RURAL SANITATION IN VIETNAM

Hanoi, 12 July 2016

MINISTRY OF HEALTH

CONTENT

1. Current status of rural sanitation

2. Barriers and challenges in rural sanitation

3. Ministry of Health (MOH)’s orientation in the

coming time

2

CURRENT STATUS

OF RURAL SANITATION

3

4

6558

7985

72

61

86

57

0

10

20

30

40

50

60

70

80

90

100

Toàn quốc Miền núi phía Bắc

Đồng bằng sông Hồng

Bắc trung Bộ Duyên hải miền Trung

Tây Nguyên Đông Nam Bộ Đồng bằng sông Cửu

Long

Coverage of hygienic latrines in households 2015

− Rural households without latrines: 10%

− Hygienic latrines in households account for 65%

− Uneven coverage of hygienic latrines across ecological areas; open defecation and

fishpond latrines remain

Source: NTP on RWS 2012-2015

Nation-wide

Northern mountain

Red River Delta

North Central

Central Coastal

Central Highland

South-eastern

Mekong Delta

20 MILLIONrural population without

access to hygienic latrines.

6

HOÀNG SA

TRƯỜNG SA

6 MILLIONopen defecation

7

Open defecation, or fishpond latrines remain popular

8

HOÀNG SA

TRƯỜNG SA

10 PROVINCESwith hygienic latrine

coverage below

50%!

9

93

80

98 96 96

84

100 98

0

10

20

30

40

50

60

70

80

90

100

Toàn quốc Miền núi phía Bắc

Đồng bằng sông Hồng

Bắc trung Bộ

Duyên hải miền Trung

TâyNguyên

Đông Nam Bộ

Đồng bằng sông Cửu

Long

-By end of 2015, 93% communal health centers have clean water facilities and

latrines

-Need more focus on sustainable maintenance of hygiene of latrines in CHCs

Coverage of hygienic latrines at communal health centers

(CHCs)

Nation-wide

Northern moun-tain

Red River Delta

North Central

Central Coastal

Central High-land

South-eastern

Mekong Delta

10

−78,6% of schools having hygienic water sources and latrines.

−Need more focus on sustainable maintenance of hygiene, hand washing with

soap

Coverage of hygienic latrines in schools

78.673.3

92.8

73.4 71.1

61.7

99.1

87.2

0

10

20

30

40

50

60

70

80

90

100

Cả nước Miền núi phía Bắc

ĐB Sông Hồng

Bắc Trung Bộ

Duyên hải Miền Trung

Tây Nguyên

Đông Nam Bộ

ĐB Sông Cửu Long

%

Nation-wide

Northern moun-tain

Red River Delta

North Central

Central Coastal

Central High-land

South-eastern

Mekong Delta

11

12

ANNUAL DIARRHEA INCIDENCES

13

millionChildren suffer from rickety or low height as a

result of poor hygiene, and most of these reside in

remote and rural areas (25% and 28-31% children with

rickety in rural and mountainous areas respectively)

14

among under-5s in communities with unhygienic latrines

(including families with hygienic latrines in such

communities) than their peers in communities with hygienic

latrines

3.7cm shorter, 5-11 IQ points lower

15

Annual economic losses in Vietnam due to poor hygiene/sanitation

=780m US$

=9,26US$ p.c.

=1,3% GDP

16

3. H/S IS AN AREA OF INVESTMENT WHICH

GREATLY BENEFITS THE COUNTRY

5. INVESTMENT IN H/S IS INVESTMENT FOR SUSTAINABLE LIVING

ENVIRONMENT

4. INVESTMENT IN H/S IS INVESTMENT FOR THE HEALTH OF THE

NATION AND FUTURE GENERATIONS

2. INVESTMENT IN H/S IS INVESTMENT FOR

DEVELOPMENT OF AN EQUAL, FAIR AND SAFE

SOCIETY.

1. INVESTMENT IN H/S IS TO ENSURE

ACCESS TO HYGIENE FOR ALL

6. INVESTMENT IN H/S IS VIETNAM’S

POLITICAL WILL

BARRIERS AND CHALLENGES

IN RURAL SANITATION

18

MAIN BARRIERS

1. Believe they can’t afford. Lack of

information on costs of latrines.

2. Lack of knowledge of

regulations/no social pressure.

Unhygienic latrines still acceptable.

3. Lack of knowledge of benefits

from hygienic latrines.

4. Don’t want to borrow. Investment

in latrines does not generate

returns.

19

Hygienic latrines just built

thanks to WASHOBA

project in Thai Nguyen

1. Lack of attention from local authorities to H/S. No strong

sanctions and regulations to terminate open defecation,

eliminate fishpond latrines, and encourage the construction

and use of hygienic latrines.

2. People do not have high awareness of the construction,

use and maintenance of hygienic latrines.

3. Construction works’ sustainability affected by improper

habitual use and maintenance.

4. NTP on RWS ended in 2015 affecting sustaining and

replication of sanitation initiatives.

5. Weak participation of private sector. Undeveloped

sanitation market. 20

KEY CHALLENGES

MOH’s ORIENTATIONS

IN THE COMING TIME

21

2015•1% VILLAGES TERMINATE OPEN DEFECATION•65% HOUSEHOLDS USE HYGIENIC LATRINES•SANITATION CRITERIA INCORPORATED IN SOCIO-ECONOMIC PLANS

2020•30% VILLAGES TERMINATE OPEN DEFECATION•75% HOUSEHOLDS USE HYGIENIC LATRINES•COMMUNE-WIDE SANITATION

2025•80% VILLAGES TERMINATE OPEN DEFECATION•90% HOUSEHOLDS USE HYGIENIC LATRINES

2030•100% VILLAGES ACHIEVE ODF•100% HOUSEHOLDS USE HYGIENIC LATRINES•SANITATION FOR ALL

VIETNAM’S SANITATION

GOALS

Create enabling environment (policies, institutions, resources)

Impvoresanitation services

and develop supply chain

Focus on BCC and create demands among population

Enhance knowledge and experience sharing

24

ORIENTATIONS IN MAINTENANCE AND REPLICATION

OF MODELS FOR SANITATION PROMOTION 2016-2020

Lack of enabling environment and

institution

Criteria for socio-economic development (national, local) and new rural areas

Sanitation in NTP on

New rural areas

Guidancce on termination

of open defecation

Encourage private

sector’s participation

Weak activities in demand creation and market development

Increase investment in BCC

Strengthen appropriate and effective communication approaches

Capacity building at all levels

Select appropriate

models

Replication of effective approaches:

- OBA, WASHOBA

- PforR

- CLTS, ODF

EFFECTIVE APPROACHES FOR SANITATION

PROMOTIONSummary Features Focus

CLTS Activate communities –

extensive changes of

sanitation conditions

• Activate

• Work toward termination of

open defecation

• Low cost solutions, local

materials

Create demands

CLTS + CLTS + Strengthen

sanitation supplies

• CLTS

• Training for masons and

strengthen supply chain

• Create demands

• Develop sanitation

market

Sanitation

marketing

Make use of social and

commercial marketing to

promote sanitation

• Market research

• Develop appropriate products

• Develop trade in private sector

• Create demands

• Develop sanitation

market

OBA Financial assistance

mechanisms through grant

packages

•Output-based assistance

•Verification of performance

• Policies,

institutions

• Group meetings

• Develop sanitation

market

PforR Output-based disbursement

mechanism (number of new

latrines, number of communes

with good sanitation, etc.)

•Output-based assistance

•Verification of performance

• Disbursement indicators associated

with water supply and sanitation

•Policies,

institutions

• Develop sanitation

market

CHOBA - WASHOBA

Attention from local authorities at various levels; good

mobilization of other local resources

Increase proactiveness: planning, implementation,

supervision and improved capacity of implementing

agencies and officials

Increase responsibility of implementing agencies:

associate water supply indicators with sanitation link

responsibility of stakeholders ensure high sustainability

of programs

Reach the poor (the most difficult target group)

Rapid increase of hygienic latrines (increase rates

verifiable thanks to supervision system for output-based

incentive payments being executed with transparency and

accuracy)

27

Efficiency in increase rates of hygienic latrines

in provinces with CHOBA – WASHOBA

18.436%

22.091%

16.247%

13.390%

.00%

5.00%

10.00%

15.00%

20.00%

25.00%

ThaiNguyen

Bac Giang Binh Dinh Ben Tre

CHOBA after 3 years’

implementation

WASHOBA after 2 years

(Jan 2014 – Aug 2015)

38%33% 31%

24%31% 32%

23%

36.120%

22.222%25.825%

18.667%22.663%

18.790%7.280%

10.915%

10.417%

0%

10%

20%

30%

40%

50%

60%

70%

Hải Dương

NinhBình

ThanhHóa

HàTĩnh

Quảng Bình

Tiền Giang

TràVinh

Đồng Tháp

Before June 2012 From July 2012 to Aug 2015

28

Playing key roles in rural sanitation promotion through

healthcare networks from national to village levels

Health care

networks

Local authorities

Women Union’s

networks

Bank for Social

Policies

- Collaborators;

- Sanitation supply services

PRIORITY SOLUTIONS FOR SANITATION

PROMOTION ACROSS LOCALITIES

Localities with % of households having hygienic

latrines

Under 30% 30-50% 50% - 65% Over 65%

Policies ++++ +++ ++ +

Increase effective models of

sanitation promotion++++ ++++ ++ +

BCC + Sanitation market, loans

from Bank for Social Policies++++ +++ +++ ++

Support of latrine technology ++++ ++++ +++ ++

Budget ++++ +++ +

• Top priority should be given to localities with <30% hygienic latrines,

followed by those with 30 – 50%.

• For those with >65%: solutions to maintain and foster natural increase of

hygienic latrines.

• Now that the NTP on RWS has ended, Government’s resources

for sanitation promotion mostly come from NTP on New Rural

Areas, and the Program for output-based replication of water

supply and sanitation in 21 provinces.

• Continue to maintain and replicate OBA and WASHOBA models

in localities with low rates of hygienic latrines

• Apart from leadership in implementation, MOH needs to provide

technical assistance to:

o Develop sanitation policies and institutions in new contexts

o Improve capacity of district, commune and grassroots healthcare

officials for rural sanitation work

o Monitor, supervise and sustain outputs that have been achieved.

o Learn, share experiences and awards for replication. 30

DEMANDS

31

Supported

Latrines

Self-constructed

latrines

Thank you

for your

attention!