KARACHI, 14 December 2008 (IRIN) - "I remember the time when I'd get up to the chirping of the birds, walk across to a nearby field, relieve myself in the fresh, open air -undisturbed - go to the nearby canal, take a bath and then come home to a hearty breakfast… before going off to work in the fields," said an old farmer.

"This is the mind-set against which we are working," said Wasim Aslam, an activist striving to make 564 villages in Pakistan open defecation free (ODF).

Aslam is from Lodhran, one of the implementers of the Community-Led Total Sanitation (CLTS) campaign initiated by the World Bank's Water and Sanitation Programme (WSP), and one 1,500 activists who have been trained to get the CLTS movement off the ground.

According to the UN Children's Fund (UNICEF), an estimated 6,000 people globally, mainly children under five, die every day due to poor sanitation, hygiene and contaminated water. Over one billion people in South Asia are still without improved sanitation services. Globally1.2 billion people are defecating in the open; two thirds (778 million) are in South Asia (SA).

"When such an alarming number of young children die due to preventable diseases, there is no reason to remain abashed," said Irfan Saeed Alrai, water and sanitation specialist at the WSP-SA.

Women drive progress

The 1,500 trained activists are mostly men, but their success is in large measure due to the women behind them. Irfanullah, a local counsellor in Peshawar, said that had it not been for his wife, he would not have made any headway.

"Whenever I so much as tried to broach the subject of the vices of defecating in the open, I was stopped immediately," he said.

Duree Iman thought it would be easy to convince his community. "I went around three villages near Baggarian, in Abbotabad District, Punjab Province, but people just got angry and told me to stop sermonising. I decided to give up," said the ex-army officer.

However, his daughter, who is a door-to-door health worker, said she and her four colleagues would help him.

"In two months she had brought about a revolution and the first two villages became ODF. It was easy once they were convinced, because people already had toilets in their homes, but were using them as store rooms," Iman said.

Some well-to-do villagers have funded the construction of latrines for those who cannot afford to build their own.

The two men were sharing their experiences and their successes at a workshop organised by the World Bank WSP-SA in Islamabad recently.

Behavioural change

The activists start by organising village meetings with the aim of provoking shame, shock and disgust among the villagers. They then explain the virtues of having indoor latrines and the problems of open defecation.

"I explain to them how healthy sanitation practices help avert disease and lead to less spending on medicines. We take a walk around the village and mark out the spots where people have defecated and then tell them how the faeces reach their homes and eventually their food," said Aslam.

"For most this is the first time they have understood the concept of hygiene and sanitation and are naturally shocked. And then it is easy to convince them of the need for a toilet," said Tariq Mehmood Sher, a master trainer from Kotli Satiyan, a village near Islamabad.

The aim of the CLTS is to stop open defecation through behavioural change, rather than supporting toilet construction for individual households.

"We want people to need a toilet. We don't just give it to them as they may not necessarily use it. We work on their psychology," said Aslam, adding that CLTS was first introduced in Pakistan in 2004.

NGO initiates change

The Integrated Regional Support Programme (IRSP), a local NGO supported by UNICEF, decided to try out the concept in 2004 in some villages in Mardan, North West Frontier Province. By the end of the year it had made 11 villages ODF free.

"The WSP-SA then facilitated assessing the approach, progress and methodology. The outcome of this project helped IRSP in promoting the CLTS to ensure sustainability at the grassroots level in Mardan District," World Bank sanitation specialist Alrai told IRIN.

In 2006 WSP decided to scale up the CLTS with support from local government.

Perhaps the biggest success of CLTS is that there is no concept of external funding for the construction of latrines. "You just prod their feelings of disgust and pride," said Alrai.

"A significant aspect of the programme's success and scaling-up… is partnership with support organisations like the Rural Support Programme Network (RSPN) and the Khushal Pakistan Fund which have helped to take the programme to scale," said Alrai.

Statistics

According to Javed Ali Khan, director-general of the Ministry of Environment, ODF initiatives have benefited about 1.12 million people. The practice of open defecation in rural areas came down from about 74 percent of the rural population in 1990, to 45 percent by 2006.

According to the Ministry of Environment, 73 percent of the population now has access to a latrine - 96 percent in urban areas, and 62 percent in rural areas.

CLTS is now included in the national sanitation policy, said Alrai. The focus of this policy is safe disposal of excreta through the use of latrines; the creation of an ODF environment; safe disposal of solid waste and effluent; and the promotion of health and hygiene practices.

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