Interview with Dr Kamal Kar, winner of the Sarphati Sanitation Life Time Achievement Award 2015

Good to see you here in Amsterdam again after three years’ time. After winning the Sarphati Sanitation Life Time Achievement Award, the world of sanitation has not stood still. What is the focus of CLTS in the new Sustainable Development Goals (SDG) era?

“One of the SDG goals for 2030 is to have an open defecation-free world. Unfortunately, that will not happen overnight. So you have to have a method and formulate actions and roadmaps to be able to achieve this. However, considering the current strategy, I do not expect the world to be totally open defecation-free (ODF), even in 2030. The CLTS approach has spread to over 69 countries since its inception in 1999 and 2000 and it has been incorporated within the respective sanitation strategies of more than 40 countries, which have moved    from providing household level hardware sanitation subsidy to no-subsidy CLTS. One of the glittering examples is Bangladesh, a country that is now almost completely open defecation-free.”

Which countries are going to declared ODF in the next five, ten years?

“It is unlikely for number of countries to follow Bangladesh’s example towards becoming ODF in the coming years. The previous books (Handbook on community-led total sanitation (), Kar, K., & Chambers, R. (2008)  and the Trainers Guide on CLTS (), Kar, K. (2010), Facilitating ‘Hands-on’ Training Workshops for Community-Led Total Sanitation: A Trainer’s Training Guide, Water Supply and Sanitation Collaborative Council, red.), I wrote was  about how to trigger CLTS in villages so that the local communities are encouraged to take up collective local action through their own analysis to move towards becoming open defecation free. My new book, ‘Scaling up CLTS: From Village to Nation’, is about the institutional hindrance towards developing open defecation free districts, regions and nations. We have learnt that if you trigger a community, they can change their behaviour and move on to becoming an ODF community and make their villages clean. But, how do you stop institutional open defecation? Many countries are faced with lack of intra- and interinstitutional coordination even at the government ministerial level often. One ministry having no idea what the other one is doing is not very uncommon. Institutions seem to be cradled  in their respective  cocoons. It is important that they take up the responsibility and allocate their own funds on improvement of sanitation and do not depend solely on  funds from donors, bilateral and multilateral organizations. How do you create this awareness and excitement among the highest leadership of these countries, so that they realize their own problem and find ways to fix it themselves? They have to identify a way to decentralize the roles and responsibilities across different ministries and departments with appropriate budget allocation to fast-track access to sanitation and achieve national open defecation free status. This cannot be the onus of the communities or the frontline extension staff alone but needs to be driven by the ministers and high level officials with real influence to change the national policies and implementation protocol.” 

Have you ever talked to people in the top layers of governments to address this?

“I sure have, in at least over 6 countries, including  Sudan, Mozambique, Eritrea, Madagascar, Benin, Niger, Timor Leste, Cambodia and Kenya among others. Based on that, we have developed a methodology at the national, sub-national, and the regional level and below. From our experience, we have noted that the moment you start triggering the institutional actors, the awareness and the sense of responsibility increases tremendously.  Often it has been seen that the ministers are foreigners in their own countries, who have no idea as to what is going on in their own country. They get totally surprised to hear the tremendous success of their local communities in achieving an ODF status without any external help and support. It is not fair to blame the communities for not scaling up the success to other communities since it is the job of the local and national governments to institutionalize and scale up home grown success of sanitation efforts.”

In 2015, you won the SSA Life Time Achievement Award. What is your lifetime achievement in relation to outstanding contribution to worldwide sanitation?

“My background is on livestock production, agriculture and natural resources. However, my experience has been varied including poverty alleviation, livelihoods and social development among others. In 1999, I was approached and requested by Water Aid London to lead an evaluation study for Water Aid, Bangladesh. I agreed, but told them that I was not a specialist in Water and Sanitation. However due to my experience in participatory impact assessment, and farmer participatory research, they wanted me to undertake the job nonetheless. When we were doing the assessment, as we passed village by village, we often stepped on human shit almost every day. I was thinking aloud: ‘what the hell is going on here? What had been the impact of constructing new toilets at households? What is the meaning of all this if the practice of open defecation continued unabated?’

One of the NGO partners of Water Aid was focussing on building number of toilets in rural Bangladesh districts, who were faring quite well. However, none of the villages I visited had total sanitation since not everyone was  using these newly built toilets. The idea I initially proposed in order to solve this problem of partial sanitation was that of differential rate of subsidy, therefore, more subsidy was to be provided to the poorest while the less poor would receive lesser amount of subsidy. Therefore, utilizing the same money, one could reach out to many. Though we felt that at first, we needed to understand why people were defecating in the open and learn more about this behaviour before finalizing this recommendation. We went into a village and started facilitating community analysis using visual participatory tools, such as mapping of who defecates where, flow diagrams depicting where and how faeces comes into the households, and that changed everything radically! Many villagers gathered around and started covering their noses and spitting. At this point, they realised what they had been doing all this time! They said, give us money and we will build toilets and do it differently. But we explained to them that we were not there to give the community members money or materials for construction of toilets or make them change their traditional sanitation behaviour. We further added that we had visited the village to learn from the community about their sanitation practices and we learnt that there was rampant open defecation and it seemed to be the main cause of the diseases the community members faced. One woman realized that open defecation takes place right beside the village’s crop fields, and that they’ve been eating each other’s faeces all this while. The community proclaimed that they will stop  open defecation in the next two months’ time and that the community will no longer allow anyone to defecate in the open. We said that if they are able to achieve this goal, we would be back with a news and media team and will disseminate the news of their success to the whole country. Theirs would be the first village in Bangladesh, which achieved the major accomplishment of becoming ODF on its own.  And, they did it in less two months’ time! That’s when I knew that we have got something revolutionary here and this is only the tip of the iceberg. Within a few months, the news started spreading among hundreds of villages in Bangladesh which mobilized collective local action to make their respective communities ODF.”

How did CLTS evolve from there?

“After a few years, in 2005, we started implementing CLTS in India, Cambodia, Indonesia, Nepal, Pakistan and after that to East and Southern African countries, and finally Central and Western African countries. One interesting finding was that people in Africa picked up on CLTS much faster than in Asia.

During this period, I also realized that many NGOs had their own agenda, and I felt that I will not be able to operate within this so-called regimented framework of development interventions. This prompted me to establish my very own foundation to be able to work independently from the direct influence of other organisation that might have conflicting views. I set up CLTS Foundation with my own money and resources. Even today, I still utilize my own resources. I did not establish CLTS Foundation as an institution to make profit margins from its work. The organization stands for the cause of better access to sanitation and hygiene, and all those who work in the CLTS or sanitation related sector feel the same way. So you can imagine how meaningful the prize money we were given through the SSA Lifetime Achievement Awards was to us because at that time, we were struggling as an institute. It would have been easy, had it been a company, but it’s not. Apart from extending our services of capacity building, advocacy and policy influencing, we have a website to maintain, identify the champions, but also document and disseminate all the lessons learned in the different countries, which has also led to this new book. In the past years, we have been financing CLTS mainly by our own financial means. But all that effort was worth it, because it is a cause, in which we strongly believe. It is tough sometimes, and even though our Foundation is quite small, we are known almost all over the world. What more could we wish for?

As a matter of fact, even the Dutch water governance is based on the idea, philosophy and principal of CLTS approach!”

Was it easy to educate people about the many disease caused by open defecation?

“Yes, because most of them already knew that. But our job is to facilitate, not to teach or lecture!” 

In your vision statement, you talk about hidden potentials and capabilities of local communities to solve their own problems in which sanitation has been/can be used as an entry point. How are communities identified and approached?

“CLTS is an approach, a methodology, which has three main pillars: Attitude and Behavioural Change, Tool and Techniques, and the third is Enabling Environment. If the enabling environment is right, that is, if the government is on the right track to help the communities and ready to accept that the communities are the solutions who may know more about their own environment than the outside technocrats, CLTS can make a massive impact. Many governments still think that constructing latrines is the only solution to solving the mammoth problems of sanitation, but it is not. The assumption is, if people are poor, give them a toilet. But CLTS has proved that all wrong. They may be poor, but nobody wants to live in shit. If the governments are not interested and if they don’t believe in the empowerment of people, we will not go there. Because we don’t preach, nor teach, and we are not salesmen of CLTS approach. But if they believe that their communities can do a lot, they can call us and we will be more than willing to support them.”

How does the selection of ‘champions’ work?

“At first, we were focussing on champions within the communities. These were generally people who are doing great things for their communities, and we take them to other neighbouring villages to help us implement CLTS there, too. They are often referred to as Natural Leaders and eventually Community Consultants, in CLTS terms. But nowadays, we also concentrate on identification of champions at local and national institutional level, such as heads of districts, regions and ministers. We have moved beyond and even identified leaders at the regional and district levels, so we have champions across all levels and therefore, can enlarge our impact. For example, the County minister of Kitui County in Kenya, saw the importance of CLTS and she was the first to put money from the County’s budget into wider implementation of CLTS. We took her to other counties in Kenya and to other countries as resource person to deliver speeches, share experiences and to encourage others to do the same by saying: “I did it! I managed to mobilize government budget into sanitation. Are you really planning to make your country ODF on somebody else’s money and resources? That’s never going to happen!”. Through this, she encouraged others to take up the issue like she did in addressing her counties’ sanitation problem responsibly. She became a real ambassador of CLTS. She further exclaimed, “If you spend on sanitation, you reduce the cost on curative health expenditure of the County on treatment, you reduce the costs of education - due to lesser number of school days lost to water borne diseases or menstrual health concerns-, of labour costs, owing to reduced loss of working days.” It has been easier for her to address this at a governmental level, because all of them operate on the same level and it had shown fascinating results. Therefore, it is important to find champions across all levels, who would be very effective in convincing many others to follow the same.”

How can CLTS empower women and girls in terms of health and sanitation?

“Oh quite a lot! Most burden of open defecation is borne by the women and children, who are the worst victims of this wrong practice. No matter which continent or country I have visited, everywhere, women have self-respect and are particular about the privacy of toilets. Unlike men, they cannot just stop alongside a road and do their business. So right during the early days of CLTS, we discovered that women mostly turned out to be the driving force, to make their village ODF quickly since they did not want their dignity and privacy to be compromised. Children are also affected by inadequate sanitation and it is often reflected in stunting, under-nutrition, incidences of diarrhoeal disease and under 5 mortality rates. But, once the children are used to toilet use and living in ODF environment, they cannot and do not want go back to open defecation anymore. It feels unnatural to them. That’s why it is so important to include kids in the CLTS approach as well.”

It is estimated that still over 900 million people are practising open defecation. Financial institutions and NGOs still seem to prefer financing drinking water projects, as providing drinking water is seen as more urgent. Which instrument can help, in your vision, to speed up the process towards an ODF world?

“Institutional triggering! Like I said before, many ministers have no idea what is going on in their own countries. Governments are crucial  to scale things up by creating an enabling environment. One of the tools that can be used, to understand the quality and strength of CLTS implementation is called CLTS Rapid Appraisal Protocol (CRAP). It has been developed by CLTS Foundation and UNICEF ESARO (Eastern and Southern Africa Regional Office). It is a quick and rapid methodology involving the country’s national, sub national and regional levels, to quickly assess the status of the practice of CLTS in their country, and what the policy context is, the financial implications are, what the budget is, the training capacity, the level of leadership and where the gaps are. Based on that outcome, we can fast-track CLTS.

Under the MDGs (Millennium Development Goals, red.), MDG 7 related to water and sanitation demonstrated some good progress. However, the SDG 6.2, has set a goal on a ODF world in 2030, which is an ambitious target considering that we are still lagging behind in sanitation sector. It is also crucial to understand that poor sanitation is a pathway to poverty and therefore addressing SDG 6.2 properly will make massive improvements with regards to the other SDGs, as well.

For the next Sarphati Sanitation Awards, look for the thinkers, the people ACTING and fast-tracking access to good sanitation! Dr Samuel Sarphati was a famous and great, practicing physician in Amsterdam, who realized that the city was surrounded by water, and diseases caused by open defecation would not only circulate but devastate the healthy population of the city. He put his own money into moving the accumulated human faeces far away from the city, and made Amsterdam one of the cleanest cities at the time. I’m afraid that someday, a new kind of viral or bacterial disease might emerge as epidemic in one of the densely populated slums with very poor sanitation anywhere in the world, which is not known as yet. This might catch a vast population totally unaware as no vaccine would be made available instantly. Such a situation might just arise because we are unable to eliminate open defecation. If that happens, it will be a disaster, like Ebola, which might kill millions of people! So reaching the goal of SDG 6.2 should be a top priority, for human health and welfare all around the world. I think sharing Dr Samuel Sarphati’s work widely will really inspire people all over the world, in this SDG era, and make them realize that sanitation hitherto a neglected topic that should be the number one priority. The human race could come to a sudden end if this is not addressed in time!”