ENVIRONMENTAL HEALTH

ACTIVITIES

IN THE PACKAGE OF SERVICE

Dr. Than Win Deputy Director

Environmental Sanitation Division Department of Health

MYAMNAR

Thailand

ChinaIndia

Bay of Bengle

2

Total Population 60 million

Area 676.578 Sq km

Growth rate 1.75%States & Regions 14Districts 66Townships 330Wards 2,786Villages 64,910U5 Mortality 46.1Infant mortality 37.5Life expectancy 64.5

MYANMARS SANITATION PROGRAMME• Sanitation Programme began in 1982• Changed to Demand driven approach in 1996• Annual National Sanitation Week from 1998 until

2011• Accelerated progress in access to improved

sanitation• Diarrhoea rates in under five children indicate

slippage• Low maintenance• Low use• Lack of awareness

• 2011 introduction of Community Led Total Sanitation (CLTS)

• National Sanitation Campaign launched in 2012 to accelerate progress, includes CLTS

1985 1990 2000 2005

Supply Driven Sanitation Approach

National Sanitation

Campaign 2012Introduction of CLTS 2010

20101995

Community Based Health Education

1986

National Sanitation Week Movement

19983 Cleans - Hands, Toilet & Water -

19964 Cleans - Food -2001

Demand Driven Sanitation Approach

Sanitation Programme 1982

Timeline of Sanitation Progress in Myanmar

National Sanitation Week Movement

2011 Ends

MYANMAR SANITATION DATA 76% coverage, 83% urban, 73% rural (JMP

2012) 60% increase in diarrhoea between 2003

and 2010 (MICS 2003 and MICS 2010) Most of the Township health profiles

indicate high levels of under five mortality from diarrhoea and dysentery

Open defecation: 1 % Urban, 8% Rural - JMP 2012- whole country

average 3% Urban, 19% Rural - KAP 2011 - areas with high

prevalence of infant mortality, poverty, etc.

1995 2000 2003 20100%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0%

2%

4%

6%

8%

10%

12%

14%

16%

Myanmars Sanitation Progres: 1995 - 2010

Open Defecation

Unimproved latrine

Improved latrine

Piped/Septic Tank

U5 Diarrhoea

Year

Excr

eta

Dis

posa

l Met

hod Und

er 5

Dia

rrho

ea

ANALYSIS OF OVER 5,000 LATRINES

65%

30%

6%

Functional Partially functionalNot functional

83%

17%

Improved LatrineUnimproved Latrine

OBJECTIVES OF NATIONAL SANITATION CAMPAIGN To advocate high political commitment To raise community awareness on  importance of

safe water supply and proper excreta disposal, To involve various sectors including NGOs,

enhance implementation and support monitoring and management in various States/Regions.

Special emphasis on Community-Led Total Sanitation(CLTS) to meet MDG goal (7)

Community participatory appraisal on Behavior Change Communication (BCC)

Community empowerment Development of sustainable environment by

Community Primarily stressed on to develop Open Defecation Free

(ODF) community No subsidy

Community-Led Total Sanitation in Myanmar

Yes for community subsidy No top-down No teaching, learning from community Sanitation Marketing Triggering the Solidarity spirit among the villages Continued to total sanitation ( drainage, wastewater

disposal, solid waste disposal) Continued to development tasks of villages, township,

States and Regions

Pre-triggeringSelecting a communityIntroduction and building rapportTriggeringParticipatory sanitation profile analysisIgnition momentPost-triggeringAction planning by the communityFollow upScaling up and going beyond CLTS ( including monitoring, supervision and evaluation on previous ones)

THE SEQUENCE OF STEPS IN CLTS

THE SEQUENCE OF OVER ALL STEPS IN CLTS Advocacy meeting Pre-triggering Triggering Post-triggering Monitoring Declaration of ODF Scaling-up of CLTS Sanitation marketing Developing of solidarity sprit

Capacity improvement and empowerment of community

Developing of solidarity sprit Leading role carrying-out for all sanitation

activities Leadership of development tasks for village and

township Scaling-up from villages to Townships, States and

Regions

THE WAYS USED TO TRIGGER CLTS

Calculating amount of faeces produced Households can use their own methods and measures for calculating how much human excreta they are generating each day.

Multiplication can be used to find a figure for the whole community, and to calculate the amount of faeces produced each week, month or year. The quantities usually surprise the community.

The calculations lead into further discussion about where the faeces go and the effects of having faeces on the ground.

The key point in the process is reached when the community realizes that open defecation needs to stop- a juncture known as ‘triggering’.

THE WAYS USED TO TRIGGER CLTSTransect walkThe process often starts with an informal talk with a few community members during a walk through the village.

During the walk, areas of OD are pointed out, as well as different types of latrines currently in use.

It is important to stop in the areas of OD and spend time there asking questions.

Having their attention drawn to the unpleasant sight and smell by a visitor to the community is a key factor in triggering mobilization.

Once the interest of a few community members has been captured, the process continues to trigger CLTS.

THE WAYS USED TO TRIGGER CLTSChildren’ activitiesChildren can be very strong advocates against open defecation.

For example, they might lead procession where they shout slogans or sings about the need to stop open defecation.

NATURAL LEADERS

Natural Leaders

ACTION PLANNING Activities that communities might decide to

carry out include:

*forming a sanitation action group with representatives from every neighborhood in the community

*making a list or map of households and their access to sanitation

*digging pits and using them as temporary latrines until others are constructed

*getting wealthy households to start constructing latrines immediately; these households could donate wood or bamboo for constructing latrines, allow poor families to use their latrine in the short term

Action planning

AT THE END OF TRIGGERING??????

CLTS TOT TRAINING CLTS TOT training course was conducted at (2) times

in Myanmar during 2011 and trained by with sponsorship of UNICEF Government staffs from Department of Health,

Department of Development Affairs, Department of Education and personnel from NGOs, INGOs

Field implementation at Two Townships Achieved the active participation in both trainings New approach was very interesting for all participants

PILOT CLTS PROJECT IN MYANMAR Pilot CLTS IN Tatkon Township nearer to Nay Pyi

Taw, new capital of Myanmar Implemented by means of no subsidy and no top-

down Active participation of Tatkon community Able to trigger to community and BHS staff Five villages became CLTS village Monitoring, supervision and evaluation Superior Requirement in CLTS approach

OPEN DEFECATION 1 % Urban, 8% Rural (JMP 2012) 3% Urban, 19% Rural (KAP 2011) MICS is whole country average KAP study looks a areas with high prevalence of infant

mortality, poverty, etc. 62% of households had family members working in the

field and 69% defecate openly while working in the field (KAP 2011)

Extent of practice of open defecation is a threat to health

CLTS IMPLEMENTATION IN MYANMAR CLTS Pilot project implementation in Tatkone township in

Nay Pyi Taw CLTS implementation in (10) townships Kawa , Tanutbin, Waw and Paungde townships in Bago

Region Nyaungdon, Kyaunggon , Hintada, Kyaiklat, Bogalay and

Ngaputaw townships in Ayeyawady Region Successful implementation in above (11) townships

including pilot township Tatkone

Through the developing of many OD Free villages Scaling-up is under piping Monitoring, supervision and evaluation Superior Requirement in on-going Sustainability is Still problematic in some flooded

villages due very recent flood of heavy rain

DOCUMENTARY PHOTOS FOR CLTS IMPLEMENTATION

DOCUMENTARY PHOTOS FOR CLTS IMPLEMENTATION

LOCALLY AVAILABLE MATERIALS SUCH AS BAMBOO FOR CONSTRUCTION OF SANITARY LATRINE IN RURAL AREAS

4

5

MONITORING THE CLTS LATRINE

MONITORING AND EVALUATION FOR CLTS ACTIVITY

IMPROVED LATRINES - CLTS

CHALLENGES Convert knowledge of good hygiene into practice Concerted and coordinated efforts of the

Government, Local NGOs , INGOs and People Acceptable and functioning community latrine

designs. CLTS results in maintainable latrines, within

community's budget Donors and other stakeholders desire to subsidize

latrine construction Get accurate sanitation indicators in 2014 census

CONCLUSIONA SUCCESSFUL SANITATION INITIATIVE Dramatically increased the Sanitation Coverage from

45% in 1995 to 84.6% in 2010 Successful 4 Cleans Campaign since 1996 has

improved peoples knowledge of hygiene and sanitation

"Sanitation for all by year 2015" Guideline based on National Health Policy - High level political commitment down to grass-root level - National Sanitation Campaign (NSC) through CLTS

CAN YOUCHANGE YOUR MINDSET ?

YOU CAN CHANGETHEIR ATTITUDE

Act now!CLTS, to achieving

Millennium Development Goal.

Thank you