Learning, progress and innovation: Sanitation and hygiene promotion in Madagascar

Date: 2nd October 2015

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Learn how the GSF-funded programme in Madagascar is promoting sustainability and achieving strong sanitation and hygiene results through a cycle of learning, progress and innovation.

Photo: The GSF-supported Fonds d’Appui pour l’Assainissement (FAA) works through sub-grantees to implement community-led total sanitation (CLTS) activities in local communities, in order to achieve large scale sanitation and hygiene results. Credit: WSSCC/Katherine Anderson

Photo: The GSF-supported Fonds d’Appui pour l’Assainissement (FAA) works through sub-grantees to implement community-led total sanitation (CLTS) activities in local communities, in order to achieve large scale sanitation and hygiene results. Credit: WSSCC/Katherine Anderson

Download the complete case study or explore the sections below:

The national context
The latest report from the Joint Monitoring Programme of the United Nations Children’s Fund and World Health Organization highlights revealing statistics on Madagascar’s sanitation and hygiene situation. Approximately 12 percent of the country’s population have access to improved sanitation, while 18 percent have access to shared sanitation that is unimproved, and 30 percent have access to other types of unimproved sanitation. Furthermore, 40 percent defecate in the open. Ensuring improved sanitation and hygiene for all remains a major challenge in the country, but innovations from local partners supported by the Global Sanitation Fund (GSF) are vigorously helping to transform this situation.
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Photo: Members of a local sanitation and hygiene advocacy group in the fokontany of Anjalazala celebrate achieving open defecation free status. Credit: FAA/Nirina Roméo Andriamparany

Photo: Members of a local sanitation and hygiene advocacy group in the fokontany of Anjalazala celebrate achieving open defecation free status. Credit: FAA/Nirina Roméo Andriamparany

The CLTS journey
In rural Madagascar, CLTS is the preferred approach for eliminating open defecation, and these actions also drive overall improvements in sanitation and hygiene. CLTS was introduced in the country in 2008, following its success in Asia. The crux of the approach lies in creating an enabling environment in which communities become self-reliant and improve their own sanitation and hygiene situation without external help.

Video: CLTS ‘triggering’ in action

Credit: Channel Africa

CLTS focuses on igniting change in sanitation and hygiene behavior within whole communities, rather than constructing toilets through subsidies. During this social awakening, or ‘triggering’ process in Madagascar, the community looks for visible faeces in their environment. When people realize they are eating faeces this provokes disgust, shame and impacts on dignity. The community then makes and immediate decision to end open defecation. These steps are highlighted in the above video.
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Photo: Triggering children in the commune of Mangarano, using the open defecation mapping tool. Credit: FAA/Fano Randriamanantsoa

Photo: ‘Triggering’ children in the commune of Mangarano, using the open defecation mapping tool. Credit: FAA/Fano Randriamanantsoa

Innovations in sanitation and hygiene behaviour change methods
As the first GSF programme, the Fonds d’Appui pour l’Assainissement (FAA) was the testing ground for various approaches based on the essence of CLTS, which helped to drive the programme’s learning and sharing culture. Sub-grantees have utilized a range of approaches within local communities, sharing their challenges and success with the larger FAA team. Through FAA’s strong learning and sharing system, many of these approaches have been evaluated for their potential to be implemented on a larger scale, and some have become best practices, both within and outside of Madagascar. This case study highlights three best practice approaches evaluated and utilized by the FAA programme: Follow-up MANDONA, local and institutional governance and sanitation marketing.

Follow-up MANDONA
Mandona-visual
Inspired by CLTS triggering approaches, Follow-up MANDONA is aimed at helping communities speed up their achievement of open defecation free status and initiate the development of local governance mechanisms for sustainability.
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Sustaining collective behaviour change through community and institutional governance

Local community governance
Sustaining behaviour change is one of the major challenges in the sanitation and hygiene sector. The FAA’s intense sub-grantee efforts and presence on the ground are difficult to sustain in the long term, and it is therefore possible that communities slip back to defecating in the open or carrying out other unhygienic practices. In addition, the need to achieve large-scale sanitation coverage and hygiene behaviours and the demand for minimum standard requirements for latrines, further accentuates the sustainability challenge. Within the FAA, the concept of local community governance emerged as one solution.
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Photo: Sanitation and hygiene activities are among the priorities of periodic community work known as ‘asam-pokonolona’. In this photo a natural leader in Ampitambe village holds a sanitation register that records all sanitation actions carried out in the community as part of ‘asam-pokonolona’. Credit: WSSCC/Matilda Jerneck

Photo: Sanitation and hygiene activities are among the priorities of periodic community work known as ‘asam-pokonolona’. In this photo a natural leader in Ampitambe village holds a sanitation register that records all sanitation actions carried out in the community as part of ‘asam-pokonolona’. Credit: WSSCC/Matilda Jerneck

Institutional governance
As part of the governance process, sub-grantees gradually hand over leadership responsibilities to local institutions, such as municipalities and local authorities, to ensure sanitation and hygiene initiatives become completely locally owned. This includes helping institutions enhance their technical, financial and organizational leadership related to sustaining open defecation free status.
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Photo: Institutional triggering is achieved, as national authorities convene to end open defecation in Madagascar by 2019. From mid-left: President of the Republic of Madagascar Hery Rajaonarimampianina, WSSCC Executive Director Chris Williams, Prime Minister Jean Ravelonarivo, Minister of Water Bénédicte Johanita Ndahimananjara, and the Chair of the GSF Programme Coordinating Mechanism Michèle Rasamison. Credit: FAA/ Nirina Roméo Andriamparany

Photo: Institutional triggering is achieved, as national authorities convene to end open defecation in Madagascar by 2019. From mid-left: President of the Republic of Madagascar Hery Rajaonarimampianina, WSSCC Executive Director Chris Williams, Prime Minister Jean Ravelonarivo, Minister of Water Bénédicte Johanita Ndahimananjara, and the Chair of the GSF Programme Coordinating Mechanism Michèle Rasamison. Credit: FAA/ Nirina Roméo Andriamparany

Sanitation marketing: low-cost approaches to technology improvements
The World Bank estimates that over 95 percent of the Malagasy population lives on less than $2 a day. This situation can be linked to the prolonged 2009-2014 political crisis that crippled the economy. Furthermore, the country is exposed to a number of natural hazards such as cyclones, floods and droughts, often leading to famine. It is within this context that the FAA has approached sanitation marketing, which applies social and commercial marketing approaches to increase supply and demand for improved sanitation facilities.
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Photo: Through collective behaviour change approaches, the GSF-supported FAA is helping increase demand for sanitation and hygiene products, which bodes well for this local business man. Credit: WSSCC/Katherine Anderson

Photo: Through collective behaviour change approaches, the GSF-supported FAA is helping increase demand for sanitation and hygiene products, which bodes well for this local business man. Credit: WSSCC/Katherine Anderson

Reflections on sustainability
In many respects the FAA programme is a trailblazer, achieving a level of scale that is almost unprecedented in Africa. This level of achievement naturally presents challenges, for example around sustainability and reliable, consistent monitoring. Regarding slippage, or households returning to previous unhygienic behaviours, the FAA and GSF in general accord great importance to verifying how communities appear to slip back to open defecation, and why. A number of internal studies have therefore been commissioned in Madagascar, both as part of and in addition to standard GSF procedures. Three recent studies by the GSF Country Programme Monitor, the programme’s Executing Agency and the Programme Coordinating Mechanism all reported slippage, but at different rates. Differences in findings seemed to relate to definitions of open defecation free – reverting to open defecation versus adhering to the programme’s very strict fly-proof latrine criteria – and to methodological differences.
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Listen to a podcast on the work of the GSF-funded Madagascar programme

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