Category Archives: World Bank

Insights from personal observations and interactions with two ethnic communities in Sekong province.

September 30, 2015. By Cecile Lantican.

Sekong Province, Lao People’s Democratic Republic – Early in the morning, our team traveled to Sekong province. With less than 100,000 residents, Sekong is the second smallest province in Lao. It is also one of the poorest. Sekong province is located in one of the most remote areas in Lao: most of the province’s 42 villages are inaccessible by road because the infrastructure has been poorly developed.

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Sekong province, Lao PDR

Our mission was to pre-test communication campaign concepts, materials, and messages for the Lao government’s sanitation program among representative audiences in two rural communities. The district coordinator of the Center of Information and Education for Health (CIEH) arranged for our group to meet villagers of Toungkeo in the Lamam district. Lamam, which means “lowland plain,” is one of the four districts in the province.

The ferry we took en route to Ban Tok Ong Keo.

The ferry we took en route to Ban Tok Ong Keo.

From the ferry station, we drove through rugged terrain and winding mountain slopes. We passed by three small streams that indicated the richness of the water reservoir further up in the hills. It was almost midday when we finally reached Ban Tok Ong Keo. Four staff of the village health center greeted us and joined us for a quick packed lunch.

One of the streams we passed.

One of the streams we passed.

Nestled in between the undulating mountain slopes, the village was covered by lush vegetation following the recent rains. The air was hot and humid. We noted electrical posts in the village, but none of the houses were connected to the main lines. There was no mobile signal and our phones did not work. Considering the distance we traveled, I could imagine how tedious and expensive it would be for latrine sales agents or businessmen to travel here with their latrine products and supplies.  Sales agent never reached this village.

Sekong province is very remote.

Sekong province is very remote.

Almost all of the houses followed a similar construction design: they were made of wood and standing on stilts. Under the houses, we noticed piles of firewood and free-range animals like pigs, goats and cows. Villagers also use the space under these houses as work and rest areas.

A typical house in Ban Tok Ong Keo.

A typical house in Ban Tok Ong Keo.

We proceeded to the house where we would meet our pre-test participants, who had been waiting for us since that morning.

Ethnicity and Language

Sekong province is ethnically diverse. There are 14 ethnic minority groups, and only three percent of the population is Lao Loum. While the government verbally recognizes the use of ethnic languages, it officially encourages people to read and write only in ethnic Lao Loum.

Village women and children.

Village women and children.

 These villagers belong to the Alak ethnic minority, which reportedly constitutes 21 percent of the province’s population. The government categorically includes them among the “Lao Theung” ethnic group, the “mid-slope Lao.” The Alak women are known for weaving unique and high quality Lao “sin” (skirts).

A group of 12 women was assembled to meet us in one of the houses.  The field coordinators explained that people are shy about talking to foreigners, so we did not ask for their names out of respect for cultural sensitivity. Instead, we noted their ages and education levels. We asked the most senior woman her age.  She said,  “I [am] maybe between 50 to 60 years old.” She could not remember her birthday. This is common among Laotians; people do not always know their birthdays and in practice, a majority do not celebrate birthdays. When asked about the names of her 19 children, she could not remember them all.  But she claimed that all 19 children and her grandchildren from her three married daughters are living with her in one house.

Women participants in Ban Tok Ong Keo.

Women participants in Ban Tok Ong Keo.

Most of the women pre-test participants spoke limited Lao language. Only three women could read Lao characters. These women reported that they had reached fourth grade in the primary school before leaving school. The rest of the women had reached only the second grade.

The government built their houses. This could explain why the majority of the houses had similar architecture. One elderly male neighbor said,  “A few years ago, the government resettled us to our present location. We used to stay in a much lower ground along the river. But every time it rained, the river overflowed. We experienced flooding.” As a result, the government built their houses in higher plains and provided gravity-fed water to a cluster of households.

The government also built a latrine for every family. But as the number of families grew over the years, others did not build more toilets. Older villagers in particular reverted to open defecation.

A government-built latrine.

A government-built latrine.

In the neighboring village of Ban Nava Kang, we met eight Alak women. None of them had attended school. They could speak very limited Lao, but could not read Lao characters. Two of the older women were asked of their age. Like the older woman in Ban Tok Ong Keo, they could not also tell us their real ages and birthdays.

Households in this village do not have latrines. We were informed that everyone goes to the open field to defecate. This observation was validated by our pre-test materials.

 Rethinking our BCC Materials and Messages for Sanitation

Among the four communities where we tested the proposed campaign concepts, messages and materials, the responses of villagers from Ban Tok Ong Keo and Ban Nava Kang led us to believe that open defecation is strongly related to factors specific to the culture of groups that practice it. The Alak villagers we met have particular ways of thinking about latrines, and they reacted to situations or events as they understood them.

Men participating in our pre-test.

Men studying our initial communication materials.

The Alak villagers of Ban Tok Ong Keo did not maximally use the pour-flush latrines built by the government. The men respondents suggested the following reasons for this disuse:

  • It is a hassle to collect water before defecating.
  • The water source is too far from their houses.
  • They would need to carry a lot of water because they have to clean the latrine after using it. If they do not clean it, it will smell bad because it is near their house.
  • They prefer to defecate in the open because they can do so easily. Feces will dry up quickly outside in the heat, rather than in a confined and unpleasant-smelling toilet.
  • They worry that neighbors will notice them walking to use the toilet.
  • They prefer the privacy offered by defecating in the bush instead of at home.

The Alak men agreed that latrines would help ensure their daughters’ safety, but the current structure of their toilets does not offer privacy. The Alak women of Ban Nava Kang told us that our visual showing the girl who feels the need to relieve herself was a woman who feels the pain of giving birth. After further probing, one of the women associated the girl’s stomach ache with “diarrhea” from eating unclean food.

Pre-testing our communications materials.

Pre-testing our communications materials.

These two Alak communities showed us that having a latrine was not among competing priorities of their daily needs. The open field where they defecated was seen as more convenient than a latrine. The open field was big, unlike the very small, closed, and hot latrines.

Open defecation has been part of their culture. It is a behavior that they have acquired over time. Hence, these communities could be resistant to changing their sanitation practices. They may choose to stop open defection, but it may take time.

The environmental conditions surrounding these villages further shaped their attitudes in favor of open defecation. In Ban Tok Ong Keo, the geophysical conditions of the village make latrine construction difficult. The soil can be too hard, and the ground water is sometimes too low. Thus, villagers were not motivated to construct new latrines.

This pre-test experience taught us valuable lessons about our communication approach to change sanitation practices among ethno-linguistic populations. It led us to strengthen the effectiveness of our approach by making it adaptive to specific local contexts.

Initially, our team agreed that a communication campaign to improve the sanitation practices of Lao communities like the Alak would require:

  • Determining the socio-cultural beliefs and ecological/environmental context of target communities,
  • Identifying the relevant communication networks, decision-making processes, and social leadership that could be utilized by the community to facilitate change, and
  • Identifying and building the capacity for trusted sources of information in the community.
CAPTION

We left Sekong province with valuable insights.


The National Centre for Environmental Health and Water Supply together with the World Bank’s Water and Sanitation Program and other development organizations have partnered with Another Option, LLC to create a series of communication products that will help to inspire the use of improved sanitation facilities in rural areas.

By Shane Powell.

Champassak province, Lao People’s Democratic Republic – Traveling the last stretch of road to Pha Kha village feels like looking out the window of an airplane that’s just broken through storm clouds and been greeted by a rich, blue sky.

Wet-season rice paddies – the road leading into Pha Kha village. Photograph by Judy Souvannavong.

Miles of dusty, potholed roads suddenly give way to vast fields of fluorescent-green rice paddies. The scene sweeps calmly to the horizon in every direction, broken only by streams and scattered, flattened rocks positioned like small islands.

Noy, 19, has spent most of her life in Pha Kha village, together with her mother and older sister. She says she likes the clean air and relaxed pace and she wants to raise her 9-month-old son here with her husband.

But having recently spent two years, caring for her younger cousins in the country’s capital city, Vientiane, Noy explains a few things she had to change once she returned home.

Noy, whose name means ‘small’ in Lao language, has helped to trigger big changes in her community in southern Lao PDR. Photograph by Cecile Lantican, Ph.D.

Noy, whose name means ‘small’ in Lao language, has helped to trigger big changes in her community in southern Lao PDR. Photograph by Cecile Lantican, Ph.D.

“I never realized how convenient having a bathroom would be,” she explains. “When I came back (from Vientiane), there was no way I was going to continue going into the fields. It was so uncomfortable.”

Noy uses the words ‘uht aht’ to describe how she felt at losing the convenience and dignity she previously had in Vientiane, forced to find a tree or bush to crouch behind. Roughly translated, the words connote the feeling of having an awkward itch that you can’t scratch.

“I told my mother ‘we’re building a bathroom’,” she says, recounting how her decision “was final”. A few weeks later, her husband and brother-in-law had finished building a brick bathroom just next to her home.

“Noy told us we had to have one,” her mother recalls. “At first, I didn’t really think it was necessary… I thought we should spend the money on something else. But now I can’t imagine not having it… And I wouldn’t want my daughters having to go without one.”

Noy’s family latrine was built in early 2014. Neighbors followed suit in their own construction of latrines, significantly raising sanitation standards in the surrounding community. Photograph by Judy Souvannavong.

Noy’s family latrine was built in early 2014. Neighbors followed suit in their own construction of latrines, significantly raising sanitation standards in the surrounding community. Photograph by Judy Souvannavong.

It wasn’t long before Noy’s neighbors also started building bathrooms. A construction salesman who lives just up the hill from her started designing a series of connected latrines and washrooms for his family that now rivals the size of smaller homes in the village.

While sending all the young women in such a village off to spend time in bigger, developed cities is not likely the answer to inspiring better sanitation in rural areas, Noy – whose name literally translates as ‘small’ – is a good example of how one person can start to catalyze a community.

“It’s happening now… it’s slow, but it’s happening,” explains Mr Bounpone, the head of the cluster of communities of which Pha Kha village is a part.

But arguably the movement to build latrines in Pha Kha is not so slow. It was just two years ago that the community had less than five latrines for more than 150 households. Today, the community has 78. Village authorities estimate that if solutions can be found to some of the village’s water problems, nearly every home will likely have a latrine in two more years.

“We want the status of having a clean and healthy village,” Mr Bounpone says. “The people here see others building latrines and they want them too. For some, it’s still a matter of money. For others, we first need to work on the locations for them to build.”

This is precisely the type of progress and development that the Lao Government’s Ministry of Health (MoH) wants to see in rural areas.

“We know that with the right inspiration, people will take ownership for their family and their community’s health,” says Dr Bouakeo Souvanthong, Chief of the Environmental Health Division in the National Centre for Environmental Health and Water Supply under MoH. “But it will take people seeing and realizing the benefits of a few, before it spreads to many.”

As for Noy, she says there are other conveniences she misses from living in a larger city. “Ease of shopping… some of the food… and nobody wanting to use my bathroom,” she laughs. “If (my neighbors) keep using this one, it’s going to overflow!”


 

The National Centre for Environmental Health and Water Supply together with the World Bank’s Water and Sanitation Program and other development organizations have partnered with Another Option, LLC to create a series of communication products that will help to inspire the use of improved sanitation facilities in rural areas.

Shane Powell is a communication specialist who has worked on behavior development issues for more than 10 years in Southeast Asia. His areas of work focus on health, nutrition, education and natural resource protection. Shane currently resides with his wife and two cats in Vientiane, Lao PDR where they maintain vast collections of tea and soap from around the world.

A quick update on the on-going field work in Nepal

Attached are pictures by the research and Another Option team taken in the far west of Nepal.

Include the landscape, interviews with influentials including a female religious or spiritual leader, and interior of a shop.

The team will be going to the terai next week….look forward to sharing those images and also the data

 

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Nepal interview - field research

Nepal interview – field research

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How well are education and health services performing in African countries, based on results for their own people?

Another Option is pleased to announce that we’ve once again been engaged by the World Bank to help communicate the results of the Service Delivery Indicators (SDI) initiative, which provides timely, accurate and rigorous data on public spending outcomes in African countries.

While access to providers has increased, the quality of services as yet remains uneven, and the end result of transactions, including how they relate to expenditures, is tough to measure.

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Coordinated by the World Bank and in partnership with in partnership with the African Economic Research Consortium and the African Development Bank, the Indicators gather actionable data on the quality of service delivery in primary schools and at frontline health facilities across countries and over time. The coalition launched in Kenya in 2013 and recently released results of its survey in Uganda, which were welcomed and discussed by leadership and the public.

Funders include World Bank, DFID, USAID, the Hewlett Foundation, and the Brookings Institution.

Another Option designed and populated the SDI web site; developed talking points and key messages for launch events; and developed materials and visuals for launches. In this new phase, we’ll be helping SDI further develop its web site, including blogs; launch and expand its social media presence; and advance its digital communication, including designing and producing a web dashboard and application.

We’ll also be covering milestone events for SDI:  The 10th anniversary of the Indicators effort, Steering Committee meeting and the release of survey results from Nigeria in mid-March.

SDI

The World Bank launched in Nairobi today its new Service Delivery Indicators Initiative – www.sdindicators.org and @WBAfrica – a rigorous evidence-based tool that provides a status report on health and education service delivery.

Working initially in six countries – Kenya, Tanzania, Nigeria, Uganda, Togo, and Senegal – with plans to expand to a total of  30 African countries….SDI makes available to policy leaders and decision makers as well as the general public information (data) so they can adequately assess the quality of health and education services and help in making informed decisions related to resource allocations.

Twenty indicators – 10 in health and 10 in education –

Visit the web site – www.sdindicators.org and congratulations to WB for this unique initiative