CASE BOX 5.2 SCHOOL- LED TOTAL SANITATION (SLTS) IN NEPAL

After a decade of violence and conflicts that caused 14,000 deaths, Nepal was still struggling with political instability in 2006, which kept the country’s pro-vision of basic services, such as sanitation facilities, to the minimum. Around 43% of the children under five were stunted, while about 50% of the popula-tion defecated in open areas and over 10 million cases of diarrhoeal disease were reported annually.

Introduced by UNICEF, the term Community Approaches to Total Sani-tation (CATS) covers a wide range of community- based activities aiming at eliminating open defecation, inducing changes in behaviour, and promoting local innovations. This approach tried to achieve the Millennium Develop-ment Goals (MDGs) of halving, “by 2015, the proportion of population with-out sustainable access to safe drinking water and basic sanitation.”

Under CATS, UNICEF worked with the Nepal government and local com-munities in 2005 to pilot School- led Total Sanitation (SLTS), a community-based people to go to the toilet independently (Oxfam, 2007). Another important concern is women’s susceptibility to violence and sexual assault when they walk to the toilet at night. Therefore, facilities for men and women should be well separated, and lighting should be provided (IASC, 2005) (see also Case Box 5.2).

FIGURE 5.4 School children in Nepal

Source: Photo by Dmitry A. Mottl/CC BY- SA 3.0 (https://en.wikipedia.org/wiki/

Education_in_Nepal#/media/File:Nepalese_school.jpg; http://creativecommons.

org/licenses/by- sa/3.0/).

The promotion of good hygiene practices, the provision of safe drinking water and the reduction of environmental health risks are the highest priority interven-tions in emergency situainterven-tions (WHO, & HPA, 2011b). The fi rst step is to generate rapid needs assessment in order to have an overview of the existing WASH problems, the services availability and the coverage. Gender analysis and cultural sensitivity should also be incorporated to counter unequal access to aid supplies for women and to consider the different types of latrines used in different cultures.

Effective hygiene promotion is believed to be one of the tools for reducing the incidence of water- related diseases. Hygiene promotion covers a wide range of activities that aim to reduce disease transmission through good hygiene practices, such as hand washing and proper latrine use.

initiative that begins at schools and extends to the surrounding communi-ties. Figure 5.4 shows some Nepalese school children with their teacher on the road in Pokhara. SLTS works with children’s clubs along with the sanita-tion subcommittee comprised of the school headmaster, chairperson of one of the children’s clubs, as well as representatives of the school management committee, the parent- teacher association, the Mother’s Club, and the Water Users and Sanitation Committee. Together they lead the campaign to educate parents and neighbours on the importance of keeping the environment clean.

Interventions

By June 2006, the programme had reached nearly 500,000 people across 15 districts. The project aimed at achieving an open- defecation- free commu-nity; enhancing personal, household, and environmental hygiene behaviour;

engaging children in development activities; increasing the ownership of sanitation and increasing hygiene activities by schools and communities; and enabling a strong school- community partnership. Project teams also assessed the sanitation and hygiene situations of schools’ catchment areas by calculat-ing the volume of faeces collected in the areas, and created maps to identify households with and without access to latrines. “One toilet, one household”

was the slogan adopted by the project and was introduced to the communi-ties using a participatory approach.

Conclusion

SLTS had reached nearly 90,000 households through 300 schools and over 1,000 settlements in 250 school catchment areas had been declared open- defecation- free (ODF) by June 2009. Fewer cases of diarrhoeal and communi-cable diseases were reported after the campaign.

Sources: Adhikari and Shrestha (2008, 2008), November, Adhikari, Shrestha, Malla, and Shrestha (2008), UNICEF (2009a, 2009b) and Shrestha (n.d.).

Food and nutrition

What is malnutrition, undernutrition, wasting and stunting?

Food and nutrition are the cornerstones of survival. The right to adequate food, enshrined as a human right in Article 25(1) of the Universal Declaration of Human Right (UN, 1948), needs to be ensured in all circumstances (see Knowledge Box 5.4). Food shortages are associated with some emergencies. Malnutrition is a broad term that commonly refers to undernutrition and overnutrition. Undernu-trition is a condition of malnuUndernu-trition that occurs when intake and absorption of energy, protein or micronutrients are insuffi cient. Acute undernutrition can result in wasting , which is characterised by a rapid deterioration in nutritional status over a short period of time defi ned as having a weight- to- height ratio that is two standard deviations below the median of a reference population. Chronic undernu-trition due to poor maternal nuundernu-trition status, poor infant and young child feeding practices or repeated infections can lead to stunting , which is characterised by achieving a height two standard deviations below the median height of people of the same age (UNICEF, 2012a). On the other hand, overnutrition is a condition of malnutrition that occurs when an excessive amount of nutrients is absorbed as a result of overconsumption of food; overweight and obesity are forms of overnutri-tion. Undernutrition is the usual form of malnutrition in emergency situations.

Severe acute malnutrition is especially of concern in low- income countries affl icted by droughts, famines, wars and confl icts. Both short- and long- term health impacts may result from malnutrition, such as growth retardation and lowered immunity from protein- energy malnutrition ; anaemia, material and foetal mortality and intra-uterine growth retardation from iron defi ciency ; and night blindness from vitamin A defi ciency . In emergency settings, it is important to ensure the affected population’s access to adequate and safe food (The Sphere Project, 2011). Disaster recovery is ham-pered by the morbidity and mortality associated with food shortages (WHO, 2000).

On the other hand, over nutrition is a condition of malnutrition that occurs when an excessive amount of nutrients is absorbed as a result of overconsumption of food; overweight and obesity are forms of overnutrition. Overall, undernutrition is the usual form of malnu trition in emergency situations.

Who are the key players?

The World Food Programme (WFP) and Food and Agriculture Organization of the United Nations (FAO) are the two international agencies which are mainly responsible for agriculture and food assistance and the United States Children's Fund (UNICEF) is responsible for nutrition in emergencies and leads the Global Nutrition Cluster (GNC).

Established in 1961, WFP is part of the United Nations system and is volun-tarily funded. WFP’s vision is to ensure every man, woman and child has access at all times to the food needed for an active and healthy life. It coordinates food sup-ply during an emergency, including natural disasters, wars and civil confl icts. After

the emergency phase, it helps communities rebuild their lives with food. WFP is also responsible for coordinating logistics. WFP augments logistics infrastructure, provides common logistics services and provides logistic information, such as the

KNOWLEDGE BOX 5.4 FACTS AND TRENDS OF