[MUSIC] Our guest today is Dr. Kamal Kar. Dr. Kar pioneered the development of CLTS, or community-led total sanitation in Bangladesh in 1999. CLTS is a policy intervention designed to trigger an increase in household demand for improved sanitation by triggering disgust and shame at open defecation practices. And since 1999, CLTS has been rolled out in dozens of countries around the world, and most international donors have adopted CLTS, in some form, in their own programs. So Kamal, it's a pleasure to have you here today. In the- >> Thank you very much. >> Yeah. >> It's a pleasure >> Yeah >> So it schooled. >> Yeah. So let me start with a question about how you came up with this idea. I mean, it was quite an innovation, right? I mean, it was very, very different from what was going on in the sector at the time. How did it happen? Was it something that developed over a long period of time or did you have a flash of inspiration? >> Yeah, in fact, the question was, it's definitely, I mean it's a huge paradigm shift, what has happened. But as you asked me that, how did it happen? In fact, it happened sometime in 1999 and early 2000. I was involved in evaluation of water aid in the country Buram in Bangladesh. And I was the team leader for the evaluation. And I went to see a traditional, this water sanitation program where latrines are built with subsidy and construction materials and design and everything were given to the people, and water facilities created. And in my team, I had many specialists, and different specialist, the hygiene education specialist, engineers and all that. But in village we visited, almost everywhere in Bangladesh, from North to South in different parts of Bangladesh, we saw that toilets who were built the local NU partner of WaterAid, VERC, Village Education Resource Center. They did a good job but the toilets were there, at the same time open defecation are also there, it was rampant. So I was thinking that why this? Is it just to increase the number of toilets in a village and nothing changes? Mostly people use them, the new toilets built but many didn't use also. You know the liberty of you know, open defecation was there, also. So I was, you know, this question was haunting me, I was thinking that, what, I mean, if this happens, then what health impact do you get it? And, there of course, rampant diarrhea, cholera, and other things, that used to be there. So from that, we, you know in my recommendation all of the recommendations you know I gave that the poverty in Bangladesh was not same. You know? But how come you know you gave the same subsidy? So one recommendation was that to conduct a participatory poverty assessment and design a difference yield subsidy. And in more poverty more poor so give more subsidy less. So that was the idea. And then they came back to me, the WaterAid, and they said, will you help? And I said okay. So after some time we went there but then my, the question was hovering in my mind. That why do people defecate in the open in the first place? Because, you know, the traditional understanding of what in the sanitation sector, the professionals, was that people were poor, that's why they defecate in the open. They don't have the means to construct a toilet. So that's the you know, on the line. >> Mindset. >> Mindset. >> Yeah, but then I thought is that a correct mindset? Because there were toilets also, you know, so there is. Okay, let's go back to the people and learn from them that why do they defecate in the open? Is it by choice? Or is it, you know, there is no means? What is it? They know you went there. And then we use some participatory tools, to mapping and who defecates where, and all sorts of things, but precisely to understand. It was totally a learning exercise. And in that village, sometime, somewhere, and it's a village called Mosmoley in Rachid District in the North of Bangladesh, you won't know that they knew and I told all my team members don't talk about toilet, don't prescribe anything, don't suggest, just learn, totally. We said, we came here to learn, that's how it began. We will start gathering huge map, people said that they put in colors where they defecate etc. We walked around the village, we saw piles of human excreta to the water body. People are taking bath and washing clothes and everything going on. So when people walked along with us, the realization started building up. And then they realize that how human excreta and shit is being generated. It was building up, the inhabit becomes a heavy you know. And other people started, women started speaking and you know some pointing. And even you know closing, I mean, their nose and everything, covering their nose and mouth and all that. I said, what's going on? You could see that. From the discussion by the people, the analysts as well, and then they were explaining what's going on because we did ourself as a learner and their role was the trainer or teacher, explaining about their village, you know, where we are strangers. It built up, and people then said sir, give us some money, then we will build toilets. Then we said, no, no, we are not here to ask you to, we reminded, you know, our role is just to learn. And then they said, then why did you ask us to do this? We said is that somebody said not really, it's not your problem, but from telling you, from teaching you, we have been realizing that it's a terrible thing we have been doing here, you know? And then they came in here and said please do something about it, we don't want to live in this environment. We said look, honestly, we told them the truth, we are just learning exercise. Then one guy stood up and he said, look sir, many in jewels, they call them in jewels mainly, give us money, and you are saying you won't give us money and you don't give us money, and you came here to learn. But look, if you really can't give us any subsidy, you talk about subsidy, we are all poor. I say I understand that, it's a poor area, you know. But this analysis we have done now, we cannot survive. We cannot live like a human being for a single day. I said yeah. What you do but whatever you do, you continue like this or you do something, it's up to you. But we have learnt that you understand so much about the situation. Then everybody said we are not going to live like this for a single day even. We are going to do on our own. And we don't have so much of money, whatever we can, we will do that. I said, fair enough. And they said, in two months time we are going to stop open defecation. I said if you read that, I also give you reward, I'll come back with the newspaper and the television and tell Bangladesh, that this is one village who didn't wait for any outside help and did it on their own and stopped open defecation and the rest is a history. I mean at least 15, 20 countries from all over the world, visited that place, well and that was about to be sildious. But I saw the tip of the iceberg when this man said, that if you talk about subsidy we're all poor, but we cannot live like this as a human being for a single day. >> So that was the flash of inspiration >> That was the flash of inspiration. >> Yeah >> He immediately referred it to subsidy. That we know it. We have been waiting for some money. But if there is no money, we are not going to wait. But, it's not that they didn't know the situation, they knew it. But, collectively to do that, they didn't do that analysis before. Individually they knew, they, cover your nose and walk some path, which is smelly and everything. >> Do you think you were just lucky? I mean, there are so many people at the time working in sanitation, >> Mm-hm >> right? Why didn't this happen in the other places? Other people see this insight, what's? >> Dale, that's a very, very interesting question that you have asked. It was as that, I come from the background of and livestock production systems, and for me it was a new way sanitation water, and sanitation.outlet, and I but when I was reading that you had these in studies mainly, because I used to do quite a bit of participatory. Analysis poverty assessment, impact assessment, to not so they brought me to check a participatory impact assessment, but then you do as why interaction to this all of water and sanitation. Coming back to the question that you raised that of course specialist of water and sanitation. But why did it not think about it, and I, being a professional coming from a different discipline, my angle, the perception of looking at this, was different. It's more from a common person's perspective. But when I asked this question, and I thought why they didn't think about it, I think, they all agreed to the underlining assumption that people are poor. They need money and support. To build toilet. So one was nobody challenges the toilet is a solution. And that's why they had to be given toilets. That used to be the thing and still hugely changed but still to some extent it is there. The toilet, they don't have money, give them toilet. And they don't understand all this teach them hygiene education. They cannot build a toilet, give them prescribe technology. So everybody agreed to that nobody challenged that one, but when we went as a learning exercise you went to the village, and when you start try to understand why do the people do it? Then I realize no, nobody spoke about toilet, they all started saying that we must talk open defecation. They were referring to be in the change question. And that do not individual change, collective change. We must not allow anyone to do this. So then it triggered in my mind. All of those things one collective behavior change. Two, non-individual uses of the toilet by some. And others. It was not that. The public good, nobody defecates in the open. >> Well, what kind of a reaction did you get from the Washington community? >> I think the initially [INAUDIBLE] I must say, there was provisional. Because again, I was talking something, which was completely new. And nobody was, hardly anyone was prepared to accept that one. They said, come on, what are you saying? No subsidy? No toilet, no money, can they build it? They can't do. They couldn't imagine that people could still do a lot, and well the simple question of breaking the fecal oral contamination, is what safe confinement of human excreted. From human contact that sanitation you could do it from $5, with no money or $5000 may not be enough, you could do a whole wide range of things but these people, the professionals, they couldn't realize that, they can do it first and they need the support. They don't do that generally that was the blocking factor, so there was huge resistance initially. But, gradually, when it started changing, and when they started watching and observing the impact on health, because which, probably they didn't look at that much, because, it was more engineering driven, and infrastructure driven kind of a thing and ideas and concepts. But It started drifting from there, to period change, to the public good versus individual good. And then participatory technology development, using local knowledge and local ideas, is all new. So that was the point, and then they started agreeing to it. Secondly, from the institutions, from the professionals, huge resistance in the initial stage. >> There was more resistance, don't you think, to the no subsidies argument then to the triggering? >> Mm-hm. >> I mean, my sense, even today, you've changed the sector, in terms of the acceptance of the idea of triggering behavioral change. But there's still a lot of debate on subsidies >> Yeah >> I mean why do you think it is- >> Yes, yes. It is again bringing it. I mean this brings us back to that understanding. They need money. They need support. Per a particular thing which we prescribe from outside for them, which is the best solution. I mean fair enough. But, the sub city question that can you give it today? If you get them the real good toilet, one that's called nice toilet and everything are they prepared to use it? You know? That's the question from where the subsidy question comes. It's not no subsidy or subsidy. It's not yes or no question. Definitely poor people, resource poor people, they need support. But, preparing them for the support and bringing the baby a change. And preparing them for the support that the government or the NGOs are offering is a process. >> How do you think subsidies should be used today? >> Yeah, that's why, I mean, when I say more subsidy, I mean, precisely I wanted to say no up front household subsidy. You see but the once they move up, and do this subsidy, it's all supply driven, that I come to you as it's different quality, this quality this and that, whether you need it or you don't need it or what your understanding, Irrespective your put, here is your support. But you can change it do it demand driven When do you treat her demand comes up. And then you come and this and that and gradually this start, they dont wait for a new one. It stop moving along. So subsidy if it is designed, first of all, it's not package that only this particular thing and this some amount of money has to be given and to a person. So these three things are answered then you can use this subsidy money quite a lot. For example, in the different stage of intervention on the scientist and latter, as they are going up. It could be a sample to the community and let the community decide that who should get it and who should not get it or it could be some portion of the construction process or it could be it. Not necessarily it has to be always subsidy for infrastructure and individual holder, it could be collective but it would be planned in a different way. >> Uh-huh. >> Or there are different, you know experiments that we have done it, that subsidy is giving a resource is unseen subsidy. Like in India and many other countries when you buy fuel or petrol, it is subsidized in resources. You are paying some money but you are paying, your purchasing that already on a subsidized price. Is not seen, but you go there to buy it. So it same thing it would come in sanitation as well. But it's demand driven, it's no longer supply driven. >> Could we shift to the rollout of CLTS around the world? You've done this now in dozens of countries, in all continents all over the world. What kind of cultural differences have you found in different countries in terms of different ways of rolling out CLTS. Is it the same everywhere or you've done differently? >> No, no, no, no, no. It's very very interesting question, it's huge, I started educating myself, I taught this the phenomenon of open defecation is probably. It's a phenomenon of you know, the sub continent India, Bangladesh, Pakistan, Nepal, these areas. But gradually we know when it started spreading out, then I found my God it's everywhere. You know what I mean, in the continent of Africa and Latin America and many places. And definitely this has got its link with the cultural you know, taboo and a lot of other things. But almost everywhere, this is a question, you know, which is not discussed and not suppose to discuss in public openly, you know, it something let's not discuss about it. Let's not go and see this, so, it remained, you know, behind the screen people and everybody discussing openly. But the moment you talk, you say, excreta, or feces, or all these, stool, and all kind of things, people think, it's another health lecture. But, shit! So people wake up, be something serious, what is it? So the first cultural thing is that one that's breaking the table amongst the professionals. But then indifferent use of toilets huge differences, the cultural differences. I remember in countries in Africa even in Kenya also the mitt, there was a kind of an understanding in some areas of Kenya among some tribes that a pregnant woman should not use a pit latrine because she might abort In a kind of a thing in a concept, you know. But, when city is scheme. It will start and it will said, no, no no no no. It is was, to difficult here and there. And your child will knows, like Bill Gates will also be continental and you suffered and you know cleanliness. Then I remember that was in, well where was that? In Madagascar. The people, Sakalava, a tribe in Madagascar community which is in the North West of Madagascar Island. Probably the largest community of the ethnic group Sakalava. Their belief was that when our people ancestor they all live underground, the dying we bury them. We can't dig a hole and shit there, we can't just do that, you know? It was completely not acceptable. So then everybody said, come on, CLTS is not going to work there, you know? I said, okay, let us try, let's try and see. And we went there. Perfect triggering, people said we will did and we'll start it. And then this opposition came. From some section of the community and Sakalava king came in the picture. The king of Sakalava and there's a whole discussion and everything he said this is perfectly all right. And he explained that nowhere it is written that you defecate anywhere and everywhere and kill your kids for diarrhea and this and that, it's not that and he explained and he signed. That it is possible. And then Sakalava in Madagascar is one of the best, you know, the tribes to adapt CLTS. All over the country they leave and then between Madagascar and different places. So different kinds of cultures and taboo. And again, probably I saw in Libya or Syria. Well, you know, people. Suppose you have an orchard or a good, you know, plot of good vegetables and all that. People might steal, you know? From there, you know? All the time you're not guarding, so. Contrarily, they put a kind of a weird looking, a hardened port or something like a ghost looking structures that stands on a ground free. And they do some kind of preams, some rituals of traditional rituals. Knowing that if you enter that one and that place, on the orchard, then this host is going chase you, and then you're going to suffer from a very severe disease or something like that. So, I knew it, but when we triggered in that village. Next morning the first thing people lead brought that structure to lead on the deviation area. And all you would go there because in order to in college people to have your own toilet don't come to these places and nobody came. Many people were so scared to came and living in there. So, they started using it. So using it for in favor of bringing that collectively change by briefing the taboo when they meet and kind of things explaining them by the community not outsiders. And also using some of the taboo to discourage of identification the both side >> You have found places where the taboo actually prevented you from rolling out so you'll, or so you just have to be sensitive to the local >> Yeah. No, I mean, when I try to imagine, it never, ever happened anywhere. I mean, from Asia, Africa, Latin America, nowhere. It stopped, CLTS. Because of the taboo, we are not going to do this. They did it and but, initially everyone from the local area, the. They were skeptic. They thought that it's not going to work. I said okay. >> You mean the professionals? >> Professionals. And I said, look, remember it's a learning exercise. If we went to a village and we found that because of their own traditional practice, or taboo or cultural something belief, people want to continue to defecate in the open, that would be our learning. Let's go and learn that, what is there? So at least we'll get one village in the where people continue to defecate everywhere and eat each other's shit because of the taboo prevents them. No, nowhere it happened. Everywhere but the most important point that we don't wish, we must not and should not try to break that taboo. Allow them to handle it. Allow them to discuss and everywhere they sorted it out and their traditional leaders, natural leaders, and the local priests, they sorted it out as I said Sagala King. And it's, it >> Talk about your concept of institutional triggering. I mean, you've seen CLTS rolled out all over the world with lots of different donors involved, different people adapting your ideas, and the way that CLTS gets used within different donor organizations. >> Yeah. >> But how big a problem do you think the donor coordination, lack of donor coordination is in the sanitation policy. [CROSSTALK] >> Absolutely. I think that used to be, as you are coming back to your, I mean referring to your allegations, that you know, did I get a resistance from the professionals and a lot of some of this and I did as I said. And gradually, they changed mindset when they saw, you know, they stopped realizing. Same way the donors, you know, also not all donors came and accepted it. It was the first British DFID, you know, when I did it in Bangladesh, they came up and they saw this was fantastic. And, and they came and they tried to scale it up, and they gave funding support to WaterAid Bangladesh to scale it up but at the same time the defeat who were convinced that this was an approach that was spreading, they supported what we were doing to scale it up. But at the same time, they supported UNICEF Bangladesh, you know, to subsidize toilet free distribution of toilets through. So both the things going on, kind of the, so that was one thing. But they did believe, and gradually they expanded their support on CLTS. But UNICEF, later on, it took some time, as I said that when Clarissa Brookerhouse, she used to be the county director of WaterAid when. >> Clarissa's been interviewed for Mook too, >> Okay, all right. >> She can't be here today to reflect on this with you. >> Yeah, yeah, so the clients are, when later on when she became the chief of >> UNICEF, in New York, she called me up and she said Kamal, can we do something? Can we change this? And this initiated this one. And then, she used to take over a hundred days of my time, in a year, in the initial stage, to bring this thing in UNICEF. And she really worked hard. I used to give some time, mainly in Africa and started ruling it out, UNICEF adapted. But and later on, The World Bank adapted, EU accepted. It took some time but the dual coordination within a country is still there is a lot of space and scope to improve that, enhance that. [CROSSTALK] >> So, what do you mean by institutional triggering? >> Yeah, institutional triggering is, again, I mean, the donors are donors. Their support comes to different countries at the country levels, but countries political leadership and the planners and decision makers, they have to take their decision that how or when my whole nation is going to be open defecation free? And what does that mean? What is the value for the prosperity of the country and everything and the health of the people and GDP growth and so on and so forth? But again if you looked at countries, that decision is also influenced so heavily by the donor's money and the donors from outside. That's not correct, because democratically elected government of a country should have that capacity of the thinking of the vision to think about that. So some donor thinks that this should, I will control from outside, this will go like this. Another donor, they say I've been also giving so much money so when it come to the country at the country level there are two, three donors not coming on a common platform. Unless it is physically developed by the donor. Telling that this is my national signed this in policy. So, you were Donor A, Donor B, Donor C you have to follow because on that policy, we have a target and we have a roadmap. So, this does not happen, is not existing in many places. So, this institutional triggering is exactly that. We go to a country and we talk to the president and the prime minister or the ministers or the senior bureaucrats or the planners. We discuss with them, we tell them, we assure them that we have hundreds of in different places in your country. Do you have one region, one district, five districts? And the nation? Any thinking? So it's again a triggering with these people to help them to think through that this hundreds, 200, 1,000, 5,000, what does that mean? But the country is still not open defecation free. Helping them to set their target and making a roadmap. What do they do and how different ministries must collaborate. How they should have, why they should have a national policy and implementing the structure of the policy at the grassroot level or the district level or the provisional level. Do the regional, all the regions have a plan? So, all this kind of things. So, in a kind of way, in a sarcastic way. We say that, community will stop the open defecation but institutional open defecation is a very serious issue. That nobody is willing to come on a common platform and help the government to see, make the country become more DF. So that's what we have developed, and structures, and ideas, and institutional triggering. This is not only restricted to the government and the national level of the country, but also to bigger institutions, maybe agency or bilateral, multilateral they have been implementing their programs in 50, 60 countries. So, how is that coordinated? What are their plans are? Because say for example, an international donor supporting through UNICEF or some international organizations in 20 different countries, but the performance of their program in 20 different countries are not same. Some are very high class, many are moderate, and quite a number pretty poor performance. So how do we really restructure particularly in water sanitation, sanitation in particularly. And learn and extrapolate those learning from the best ones, and bring them all to a level. The whole idea is that efficiency of utilization of the donor money is improved. You know, it's eventually some taxpayer money of somewhere, isn't it? >> Yeah. >> So that's the idea that you trigger so that these people, these institutions, do not only think in scaling up a lateral spread. But also think at the same time in vertical spread. I mean, going up, thinking quality and improvement and enhancement and all that so that utilization of each dollar or pound increases. And [COUGH] the whole intervention becomes more sustained and then newer intervention is not looked at or does not remain as a something one off, coming from outside. But rather, it is mainstreamed within the government. So that when your donor support or the programming is withdrawn, the capacity is built up, it stays. So these are the kinds of things that we try to do, setting a vision, road map and etc, policy influencing in order to help the country to progress. And precisely, focus towards scaling up CLTS to country-wide scaling up of CLTS. Learning from their own experiences and the examples that sit in the country. And it's, again, that donor coordination, or donor support and acceptance and also quite a bit because we never force that any donor or country that you have to do CLTS. Because that itself is again, if they think this approach is okay, otherwise they are free to stay, continue with the traditional approach, or any other approach they feel like. But, this is precisely an empowerment approach, community empowerment approach. A community-led approach, not outside institution-led approach. And that really to institutionalize this thing, a lot has to be done. >> If you could explain your idea of missing toilets for our students. What do you mean by missing- >> Missing toilets it's again, Dale, you are asking very interesting questions and they are so interrelated. When you asked that what had been the resistance from the professionals, and then the reluctance to accept no subsidy, subsidy, etc. And then the donor, and coordination, it's all leads to that toilet, a commodity, as the final answer. Not the people, but things to people that shift. And that's where, because if the toilet is the whole thing, it's from the donors, from the professionals, from the government, that's the one. So it would be nice toilet, it could be used, it would exist, it would exist only in the paper and totally missing. So there are whole stories in that and so you can play around with that. So there are countries in Africa and in Asia where the toilet, missing toilets, meaning, toilets do exist on paper but there is no existence of it. Meaning, it's the resources has been misutilized. >> The government ministry, it has it in their records that they spent the money to build the toilets. >> Yeah. >> And they were never built? >> They were never built. Like in my own country even the, government of India is reporting says that millions of toilets missing. In Africa also, that, countries, the toilets are missing, it's kind of- >> Is it because they were never built or people have used these materials for other things and this is- >> Dismantled and used. >> That's also the like the materials support has been given to the people. And often, that material support meaning, they supposed to ring and the slab, the rings are ending up in a cattle trough or manger for animals or something. Or the door of the CGI team, roof, or things that's all utilized for different purposes. All the materials given to them. So the toilet, with all the materials in place, do not exist, it's gone. So that's also missing and then the money spent, but full toilet is not constructed, is also there. You can see a super-structure, but there's hardly anything sub-structure. So that means it's just to show you from outside it has a toilet but it is never used, it cannot be used. >> There's no pit there, right? >> No pit there. [LAUGH] So these kinds of things. So these all come from the one factor, that it is supply driven. >> Yeah. >> There is no need, the moment you make it demand-driven, these things not going to happen. People will come to you, they will have it, because it has to be a functional something. >> Yeah, can we talk about India now? >> Yeah. >> Prime Minister Modi has made a big push on sanitation and my understanding is that the government of India signed a $1.5 billion loan with the World Bank. >> Yeah. >> What advice would you have for the government of India in terms of how to spend that $1.5 billion? >> Yeah, actually, I was talking to people in the World Bank, and they told me that this loan is, it will be give on outcome basis. It's not that toilet construction or everything, the same old style and hardware construction etc. But it's going to be used for quite a bit of sustained outcome. So ODF areas or ODF blocks or districts or whatever. So I thought, that's fine. But the question is that, how, in a policy environment which still talks about subsidy, increased subsidy and this World Bank's 1.5 billion, how that fits in. That needs to be unpacked a little bit. But as you said, Prime Minister Modi's mission, the program, is a program. It's something India really needs and this one prime minister who has emphasized so much. The prime minister has so much on this. Not only on sanitation but also environmental, cleaning up on, everything in the Ganges, a lot. And, if it's a clean India, it's a different nation, actually. And people can do it, but what is really needed is involving millions of people. And that is the present system of government-driven, subsidy-driven, prescriptive. Do this, do that, and here is the money. From that, that shift is needed. As I was telling you that the collective behavior change and community led. And only then you could engage millions of hands to work on this, more than millions of hands. And it moves on. So one as you've asked me that the recommendations would be, I would say they should really focus to strengthen the software, meaning collective behavior change, training on those things. Building institutions which do not exist or some do exist but enhancing their capacity for a deeper understanding of behavior change, sustained behavior change needed. Otherwise, the risk is it might end up into that NGP, the. People, false reporting, there are lots of audiophiles emerged open defecation free villages, they receive lots of money as a reward. But eventually, now most of these villages, the ODF villages, didn't stay as ODF. It became to full fledged, the practice of open defecation came back. So the government learned from that that big money, an element of a big reward or something, might lead to false reporting without verification. And then that NDP, the the clean village, if you want, scheme was abundant. That was stopped. It might become something like that. A district, truly if it is not ODF, so I would say monetary mechanism must be very very strong. And from this 1.5 billion from the World Bank this is indeed a great initiative. And it is, if it is properly implemented and guided, I think Prime Minister Morris, the such program will be the solid booster of it, definitely. But the monetary, is it really ODF? Is it going to be sustained ODF? Coming back to your one question you asked me earlier, that's slippage. All over the world, slippage is a phenomenon. When that slippage to some extent, but what extent that slippage is taking place depends quite a bit on different factors. One important factor is how the quality of triggering and what is the quality of post triggering follow-up. And that is the time when and post ODF activities. It depends from country to country, institutions to institutions. But a village which moved up say, 5% access to basic sanitation, to moving up to some time 90%, 99% or a 100% ODF It's slipping down to 5% to 10%. And that 10%, it goes up and down, you know. There are different factors. Never, ever coming back to that 10%, back to square one. When it is hugely incentive led or reward led. You are not defecating outside, so here is your huge reward. Motorbike or something. So how do you feel? So this chances are there that it is not really a true verification, is not sustained ODF status. So coming from there, the idea is indeed great that it really has to be outcome focused. Maybe the health outcome, their should be some mechanism to record the health outcome because if the village is ODF, if fecal oral contamination chain is broken, there has to be health outcome. Diarrhea has to come down, stunting, everything, lots of other disease. You will simply see that. I have seen in very, very poor villages in Africa and many, many countries a completely different look. Children look different there. >> I teach in an engineering department, and one of the things that we're worried about in sort of planning bulk water and sanitation is to keep the pit latrines away from the wells, right, because cross contamination. >> Yeah. Absolutely. >> But if the pits are built and the people do use the latrines, then there's always this risk. >> Yeah. >> So when you're working in a village to eliminate open defecation and people get triggered and they start building latrines, how do you ensure that the latrines are far enough away from the house? >> Yeah, yeah. Actually, I must tell you that CLTS, the whole CLTS has got four phases. We call it pre-triggering, I mean, fixing with the community, the preparing of this, and then triggering and then post triggering follow up. Once they are triggered, from the time they are triggered till the time they become open defecation free. We call it the post triggering follow up and then once it becomes ODF, we there is another stage which is post ODF activities. So in that post triggering follow up, we come there and you know, the facility that's from the outside we go and they asked the community that, this is your dug well, drinking water well and what do you think and where are you going to build the toilet? In discussions, you know, close to it or away from there? They say no, no. As much as possible in a distance. They know it but often what happens due to non availability of in op space and this and that stuff and then there are, we have always seen, that initial stage one or two days when the spirit that everybody is trying to dig pits and construct toilets. We don't say anything at the initial stage, but once they begin, they ask their resource people within the village. And there are people they will tell you that normally as far as possible you have to make it keep a distance and the pit side and etc., but the specialists are also our level. As the construction process, they get into construction process, they ask questions. If they ask questions, you answer, but you don't go and prescribe straightaway. So at that very initial stage, and people will have seen that as the concept of goes on, they ask the village persons, they ask the outside professionals to setting up the distance if they have the space. But- >> You don't really think this is going to be a problem. >> This is, like I have seen in the the advanced states in India, like Kerala, who became ODF a long time back, even before CLTS but we all had the pit latrines and the, and not everywhere the septic tanks, the floor was not lined or anything. So that leaching, that heavily contaminated that groundwater. So the water sample, you know, it has got all the contaminants and all that. So that's there. But the water table goes up and down so that way pit latrines, these things are there but whatever the hand pump, the what do you call it, tube wells, they draw water from a very good depth. It is not there, and it, not everywhere we have checked that water sample, but the Gormen supply in particularly in India in the CLTS, the facilitators they use the H2 as files and collect the water sample and it becomes Dark and black, you know. It is fully formed and all that. >> My impression of it is the heart of the open defecation area in India is the Ganges plain. I heard a lot the area and ground water there is not so, not so deep right? >> Yeah, hm, hm. >> Yeah, yeah, real interesting. Could you talk a little bit about your, sort of, vision of the sanitation ladder. I've heard the anecdotal evidence that people use the trains until they fill up, and then sometimes they get abandoned, as people go back to open defecation. >> Yes, yes, yes hm, hm. >> But what's your vision of after Open application has ended, there are a lot of participatory techniques that you've, years. [CROSSTALK] What, how does it progress? What's the future development path for these villages. >> Yeah, yeah. You know it's again, that's safety no from. Colleague as a solution to capability to change as this solution on sustained solution it brings as back there. So imagine if how many or a community. Who have never, ever used toilets across generations, many generations. The first time they're using toilets. And when it is triggered, they generally start a pit latrine, a simple pit latrine, and start moving from there. And as soon as the behavior change has taken place and these simple toilets tend to collapse and everything, and they don't want to go back to the open defecation again. The interest for investment, or going to different sources for building the toilets, better toilets, moving along the sanitation ladder, that comes out. And at that time, what is generally done instead of giving one solution and asking for choice, different options are given? But again, we have seen so many places like in Cambodia and then some places in the name of scientist and marketing. Something the toilet prescription comes up again, because when it comes as one solution it's a problem, but if it comes up with so many other options there's not a problem. But the last roend of the latter is so expensive, not necessarily all community everywhere we'll be able to access that because of its cost. >> You mean the last rung being pipe sewage. >> No I mean the first rung. Meaning, say the toilet model unit cost you $50 to $60 or whatever, $40. Not that everybody will be able to access that. That's one, the cost. And the number two. The easy access to that material. Somebody has to go to a long distance to bring it, and etc. So in places like this, in remote places, etc. What is really best is that, we have tried this, and then facilitators in many countries they have tried this. It's participatory technology development. You know, it's the technology assessment and technology definement, because some idea exist there. They have been using, you know, local materials and how do you, you know, find human that technology improve the engineering aspect of it. Again using local materials and with blending some other materials so that the structure becomes stronger and durable. So a lot of good work has been done by a group called engineers without borders in Malawi. And they have done beautiful toilets and they have been working on this particularly. I had an opportunity to listen in to their presentation. In the Wittick conference in Nakuru probably in Kenya. And you know they have publications and everything. Like this in Cambodia also have done with them is participatory technology development. Technology assessment and refinement so that it's not a technology prescription, everything coming from outside. So it becomes durable and their ideas, say for example, I was, I've seen that in places where water table is very high or there are problems of seasonal flooding. Whole community brought their ideas and made raised platform, raised pit latrines. And using the trunks of the coconut or the palm tree, making and drilling a hole on it. And at the whole platform the plate sits on that and it's raised and then soiled and then covered and the superstructure is on that. So you climb a few steps on the ladder and there you. That is your toilet. >> You mentioned changing or creating institutions. That's a question that I wanted to ask. I mean you watched CLTS get rolled out all over the world and different kinds of institutional environments, do you have any recommendations on the institutional arrangements that the country needs to make [CROSSTALK] be scaling up CLTS mos effectively? >> Yes, quite a bit. And this relates to, again that country wide scaling up and a road map for getting or give nation differently. Because they want to see that this is a new thing, and some people from the professional sector, from major players of water in sanitation. Sanitation in a country they are the ones who used to do top down prescriptive sanitation approaches and subsidize. Then they came into this, they were the ones again, many of them used fast participatory hygiene transformation and all that. And they're the ones now bringing CLTS. So across the time ages they are changing their things but these needs a lot of facilities and skill good understanding of the society and all that. Some do good, some not so good but if a nation or the government or the some international funding helps to develop this as an institutionalized this streaming and improving the capacity of the existing trainers. Because trainers are needed, definitely. Many more trainers are needed for every country at the national level, at the district level, all the regional level. So, it dedicated institution. Could do that much better than as some ad hoc temporary institution. >> Do you think it should be part of the ministry of health, or the ministry of water resources, where do you think it would be best located? >> Exactly, it's linking to that one point five billion dollar you said that >> In some countries the responsibility of sanitation, it sits with the rural development ministry or the engineering, the public works or etc etc. And it's governed by a set of professionals who under stand much better, infrastructure creations and the hardware etc. Again the countries where the sanitation response really is on the Health or Ministry of Public Health, like in Kenya, it used to be Public Health Ministry. Health ministry and public health ministry, and they are one health ministry. In Eurasia, it's the ministry of health. Many many countries, you know? >> You think that's a good idea. >> It's a great great idea. Because whatever you do in sanitation, you must measure the health out come at the end of the day, isn't it? Because if I have not having diarrhea or my kids never have had any diarrhea and millions of those kids you know, no one has diarrhea. That's the final outcome we are looking at but we have our toilets and everything but diarrhea is also sometimes it comes and cholera, this and that. So health outcome must be there must be a some system to look into this health outcome. Because the best is if say for example in India, maybe giving the flexibility to the state that okay, because sanitation in India is a state subject. The states feel free is going to give you the guidance etc but feel free whether you responsibility on a prior basis to ministry. Some state can feel free to check it, because at the end of the day, if a state is reporting that India's average of child mortality under five or the average of diarrhea patients or cholera patients or enteric diseases reporting to a hospital. My state is far below the national average. It's a great thing, isn't it? How do you do it? You have to come to this one. Or a mechanism could be created so that the health ministry and the ministry involved in water and sanitation are linked up, there's a functional system working. And this is all monitored, because at the end of the day, we have to see that millions of cases of diarrhea are gone from India. It's very limited and stunting. It's a serious issue in India now that must to open defecation, and warm loads due to open defecation. There are huge warm loads. And the nutrients the are getting, it's and parasites inside and all these things. So these thing has to come at somewhere or the other. And then it's sustainable. >> I wanted to ask you about the sustainable development goal for sanitation. >> Yeah. >> I guess the goal is for the world to be open defecation free by 2030, right? >> Yeah. >> You think that's a feasible goal? >> I think, I mean, I must say, I'm convinced that it is not impossible. But I must say that we have to really work hard and do things out of the box thinking and try and do things. because this kind of institutional mechanisms and inter ministry coordination's and encouraging the government and president and some prime ministers to set their goal the target and help the roadmap. Keeping it goal is not enough but do achieve that goal that road map depending that roadmap and bringing everything needed, bringing them in a place Is more important. In 2015, there are almost open defecation free 99% isn't it a great achievement, is it? And Bangladesh is not a hugely rich country. But now, they have moved up so much. The basic development indicators, the child mortality and the incidents of diarrhea and cholera, this and that, fantastic you know. So that's why I think it's possible providing information Intel to those we are been working with the with this small country like Timolestio, Quivas or places you know like Gambia. You know we are actually intact of the minister Kala And we all helping them to double this kind of a target in institutional query. >> That reminds me about your COCS Foundation, our students have access to the handbook and other kinds of materials But I wanted to just ask you is there any new material? >> Yes. >> That you recommend that they look at or? >> Yes, yes it is coming up very soon we will announce from the in from the website of Silt Foundation that the as I said that the handbook that I wrote It's quite old but since then, a lot has changed. So the new book is coming up. It's almost finished or very soon, From pillage to mission, precisely covering that we used to talk about. Now in the SDG, we must talk about. In the next four, five years, six years, we should have a few more missions, which are ODF. Otherwise the dream of chasing the dream of ODF is the ODF. This world have been picked up from the and probably did not exist before. People have been talking quite a bit of ODF, open definition free. So from toilet coverage to open defecation free, two different things. We got that guarantees that use of toilet and everything. So this is coming up and then as I told you that on institutional triggering it's coming up and also a few other things like on the matter leaders and all this Literally just because we knew experiences we were putting it together sometimes yeah. >> Do you have any last thoughts for our students on sort of out of the box thinking or any advice on sort of how to be creative in this space? >> Surely I mean I was very very impressed when I lectured your class yesterday And the School of Public Policy and the Worker Institute. And I found that there were students from different areas. That was so exciting and in this point, in this particular question, I would say that we must encourage students to think out of the box. Because in my case, you know, as you know, that I come from the, from the discipline of livestock production and agriculture. I looked at water sanitation from a completely different perspective, and a neutral perspective. And these ideas, this whole CLTS, because it was, only common sense. Trying to see, look at things, and why this happens. It could why not, it could happen, the other way. Many words, innovations, I've seen that it came from those people, who came from the outside of the particular specialize area. And they taught, and they contributed. And they created some ripple in the whole area. So I think we must encourage the students to think anything globally, holistically. Not necessarily my thinking should be restricted to the area of my specialization on which I've been trained. Or MSC, PhD, this and that, but, I could think of other areas as well? That and that synergy, it builds up. And, when I look at CLTS and sanitation goes to water aid, London They somehow very well. In my evaluation I was leading, I was the team leader for the evaluation. But all the other team members, they came from water and sanitation areas, engineers I was the only one. So it was of course, the was very high. People say that who is this man, he's not a specialist. But later on, it grew up actually. >> I think that's a great place to end the interview. We've got thousands of students watching this. So on their behalf, I'd like I have to really thank you for coming to Yes To Water Policy, here in Singapore and New School. It's been great having you, so thank you. >> Thank you very much Dean, it's a great pleasure talking to you on this wonderful [SOUND]
