Lessons learned from the national sanitation campaign in Njombe district, Tanzania

Sanitation remains one of the Sustainable Development Goals, with slow progress. Tanzania has been implementing the National Sanitation Campaign through a Community-Led Total Sanitation (CLTS) approach since 2012. Njombe District Council (DC) has been identi ﬁ ed to be among the best performing councils in the implementation of the sanitation campaign. A qualitative study was conducted to document how the CLTS was carried out in Njombe DC, assess progress on CLTS implementation and de ﬁ ne the success factors for CLTS implementation. Findings show that CLTS intervention has resulted in increased coverage of improved latrines at a household level from 7.5% before the intervention in 2011 to 99.8% in September 2018. In addition, households with functional hand washing facilities have increased from 5.1% before the intervention to 94% in September 2018. Involvement of political leaders and government of ﬁ cials from the council level to the lowest governmental unit offered important support for CLTS implementation. The best mix of sanitation education, regulation and enforcement was instrumental in raising community awareness, changing collective behavior, making people comply with the village sanitation laws, and the overall success in the sanitation campaign.

The FGDs were conducted in public areas, mainly in the village offices and schools. Both oral and written consent were sought. The discussions focused on sanitation practices, methodology used to communicate sanitation behavior change and local resources, and community capacities in supporting the CLTS initiatives. Other aspects were the achievements of NSC, success factors, implementation challenges and sustainability. In addition, 28 key informants who represented the national, regional, district, ward and village levels were interviewed. Interviews focused on the WASH sector governance; experience on pre-and post-triggering intervention, success factors for the CLTS implementation as well as the challenges and sustainability of the intervention. Data were transcribed and categorized into various themes and sub-themes and analyzed through content analysis techniques.

RESULTS AND DISCUSSIONS
Approach on sanitation campaign

Sanitation in schools
Before the NSC campaign, the sanitation and hygiene situation in primary schools was poor, and improvement of The by-laws were enacted by the local government to discipline community members who were not implementing agreed actions. The implementation of the sanitation campaign in Njombe is summarized in Figure 2. Other initiatives during the campaign process involved training local artisans in order to provide technical support for the construction of latrines. Training local actors, including the artisans and opinion leaders, on CLTS intervention fits the diffusion theory whose position is that peer-communication facilitates the adoption of new behavior (Rogers ). Local supplies of construction materials were made available by local business people because the demand was already created. In general, this was an all-inclusive campaign. Sanitation became a common agenda across the relevant service sectors (health, water, education and community development).
It is worth noting that community engagement in improving the standards of latrines was gradual. At first, emphasis was placed on ensuring that latrines met the conditions of cleanliness, privacy, convenience and safety. The District Council, in collaboration with the village authority, prepared implementation plans with a set of targets which were to be accomplished within a specified time. At the end of the implementation period, evaluation was conducted to assess the success and challenges. The implementation plan for the period that followed required approval by community members. Generally, the majority of people moved up the sanitation ladder. Likewise, at the beginning of the campaign, the CLTS team promoted the use of a tippy tap as a hand washing facility. However, as time went by, community awareness of sanitation raised so much that a water bucket fixed with a tap was preferred to a simple tippy tap. Thus, communities no longer use tippytaps as they are considered not user friendly and less dur- In the face of this resistance, non-compliants were given time to build improved toilets. They received more health education, formal warnings or punitive measures.
Such measures included naming, shaming in public meetings, and imposing fines or prosecutions. Fines were largely used to purchase construction materials for the penalized households. During public meetings, names of the household heads who did not have improved sanitation facilities were read aloud. This was regarded as a shame.
In the end, non-compliance became more costly than constructing and using improved latrines. However, experience has shown that as far back as 1937: 'it is far easier to get the population to dig a latrine than to use it' (Nyasaland Annual Report cited in Austin ). In the context of Njombe DC, it was equally difficult to change the habits of people in various aspects including, for example, stopping open defecation or changing the habit of using grass and maize cobs for anal cleansing. In some households, pour flush latrines were built but members of the family kept using the old pit latrine to the extent that the village government had to abolish such latrines forcibly. This experience suggests that the use of pit latrines was habitual so that switching to new types of latrines required extra effort beforehand.

Progress on implementation of sanitation campaign
The sanitation campaign in Njombe District was launched in 2013. The first task was to conduct a baseline of the

Implementation quality
In this study, we established that there were systematic selec-  Part of the campaign was to explain to people that unimproved latrines were in the long run more costly than improved ones, both on social well-being and economic grounds. This is important because if constraints are perceived as unchangeable, they result in an end to planning latrine adoption at an early stage of behavior change models (Ajzen ). Indeed, a study from India also revealed that the culturally instilled perception of latrines as luxury assets and resistance to use inexpensive latrines had a stronger impact than the lack of material or financial resources (Coffey et al. ).

Community participation
The intervention was designed primarily to include every- Arrangements were made to engage the sons and daughters or close relatives of the elderly, sick or people living with disabilities who were unable to construct improved latrines to help them do so. Individuals who would potentially provide assistance were contacted even if they lived far from the district. In the cases where one had no relatives to assist, the village administration engaged communities to help the less able person. Finally, villagers were encouraged to form groups through which they could share transport costs for materials such as sand and cement. There were also arrangements with material suppliers to allow for payments in installments. For instance, of the 12 wards in the council, only five have Environmental Health Officers (EHOs). Given this challenge, the council had to train other cadres, such as community development officers, on CLTS techniques to assist with the implementation of the campaign. Third, inadequate or unreliable transport to facilitate monitoring of sanitation-related activities remain a challenge. Fourth, limited access to water service in some villages slows progress in sanitation and hygiene practices and fifth, future management of fecal sludge is a concern as most toilet facilities use onsite technology. Disposal of fecal sludge from these facilities will become a serious problem if not considered from the beginning.

Sustainability
In mapping the sanitation sustainability, experience on the ground suggests that the achieved sanitation status will be sustained given that communities are overwhelmingly satisfied with the cleanliness, privacy, convenience and safety the improved latrines provide. In addition, involvement of children and the behavioral transformation instilled in them has become their norm in early life. In this regard, it is more likely that these children will continue with the learned hygiene practices through their adult life. Evidence from literature also shows that CLTS outcomes are more sustainable where there is a supportive enabling environment (e.g. sufficient follow-up visits), where communities have access to latrine products and materials and where sanitation education, regulation and enforcement was instrumental in raising community awareness, changing collective behavior and helping people to comply with WASH related by-laws. To sustain these achievements there is a need for the local government authority to develop a post-ODF strategy that would help early detection of poorly maintained latrines or reversion to OD. Further, continued government commitment is needed for sustained progression and helping more people move up the sanitation ladder.