the CATS experiences to other communities Observation National Months and International Days Monitoring by ODF certification team and community

hygiene wash in school Others

Outcome 2 Improved handwashing practices among dwellers in 500 communities Results

85,000 people adopt improved hand washing practices after the use of the toilet 333,000 people have increased their knowledge on hand washing with water and soap (including at least 75,000 school girls and boys)

Activities

Social mobilization for WASH demand generation Development of IEC & BCC materials Conduct HP sessions in each community Conduct quarterly participatory monitoring at community and school Training on ODF and HP for para workers Training on HP for Health Worker Interactive campaign Theatre for Development (TfD) show Mobile film show Workshop and meeting Participatory progress review Advocacy and influence activities Demonstration, documentation & project learning sharing

Outcome 3 Improved handwashing practices among children in 200 schools Results

Water, sanitation and hand washing facilities are sustainably used and maintained 45,000 students adopt improved hand washing practices after using the toilet

Activities

WASH in Schools (WinS): selection, establish benchmarks Awareness campaign and mobilization activities for WinS Conduct HP sessions Orientation of SMC & Teacher on School Sanitation and Household Hygiene Education (SSHHE) Training of Resource Teacher on SSHHE Training of Students Council on SSHHE Debate and art ceremony at school level Rehabilitation of sanitation facilities/installation of hand washing/ water facilities

Intervention The CATS project also includes capacity building of health staff to promote hygiene practices (especially hand washing with soap) through awareness raising and outreach interventions within communities. In addition, WASH facilities in schools are being rehabilitated, and hygiene practices are being promoted through the child to child approach.

Activities

Organise project start up workshop Capacity building training on CATS Baseline survey including a KAP study Project orientation and launching ceremony Project Endline Survey Project exit workshop

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3. Improved hygiene practices maintained in School

2. Household members improve hygiene practices related to hand washing after using toilets

1. People achieved better hygiene outcomes through changed sanitation behaviours

Outcomes

3.2. 45,000 children from 200 schools have adopted improved hand washing practice after using toilets

3.1. Water, sanitation and hand washing facilities are rehabilitated and sustainably used and maintained

Number of school children who are effectively washing their hands with water and soap after the use of toilets (B=TBD, Target=+45,000)

Number of schools with Water and sanitation facilities (B:TBD; Target: + 100) Number of schools with adequate hand washing facilities (B:0, Target:200) Number of schools with budgetary allocation for operation and maintenance of WASH facilities (B=TBD; Target = +100)

Number of community members who are effectively washing their hands with water and soap after the use of toilets (B=TBD; Target = +84,000).

2.2. 84,000 community members have adopted improved hand washing practice after using toilets

Number of Local Sanitation Entrepreneurs serving project areas communities (B=TBD; target = +100)

1.3. Local Sanitation Entrepreneurs identified and linked with LGIs and targeted communities Number of people in project communities able to recite at least 3 critical times for hand washing (B=TBD; Target =+333,000)

Number of households in the project area with additional fixed-place defecation facilities (B=TBD; Target = 20,000)

1.2. 100,000 people (in project area) have shifted from open defecation to fixed place defecation

2.1. 333,000 people have increased their knowledge about 3 critical time for hand washing

Number of communities certified open defecation free (Baseline: 0, Target: +500) Population living in an certified open defecation free environment (B:0, Target 200,000)

Objectively Verifiable Indicators (with baselines and Targets)

1.1. At least 200,000 people (in project area) live in an open defecation free environment

Outputs

CATS Project Result Framework

• Political unrest and instability prevails within tolerable limit • Major disasters (Flood and cold wave) remains in tolerable limit • The Government priority for Total Sanitation will remain priority.

• Union level Health and Family Planning staff will remain cooperative.

• LGIs will cooperate

Risks & Assumptions

• Baseline report • Monitoring and Progress report • Evaluation report

• Political unrest and instability prevails within tolerable limit • Major disasters (Flood and cold wave) remains in tolerable limit • The Government priority for School Sanitation will remain priority.

• The primary education department will cooperate

• Baseline report • Political unrest and • Monitoring and instability prevails within Progress report tolerable limit • KAP study • Major disasters (Flood • Evaluation and cold wave) remains report in tolerable limit

• KAP Baseline (OD map and CAP) report • Progress reports • Evaluation report

Sources/Means of Verification

2. Project implementation 2.1 Baseline and KAP study 2.2 Capacity Building of LGIs 2.3 Community Engagement 2.4 CLTS triggering 2.5 Verification and Certification of ODF 2.6 Community based monitoring 2.7 Hygiene Promotion by Schools & Health Workers 2.8 WASH in school (WinS) 2.9 The AECM Project 2.10 Establishment of SaniMart 2.11 Market Facilitation 2.12 Advocacy 2.13 Linkage to UNICEFâ&#x20AC;&#x2122;s MoRES 2.14 Sustainability of Results

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2.1 Baseline and KAP study The project commenced with a community meeting to oversee the situation on open defecation and hygiene practices of selected communities through consultation with natural leaders, a transect walk and rapport building. Following this, a study was carried out to query the knowledge, attitudes and practices (KAP) of the communities in regards to open defecation and hygiene in the project area. A baseline study was also undertaken to assess the defecation and hygiene related issues in communities and schools as well as to establish a benchmark to examine the change triggered by the interventions.

2.2 Capacity Building of LGIs The project interventions were coordinated through the Upazila office but implemented at the Union Parishad, Ward, Para (cluster household) level. These local government institutions played the coordinating role in ensuring the involvement of all government and non-government stakeholders in the implementation of total sanitation.

The project developed the capacity of the UPs to take a lead role in community mobilization and implementing sanitation activities in their respective unions with the goal of creating an enabling environment to work collectively to achieve common goals. The capacity of Union Parishad members on CATS was enhanced through training and orientation enabling these LGI representatives to take the lead in the implementation of the CATS process. The project trained two WASH Facilitators per Union Parishad in Barisal division and three WASH Facilitators in the Chittagong Hill Tracts. The training focused on both the specific issues and needs of women and girls, as well as the demonstrated catalyst role that they play in CATS. The training package covered the present WASH situation of the union, implementation approaches, participation women and girls in decision making process, local resources mobilization, GoB polices and strategies, role and responsibility of UP, planning, monitoring and documentation of the project activities.

2.3 Community Engagement Plan International Bangladesh built the capacity of government health workers, Ward representatives and â&#x20AC;&#x2DC;Natural Leadersâ&#x20AC;&#x2122; through need-based training, coaching, demonstration and exposure visits. They played significant roles in the facilitation of community triggering sessions, planning processes, implementing and monitoring sanitation activities at para, village and union levels.

Plan International Bangladesh and partner NGO ensured girlsâ&#x20AC;&#x2122; and boys participation in all CATS processes and events. The organisation also provided different training to the children through the Student Councils to act as hygiene change agents in the targeted communities.

Plan International sensitised and enhanced the capacity of local private entrepreneurs to promote a range of sanitation technology options with hand washing facilities such as technologies suit with geo-physical situation, gender and child friendliness as well as people with disabilities and easy operation and maintenance. The trained local entrepreneurs were encouraged to introduce and promote multiple and affordable sanitation options for poor households in the community.

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Community Approaches to Total Sanitation (CATS) Community Approaches to Total Sanitation (CATS) are an umbrella term used by UNICEF sanitation practitioners to encompass a wide range of community-based sanitation programming. CATS shares the goal of eliminating open defecation; is rooted in community demand and leadership, focused on behaviour and social change, and committed to local innovation.

The essential elements of CATS are a framework for action that provides a common foundation for sanitation and hygiene engagement in the sector while allowing for a broad variation in the way programmes are applied and translated locally (as further detailed below).

1. CATS aim to achieve 100 percent open defecation free (ODF) communities through affordable, appropriate technology and behaviour change. The emphasis of CATS is the sustainable use of sanitation facilities rather than the construction of infrastructure including the safe disposal of infant and young children’s faeces in toilets.

2. CATS depend on broad engagement with diverse members of the community, including households, schools, health centres and traditional leadership structures.

3. Communities lead the change process and use their own capacities to attain their objectives. Their role is central in planning and implementing improved sanitation, taking into account the needs of diverse community members, including vulnerable groups, people with disabilities, and women and girls.

4. Subsidies – whether funds, hardware or other forms – should not be given directly to households.

Community rewards, subsidies and incentives are acceptable only where they encourage collective action in support of total sanitation and where they facilitate the sustainable use of sanitation facilities.

5. CATS support communities to determine for themselves what design and materials work best for sanitation infrastructure rather than imposing standards. External agencies provide guidance rather than regulation. Thus, households build toilets based on locally available materials using the skills of local technicians and artisans.

6. CATS focus on building local capacities to enable sustainability. This includes the training of community facilitators and local artisans, and the encouragement of local champions for community-led programmes.

7. Government participation from the outset – at the local and national levels – ensures the effectiveness of CATS and the potential for scaling up.

8. CATS have the greatest impact when they integrate hygiene promotion into programme design. The definition, scope and sequencing of hygiene components should always be based on the local context.

9. CATS are an entry point for social change and a potential catalyst for wider community mobilization.

2.4 CLTS: Pre-triggering, triggering and post-triggering The underlying assumption of CLTS is that once women, men, boys and girls are convinced of the need for sanitation they will be self-motivated to construct their own toilets using locally available resources. CLTS focuses on igniting change in sanitation behaviour at the community level rather than on individual behaviours in order to achieve Open Defecation Free (ODF) communities. Plan International Bangladesh used sequential steps of CLTS for community sensitisation and mobilisation to achieve 100 percent ODF status in intervention communities that includes pre-triggering, triggering and post triggering events at the community level.

The project followed the principle of CLTS and organized different activities such as organized triggering sessions to demonstrate the effect and consequences of open defecation and using unhygienic latrine. Through this session a group of selves motivated people were come forward (including men, women, youth girls and boys, people with

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CLTS convinces Monkhathoai to install an improved latrine Mongbaaung is a para of 110 households situated in Alikadam Sadar Union of Bandarban district.

At the time of community situation analysis through CLTS triggering session, more than 52% of the households in Mongbaaung para were without an improved latrine as community situation analysis through triggering session. The common practice of open defecation meant that residents frequently suffered from water and sanitation related diseases.

In May 2015, the CATS project organised an awareness-raising session on Community Led Total Sanitation (CLTS) in Mongbuaaung para. Through this session, a social map presenting the sanitation situation of the para was developed, and the para residents were oriented on the consequences of open defecation and the failure to wash hands at three critical times. All the household members in the para were ignited by the project interventions to install hygienic latrines or to upgrade their existing unhygienic latrines.

The household of Mongkhathoai Marma was an exception. Although Mongkhathoai had previously received a set of latrine rings and slab from the government, he had opted to sell the materials rather than install a latrine. Mongkhathoai cited several reasons including a financial crisis for not having a hygienic latrine of his own. Meanwhile, his family continued to practice open defecation in places that were very close to the kitchen of his neighbourâ&#x20AC;&#x2122;s house. While conducting regular monitoring visits, project staff and UP representatives tried to convince Mongkhathoai Marma that open defecation harmed both themselves and others. Finally, Mongkhathoai committed to install a sanitary latrine in his residence.

In October, 2015 Mongbaaung para was declared as ODF. The people in this locality now live in a healthier environment where nobody defecates in the open. Like other households in the para, Mongkhathoai Marma and all of his household are using their sanitary latrine and washing their hands at critical times. Mongkhathoai Marma says that â&#x20AC;&#x153;the environment of our house and surroundings has dramatically changed after the installation of this hygienic latrine. There is no longer such a bad smell around our house.â&#x20AC;?

disability) to form a community based committee (cluster/sub-cluster action team) and developing an action plan for achieving the ODF. In the process of triggering session social map the women and children indicated the households did not have latrine, place of open defecation, etc. and prepared community action plan (CAP); and updating the social map and Community Action Plan (CAP), mass monitoring and house to house visits. Post-ODF support helped ensure ODF communities are not only maintaining this status but that they are also climbing the sanitation ladder with the installation of improved and more sustainable latrine options with handwashing devices.

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2.5 Verification and Certification of ODF status The verification and certification of ODF status was a key area of project support. Following notification by the community sanitation committee and natural leaders, the Union Parishad WATSAN committee verifies whether a community is 100% ODF. Following this, an application is submitted to the Union WATSAN committee chaired by Union Parishad Chairman required to issue a certificate on the open defecation free status of the community.

2.6 Community based monitoring As this project followed a community based approach, Plan International Bangladesh and partner NGO built community capacity, developed necessary monitoring tools and engaged male and female community members for routine monitoring. The organisation used the monitoring capacity of local governments and other partners to validate a certain percentage of data generated from the community based monitoring. In addition, WASH issues were integrated into the para micro plan under the Integrated Community Development Programme (ICDP) activities at para centres of Chittagong Hill Tracts and the Para Workers monitored the progress.

Nolbunia village achieves ODF status North Nolbunia is a small village of 136 households under Sharikkhali union of Taltoli Upazila under Barguna district. Together with the community members, the project conducted a CLTS triggering session and a sanitation situation analysis in the village in April, 2015. During the preparation of a Sanitation Social Map it was found that only 31 out of 136 households had an improved latrine while 102 households had unimproved latrines and 3 had no latrine at all.

Village residents were sensitized through the CATS approach and prepared an action plan to make their village ODF. A committee of community members and local government representatives conducted awareness raising initiatives including interactive campaigns, film screenings, house to house visit as well as theatre for development (TfD) shows by adolescent boys and girls, hygiene messages disseminated by mother and adolescent group, monitoring visits by children group and WATSAN committees also established linkages with sanitation entrepreneurs in order to make the village ODF. Households with no latrine installed latrine facilities however some of the households with unhygienic latrines claimed that they couldnâ&#x20AC;&#x2122;t afford the cost to upgrade to improved latrines. The committee observed that most of the unhygienic latrines would be improved if a gooseneck or water seal was installed on the ring slab of the unimproved latrines. The committee then appointed a local sweeper named Korshed to install water seals on the 81 unimproved latrines at a cost of 70 taka for each household.

Following this, North Nolbunia village was declared ODF by the Sharikkhali Union Parishad.

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2.7 Hygiene Promotion by Schools & Health Workers The CATS project aimed to promote good hygiene behaviour through building the capacity of professional health workers to ensure the greater participation, ownership and awareness of the community in hygiene behaviour change. The project targeted different health workers including health assistants, family welfare assistants, health and family planning inspectors, sanitary inspectors, NGO health workers, village doctors and skilled birth attendants.

Trained health workers and school teachers facilitated interactive sessions in communities, health centres and schools. Four sessions in three waves (ODF, hand-washing and clean latrines) were conducted in each of the EPI clusters of the selected 20 Union Parishads.

Trainings were also provided to the children to act as hygiene change agents in their own communities through the Student Council. Adolescent girls and boys also received training and participated in different events such as visit household latrines, checked cleanliness of the latrines, availability of hand washing device, soap and water and discussed with household members regarding benefit of good sanitation & hygiene practice, consequence of open defecation and using unhygenic latrine in relation of health, economic, social etc.

2.8 WASH in school (WinS) The UNICEF-promoted ‘Three Star’7 approach (daily supervised hand washing, supervised cleaning of toilet, monitoring of open defecation, improved sanitation and hygiene facilities) was deployed in the 200 target schools. The rehabilitation / installation of WASH facilities was targeted in the schools that scored two stars or less. The ‘Fit for School’8 approach prioritizing local solutions to improve hand washing was adopted to complement the ‘three star’ approach. Training and coaching sessions were conducted for teachers, SMC members, student council, parent teacher associations and Upazila Education Officers to facilitate hygiene behavioural change. These sessions were focused on hand washing and the School Led Total Sanitation (SLTS) approach which adapts the CLTS methodology to the school setting. The project organized different types of mobilization and awareness activities including art competitions, debates, rallies, role-play, games and the celebration of hand washing day and sanitation month within the schools.

2.9 The Accelerating Action Towards Ending Child Marriage Project In August 2015, Plan International Bangladesh and UNICEF signed a Programme Cooperation Agreement (PCA) for the implementation of project titled “Accelerating action towards ending child marriage (AECM)”. The project was two phases, the first ended on 31 March 2016 then extended for six months from April –September 2016. This project included both entrepreneurship and social skills building of targeted adolescent girls and the establishment and operation of four “SaniMarts” where local sanitation entrepreneurs partnered with adolescent girls groups to produce low-cost sanitary napkins as well as provide income generating opportunities for group members.

The Three Star Approach is a means of benchmarking WASH service delivery performance in schools in a progressive manner to meet national WinS standards.

8 The Fit for School approach applies school-based management to implement simple evidence-based interventions that address key health determinants (i.e. appropriate sanitation, washing facilities and clean water) in a single package that prioritizes simplicity, scalability and sustainability.

7

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2.10 Establishment of SaniMart As part of the Accelerating Action towards Ending Child Marriage (AECM) project, four SaniMarts have been established in Bhola Sadar and Charfashion Upazila. These SaniMarts seek to reduce the risks of child marriage by supporting girlsâ&#x20AC;&#x2122; economic and social empowerment along with addressing the barriers they face to equally participating and learning in schools due to the personal challenges they experience during menstruation. The creation and supply of affordable and easily accessible sanitary napkins by and for girls helps girl clients and teachers improve their menstrual hygiene management to then be better able to participate in school. The social and entrepreneurial skills-building is two-fold. Girls are trained and encouraged to take active roles in hygiene education promotion in schools and in communities. They are also trained in production and sale of sanitary napkins including in entrepreneurship. This opportunity to become active agents in their own communities and to be self-employed further enables them to stay in school, thus reducing risks of early marriage.

Adolescent girls aged 14 -18 groups started the production of sanitary napkin pads in March, 2016. In this short time span, important activities have been realized. In partnership with local sanitation entrepreneurs, these adolescent girls groups established retail outlets and are communicating and developing linkages with shopkeepers, pharmacies, Community Clinics, schools and colleges to encourage them to purchase their sanitary napkin pads. They are also involved in awareness raising for other pre-adolescent girls and women on the benefits of using the sanitary napkin as part of safe menstrual hygiene management.

Complementing the sanimarts, awareness raising and sensitization sessions on MHM in schools and communities were also conducted which engaged boys and men as well as girls and women.

What is a SaniMart?

The global concept of SaniMart is to bring together in one place all the various components required to construct and maintain a latrine, as well as other personal hygiene items. It is a small shop located in an accessible bazaar or community. A SaniMart is both a shop and production centre sanitation items of materials and manufacture of sanitary napkins. Under the AECM project local sanitation entrepreneurs along with adolescent girls groups were established and trained on the production of sanitary napkins.

These groups were then provided with machines and raw materials, introduced to the suppliers of the raw materials and several clients such as the Upazila health complex and pharmaceutical shops for the bulk purchase of sanitary napkins as well as individual to purchase napkin and other goods.

The production of sanitary napkins involves 4 types of machines as further detailed below: 1. Raw Materials: Local cotton fabric, medical cotton & cotton net suppliers are identified 2. Refining: Collected local fabric (Jhut) is processed in a cotton refining machine.

3. Rolling & Cutting: The refined cotton is rolled with medical cotton layer by layer, covered with netting and cut to the prescribed size.

4. Sewing: Each piece of napkin is then sewn adding a cotton loop.

5. Sterilizing: Finished napkins are placed in an auto-clave machine for dis-infection.

6. Drying: After disinfection the napkins are placed in a dryer to remove all moisture.

7. Packing: 8-10 napkins are then bundled together in a sealed package.

8. Marketing: Napkins are sold either directly to women or via pharmacy/health outlets

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raw cotton

01

refining

02

rolling + cutting 03

sewing + loop

04

08

marketing

07

packaging

06

drying

05

sterilizing

Financial viability: During the training on the production of sanitary napkins, the analysis of costs is discussed. At current prices, one packet consisting of 8/10 napkins costs BDT 32/40 to produce and sells at BDT 40/50. This is a profit of roughly 1 BDT per napkin.

Supply and Production: As revolving fund the AECM project provided machineries and raw materials (cotton, cloth, rapping packet, etc.). Adolescent girls groups are primarily producing these napkins at the site of the SaniMart in addition to their study and other activities. With each member spending 1-2 hours per day producing napkins, an average 400 - 550 packets (3,200 - 4,500 pieces) are produced each month.

Marketing: Most napkins are supplied to medical shops, Community Clinics, Schools/colleages and the demand is relatively high as compared to other napkins due locally available with comparatively low prices and good quality. Group members sell napkins in their schools and colleges and the Health Complex supplies these napkins to the upazila hospital and union health complex. In addition local sanitation entrepreneur and girls groups are selling other sanitary goods (toiletries, handwashing devices, etc.).

SaniMarts enable adolescent group members to generate some income that is proving useful in the battle against early marriage and school dropout. At the same time it is increasing awareness and access to safe menstrual hygiene products particularly in the rural and hard to reach areas. Strong linkages between the education and health departments at the Upazila level increase the sustainability and effectiveness of SaniMarts in improving menstrual hygiene, improving the school attendance of adolescent females and resisting early marriage.

2.11 Market Facilitation The CATS project established various linkages with local sanitation entrepreneurs, hardware shopkeepers, masons and plumbers to facilitate the access of project beneficiaries to sanitation facilities. In some of the project areas where other major WASH programs were being conducted, the project assisted male and female community members to access supply chains and market financing developed through these interventions.

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2.12 Advocacy Local Government Institutions played a key role in the advocacy for improved sanitation and hygiene. Union Parishads were strengthened to improve the coordination of all sanitation and hygiene activities within their jurisdiction. In addition, Union Parishads were encouraged to allocate a portion of their local budget for sanitation and hygiene interventions. Through open budget processes communities were involved in the budget planning discussion especially in regards to the allocation of any sanitation subsidies. Communities were also encouraged to engage in the targeting of subsidies in the ODF targeted areas.

2.13 Linkage to UNICEFâ&#x20AC;&#x2122;s Monitoring Results for Equity Systems (MoRES) A sanitation tracer developed by Plan International Bangladesh at the household and community level sought to track the progress of individual and collective behaviour change in ODF target areas. The indicators adopted in the sanitation tracer were selected to align with the UNICEF monitoring results for equity systems (MoRES).

Sanitation Tracer Framework Coverage level

Frequency

Assessment criteria

Sample Survey for Baseline, midline & Endline

6 months, Baseline, Midline & Endline

Depends on Baseline, Midline & Endline Surveys, quarterly FGD reports

% of households surveyed with an improved functional latrine within 20m of the HH

Sample Survey for Baseline, midline & Endline

6 months, Baseline, Midline & Endline

Depends on Baseline, Midline & Endline Surveys, quarterly FGD reports

Utilization

% of households which use an improved functional latrine within 20m of the HH by all members of the household (over 5 years of age)

Sample Survey for Baseline, midline & Endline

6 months, Baseline, Midline & Endline

Depends on Baseline, Midline & Endline Surveys, quarterly FGD reports

Adequate Coverage

% of households using an improved functional latrine which is within 20m of the HH and which is clean, functional and accessible by all members of the household (over 5 years of age) all year round.

Sample Survey for Baseline, midline & endline

6 months, Baseline, Midline & Endline

Depends on Baseline, Midline & Endline Surveys, quarterly FGD reports

Sample Survey for Baseline, midline & endline

6 months, Baseline, Midline & Endline

Depends on Baseline, Midline & Endline Surveys, quarterly FGD reports

Effective Coverage

% of households using an improved functional latrine which is within 20m of the HH and which is clean, functional and accessible by all members of the household (over 5 years of age) all year round, which has hand washing facilities (water and soap ) available inside or within 5m of the latrine

Availability

Accessibility

Indicators

MoV

% of improved functional latrines in the village sufficient (one latrine for one HH) to serve total number of households in the village.

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2.14 Sustainability of achieved results under the CATS project The sustainability of the results achieved through the CATS project have been prioritized through the strengthening of the institutions that demand, supply, ensure and regulate the quality of sanitation and hygiene services for all.

2.14.1 Development of natural leaders The project focuses on developing the leadership and facilitation skills of male and female natural leaders through organizing training and orientation to continue to motivate the different sections of the community to sustain ODF status. The female natural leaders can easily entire into the households and motivate the female members. The project also developed linkages between the male and female natural leaders and other key actors (i.e.

LGIs, government health workers and sanitation entrepreneurs) to work together to achieve, sustain and move beyond ODF status. Horizontal learning encouraged the natural leaders to enhance their confidence and commitment to be champion to solve any problems for their community.

2.14.2 Building on local government structures Local government institutions such as the Upazila and Union Parishad are expected take the lead in the development of community action plans in close coordination with the natural leaders. The CATS project developed the capacity of these local government institutions for negotiation, coordination, situation analysis, planning and resource mobilization to achieve total sanitation. All these were supportive to strengthening the government system as an institutionalized process.

2.14.3 Working with health systems The capacity of the government health department and health workers to undertake hygiene promotion and monitoring has been developed under the CATS project. In particular, the coordination of health department staff with LGIs and community organizations was prioritized to improve the sustainability of the behaviour change messaging.

2.14.4 Sanitation Markets The CATS project trained up 100 local sanitation entrepreneurs on the production quality latrine components and installation of improved sanitary latrine. The installation of improved latrine models created silent competition among the community to climb sanitation ladder.

The AECM project aims to enhance the local sanitation market through capacity building of adolescent girls groups and establishing SaniMarts. The project encouraged the adolescent girls and boys and the Unions to reduce child marriage through the creation of self-employment for adolescent girls, to strengthen social and entrepreneurial skills, and to improve menstrual hygiene management practices of local women and girls. Gender training was provided to the Adolescent girls and boys which helped them and Unions to become active agents in supporting adolescent girls to develop their own businesses all in the name of reducing child marriage.

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3. Implementation Modalities 3.1 Project management and coordination 3.2 Fund Management 3.3 Monitoring, evaluation and reporting 3.4 Blank Local Procurement Authorization

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3.1 Project management and coordination Plan International Bangladesh and its local NGO partner, Dhaka Ahsania Mission (DAM) jointly implemented the CATS project until March 2016. Project activities were directly implemented by Plan International Bangladesh in Taltoli Upazila of Barguna district while DAM implemented activities in the 4 other Upazilas within 3 districts (Bhola, Khagrachari and Bandarban). In the project extension phase (Apr - Sep 2016), Plan International Bangladesh directly implemented the project in Taltoli Upazila of Barguna district, Charfashion and Sadar Upazila of Bhola district and DAM was replaced by a new NGO partner, Green Hill, who implemented in Laxmichari Upazila of Khagrachari district and Alikadam Upazila of Bandarban district. In addition, Plan International Bangladesh provided overall technical support, supervising and monitoring to ensure the quality of activities being implemented in the field which includes mainstreaming of gender equality considerations.

Green Hill was selected and assessed based on its overall capacity in the WASH activities, geographical coverage and organizational reputation at the community, civil society and local administration level. The organization has been actively engaged in empowering the poorer and deprived hill communities with special focus on women, children, socially excluded persons, extreme poor and ethnic minor communities living in the hard to reach and underserved areas of the CHT since 1994.

Plan International Bangladesh and partner NGOs (DAM / Green Hill) have built partnerships with 20 Union Parishads through signing MoUs and coordinating with the Department of Public Health Engineering (DPHE), the Director General of Health Services, the Directorate of Primary Education, the Directorate of Secondary and Higher Education and UNICEF Zonal Offices. Plan International Bangladesh was responsible for the coordination with government and non-government stakeholders for facilitating implementation and regularly monitoring project progress against the targets set under the project. This included the regular sharing with the other UNICEF partners implementing the CATS programme to exchange learning to further improve the implementation of the project activities.

3.2 Fund Management Plan International Bangladesh has maintained a transparent financial management system in keeping with the requirements of UNICEF established in the Project Cooperation Agreement (PCA) guidelines. While field offices managed expenditures, head office was in charge of overall budgetary control including monitoring of transactions and disbursement of funds as per the organizations own financial management and accounting procedures.

Plan International Bangladesh also provided funding to the partner NGOs as per the project agreement on a quarterly basis. Plan International Bangladeshâ&#x20AC;&#x2122;s finance department regularly followed up and monitored the expenditure statement and other related documents, organized training for the concerned staffs of partner organization on Field Operation Book (FOB).

3.3 Monitoring, evaluation and reporting Plan International Bangladesh, with support of UNICEF, developed an integrated mechanism on participatory monitoring, periodical progress review, project evaluation and reporting system on the basis of the Result Framework with clear consistent outcomes, outputs, and agreed indicators. Participation of the key stakeholders was ensured in the process of baseline study, monitoring, evaluation and reporting of the project.

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3.3.1 Mobile based monitoring system Plan International Bangladesh applied mobile phone based monitoring system for real-time data collection and monitoring. Training was organized for the WASH facilitators (Union Parishad staffs) to build the knowledge and skill online data collection using Tabs. The system increases the reliability of data, enhances the capacity of field staff and reduces staff supervision due to the opportunity for quick analysis of the outputs based on the updated data. The system runs with a tailor-made App in the Android based smart mobile phone.

3.3.2 Community based Monitoring The community representatives of the working areas were the key actors of community monitoring on ODF and hand washing progress. Participatory monitoring is a continuous process, starting with the baseline KAP study with mapping and preparing Community Action Plan, and periodical monitoring and progress review continued up to end of the project period. The monitoring guidelines and baselines checklists were developed in consultation with UNICEF.

3.3.3 Level 3 monitoring Analysis of the conceptual framework Monitoring Results for Equity Systems (MoRES) was carried out with active facilitation of UNICEF for effective planning, implementation, monitoring and managing results. Level 3 monitoring assesses and addresses bottlenecks and barriers to estimate progress towards outcomes in representative areas or groups of the project.

3.3.4 Final evaluation Plan International Bangladesh jointly with other implementation partners of CATS project (CARE, Practical Action) conducted an endline study on completion of the project by the external evaluators to assess the extent to which the outputs and outcomes have been achieved, the effectiveness of the interventions, and identify the key lessons learned.

3.3.5 Reporting Monthly narrative and quarterly narrative and financial reports were submitted to UNICEF compiling the accomplishments of the quarter along. Progress review meetings were took place every quarter.

3.4 Blank Local Procurement Authorization A Blank Local Procurement Authorisation (BLPA) was granted to cover the rehabilitation of water and sanitation facilities. The BLPA was awarded on the basis of Quality Assurance commitments of the implementing partners as well as monitoring by UNICEF and third party agencies. A Construction Agreement was also developed detailing the standards for water supply and sanitation rehabilitation activities in assisted schools. In September 2016, UNICEF completed the final inspection of water and sanitation facilities.

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4. Achievement of Targets 4.1 Improved Sanitation Outcomes 4.2 Improved Hygiene Outcomes 4.3 Improved School WASH Outcomes

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4. Achievement of Targets The implementation of the CATS project in 500 Communities and 200 schools in Barisal and Chittagong divisions was targeted towards the hard to reach unions in the Upazilas where a significant proportion of the population are still practices open defecation.

Target vs achievements against major activities Project target

Achieved

Pre-triggering and triggering communities

500

762

152%

Post-triggering

791

845

107%

4,342

8,473

195%

17,373

36,571

211%

100,000

221,457

221%

Number of communities declared ODF

500

762

152%

ODF post-certification periodic monitoring

500

762

152%

200,000

330,078

165%

100

100

100%

279

296

106%

3,600

3,619

101%

333,000

400,793

120%

Major activities

% of target

CLTS - new latrines (100,000 people in 500 communities)

Number of new improved latrines constructed Number of latrines upgraded to improve from unimproved Number of people gaining access to improved latrines CLTS - 500 communities declared and 200,000 people ODF

Number of people living in ODF communities Sanitation- 100 local sanitation entrepreneurs established Number of local sanitation entrepreneurs established

Hygiene promotion- 333,000 people reached with hygiene education Number of health workers trained on hygiene promotion Number of Natural Leaders trained on CATS Number of people reached with hygiene education

Hygiene promotion- 85,000 people practice hand-washing with soap Available handwashing facilities / devices in use at HHs

17,000

20,860

123%

Number of people practicing handwashing with soap

85,000

104,300

123%

Rehabilitation of hand washing facilities in 200 schools

200

200

100%

Rehabilitation of sanitation facilities in 100 schools

100

100

100%

28

28

100%

WinS- 200 schools have rehabilitated WASH facilities

Installation of water facilities

WinS - 45,000 students have access to WASH facilities with water and soap Number of teachers trained on hygiene promotion

400

402

101%

SLTS sanitation and hygiene sessions plans at schools

200

200

100%

2,000

2,690

135%

45,000

53,142

118%

100

200

200%

Number of SMC members trained Number of students that have access to soap and water at school for handwashing Establish a mechanism for O&M of WASH in schools

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Jointly implemented with Partner NGOs, the project achieved 100 percent ODF status and improved hygiene behaviour in the targeted populations through the adoption of the Community Approaches to Total Sanitation (CATS).The project included capacity building of: health staff to promote hygiene practices; school teachers to educate girls and boys students on safe hygiene practices; local government institutions to ensure 100% inclusion; local entrepreneurs to market improved sanitation options; adolescent groups to manufacture and market menstrual hygiene products. In addition, the WASH facilities in schools were rehabilitated and improved hygiene practices promoted through the child to child approach.

4.1 Improved Sanitation Outcomes 4.1.1 Social map and Community Action Plan (CAP) A total of 762 social maps and Community Action Plans (CAP) were prepared during the triggering of CLTS and updated at the community level with the participation of all segments of community members (men, women, adolescents, girls, boys, teachers, religious leaders and UP representatives) during the project period. Women, men, girls and boys from the communities planned and reviewed their progress against their plans; placed the updated symbol (legend) in their social maps; analysed any challenges; and identified households atrines. A total of 180 batches of day-long orientations were held for Natural Leaders on ODF triggering and participatory monitoring under the project. Overall, 3619 Ward level Natural Leaders (2480 males and 1139 females) were trained and supported to develop an action plan to mobilize their community to achieve ODF status.

4.1.3 Community Triggering A total of 762 CLTS triggering sessions were conducted with the participation of all segments of the community. A total of 27,579 community members (12650 adult males, 12482 adult females, 1171 girls and 1276 boys) which included teachers & religious leaders, Ward members & influential attended these triggering sessions. Different PRA tools like transect walk, social mapping, faeces calculation, flow diagram of faeces were used to mobilize the community to realize the effect and consequences of open defecation leading to the creation of social maps, community action plans and cluster action teams in all of these communities.

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triggering community to end opendefecation

4.1.4 Training for Union WATSAN Committee Members The training of twenty Union Parishads was conducted on the Community Approach to Total Sanitation (CATS) in the project areas. All Union Parishad members, the secretary and the chair participated in these trainings. These sessions primarily sought to train elected Union Parishad representatives on the requirements for monitoring sanitation and hygiene. The training covered the sanitation & hygiene status of UPs, WASH in school, local resources mobilization, GoB policies and strategies, UP roles and responsibilities, the UP long term and annual development plan, monitoring and documentation of the project activities etc.

A total of 465 representatives (405 males and 60 females) participated in this training.

4.1.5 Union Parishad Annual Development Plan Planning workshops were held in all of the Union Parishads in the project areas with the participation of Union WATSAN committee members. Annual WASH plans were developed in line with â&#x20AC;&#x2DC;UP Long Term WASH planâ&#x20AC;&#x2122;. Union Parishads developed their annual plan for WASH, such as mobilizing male and female community members, coordination with different stakeholders in UP level, regular programme monitoring and progress review, hygiene promotion and activities to achieve ODF status in their community. They allocated budget for WASH interventions from the annual development fund and local governance programme.

4.1.6 Training for Local Sanitation Entrepreneurs (LSE) Two-days long training in each of the 5 Upazilas were conducted for a total of 100 Local Sanitation Entrepreneurs (LSEs) under the CATS project. Through this training, LSEs gained a better understanding on the demand of community members for the installation of improved quality latrines, different latrine design options; preferred quality materials; construction process; workmanship; social marketing; developed linkages with communities and extension agents like the Natural Leaders. At the end of orientation programme the LSEs developed action plans for the extension of sanitation marketing.

4.1.7 Latrine Model Demonstration Achieving ODF status in the hard to reach communities is difficult due to the challenging geographical, geophysical and cultural challenges. The availability of affordable and appropriate hygienic latrines to suit any condition is a necessary pre-condition to achieve ODF status for a whole community. To address this issue, the project arranged for the demonstration of different improved latrine models (Offset pit latrine, Water sealed pit latrine, Pit latrine with plastic SATU pan, etc.) in all of the target union parishads so that individuals and community can identify preferable latrine models according to their budget and their geophysical terrain.

4.1.8 Interactive campaign sessions Interactive sessions were organized at the community level following the CLTS triggering sessions. The main objectives of these sessions were to dialogue with local female and

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male leaders and community members to mobilize those who are not convinced that they should change their unhygenic practices. Members of the Ward WATSAN committees have taken a lead role in following-up on individual behaviour change. Over the duration of the project a total of 1260 interactive sessions were organized by Ward WATSAN committees and visited more than 20 thousand households.

Interactive sessions were organized under EPI cluster / sub-clusters, where male and female participants visited household latrines and checked their cleanliness, as well as the availability of a hand washing device, soap and water. They discussed with male and female household members the benefits of good sanitation and hygiene practices and the detrimental health, economic and social consequences of open defecation and the use of unhygenic latrines. Ward WATSAN committee awarded ODF declaration of 762 villages during community gatherings. The adolescent girls and boys played a particularly transformational role to mobilize the community on the installation and use of sanitary latrine and good hygiene practices.

4.1.9 Monitoring visits by Union Parishad on ODF and HP Activities at the community level have been led by the Union Parishads, who are playing a vital role in achieving Open Defecation Free (ODF) status within target communities. Each of the 20 Union Parishads has prepared annual development plans with key milestones for sanitation. The UPs along with their WATSAN Committees conducted follow-up and monitoring visits to observe the sanitation status in communities. They also organized review and planning at UP offices to follow-up on progress in each of the Wards on a monthly basis. A total of 120 monitoring visits were carried out by UPs over the project period.

4.1.10 Union to Union Learning Visits Through the CATS project, many good practices were developed in many Union Parishads.

The main objective of the exposure visits is to expose some Union Parishads to the good practices of other Union Parishads that can replicate these lessons in their working areas.

Such visits also build confidence amongst the good practice proponents and open up new windows for local innovation. A total of 20 Union to Union exposure visits were undertaken during the project period. After visiting other good practice communities, Union Parishads became more committed and equipped to achieve ODF conditions within their jurisdiction.

4.2 Improved Hygiene Outcomes 4.2.1 Training for Para Workers In the Chittagong Hill Tracts, four batches of training on eradicating open defecation and hygiene promotion were organized for Para Workers. The trainings were organized at Union Parishad level to develop skills necessary to make their community ODF. A total of 236 participants attended this session (2 males and 234 females) on the CLTS approach, local resources mobilization, Para micro-plan and the monitoring of project activities. At the end of the training, each of the Para Workers prepared an action plan to make their para ODF.

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The para workers (female and male) selected mostly from the local community therefore they are acquainted on the socio-cultural dynamics of the people and skilled on the community mobilization as change agents.

4.2.2 Adolescent Training on Gender and Sanitation Under this project 20 batches of a three-day training on gender and sanitation were organized for adolescent groups at the Union Parishad level. The training sought to impart knowledge on the concepts of gender, gender mainstreaming, gender discrimination, sanitation and gender, gender violence, and gender roles. A total of 600 adolescents (179 boys and 421 girls) from 5 upazilas were trained up on gender issues and developed their action plans to ensure gender equality in their communities.

4.2.3 Film show on WASH and Hygiene Promotion Films are a strong tool for awareness raising and thus towards long term behavior change. Films to raise the awareness of communities on eradicating open defecation and good hygiene practice were shown in public places of such as bazaars, bus stands & school premises.

A total of 180 film shows were held throughout the project period. These events were organized in collaboration with LGIs and Community groups.

WASH facilitators took the lead role in organizing and facilitation of the film show along with the Ward members. A total of 30,879 people attended these films of which the adult audience was 27,389 (11221 males and 16128 females) and children audience was 3490 (1803 boys and 1687 girls).

public screening of wash film

4.2.4 Theater for Development (TFD) TFD is a powerful tool for triggering dialogue on sensitive matters such as open defecation.

The negative impacts on the community of ingesting other peopleâ&#x20AC;&#x2122;s shit can be placed in perspective and hurdles for change transcended by drama techniques such as mirroring, exaggeration and ridiculing. The project organized professional stage performers of the locality to perform these TFD shows. These TFD shows reached over 20,321 community members (of which around 50% were children) with challenging messages on the dangers of open defecation and poor hygiene practices.

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4.2.5 Training of Health Workers on Hygiene Promotion The CATS project aims to change individual hygiene behavior by building the capacity of communities and professional health workers to support this changes. A number of trainings on hygiene promotion for Health Assistants, Family Welfare Assistants, Health and Family Planning Inspectors and Sanitary Inspectors were organized by the Health Education Bureau, under the Director General of Health Services, with Plan International Bangladesh and Partner NGOs. These training courses imparted knowledge and skills on community mobilization and dissemination of hygiene messages to achieve sustainable behaviour change within the target populations. In addition, training sessions also discussed the concepts of hygiene promotion and its importance; triggering sessions on hygiene; the process of disseminating hygiene messages; organizing courtyard sessions; monitoring and reporting mechanisms; and the role of health workers.

4.2.6 Observation of National Sanitation Month Observation of designated â&#x20AC;&#x153;daysâ&#x20AC;? is one of means of raising hygiene and sanitation awareness. During the project period, National Sanitation Month (October), Global Hand Washing Day (15 October) and World Toilet Day (19 November), World Menstrual Management Day (May 28)), World Environment Day (June 5) were observed in each of the project areas. Events included rallies, hand washing demonstrations, signature campaigns, discussions, meetings, and mobile film screenings. Participants included district and upazila level GoB officials, NGOs, civil society, teachers, students and journalists. A total of 25 events were organized with the participation of 97,130 people, including 52,384 children.

students at khagrachari observes global handwashing day

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4.2.7 BCC sessions on ODF and HP Behavioral Change Communication (BCC) sessions are an important tool for mobilizing and motivating large numbers of women and men to reduce water and excreta borne diseases by improving their hygiene practices. The CATS project organized and facilitated court yard sessions on hygiene promotion with mother’s groups in each EPI cluster through health workers. The court yard sessions focused on hand washing with soap at three critical times: before eating and feeding children, after defecation and after cleaning a baby’s bottom.

During the project period, a total of 2,507 BCC sessions were conducted for a total of 62,675 women of which 10,710 were mothers of children under five years of age.

4.2.8 Establishment of SaniMarts Under the AECM project, one of the obje ctives of the establishment of SaniMarts is to help reduce child marriage through the creation of self-employment opportunities for adolescent girls, to strengthen social and entrepreneurial skills, and to improve menstrual hygiene management. The project established four SaniMarts in Bhola Sadar and Charfashion following the identification of four Local Sanitation Entrepreneurs. The project sensitized adolescent girls groups in these four areas linking them to the LSEs to establish a SaniMart.

4.2.8.1 Marketing of SaniMart products For promotion and marketing of sanitary napkin, the adolescent girls groups communicated with schools, colleges, pharmacies, local shops, natural leaders, mothers and their peers.

Adolescent girls briefed them on their product, quality, price and encouraged them to purchase their product. In communicating with these different stakeholders including mothers and girls, adolescents girls exchange on the hardships of menstruation and puberty and how these sanitary napkins improved girls’ personal hygiene and social status (not feeling embarrassed or ashamed from fear of others seeing that they have their period). The adolescent groups are continuing to sell their sanitary napkins in 25 shops, 8 pharmacies, and 138 schools as well as at individual at community levels.

4.2.8.2 Refresher training for the local entrepreneurs A day-long refresher training for adolescent girls and local sanitation entrepreneurs was organized and facilitated at Bhola Sadar and Charfasion Upazila after six months of initial training. Four batches of refresher trainings were organized including 60 adolescent girls and 4 male local sanitation entrepreneurs. The objectives of the training were to reinforce knowledge and skills related to the manufacture and marketing of sanitary napkins.

julia, the changemaker Julia is 15 years old and is a class nine student of Gungerhat Secondary School. Previously she used to miss 4 -5 days of her classes each month during her menstrual period. After joining the SaniMart she now works there earning an additional BDT 700 - 800 per month in addition to attending school. She has become a female change agent by using these sanitary napkins and raising awareness on the benefits of hygienic sanitary napkins and disposal systems.

She says “I easily and safely manage my menstruation period, I am going regularly to school, working at SaniMart during my leisure time and earning some money towards the cost of my education. I work hard to raise the awareness of women on the benefits of using sanitary napkins.

My dream is to become a successful women entrepreneur.”

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4.3 Improved School WASH Outcomes 4.3.1 Orientation of SMC and School Teacher School Management Committee (SMC) members and school teachers can play a significant role in improving WASH in schools. Plan International Bangladesh and its implementing partners organized and facilitated day-long orientations to SSMCs and teachers on WASH and hygiene promotion through Child to Child (C2C) approach. A total of 3,000 SMC members and school teachers participated in the orientation. The orientation covered the present WASH situation; the importance of WASH in School (WinS); the GoB policy and strategy; support of WASH facilities; hygiene promotion; and the role of SMCs and teachers. This orientation helped them to see the critical importance of helping girls champion on MHM.

4.3.2 Training of Resource Teacher on Hygiene Promotion Adequate gender sensitive and child friendly safe water supply, sanitation and hygiene facilities are essential for fostering an effective learning environment at school. Therefore the project implemented WinS through the Child to Child (C2C) approach. The training of the Resource Teachers was an important activity because teachers are the main driving force for the implementation hygiene promotion activities at school. The objective of this training was to impart knowledge and skill on hygiene promotion through the C2C, three (3) star and fit for school approaches, Convention on the Right of Children, Student Council, water sanitation and hygiene facilities at school, etc. This was a two-day long non–residential training course. Two teachers from each intervention school participated in the training (one female and one male). A total of 402 resource teachers (male-216, female-186) from 200 schools participated in the training course.

MHM, an eye opener “I was not clear about why the girls students (including the best students) are absent in school near 3-5 days in a month. After receiving the training, I understood that menstrual hygiene management is the factors for girls absent in schools. After returning from training, we separated the toilet one for girls with female teacher and another for male teacher. We also arranged hand washing device, available the soap, waste bin at class room. The resource teacher’s training just opened my eye.”

Md. Imam Hossain, Head Teacher, Kulsumbag High School Aminabad Union, Charfashion, Bhola

4.3.3 Student Council Training Plan International Bangladesh believes that boys and girls can act as change agents to play a vital role in bringing positive change in their schools and communities. Trainings on hygiene promotion were conducted for student council members to enable them to fast-track hygiene promotion in their schools and catchment areas through child to child (C2C) approach. A total of 200 batches of training for student councils were conducted, with the participation of 3,000 student council members from 200 schools (1,500 boys 1,500 girls).

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4.3.4 Hygiene Promotion Campaigns A total of 1,400 Hygiene Promotion campaigns were organized and facilitated by student councils on school premises and in their catchment areas. A total of 53,141 students from 200 schools (26,039 boys, 27,102 girls) participated in these hygiene promotion campaigns.

In addition, hygiene promotion sessions were also organized in those 200 schools. Debate, art, quiz, easy competition among the school students and hand washing demonstration, drama, folk song, soap day etc. were organized and facilitated in the hygiene campaign.

4.3.5 Installation of group hand washing devices in schools A lack of hand washing facilities in schools, means that many students who are aware of the importance of hand washing cannot wash their hands at critical times. The CATS project targeted 200 schools to install child-friendly group hand washing facilities so that girls and boys students can wash their hands at school. Group hand washing facilities were installed in 200 schoolsschools: 42 schools in Taltoli upazila, 45 schools in Bhola Sadar upazila, 60 schools in Charfashion upazila, 28 schools in Alikadam upazila, and 25 schools in Laxmichari Upazila.

4.3.6 Rehabilitation of WASH facilities at schools Hygienic latrines in school are essential for girls and boys and they help prevent open defecation and disease transmission. In the project period, WASH facilities were repaired in 100 schools. Repair/rehabilitation works included: assessing water and sanitation conditions in schools; fixing or replacing doors; plastering and painting walls; replacing pans; tiling; installing taps; and emptying/repairing pits or septic tanks etc.

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5. CATS Project Results 5.1 Households 5.2 WASH in School

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5. CATS Project Results In collaboration with UNICEF and the other two implementation partners (Practical Action and CARE), a baseline survey was conducted during February-March 2015. An end-line study has been conducted in June â&#x20AC;&#x201C; July 2016 to assess the impact of the overall project.

Both the studies used cross-sectional survey across representative clusters of intervention communities and schools. The studies collected sanitation and hygiene outcome measures via face to face interviews and spot checks. Handwashing data was collected using structured observation where the field enumerators conducted 5-hour structured observations at households and 3-hour observations at schools.

5.1 Households The end-line study found a higher level of awareness and recall of sanitation and handwashing messages (over 90 percent were able to recall 3 or more messages).

This could be attributable to rigorous promotion of sanitation and handwashing awareness through regular household visits, the installation of handwashing devices at latrine locations, and school level WASH education and awareness raising interventions.

Latrine installation at the household level increased considerably during the project period accounting for over 52 percent of all improved latrines. The majority of latrines installed over the project were installed by households using their own money indicating that people were aware and motivated, possibly due to the project interventions.

Over the project period there was a significant increase in the cleaning of latrines by both male and female members of households and there was evidence of an associated reduction of visible faeces over latrine slab, floor and pan of the latrine structures inside.

But women still remained as taking on a large amount of the work.

CATS project sanitation tracer achievements

% of Households

90

82

67.5 45

Baseline 2015 Endline 2016

57 31

22.5

23

26

22

16 6

0

Availability

Accessibility

Utilization

Adequate Coverage

17 2 Effective Coverage

The end-line survey found a considerable increase in handwashing stations with soap and water near to latrines. The end line survey also found a considerable increase in hand cleanliness for both children and respondents. This high level of positive change is likely because of the successful introduction of new low cost hand washing devices near latrines such as jar, tipi tap etc.

Structured observation data recorded observed handwashing behavior. Observational data at end-line resulted in an exceptionally high rate of handwashing, in the region of 90 percent. The exceptionally high rate of handwashing suggests observer and respondent

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CATS project sanitation & Hygiene achievements Indicators

% Baseline (Mar 2015)

% End-line (Oct 2016)

24

82

No latrine access for the households (OD)

22.5

0.69

Households had access to a functional latrine and the latrine was within 20 meters from the household

66.8

68

Household had year round access to a functional latrine

54.1

92

Visible faeces were notices over latrine slab and/or floor

72

15

Handwashing location <5 meters from the latrine

27

76.1

HW location was in <5m from latrine and water was available

20

72.8

Respondents hands appeared visibly clean

28

90

Observed handwashing: before eating washed with soap

1.8

89

Observed handwashing: after defecation washed with soap

17

94

Access to improved latrine- owned by the households

bias / reactivity in influencing the results. It seems likely that participating households guessed the nature of the data collection exercise and altered their behavior accordingly (consciously or otherwise). Similarly, it is possible that observers, who were not blind to the intervention status of households, may have been inclined to interpret ambiguous observations as positive (again this may not have been conscious). Moreover, observed handwashing behaviours indicated an association between convenient handwashing locations and handwashing behaviour irrespective of population group.

With regards to sustainability, the reports of community level FGDs and household respondents were quite similar across all topics related to OD, faecal sludge management, and WASH monitoring/management committees and activities. This consistency in responses indicated that CATS project interventions were able to bring together various actors including communities, schools, local elites and locally elected representatives to improve the sanitation coverage and knowledge of sanitation and hygiene in targeted communities. However, pit emptying and management of sludge remains an issue.

5.2 WASH in School Functionality of available water points in schools had increased significantly compared to the baseline survey. There was also an increase in schools with deep tube-well facilities and piped water, many facilitated by construction activities carried out under the CATS project.

Although access to improved latrines in schools increased significantly, actual access to latrine facilities by girls and boys students was slightly lower than would be suggested simply by the presence of an improved latrine. Access to improved latrines by both boys and girls students increased significantly compared to the baseline due to repairing of latrine chamber by the CATS project. This indicated, issues related to equity and equality in reducing gender disparity in regards to sanitation access at schools was not addressed appropriately as there was not provision for constructing new latrine chamber.

Spot-check data show a sharp increase in handwashing locations where water and soap were available. One of the reasons for this change could be the installation of group handwashing devices (100 percent) at schools, a key CATS project intervention, where 80

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percent schools were ensured water and soap available at the location of group handwashing devices. Another likely reason could be, school sanitation and hygiene sessions emphasized one of the awareness activities such as, keeping water and soap available at handwashing locations.

Cleanliness of school latrines improved as indicated by the proportion of school latrines having no visible faeces over latrine slab, floor or pan had. Availability of cleaning materials for latrines had also increased. These are some indications of effective implementation of CATS school components. Reasons of such clean maintenance of latrine compound could be because of the close monitoring, awareness, formation and activation of student council.

The baseline survey showed that almost none of the schools had activated student council to gather WASH knowledge to address the issues related to improvement of WASH facilities at schools. Student council also reported shouldering some level of responsibilities together with teachers to ensure the overall O&M of school WASH facilities and services.

Over 90 percent of students in the end-line study consistently demonstrated knowledge of latrine use and handwashing awareness messages and accordingly they were able to recall at least three messages around categories of latrine use and handwashing. These are some good examples of the efficient implementation of CATS project intervention such as sanitation and hygiene promotion initiatives.

Observation of studentsâ&#x20AC;&#x2122; handwashing showed a dramatic increase from 1 percent to around 90 percent, with reported practice being even higher at some schools. The marked changes in handwashing behaviour practices could be because of mass promotion of awareness, making availability of handwashing facilities such as installation of group handwashing devices, and making soap and water available at handwashing locations.

The end-line survey indicated that more schools were sourcing funds for O&M of WASH facilities, with the most frequent sources being SLIP or SMC initiatives. This suggests that school administrations are making greater efforts towards sustaining their WASH facilities.

CATS project WASH achievements in school % Baseline (March 2015)

% End-line (October 2016)

88

94

Schools had improved latrine access for students

63.9

100

Visible faeces were noticed over pan or slab or floor

50.8

11.1

31

100

32.8

100

Indicators Water points available at school

Solid waste disposal places/facilities available at schools One or more teachers received training related to school sanitation and hygiene education

Finally, some positive indications of potential sustainability of WASH outcomes are noticed.

For instances, almost all schools in the intervention areas reported one or more teachers attending WASH-related training with evidence of subsequent initiatives such as bringing a WASH agenda to schools, formation of student council, conducting WASH orientation for student council members, support to school to install group handwashing devices, and ensuring water and soap at handwashing locations. Overall, there was significant positive change with regards to WASH knowledge, access and practices. In addition, the prevailing level of knowledge about national level budgetary allocations, awareness and utilization of WASH education management information systems (EMIS), and awareness of the national policy framework might conceivably support the sustainability of WASH interventions.

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6. Challenges with Mitigation paln 40

6. Challenges and risks with mitigation plan Struggling with organizing Health Workersâ&#x20AC;&#x2122; training as Upazila Health and Family Planning Officer are not agreeing to organize training without authorization letter from health department.

Mitigation: Negotiated with local health offices; especially with Civil Surgeon (district level) and with UNICEF office and managed to organize training for Health Worker in Alikadam, Bhola Sadar, Charfasion and Taltoli Upazila.

Installation of hand washing devices and rehabilitation of WASH facilities of schools have been bit delayed due to receiving authorization letter from education department.

Mitigation: Maintained continuous communication with education department at central and local offices, UNICEF offices, school authorities to get the authorization and started hand washing devises installation and WASH rehabilitation activities at possible soonest time

Coordination among the multi stakeholders (LGIs, Government Departments, NGO, etc.) and building common understanding on the implementation of project activities.

Mitigation: Activation/reactivation of WATSAN committees at different levels and mobilization of key actors to play the leadership role such as UP Chairman to play the coordination role at Union level.

As end of March, 2016 10% payment is not paid for a number of schools due to incompletion of defect liability period (DLP) of those school. As per agreement partnership with DAM will be finished in March, 2016 and the vendors (with 10% unsettled payments) were not allowing DAM to leave station without making their payments.

Mitigation: This issue has been discussed in a meeting at Upazila level with the vendors and agreement were signed with the vendors and Plan International Bangladesh. The vendors were assured to be paid their owing by Plan International Bangladesh after end of DLP.

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7. key lessons learned

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7. Key Lesson Learned Key lessons of this project include: Paradigm shift has been noticed in relation to the changes of orientation of the local government representatives from hardware to software interventions. It has been noted that the UP chair and members play critical roles in community mobilization for achieving ODF community.

As the key agents of changes, boys and girls children/adolescents use different modalities to advocate and influence the adults for stopping open defecations.

Hygiene promotion is an integral part of total sanitation and facilitate hygiene promotion sessions by Health Worker, effectively functions to promote hygiene practices among the community people Hygiene promotion in school programs through School Led Total Sanitation approaches effectively functions to promote hygiene practices among the school children.

The SaniMart centre producing and marketing low cost sanitary napkin, and sensitizing women and adolescents girls at community and school level for safe management of menstrual hygiene through using sanitary napkins, which is effectively integrating gender equality. The adolescentâ&#x20AC;&#x2122;s girls are developing the linkage with schools, shop keepers, pharmacy and schools and encouraging them for purchasing their product. Promoting gender responsive entrepreneur development for ensuring menstrual hygiene management at school and community level for accelerating towards ending child marriage initiative Women are great champions of WASH and are very active in effectively promoting sanitation and hygiene in their respective communities.

Enabling environment is critical for achieving the project result and sustainability.

Partnership with LGIs contribute to sustainability of the program.

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8. Reflection of Stakeholders

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8. Reflection of Stakeholders “Plan International Bangladesh engaged community people following PRA method and took robust initiative to stop open defecation. The percentage of open defecation is now zero in the project areas. Achievements of stopping open defecation are being displayed through billboard at public places” -Rashidul Haque, Project Director, GoB-UNICEF WASH project, DPHE Dr. Farid Ahmmed, Civil Surgeon of Bhola district -“Adolescents is the transitional stage in which a child takes into an adult turn. It is necessary to discuss with adolescents on menstrual hygiene management. Thanks to CATS Project as they do the same activities to help girls for growing positive attitudes about menstruation, which will have a great impact on the girls’ ability to take an important decision about their health and well-being.”

Moshiur Rahman, Executive Engineer of DPHE, Bhola - “though, we were far from achieving the 100 percent success that already achieved by the CATS, bringing behavioral change among women, children and youth in the area” .

Kazi Tofayal Ahmad, Upazila Nirbahi Officer, Sadar Upazila, Bhola - “the DPHE, UNICEF and Plan International Bangladesh have been successfully implemented a large-scale WASH programmes in Bhola. “We further replicate its leanings in a wider area to make it ODF”.

“Plan International Bangladesh worked for 11 schools of Dania Union Parishad to educate the students on washing hand with soap, usages of hygienic latrine. In my Union Parishad about 6000 families are using hygienic latrines and practices hand washing with soap. Plan International worked very successfully in my Union Parishad” -” said Amdad Hossain Kabir, Chairman, Dhania Union Parishad, Sadar Upazila, Bhola.

“At the beginning of the CATS project, we went door to door marked the houses with poor sanitation conditions red and the good ones were marked green in the social map. We walked and worked in our areas to improve hygienic practices and sanitation conditions” – Motasin Bari, Natural Leader, Sadar Upazila, Bhola.

“Before implementation the CATS project, I need to spend a handsome amount of money for treatments and frequent visits to the Bhola Sadar hospital. Today, the situation has improved in my areas. I have not spent money for treating diseases ever since my family has been following the teachings from the project” – Sufia Akter, member of Mother group, Bhola.

“Earlier, we did not maintain cleanliness. We had no toilets, we defecated in the forest, near hills and out in the open. As a result, we were infected from various diseases like dysentery and diarrhea. From the CATS project, we learnt many good practices including the process of washing hands with soap and usage of hygienic latrine through attending various meetings and dialogues. Our sanitation condition is better now. At present, the health risk has reduced. Today, we do not use the jungle for defecation. We do not keep waste in front of our door. We keep it at a certain place. We know how to wash hands with soap after defecation. Everyone installed hygienic latrines in their homes” – Misang Marma, Beneficiary, Alikadam, Bandarban "It was not an easy task to change the behaviour of local people to have and use of latrine as it is their traditional practice to open defecation. I talked to the people about installing sanitary latrine during Friday prayers at the local mosque” - Omar Faruk an imam of the local mosque, Pachchim Meduya village of Sadar Upazila, Bhola.

“I started to motivate the villagers to create demands for improved latrine as well as installation.

I expanded my business for meeting the growing demand of ten neighboring villages. I also gained popularity in the market as well as in the community” – Nasir Shikdar, Local Sanitation Entrepreneur, Sadar Upazila, Bhola

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“The CATS project trained me how to wash hands with soap, keep soap in the latrine, keep utensils clean and drink safe water. It also taught me how diseases are transmitted if we do not practice hand washing with saop. I have transferred my learning to the women and children of my community through courtyard sessions. I demonstrated the process as well. I saw the noticeable changes. Earlier, children did not use slippers, now they use it. Children also wash their hands with soap after defecation” - Moriom Begum, FWV, Alikadam, Bandarban.

“Health worker conducted BCC session and visited the households for monitoring the progress of hygiene practice. Hygiene issue has included in the monthly work plan of health worker and set an agenda for health interventions. In the monthly meeting, the status of hygiene promotion is reviewed and prepared next plan of action.” said Dr. Mohibulla, Upazila Health and Family Planning Officer of Sadar Upazila, Bhola.

“I visited house to house and demonstrated to mother and their children on how to wash hands with soap and discussed important of hand washing” – Fetema Begum, ideal mother, Poschim Elisha Union of Sadar Upazila, Bhola “Previously, the students of this school suffered from water borne diseases that negatively impacted on the attendance ratio in the class. Last year, GoB UNICEF CATS project installed hand washing devices, repaired latrines and arranged training on handwashing with saop in our school. As a result, our students are not affected by water and feaces borne diseases today.

This supports contributed to increasing attendance ratio of the students. In our school, ring well is functional now and we drink water from there”- head teacher of Babu Para GPS, Alikadam, Bandarban.

“Earlier, we did not know the process of hand washing. Now we are washing hands with saop after receiving the training from CATS project. We teach this to the family members, neighbours and community. Diseases have reduced in our community now” – Student, Babu Para GPS, Alikadam, Bandarban.

“Leaded the planning process at my territory and reviewed the progress with stakeholders. We encouraged to households and community people for installation of hygienic latrine to achieve open defecation free community. After predicating significance of the improved sanitation, people thought that they have no longer chance to go back for open defecation” - Ukkojay Marma, Headman, Alikadam, Bandarban.

“The CATS project created an innovative example on WASH in school for the establishment of child friendly and gender sensitive WASH facilities, good hygiene promotion through group hand washing station and menstrual hygiene management. It plays as model, we hope to replicate this learning in all school” - Mr. Mohibur Rahman, Secondary Education Officer, Sadar Upazila, Bhola.

“We faced unpleasant situation when went to outside for collecting the drinking water from other tube well. Now we are proud that we have a deep tube well, hygienic latrine, hand washing device with running water” said Nishi, students of class eight, South Charpata high school, Sadar Upazila, Bhola.

“We produce 1700 pieces of sanitary napkins in a week. From each packet we make a profit of BDT 20 to 22. Now I make a handsome income from SaniMart. I spend a large proportion of my income on childcare and domestic help. We are hopeful that one day this small initiatives will turn into a large business enterprise’, said Lucky Begum, Shanti SaniMart Centre, Bhola.

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9. Conclusion

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9 Conclusion Despite increases in awareness, access and practice of sanitation and handwashing behaviours, effective coverage as defined in the sanitation tracer matrix, was much lower.

Although it was notably higher than the baseline, this suggests there remains room for improvement.

With regard to open defecation, the sustainability survey at both community FGD participants and individual householdsâ&#x20AC;&#x2122; respondents reflected that communities are ODF. However, it is in the early stage of ODF. To sustain results, continuous follow up by community leaders and local government officials is needed.

Since girls still did not have access to facilities for MHM in school. Although the CATS project rehabilitated the existing sanitation facilities at school, few measures to make them MHM friendly were under taken. It seems there is scope to improve further with respect to equity and equality issues to reduce gender disparities and to respond to the specific barriers girls face because of MHM and risk of gender based violence in not having access to appropriate safe and private sex-segregated latrines.

The end-line study showed that the latrine to student ratio was 1: 89, which was near about two times more crowded than the Bangladesh National WASH standard though an improvement from the baseline (1:118).. Increase of school latrine chambers proportional to students is highly recommended. Installation of group handwashing devices at schools was associated with better availability of water and soap at handwashing locations after defecation and or other related personal hygiene purposes.

End-line study found formation and activation of student council acted well in order to maintain the cleanliness of school latrines.

Sourcing out money from SLIP fund or SMC for ensuring continuing WASH related O&M was something new, since the baseline. In respect to O&M of school WASH facilities and services, it is noticed that improvements with regards to funding, caretaking, monitoring cleanliness, and availability of cleaning materials in schools. However, there are rooms available to improve further.

Studentsâ&#x20AC;&#x2122; reported latrine use at schools increased which could be attributable to high level of awareness, greater level of availability and accessibility of latrine facilities including water and soap.

Lastly, sustainability indicators suggested that the WASH interventions would be sustained at least as long as monitoring, supervision and support remains active across communities, schools and local government representatives. Increased awareness of national policy along with budgetary allocations and recall of training knowledge were all positive indications of potential for sustainability of the intervention in schools.

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