Alone we can do little, together we can do so much
The renowned Helen Keller once said, ‘Alone we can do little; together we can do so much.’ In Bhutan, pathways to realise 100% sanitation and hygiene are designed collaboratively. This method of working has been vital in the ongoing success of Bhutan. Four years ago, Tsakaling gewog and 13 other gewogs received government certifications for accomplishing 100% improved sanitation. This is Tsakaling gewog’s story.
Sanitation and hygiene are critical to health, survival, and development. In Bhutan, UNICEF and SNV are the main development partners of the government’s Rural Sanitation and Hygiene Programme (RSAHP). The RSAHP contributes to ensuring universal access to health and increasing Bhutan’s Gross National Happiness. Among its many activities include organising and facilitating tailored Community Development for Health (CDH) workshops  in communities. Drawing strength from collaboration, the CDH workshops have consistently been yielding positive sanitation and hygiene results and outcomes.
In Tsakaling gewog, the Public Health Engineering Division (PHED) of Bhutan’s Ministry of Health organised a two-day CDH inception workshop to reach various clusters of the community, including local leaders, non-WASH sector actors, sanitation suppliers, and religious bodies. Together and individually, these clusters played a pivotal role to accelerate the pace in prioritising sanitation and hygiene improvements in the gewog.
Towards achieving 100% improved sanitation, Tsakaling (similar to many other gewogs) had to overcome several challenges, including those resulting from old age, living alone/single-parent households, land disputes, new constructions, empty households, financial problems, and temporary settlements. Due to the increasing recognition that WASH improvements in health care facilities (HCFs) cannot be addressed by the health sector alone, addressing the challenges of WASH in HCFs became a concerted effort; between relevant sector professionals, local leaders, village health workers (VHWs), natural leaders, religious leaders, and sanitation suppliers.
Exterior of toilet in construction
Interior of toilet in construction
Key success factors that helped overcome these challenges, in the context of Tsakaling gewog, include,
- Masons and carpenters received technical training to deliver tailored services to the community.
- Vehicles in the community helped to transport sanitation and hygiene materials, at subsidised rates, to areas located as far as the border towns.
- Sanitation and hygiene groups, including those for constructing toilets, were formed.
- Support of local leaders, natural and religious leaders, VHWs, and influential leaders were mobilised to create demand and raise awareness on sanitation and hygiene – themselves setting an example by constructing their toilets first.
- CDH workshops organised were key to changing the mindset.
- Households that needed community support the most – due to household members’ inability to construct toilets themselves – were identified and received gewog and/or the community’s support, in kind.
- A timely schedule for follow up and monitoring processes was developed by local leaders and health workers.
Over the years, the partnership’s sanitation and hygiene efforts have started bearing fruit. There is anecdotal evidence that the working students of two households helped their parents build a latrine during the winter vacation. Wages saved by these students went to the household’s toilet construction. During World Toilet Day 2016, Tsakaling gewog was among the 14 gewogs to receive government certification for accomplishing 100% improved sanitation coverage.
Reporting live from Tsakaling gewog, Pema Lobzang
These achievements were realised by the partnership’s engagement in sanitation and hygiene demand creation, supply chain strengthening, and behaviour change communication (BCC) activities – with no subsidy from the government. Having had met the government’s zero subsidy policy for sanitation, to date, we continue to pride ourselves with our achievements.
Going forward, to sustain sanitation and hygiene, Tsakaling gewog has enacted for each new household construction to make provisions for building a toilet. Household building compliance is verified by the Gup (district local leader). Further, constant awareness raising on good hygiene – through BCC – is also being conducted in all public gatherings.
Contributor: Pema Lobzang, Health Assistant I, Tsakaling PHC. Mogar
Note: This story is part of a blog series by SNV in Bhutan's sanitation and hygiene partners in local government and health care facilities. In this blog series, partners reflect on past and present sanitation and hygiene activities that have been (or are being) rolled out by SNV through the Government of Bhutan's Rural Sanitation and Hygiene Programme (RSAHP). SNV activities in the country are supported by the Australian Government's Water for Women Fund.
 Community Development for Health workshops are demand creation/triggering workshops that combine elements of Community-Led Total Sanitation (CLTS) and Participatory Hygiene and Sanitation Transformation (PHAST) approaches to raise demand for sanitation and hygiene. The CDH workshops are adapted to the specific environments and needs of villages and household settings. In addition to creating demand, ownership and forging links between demand and sanitation technology options, products, and services are the objectives of CDH workshops. CDH workshops give particular emphasis to facilitating the participation of potentially disadvantaged groups, including people with disabilities, people living in poverty, and women.