Title: How to achieve change at scale?

Open Defecation Commune case

SBCC summit theme addressed: Expanding the boundaries of SBCC through multisectoral engagement
and a focus on structural determinants. 

Summary

Open defecation remains a challenge in Madagascar. Currently, 40% of Malagasy still practice open
defecation. The government has set a goal of reducing this practice to 10% by 2023 in its national
initiative "Clean Madagascar." The USAID-funded RANO WASH project has implemented a multi-
pronged approach for Communes to achieve Open Defecation Free (ODF) status. ODF status is the
basis for sanitation and hygiene interventions and, at the same time, ensures regular handwashing
with soap, an essential behavior, especially in this period still dominated by the COVID-19 pandemic.

This approach mobilizes multiple actors, addresses multiple factors, and goes beyond behavior
change communication interventions. Activities include strengthening the leadership of local
authorities to drive large-scale change, conducting communication campaigns to sensitize
communities, partnering with private operators to structure service and product offerings that
facilitate behavioral practice, mobilizing Village Savings and Loans Associations (VSLA) to improve the
availability of financing for both households and small private operators, a household coaching
campaign based on a progressive reward for achieving model household status, and a targeted
intervention with public institutions.

In two years, it resulted in 22 ODF Communes and mobilized several local, communal, and regional
entities. It reveals the importance of a multi-stakeholder and multi-level approach to achieving
sustainable change at scale.

Context/objectives

The USAID-funded RANO WASH project aims to increase equitable and sustainable access to water,
sanitation, and hygiene services to maximize health, nutrition, and environmental impacts in six
regions of Madagascar. The project experimented with combined approaches to help a Commune
become ODF. The Commune is the decentralized authority closest to the population, with an average
size of about 16,000 inhabitants, indicating the potential scale of such an approach to eradicate open
defecation. The COVID-19 pandemic has also raised the stakes in sanitation and hygiene promotion.
The project has developed this combined approach to achieve results at scale and ensure
sustainability.

Description of the intervention (practice-oriented proposals)

The intervention implements approaches in a coordinated manner to create conditions for change at
the household, community, institutional and structural levels. Instead of focusing on small rural
communities bounded by hamlets and villages, this approach aims to make the entire Commune
ODF.

This multi-stakeholder, multi-approach intervention focuses on strengthening the leadership of local

authorities, who then anchor all activities in their strategy to improve access to and use of WASH
services and the sustainability of hygiene practices.

Key activities:

- Strengthening governance and leadership at the local, regional and national levels, including
WASH planning and partners' coordination
 - Implementation of the Community-Led Total Sanitation, a community-based approach based
on empowering local communities to take charge of behavior change around sanitation and
hygiene
- Building capacity of local masons or other local private enterprises to provide improved and
sustainable toilet construction and handwashing facilities,
- Improving local financing mechanisms through VSLAs and using them as platforms and
partners for behavior change activities
- Implementation of a household strategy based on a reward system (Model Household)
- Supporting institutions to reach "WASH friendly" status
- A "Clean Commune" competition organized by regional authorities and with mobilization of
all actors for celebratory events

Results

Since implementing this multi-pronged approach, 22 Communes reached ODF status out of the 250
project intervention Communes. Four communes reached ODF status in 2020 and 18 in 2021 after
learning and scaling up in the six intervention regions. Currently, this approach is used by the project
team in all six regions. It is shared with other WASH partners at the regional and national levels to
contribute to scaling results. Communes that have become ODF have sustainability measures in
consultation with their communities to maintain their status.

This approach also built the capacity of local leaders and enabled them to structure their efforts to
achieve a common goal and make that goal part of a larger regional and national effort. Finally, this
approach fostered partnership among the various actors at the local and regional levels and
improved communication among those whose primary motivation was to achieve the common goal.

Discussion/implications for the field

This implementation of integrated approaches to achieve ODF status has highlighted that there is no
"silver bullet" solution. Behavior change can be scaled up with the leadership of local authorities.
Change must also be part of a more global approach to governance. Those primarily responsible for a
given territory must commit to mobilizing resources. Finally, the change must also be celebrated to
create a desire for change in neighboring municipalities.

The implementation of this approach revealed three essential elements: (1) behavior change is easier
under the leadership of the authorities, hence the importance of strong local governance support:
behavior change is part of the planned, budgeted, and coordinated activities of the Commune, not an
activity implemented by separate entities. It is also supported by legal and regulatory measures that
have been defined in a concerted and inclusive manner; (2) behavior change requires the availability
of services and products that support and perpetuate this change; hence the importance of involving
small private operators in the process; (3) behavior change is supported by the various institutions
and structures that exist within the community. It relies on structures (civil society organizations,
VSLAs, etc.) and institutions such as schools and health centers.

Session format: oral presentation