ABSTRACT

Inadequate sanitation and hygiene contribute to morbidity and mortality. The Community- Led Total Sanitation (CLTS) approach is used by the Ministry of Health to increase access to sanitation and hygiene in Kenya. This study sought to assess the gender outcomes of the CLTS approach in three sub counties in Kenya. CLTS is considered successful in Kenya, yet its impact on men and women has limited literature available. Therefore, this study sought to document the impact on gender relations as a result of the CLTS implementation in Siaya, Nambale and Teso North Sub Counties. The Moser Framework, the gender socialization concept and the Gaventa Power Framework were applied. A complete census of the households was done, followed by cluster random sampling to determine the households to be interviewed. The Z-Score was used to determine the respondents. Further, 3 Focus group discussions were held with Village Health Committees and 12 key in depth interviews with Public Health Officers from the Ministry of Health. 384 Structured interview guides and observation check lists were applied in the sampled households. Quantitative data yielded was analysed by statistical package for social science and qualitative data was analysed through Atlas t 6.0 and Open Code 3.4. The data was presented in tables. The study found that the Kenya Environmental Sanitation Policy and the CLTS Trainers‟ Handbook did not address gender needs adequately yet CLTS was considered a success in Kenya. That 75% PHOs who were mandated to deliver CLTS were gender blind. That 67% of PHOs made decisions based on general data as they did not have gender disaggregated data on CLTS interventions. Further, it was found that men led in decision making at all levels of CLTS implementation. 64% of PHOs were men at county level and 85% at sub county level. 80% of the people present at community triggering were men and 70% of households reported that men led the decision-making process at the household level in relation to sanitation and hygiene interventions. Men were recognized more during the ODF celebrations as compared to women. 56% of VHCs are women who work without pay. The women provided sanitation and hygiene services in the home as part of their reproductive role and served as VHC resulting to unequal division of labour in CLTS with the women shouldering the heaviest burden. Women faced challenges with limited access to key sanitation resources, such as land and building materials where in households interviewed, 23% were women in Nambale, 15% in Teso and 25% in Siaya. Besides, women had limited access to the latrines and bathrooms, such that it curtailed the benefits at 36% in Nambale, 29% in Teso and 37% in Siaya. Participation of women in decision making in CLTS was tokenistic, whereby there was only an increase of 2.3% of women invited in the decision-making space with minimal strategic benefits, they were not able to claim any space or autonomy in CLTS implementation. The study concluded that despite CLTS being considered a great success in Kenya at 58% as reported by PHOs, it was not applied in a gender sensitive manner thus entrenching unequal outcomes. Teso registered at 23% ODF and Siaya and Nambale registered 93% ODF. The study recommends that there should be a review of the KESH policy and CLTS manual to integrate gender responsive impact assessments and initiate critical enablers. Also, all PHOs should be trained on gender mainstreaming. Similarly, gender mainstreaming should be integrated into CLTS intervention through having flexible gender strategies that would ensure equitable outcomes. The study therefore contributes to the existing literature on community led total sanitation and may inform policy formulation and implementation by the relevant stakeholders.

            Background of the Study

CHAPTER ONE INTRODUCTION

World Health Organization estimated that about 4.5 billion people in the world have lack access to safely managed sanitation services (WHO, 2017). As a result, 361,000 children under 5 years of age die due to diarrhoea in developing countries, a disease associated with inadequate sanitation and poor hygiene conditions (WHO, 2017). Adequate sanitation is the foundation for social development. Safe water, effective sanitation and hygiene are critical to the health of every community, and thus are essential to building stronger, healthier, and more equitable societies (United Nations Children‟s Fund, 2017). The United Nations (UN, 2004) indicates that the existence of improved household sanitation facilities does not necessarily imply that they will always be used. In most societies, women have the primary responsibility of managing household water supply, sanitation and health because of their reproductive role in the communities (USAID, 2010). However, efforts geared towards improving the management and access to safe drinking water and adequate sanitation, often overlook the central role that women play (Mehta, 2017). A WHO report in 2013, stated that women‟s participation in decision-making is hampered by cultural barriers and traditional gender roles.

Studies have shown that the lack of safely managed sanitation affect men, women, girls and boys differently, and their roles in ensuring improved access to sanitation and hygiene also varied. This calls for applying sanitation interventions using the gender lenses (Mehta, 2017). Gender was considered as the norms, roles and relationships between men and women in relation to sanitation and hygiene programming. In the absence of a gender

analysis in projects and programmes, there was a risk of failure, less success or reinforcement of inequalities. An analysis of this kind could be undertaken at any stage of the development intervention to ensure that there were limited unintended impacts of the development intervention in relation to reinforcing inequalities (Africa Union Commission, 2015).

Community Led Total Sanitation (CLTS) approach was first developed and tested in Bangladesh as an innovative methodology for mobilizing communities to eliminate open defecation especially in rural areas (Kar et al., 2008). CLTS began at the community level where respected individuals in the community, identified as “community champions,” were trained to facilitate a process known as “triggering.” Triggering was a 2–3-hour process using hands on exercises designed to persuade communities to realize that residents “eat their own faeces” because of poor hygiene and sanitation. One tool used for triggering the community was the transect walk, often referred to as the “walk of shame” involving leading participants around their village and surrounding area to locate faeces resulting from open defecation. The communities would then respond to the triggering process in different ways as follows;

1. Match in a gas station – Entire community is fully ignited, and all are prepared to start local action immediately to stop open defecation.
   1. Promising flames – Majority of the community members have agreed but a good number are still not decided.
   1. Scattered sparks – Majority of the people are not decided on collective action, and there are many fence-sitters, and only a few have started thinking about going ahead.

• Damp matchbox – Entire community is not at all interested to do anything to stop open defecation. (Kar et al., 2008).

After the triggering, communities would usually decide to create a formalized sanitation committee and to try to become ODF, leading to latrine building and waste management improvements (Kar et al., 2008). It is worth noting that these decisions emerge from the community members, rather than being imposed by the CLTS implementers.