2016年-世界发展银行全球_Sanitation_Marketing_in_Lao_Peoples_Democratic_Republic_69页_1mb

Summary of Sanitation Marketing in Lao PDR

Core Content

This report provides a synthesis of the results, lessons, and recommendations from two World Bank Water and Sanitation Program (WSP) Technical Assistance (TA) projects:

• "Supporting Demand Creation for Sanitation through Community-Led Total Sanitation" (P132453)
• "Sanitation Marketing in Lao PDR" (P132368)

The TA was implemented between 2012 and 2015, with the aim of increasing improved sanitation and hygiene practices in rural areas and achieving Open Defecation Free (ODF) status at the village level. It was conducted in collaboration with the National Center for Environmental Health and Water Supply (Nam Saat) and the Department of Hygiene and Health Promotion, Ministry of Health.

Main Objectives

1. Increase improved sanitation access and hygiene practices
2. Achieve ODF status at the village level
3. Develop scalable models for demand creation through CLTS
4. Strengthen supply chains for affordable and aspirational sanitation products and services
5. Implement behavior change communication (BCC) strategies

Key Outcomes

• Sanitation access increased significantly in CLTS-triggered villages, with a 32% rise from July 2014 to February 2016.
• 113 villages were declared ODF, and almost 40,000 people gained access to improved sanitation facilities.
• 1,465 toilets were sold by 10 enterprises, with 102 sales agents trained.
• 12 enterprises were trained in latrine manufacturing and business skills.
• BCC tools were developed to support behavior change, with a focus on visual materials due to low literacy rates among ethnic minorities.
• A national CLTS toolkit was issued and is being used by 10 NGOs across 31 districts in 10 provinces.
• A CLTS curriculum was developed for the University of Health and Science, to be implemented in the 2017/2018 academic year.

Main Viewpoints

• Community-Led Total Sanitation (CLTS) is a critical tool for demand creation, emphasizing local ownership and behavior change.
• Sanitation marketing is essential for sustainable service delivery, requiring a streamlined supply chain and market facilitation.
• Behavior Change Communications (BCC) must be tailored to address cultural, social, and linguistic barriers, particularly for ethnic minorities.
• Partnerships with agencies like the Poverty Reduction Fund (PRF) and the Lao Women Union are crucial for scaling up sanitation programs.
• Institutional capacity building and policy alignment are necessary to support long-term sanitation service delivery and achieve the Sustainable Development Goals (SDGs).
• Gender and ethnic inclusivity are important for effective BCC strategies and community engagement.

Key Information

• Sanitation access in Lao PDR increased from 28% in 2000 to 71% in 2015, with urban access at 94% and rural access at 56% in 2015.
• Stunting rates among rural children were high at 49% in 2011, highlighting the health impacts of poor sanitation.
• National targets for 2020 include 90% of the population using clean water and 80% using a latrine, but rural sanitation access remains low, especially among the poorest quintile (13% vs. 100% for the richest).
• Annual access requirement for 80% rural sanitation by 2020 is estimated at over 200,000 people, requiring a minimum annual budget of USD 2.3-2.8 million.
• SDG targets for universal sanitation access by 2030 are ambitious and require accelerated progress.
• The One-Stop-Shop model was introduced to simplify the purchase of sanitation products for households.
• Sanitation marketing toolkit was developed to align strategies and support replication in other regions.

Challenges and Recommendations

Challenges Identified

• Fragmented supply chains for sanitation products hindered access.
• Lack of microcredit for rural households limited financial inclusion.
• Inequities in sanitation access persist across regions and socio-economic groups.
• Low literacy among ethnic minorities necessitates the use of visual BCC materials.
• Need for institutional strengthening and policy alignment for sustainable service delivery.

Recommendations

1. Establish a dedicated national rural sanitation sub-program under the Ministry of Health (MoH), with a clear budget line and operational support.
2. Integrate rural sanitation into multi-sectoral nutrition programs, leveraging existing tools and strategies.
3. Tailor BCC strategies to address gender and ethnic minority issues, ensuring inclusivity and cultural relevance.
4. Scale up the partnership with the Poverty Reduction Fund (PRF), focusing on a district-wide approach and expanding collaboration.
5. Align WSP technical assistance with the Health Governance and Nutrition Development Project (HGNDP), targeting 12 districts in four provinces.
6. Develop a harmonized financing guideline for pro-poor support, including targeted subsidies and ODF-awards.
7. Enhance institutional capacity through training, curriculum development, and coordination with local authorities.
8. Improve monitoring and evaluation systems to track progress and ensure accountability.
9. Promote the use of visual BCC materials to overcome literacy barriers among ethnic minorities.
10. Support rural sanitation entrepreneurs through external assistance and efficient NGO facilitation.

Conclusion

The TA program demonstrated that a combination of CLTS, sanitation marketing, and BCC strategies can significantly improve rural sanitation access. However, achieving the SDG targets and national sanitation goals requires strong institutional support, policy alignment, and sustainable funding mechanisms. The report emphasizes the need for a comprehensive and inclusive approach to sanitation service delivery, with a focus on community engagement, market development, and behavioral change.