Sengdhyen: A tale of sanitation and hygiene success by a humble health worker

‘Sengdhyen will never achieve 100%,’ said one government official during the earlier days of the government’s Rural Sanitation and Hygiene Programme. But to everyone’s surprise, Sengdhyen became the first village to achieve 100% improved sanitation and hygiene in Samtse dzongkhag (district). A dream that I’ve been chasing in the last 22 years of service. Here, I share Sengdhyen's success story: an achievement realised through hard work, timely planning, and implementation.

Sengdhyen is located in the north east of Samtse dzongkhag. It is home to the Lhop people; one of the oldest aboriginal inhabitants of Bhutan. In Sengdhyen, literacy rate is low, and beliefs and customs are deeply rooted in the historical traditions of the Lhop people. Bringing about change to generations and generations of practice was very hard. Despite the rising significance of sanitation and hygiene as a development priority throughout Bhutan, sanitation and hygiene-related morbidity remained high. Diseases like diarrhoea, dysentery, and skin infections always topped the list of ten illnesses. In 2015, the government’s Annual Household Survey found that of the 404 households, only 61 had improved toilet, 238 households were still using pit toilets, and 13 households did not have access to proper toilets at all.

RSAHP activities started in Samtse in 2015, with support from PHED, SNV, and DFAT of the Government of Australia.[1] The RSAHP followed a simple concept and an easy-to-apply methodology. Activities were well-structured, with strategies and follow-up mechanisms set in place. Many stakeholders were involved in the process, including health assistants. Within RSAHP, health assistants (HAs) participated in Community Development Health workshops. HAs such as myself were trained on how to promote sanitation and hygiene differently and more effectively within our respective communities.

Achieving 100% success did not occur overnight. Along the way, we met numerous challenges, from zero to limited sources of income to facilitate sanitation and hygiene upgrades, weak administration-related coordination and support mechanisms during the start-up phase, lack of access to facilities and skills to build toilets and handwashing facilities, rising number of members in households, land and property ownership challenges, etc. In order to overcome these challenges, we:

• created an action plan and set the frequency for review and updates;

• set up a quarterly multi-stakeholder review meeting for staff, Tshogpas, VHWs, Chipons (local leaders), and influential leaders;

• conducted consistent follow-up and monitoring activities in the villages; and

• facilitated intra-community support to ensure that everyone, together, gained the appropriate opportunities and support to reach the shared goal of sanitation and hygiene improvements, without leaving no-one behind.

As a participant of CDH workshops, I learnt about the importance of engaging the participation of diverse community members and giving them ownership. ­These formed the core principles of our team’s strategies in Sengdhyen; right at the beginning of the programme.

Right from programme inception I told myself that I am going to work hard. That I would take the responsibility to seek out solutions on my own. But I also found comfort in knowing that I had the backing and support of individuals, group, institutions, and communities, when there was a need. Through the years, my sanitation and hygiene work benefited from the support of:

• community people taking ownership and active participation in promoting proper sanitation and hygiene practice;

• Village Health Workers (VHWs)

• two Chiwog (villages) Tshogpas whose responsibility was to mobilise the active participation of community;

• a teacher in Sengdhyen Lower Secondary School, students, and members of the Tarayana club who helped two families construct toilets that could not build these themselves;

• dungkhag (sub-district) and gewog (group of villages) administration officers for their subsequent education and motivation; and

• the Dzongkhag Health office, for their continuous encouragement and guidance.

Our success has had a huge health impact in the community. Sanitation and hygiene-related diseases dropped drastically. People in the community are happier and feel greater comfort in knowing that their toilets are near their houses. And, it is now accepted in the community where I work that a toilet is one of the most important assets for people to lead healthier lives.

As a health worker, I did not have high hopes at the start of the programme. But this journey has allowed me to work towards a goal that brings me great pride. I am thankful to my mentors from SNV and PHED/MoH, and for their recognition of my contributions to sanitation and hygiene progress. Last 19 November 2019, I received official recognition for my contributions to the programme.[2]

Contributor: Ugyen Thinley, Health Assistant, Norbugang PHC, Samtse

[1] In Samtse, Southern, sanitation and hygiene interventions are supported by SNV, with financing from the Australian Government’s Water for Women Fund.
[2] 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