In 2017, Bhutan’s Annual Health Household survey found that there were only 38 pour flush toilets in Toedtsho gewog (group of villages): an area populated by 88 households. Fast forward to 2020, health assistant Sonam Dorji reports that 100% access has been achieved. This is a story about the success of a multi-stakeholder approach to sanitation and hygiene improvements and some of the strategies taken by the team to overcome challenges.
The success of Toedtsho gewog would not have been achieved had local officials and sanitation and hygiene stakeholders did not work, together, towards a common goal. Collaborative efforts between Jangphutse’s health assistant, the Toedtsho Gewog Administration, and chiwog (village) leaders, and the diverse but coordinated actions taken by many relevant individuals ensured that 100% access would be realised. For example, the Gewog Administration provided materials for the construction of improved toilets. The provision of facilities was complemented by rigorous awareness and behavioural change communication activities across the village; carried out by health assistants supported by PHED and SNV. In 2019 alone, health care workers and local leaders met more than three times to discuss the benefits of improved sanitation and hygiene, and to seek for ways on how to redress the health risk and threats of (preventative) sanitation and hygiene-related diseases, at a large scale. In early 2020, the Toedtsho Gewog formed a Monitoring Committee to track progress.
Towards the end of February 2020, the committee found that sanitation facilities outnumbered households by 21 (109 toilets to 88 households), with some households constructing two toilets.
This success would not have been realised without the help of trained masons, village health worker Ms Tshering Deki, and student/community volunteers. But reaching 100% improved sanitation and hygiene coverage was not an easy one. Some obstacles that had to be overcome include,
- long distances of some villages from access roads increased work hours and level of difficulty to carry sanitation materials for construction,
- promoting a relatively new sanitation technology, the pour flush toilet, demanded a lot of time, especially in sparking elderly people’s interest for change (the elderly comprising the largest age group in the area),
- similarly encouraging the adoption of new sanitation and hygiene behaviours does not happen overnight,
- the above were compounded by human resource challenges: there were few sanitation champions among gewog leaders (Gups, Mangmis, Tshogpas), village health workers, and trained masons, and
- owning a toilet was never a priority for the villagers.
Toilet construction in neighbouring Lhuentse (SNV/Aidan Dockery)
But through collaboration and perseverance, we brought about the change. Sanitation and hygiene, and toilets are now prioritised by villagers. To make sure that the village continues to have access to improved sanitation and hygiene conditions, health assistants and gewog leaders have pledged to meet quarterly to monitor progress.
Contributor: Sonam Dorji, Jangphutse Sub-post, Trashiyangtse
 In Jangphutse, Trashiyangtse sanitation and hygiene interventions are supported by SNV, with financing from the Australian Government’s Water for Women Fund.
 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, contact: Thinley Dem, Behavioural Change Communications Advisor, SNV in Bhutan