Approximately 70% of households in Bhutan’s capital city of Thimphu rely on onsite sanitation because the centralised sewerage systems are currently not economically viable or out of reach. Towns continue to promote onsite sanitation with an increasing use of septic tanks but without a corresponding focus on developing sludge management services. The growing environmental health issues around faecal sludge disposal are difficult to ignore with leaking tanks, infrequent and unsafe emptying in urban settings.
This report documents the formative research of sanitation behaviours in Pemagatshel Dzongkhag undertaken as part of the Sustainable Sanitation and Hygiene for All Programme in partnership with the Ministry of Health. The overall objective of this research was to identify opportunity, ability and motivations of selected sanitation related behaviours in the district. The qualitative research design used the SaniFOAM framework as a means of organizing and analyzing the behavioural determinants. The research was conducted to provide the basis for the design of an evidence-based behaviour change communication strategy for the District in 2012 to improve access to improved sanitation and safe hygiene practices.
Official coverage figures for rural water supply make us hopeful - MDG targets for water will likely be met. Yet, the disappointing reality is that only a fraction of this is functional and providing regular water supply that is safe for drinking. The premature deterioration of ‘improved’ water supply makes unreliable and unsafe water services a daily reality for large parts of the rural population in Asia.
SNV recognises that providing functional and sustainable water supply services is a challenge that goes far beyond coverage at a given point in time. Increased capacity at all levels is essential for sustainability.
Poor sanitation is one of the leading causes of diarrhoeal diseases, which kill hundreds of people including children around the world everyday. The story in Bhutan is not any different either. The sanitation coverage in terms of presence of toilet in Bhutan is 91% and in the case of water supply, 84.5% of households had access to water supply in 2009, and 80.1% of the households had functional piped water schemes. However despite these good figures, the incidence of illness due to water and sanitation-related diseases is still high and the figure for under-five child mortality is one of the highest in South Asia (85/1000 live birth).
This is thought to be due to continued poor hygiene practice and in particular the poor state of latrines and associated facilities. Although the construction coverage of latrines is relatively high, the conditions are thought to be very poor and the amount of use low.
The Rural Sanitation and Hygiene Programme (RSAHP) co-ordinated by Public Health Engineering Division (PHED) under the Ministry of Health with technical assistance from SNV Netherlands Development Organisation had been assisting the primary client in rural areas by developing new approaches to improving the overall sanitation and hygiene practices in the rural communities in Bhutan. The initial programme area starting in 2008 was in the four pilot Geogs of Nanong (Pemagatshel), Hiley (Sarpang), Laya (Gasa) and Jarey (Lhuentse). The programme was later upscaled to the whole Dzongkhag of Lhuentse covering 7 more Geogs (Kurtoe, Khoma, Gangzur, Metsho, Menbi, Minjay and Tsenkhar) in June 2010.
There were two primary objectives under the RSAHP. Firstly, to explore, adapt and pilot best international practices to develop a model that can be rolled out country-wide. The model to be explored and piloted included an approach termed Community-Led Total Sanitation (CLTS), of which the outcome is measured in a complete end to open defecation and unsanitary conditions for entire communities rather than in terms of individual household latrine construction coverage. Secondly to study, explore and pilot sustainable, affordable and appropriate sanitation technologies in the programme areas. This handbook is a result of this second primary objective of the programme.
In the remote area of Lhuentse in Eastern Bhutan, lack of access to improved sanitation and a high incidence of poverty continue to persist. SNV Bhutan, together with the Rural Sanitation and Hygiene Programme of the Ministry of Health, collaboratively engage in qualitative research to identify support mechanisms to assist people living in poverty to meet their aspirations for improved hygiene and sanitation.
This paper highlights an approach that employs a research methodology based on inclusion and participation, which allows communities to define their own access barriers and suggest possible solutions for improved sanitation. This community reflection results in raised awareness of the collective responsibility for sanitation,promotes the mobilisation of local leaders to source materials and labour for construction, and encourages transparency at a local level by enabling open discussion.
The paper is part of a new publication "Towards Inclusive WASH: Sharing evidence and experience from the field" supported by AusAID’s Innovations Fund. This publication is a record of the sector's efforts to achieve equity and inclusion in WASH programming around the world. It includes one keynote paper and 16 case studies from a wide range of organisations in 13 countries and with examples from urban, rural and school WASH programming. The case studies provide stories of policy, technology and process innovations through four lenses: Poorest of the poor, Living with HIV and AIDS, Disability and Gender.
This work on Rural Sanitation Supply Chains and Finance is part of the SNV/IRC Sustainable Sanitation and Hygiene for All programme, which aims to improve the health and quality of life of rural people in five Asian countries (Bhutan, Cambodia, Laos, Nepal and Vietnam) through enhanced access to improved sanitation and hygiene practices. It has four integrated technical components, strengthening local capacities for a rural sanitation service delivery with a district-wide approach. An additional cross-cutting regional component of the programme focusses on analysis, dissemination, and learning.
This Brief shares some of the lessons learned from working on the Rural Sanitation Supply Chains and Finance. It also introduces the thinking behind its design and its main activities.
Access to sanitation is essential for human well-being, dignity and economic development. While demand creation innovations such as Community Led Total Sanitation are providing an unprecedented opportunity to start changing hygiene behaviour of rural people, evidence shows that behavioural change will not be sustained unless a number of key supporting conditions are met. One of these conditions is access to affordable and appropriate sanitation hardware and services.
Market-based sanitation solutions have the most potential for scale and sustainability. However, rural sanitation markets are poorly developed and outreach is limited. Shops selling hardware and masons building toilets exist in any country, but the challenge is to reach many more customers across the socio-economic spectrum.
Particular attention is required to address the needs and preferences of different consumer segments, most notably special needs groups, households living in poverty, ethnic minorities and low caste groups. Because rural sanitation supply chains and finance often need to be strengthened, work should start in this area before and then be conducted in parallel to demand creation activities.
Diarrhoeal disease is the second largest killer of children under five. Evidence shows that improved sanitation and hygiene behavior and safe disposal of human excreta is the most effective way to reduce the incidence of diarrhoeal disease.
Improved sanitation and hygiene behavior is as much an individual choice of people and families as it is a common good for communities. Disease transmission is not stopped by household boundaries: the unhygienic practices of one family may infect a whole community.