Rabtey: How sanitation and hygiene changed the health and life of our community
In this blog, Sither Dorji, a health assistant in Bhutan’s Rabtey sub-post, shares two strategies that have been effective in improving the sanitation and hygiene conditions of Rabtey village. Prior to RSAHP implementation in Rabtey, there was limited interest to construct a toilet in spite of repeated awareness raising initiatives. There was also a low sense of urgency to construct a toilet since no one in the neighbourhood owned a decent toilet.
Rabtey village is one of the remotest chiwogs in Yangtse. It is located 70 km from the gewog (group of villages) center. Deprived of access to many facilities and development initiatives, it is not easy for gewog officials to reach Rabtey. As the health staff lead of the sub-post’s newly formed sanitation committee, the entrance of the government’s Rural Sanitation and Hygiene Program (RSAHP) in Rabtey – with support from the Swiss Red Cross, the Ministry of Health’s Public Health Engineering Division (PHED), and SNV – came as a welcome relief to me and Rabtey’s other health staff, local leaders, and the community. Finally, the road to better health opportunities was being laid out in Rabtey.
There are no limits to what you can accomplish, except the limits you place on your own thinking! 
Reaching every household was not an easy feat. Health assistants like myself carry out multiple tasks. Success cannot be guaranteed by one person alone.
To reach our goals, health assistants must be able to rely on the support of chiwog Tshogpas and village health workers (VHWs) to produce quarterly progress reports, undertake monthly monitoring activities, etc. For example, I appointed four observers to monitor the progress of 10-15 households each for a period of 3-5 months. Each observer was provided ‘talk time’ credit for their mobile phones to make sure that they had sufficient resources to keep me updated me with their progress. The observers did not only help me reach more households, but they were more effective (and had greater influence) than me to encourage villagers to improve their sanitation and hygiene practice.
One of the villagers Mr Phuntsho, 53 years old, explained that he used to feel very embarrassed whenever guests would visit and ask him about the state of his toilet. Because he did not have a rational response to such questions, at times, he would hide from them and pretend that he was not home. After all, Mr Phuntsho knew that going out during the night to relieve himself, at times while it was raining, in an open space with no privacy, was not safe for him nor his family. Thanks to the community-based observer who supported his household in the sanitation change process, the team was able to overcome Mr Phuntsho’s shame. Today, Mr Phuntsho and family are proud owners of an improved toilet.
The future belongs to the competent. Get good, get better, be the best!
‘Mirroring’ is a common human behaviour that has driven people to consciously or subconsciously mimic gestures, mannerisms, and practices of people they look up to. In Rabtey village, mirroring has been effective in bringing about sanitation improvements.
When Mr. Phuntsho started his toilet construction, many villagers started talking about how great it would be to have their own toilet. Very soon, they too started their own construction. After a few months we started seeing toilets sprout around the village. Thanks to Mr Phuntsho, his neighbors were compelled to build, and above all gain the pride of owning an improved toilet.
As more ‘Mr Phuntsho’s’ built their improved toilets, data in health centres started to show that diarrheal diseases and skin infections were on the decline. Over the past three years, these positive results have been directly linked to the community’s success to end open defecation practice, and to start up the use of conventional pit toilets.
Contributor: Sither Dorji, Health Assistant, Rabtey sub-post
Banner photo: Chorten Kora in East Bhutan (Vikramjit Kakati, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons)
 In Trashiyangtse, Eastern Bhutan, sanitation and hygiene interventions are supported by the Red Cross with technical support from PHED and SNV.
 This story is part of an SNV in Bhutan SSH4A blog series by local government, health care, and community partners. In this series, partners reflect on the success of Community Development Health (CDH) workshops in encouraging villages, sub-districts, and whole districts to prioritise their sanitation and hygiene conditions.
For more information on SNV’s CDH-related activities, contact: Thinley Dem, Behavioural Change Communications Advisor, SNV in Bhutan