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Nepal CASE Study on ODF; Challenges, lessons learned and comparisons with CLTS. How can ODF be adapted for emergencies?

Jason Snuggs, WASH Senior Sector Specialist, and Santosh Sharma, DRR and Social Analysis Coordinator CARE Nepal

Originating in Bangladesh in the late 1990s, Community Led Total Sanitation (CLTS) was introduced to Nepal in 2003 by NEWA (Nepal Water for Health) and WaterAid. CLTS is an approach aimed at facilitating rural communities to:
a) conduct their own appraisal of sanitation problems;
b) derive their own conclusions; and
c) promote community‐wide action with the ultimate aim of achieving Open Defecation Free (ODF) communities.

This approach contrasts with more conventional stakeholder approaches characterized as instructing (rather than facilitating), subsidizing engineering‐based solutions (rather than promoting behaviour change), and using numbers of latrines constructed as a metric of success (rather than the number of communities that are changing their practices).

In 2011 the Government of Nepal (GoN) developed a National Sanitation and Hygiene Master Plan which sets an ambitious target of achieving 100% Total Behaviour Change (TBC incorporates ODF along with 11 other WASH related indicators) status across all 75 Districts by 2017. The adoption of such difficult targets indicates a strong commitment by the GoN to transform the lives and wellbeing of its population. Subsequently sanitation coverage has risen from 6% in 1990 to 62% in 2012. Interesting lessons can be learned through the challenges that multiple stakeholders have faced and addressed in Nepal to ensure the government’s goal of becoming 100% TBC, becomes a collective national priority.

For more information on this project, see the following case study:



Emergency Cholera Response Program in Sierra Leone

Nick Brooks, the Asia-Pacific WASH Advisor
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Between 7th August – 12th October 2012, CARE International in Sierra Leone worked with the local government health departments and community volunteers to ensure that vulnerable people in 4 Districts of Sierra Leone were able to protect themselves from cholera. Between 1 January and 8 October 2012 there were 21,255 cholera cases nationally, with 288 deaths (Case Fatality Ratio 1.4%). CARE distributed ‘cholera prevention kits’ comprising chlorine tablets, handwashing soap and oral rehydration salts (ORS) to 13,640 households. This was complemented by community-level and door-to-door hygiene promotion, market drama and mass sensitisation through local radio stations. Funding was provided by DFID/UKaid ‘Rapid Response Facility’ (GBP £240,000).

For more information on Nick's deployment, see the following documents:




Deployment to Lebanon

Monica Ramos (Inter-Agency Rapid Assessment Team - RAT)

During February 2013, Monica coordinated and participated in a deployment to Lebanon to provide support to assess the WASH needs of Syrian refugees and other groups affected by the Syrian crisis in Lebanon, in collaboration with RAT member Abel Augustino from IFRC. The assessment team worked with a Technical Working Group for Assessments, composed of representatives from ACF, CISP, Oxfam, PU-AMI and WVI to determine the main priority areas for support by the RAT:
  • Standardization of assessment methodology and development of a continuous needs assessment framework (considered most important)
  • Capacity assessment of WASH sector response in country.

A standardized assessment framework was developed; including, core indicators and data sets, sampling size, sampling and data collection methods and a workshop was held on March 6th, with the participation of 25 representatives from NGOs and UN agencies. A capacity assessment tool was also developed and shared with the WASH Sector Working Group.
See the below ‘End of Mission Report: Lebanon’ for further information on Monica’s work in Lebanon (the annexes are available upon request), and ‘Resources’ section of the RECA website for additional assessment and deployment information http://recaproject.org/resources/




Deployments to Ethiopia

Peter McArdle & Travis John (WASH Trainees)
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During late 2012 and early 2013, two trainee emergency WASH Advisors, Peter McArdle and Travis John, were deployed to Ethiopia to assist with Emergency WASH Projects.
CARE Ethiopia was implementing emergency WASH projects in East and West Hararghe zones of Oromiya region. Project activities were varied and included providing technical support for the construction of latrine and water points, and support and back up for project officers to timely assess construction progress, quality and material sources. Travis and Peter also offered field staff assistance in developing hand over documents for rehabilitated water points and constructed school latrines, as well as delivering technical support to water sectors and project officers to implement training on rehabilitation water schemes.

Outcomes achieved:
  • Increasing of staff capacity, in-terms of their technical knowledge and management skills;
  • Progressing of school latrine construction as per the standard;
  • Rehabilitation of water points; and the
  • Utilisation of Community Led Total Sanitation (CLTS) and Children Hygiene and Sanitation Training (CHAST) approaches in selected villages and schools.

If you are interested in hearing more about the work of Travis and Peter in Ethiopia, check out their Final Reports:



Northern Cameroon Flooding

Nigel Stuart (Roster for Emergency Deployment)
The Northern Cameroon floods originated during August 2012. As part of CARE’s emergency response, Nigel was engaged as WASH Specialist for the period of 5th to 18 October 2012, and was responsible for the assessment, design and implementation of the WASH component of CARE’s emergency response strategy. When Nigel was deployed, the emergency was in the transitional phase and there was a strong possibly of a cholera outbreak.

After the flooding, low levels of public health awareness especially in the rural population and urban fringe meant the next public health emergency was only a matter of time. Good hygiene practices played a major role in stopping the transmission of waterborne disease. CARE started their WASH efforts during the emergency with distribution of Emergency Water Kits that contained materials and equipment for water sterilization and hygiene promotion (purification chemicals (Sur-Eau) together with the needed buckets, jerry cans).CARE also included soap in the Emergency Water Kits and this was hoped to improve the overall chances of interrupting the transmission of water borne disease in recipient families. General emergency kits included rice and oil in addition to water purification supplies.
For more information on Nigel's work in Northern Cameroon, see his final report: