Approaches

APPROACHES FOR SANITATION ACCESS IN
PASTORALIST AREAS WITHIN THE ARID AND

SEMI-ARID LANDS OF KENYA
FINAL REPORT
SEPTEMBER 2021
This publication was produced for review by the United States Agency for
International Development. It was prepared by Tetra Tech.
ACKNOWLEDGEMENTS
John Trimmer (Aquaya) managed this task, with additional conception and design input by Ranjiv Khush,
Rachel Peletz, and Jeff Albert (Aquaya) and Morris Israel (Tetra Tech). Field data collection was
performed by Edinah Samuel and Brian Mwangi (Aquaya).and Charles Matemo (independent consultant),
and qualitative analysis was performed by Jessica Tribbe, Edinah Samuel, and Brian Mwangi (Aquaya).
USAID Mission staff in Kenya supported this work via informed guidance and introductions to local
partners. We extend our appreciation to Amanda Robertson, Martin Mulongo, Walter Ong’eng’a, and
Beverly Mademba in Nairobi.
This research would not have been possible without the generous time and insights of government
officials, non-governmental organizations, community leaders, and community health workers in
Samburu, Turkana, and Kitui Counties in Kenya.
Finally, we thank Elizabeth Jordan and Jesse Shapiro for the close and enriching attention they have
afforded the work.
Preferred citation: USAID. (2021). Approaches for Sanitation Access in Pastoralist Areas Within
the Arid and Semi-Arid Lands of Kenya: Final Report. Washington, D.C.,
USAID Water, Sanitation, and Hygiene Partnerships and Learning for
Sustainability (WASHPaLS) Project.
Cover Photo: Focus group discussion in Turkana County

Credit: Brian Mwangi
Prepared for the United States Agency for International Development by the Water, Sanitation, and
Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project under Task Order number
AID-OAA-TO-16-00016 of the Water and Development Indefinite Delivery Quantity Contract (WADI),
contract number AID-OAA-I-14-00068.
Tetra Tech Contacts: Morris Israel, Project Director

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Tetra Tech
1320 N. Courthouse Road, Suite 600, Arlington VA 22201
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Approaches for Sanitation Access in
Pastoralist Areas Within the Arid and
Semi-Arid Lands of Kenya
Final Report
SEPTEMBER 2021
DISCLAIMER
The author’s views expressed in this publication do not necessarily reflect the views of the
United States Agency for International Development or the United States Government.
TABLE OF CONTENTS
ACKNOWLEDGEMENTS ........................................................................................................... II
TABLE OF CONTENTS ............................................................................................................... I
LIST OF FIGURES ........................................................................................................................ II
LIST OF TABLES .......................................................................................................................... II
ACRONYM LIST .......................................................................................................................... III
EXECUTIVE SUMMARY............................................................................................................ IV
1.0 MOTIVATION AND OBJECTIVES ..................................................................................... 1
1.1 THE NEED TO ADAPT COMMUNITY-LED TOTAL SANITATION FOR PASTORAL COMMUNITIES ........... 1
1.2 RESEARCH QUESTIONS ..................................................................................................................................... 3
2.0 SUMMARY OF CONTEXT AND METHODS .................................................................... 4
2.1 CHARACTERISTICS OF SELECTED COUNTIES ................................................................................................. 4
2.2 CHARACTERISTICS OF SELECTED VILLAGES ................................................................................................... 6
2.3 SUMMARY OF QUALITATIVE DATA COLLECTION......................................................................................... 7
2.4 SUMMARY OF QUALITATIVE DATA ANALYSIS ............................................................................................... 8
3.0 FINDINGS .............................................................................................................................. 9
3.1 CONSTRAINTS AND BARRIERS TO LATRINE ADOPTION (RQ 1) ............................................................... 9
3.1.1 Contextual Constraints .................................................................................................................... 11
3.1.2 Psychosocial Constraints ................................................................................................................. 12
3.1.3 Technological Constraints ............................................................................................................... 13
3.1.4 Constraints Related to the Enabling Environment..................................................................... 14
3.2 ACCEPTABLE SANITATION STANDARDS (RQ 2) ........................................................................................ 16
3.2.1 Semi-Settled and Settled: Durable, Private, and Appropriate Facilities ................................ 16
3.2.2 Nomadic: Open Defecation is Perceived as the Best Option ................................................ 17
3.2.3 Reasons for Adopting Latrines ....................................................................................................... 18
3.2.4 Suggestions from Communities on How to Improve Sanitation............................................ 19
3.3 CASE STUDIES OF SUCCESS ............................................................................................................................ 19
3.3.1 Samburu Village 1: Subsidies and High-Level County Engagement ........................................ 20
3.3.2 Turkana Village 2: Institutional Triggering, By-Laws, and Sharing .......................................... 20
3.3.3 Kitui Village 1: Household Triggering and Government Engagement ................................... 21
4.0 RECOMMENDATIONS (RQ 3) .......................................................................................... 22
4.1 ENABLING ENVIRONMENT: RECOMMENDATIONS FOR GOVERNMENT ................................................... 22
4.2 TAILORED IMPLEMENTATION STRATEGIES: RECOMMENDATIONS FOR IMPLEMENTERS ......................... 25
5.0 CONCLUSIONS AND KEY TAKEAWAYS ..................................................................... 32
REFERENCES .............................................................................................................................. 33
APPENDIX A. SELECTION OF STUDY VILLAGES .............................................................. 37
APPENDIX B. DETAILED SUMMARY OF STUDY VILLAGE CHARACTERISTICS ........ 39
APPENDIX C. REPRESENTATIVE PHOTOGRAPHS ........................................................... 47
APPENDIX D. COUNTY GOVERNMENT CLTS REPORTING AND IMPLEMENTATION
STRUCTURES ..................................................................................................................... 50
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT i
LIST OF FIGURES
Figure 1. (a) Counties in Kenya classified as arid, semi-arid, and non-ASAL, and (b) sub-counties shaded
according to open defecation rates reported in Kenya’s 2019 Census. The three labeled
counties are where this study’s field work was conducted. ................................................................... 1
Figure 2. Framework for CLTS reporting in Kitui. Dark blue shading indicates actors directly involved in
CLTS reporting and implementation at multiple levels, while white/no shading indicates upper-
level management overseeing all health-related activities in the county. .......................................... 16
Figure 3. Incorporating a simple contextual analysis into pre-triggering to guide sanitation
implementation for individual pastoral communities with differing levels of mobility. .................. 26
Figure 4. Examples of potential implementation approaches tailored to a specific community based on
constraints or opportunities identified during a contextual analysis. For each of these strategies,
the team found or heard about at least one example in the field (except for CLTS
implementers working with non-sanitation actors to address other issues simultaneously).
However, conducting additional field piloting would likely be appropriate to test the strategies
on a broader scale. ......................................................................................................................................... 26
Figure A1. Criteria for village selection in each county, including adaptations based on available
information. ...................................................................................................................................................... 37
Figure D1. Framework for formal (left) and informal (i.e., actual; right) CLTS reporting in Samburu. Dark
blue shading indicates actors directly involved in CLTS reporting and implementation at
multiple levels, while white/no shading indicates upper-level management overseeing all health-
related activities in the county..................................................................................................................... 51
Figure D2. Framework for CLTS reporting in Turkana. Dark blue shading indicates actors directly
involved in CLTS reporting and implementation at multiple levels, while white/no shading
indicates upper-level management overseeing all health-related activities in the county. ............ 52
LIST OF TABLES
Table 1. Factors identified from previous work that may affect latrine adoption among pastoralists. ......... 2
Table 2. Refined definitions of pastoral mobility categories based on field experiences. ................................ 4
Table 3. Sanitation status and other characteristics in Samburu, Turkana, and Kitui. In the CLTS RTMS,
sub-villages (“Vijiji”) are the primary unit for CLTS implementation. .................................................... 6
Table 4. Characteristics of study villages reported by CHVs and verified by WASHPaLS’ rapid
observational surveys......................................................................................................................................... 6
Table 5. Constraints on latrine adoption and sanitation programming. Points in italics represent findings
that, to the team’s knowledge, have not been identified in previous work. ........................................ 9
Table B1. Sanitation status of study villages, as reported by local CHVs during rapid observational
surveys and as recorded in Kenya’s CLTS Real-Time Monitoring System (GoK, 2021)................. 43
Table B2. Additional information gathered on each study village from rapid observational surveys. ......... 44
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT ii
ACRONYM LIST
AMREF African Medical and Research Foundation
ASAL Arid and Semi-Arid Land
CHEW Community Health Extension Worker
CHV Community Health Volunteer
CLTS Community-Led Total Sanitation
CLTS RTMS Community-Led Total Sanitation Real-Time Monitoring System
EQND Equality and Non-Discrimination
FGD Focus Group Discussion
FUM Follow-Up MANDONA
GoK Government of Kenya
HH Household
IBM-WASH Integrated Behavior Model for Water, Sanitation, and Hygiene
KES Kenyan Shilling
KII Key Informant Interview
KIWASH USAID Kenya Integrated Water, Sanitation, and Hygiene Project
NGO Nongovernmental Organization
ODF Open Defecation Free
PHO Public Health Officer
RQ Research Question
RTMS Real-Time Monitoring System
UNICEF United Nations International Children's Fund
USAID United States Agency for International Development
VSLA Village Saving and Loan Association
WASH Water, Sanitation, and Hygiene
WASHPaLS Water, Sanitation, and Hygiene Partnerships and Learning for Sustainability
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT iii
EXECUTIVE SUMMARY
Community-led total sanitation (CLTS) has been widely used and adapted as a strategy for reducing
open defecation. The Government of Kenya has adopted CLTS as a core strategy, but standard methods
have been difficult to implement and have achieved limited success among pastoralist groups in low-
density, water-scarce regions. Pastoralists’ lives often involve movement to find water and pasture for
livestock, potentially decreasing the value of stationary sanitation infrastructure, while other contextual
constraints (e.g., soil conditions and durability of local materials in arid regions) may also hinder
sanitation implementation. Therefore, this research examined the underlying factors and constraints
affecting sanitation adoption among pastoralists and identified strategies to achieve greater levels of
improved sanitation coverage.
Across three counties (Samburu, Turkana, Kitui) in the arid and semi-arid lands (ASALs) of Kenya with
varying contexts of sanitation and pastoralism, the Water, Sanitation, and Hygiene Partnerships and
Learning for Sustainability Project (WASHPaLS) conducted qualitative research in 17 pastoral
communities. In total, the team completed 34 focus group discussions and 154 interviews with
household members, community leaders, government officials, and implementing partners, which they
then analyzed via the Integrated Behavior Model for Water, Sanitation, and Hygiene (WASH) (IBM-
WASH). The team’s summarized findings with respect to three core research questions are presented
below.
Research Question 1. What are the underlying factors and constraints affecting sanitation
adoption in the ASALs?
The team’s findings indicate that pastoralists face a number of distinct and intense barriers to
latrine adoption, many of which agree with those reported in previous literature. These barriers tend
to relate to the fact that pastoralists often live and move throughout remote, arid, difficult-to-reach
areas, resulting in conditions that can reduce the effectiveness of conventional CLTS approaches. In
particular, WASHPaLS found common constraints that cut across all study contexts and align with
previous research:
• Water scarcity, poverty, and insecurity contribute to movement of pastoral groups and
reduce the degree to which sanitation is seen as a high priority.
• The combination of limited access to durable materials and challenging environmental
conditions (e.g., unstable soils, flooding) makes pit excavation difficult and results in frequent latrine
collapse, which becomes demoralizing and reduces the likelihood that households will (re)build.
• Settlements are often dynamic, changing in composition due to migration, seasonal movement,
insecurity, and other factors, which can reduce both social cohesion and previous sanitation
progress that was made.
The team also noted distinct constraints that affected sanitation success in specific situations. In
particular, existing latrines in study villages that are at least partially mobile do not meet cultural
requirements related to latrine sharing and the defecation behaviors of certain groups (e.g., morans),
while poverty and provision of basic needs (e.g., food, water) take priority and tend to override other
considerations among more nomadic communities. CLTS has been more successful in Kitui, which
contains primarily settled, agro-pastoral communities; however, challenges still exist in harder-to-reach
areas containing newly formed or relocated communities, with low household density and difficult
environmental conditions.
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT iv
Research Question 2. What are acceptable standards for sanitation in pastoralist
communities, with regard to both user experience and public health?
Despite these numerous constraints, WASHPaLS also sees evidence that pastoralists are interested
in latrines and would use them, if they conform to certain standards. However, the team sees
a stark distinction between populations that are more settled and those that are nomadic.
• Households in settled and semi-settled communities want durable latrines that do not
collapse in the face of challenging environmental conditions (e.g., unstable soils, flooding).
• Privacy, safety, and pride are key concerns among these communities, and latrines should be
designed and sited to maximize privacy and discretion. People also emphasize the value of latrines
that do not put their livestock at risk (as livestock are highly valued) and the pride they feel in being
able to offer visitors a latrine to use.
• Nomadic communities see open defecation as the best option for their mobile lifestyles
and are resistant to latrine use, as it is difficult to carry latrine materials with them. However, they
may be open to latrine use if they were to transition to a more settled way of life.
Notably, WASHPaLS also sees evidence of recent trends that offer opportunities for improved
sanitation adoption, some of which relate to how pastoral lifestyles, beliefs, and values are
evolving. In particular:
• Nomadic lifestyles are changing, with communities often becoming more settled and reducing
barriers to latrine adoption associated with high levels of mobility. These new lifestyles also expose
people to new ideas concerning the dangers of open defecation and the value of latrines.
• Cultural beliefs that promote open defecation and constrain latrine adoption still exist
in some cases but are becoming less prevalent, and many respondents feel that sanitation
interventions and designs can be adapted to align with remaining cultural considerations.
• Education is highly valued across the team’s study villages, which offers opportunities to
promote sanitation in schools and involve schools in community-wide interventions.
Research Question 3. What potential adaptations to CLTS will address the challenges
associated with sanitation among pastoral communities in the ASALs?
Following from these constraints and opportunities, WASHPaLS provides several recommendations for
governments and implementers.
Governments can create a strong enabling environment for sanitation interventions by:
• Strengthening implementation and reporting structures by consolidating and increasing
coordination across areas currently acting in parallel, while also clearly defining roles and
responsibilities. The Kenya Public Service Commission has developed general guidance on crafting
effective organizational structures that is applicable to many of the challenges identified.
• Identifying committed sanitation champions at both the county and community levels, to
coordinate activities, disseminate success stories, and create healthy competition.
• Dedicating funding to sanitation in county budgets, with detailed items to ensure funds are
allocated appropriately and are sufficient to cover complete implementation of CLTS, including
ensuring that local staff are able to conduct monitoring and follow-up activities.
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT v
• Providing nuanced guidance on initiatives to leave no one behind, including pro-poor
programs in challenging contexts. This may be an area where the national government can assist in
developing overarching policies or guidelines related to strategies such as cash transfers, vouchers,
or rebates, based on experiences in other countries or from programs beyond sanitation within
Kenya.
Implementers can tailor implementation approaches to specific pastoral communities
based on their characteristics. Implementers can employ a simple questionnaire to conduct a
contextual analysis during the pre-triggering phase, using the results to identify and tailor appropriate
implementation approaches to a particular community. Building on IBM-WASH, the team developed an
example questionnaire specifically designed for pastoral communities. It includes a small set of targeted
questions about key sanitation drivers related to such topics as environmental conditions, culture,
economic status, and community leadership in order to tailor strategies for program implementation.
Additional research and piloting can refine it for use in pastoral communities.
Given the constraints and opportunities WASHPaLS identified, the following recommendations for
implementers may be appropriate in certain contexts (based on the results of a contextual analysis):
1) Tailor latrine designs and messaging to pastoralists’ values and contextual challenges,
particularly focusing on key concerns such as privacy, pride in offering a latrine to visitors,
protection of livestock, and preventing pit collapse in unstable soils.
2) Engage schools and community leaders in the initial stages of (or before) triggering.
Schools provide opportunities for installing demonstration facilities, increasing community
involvement in triggering, and supporting sanitation champions.
3) Target specific groups for education, when those groups may be especially resistant to latrine
adoption due to cultural or other factors (e.g., peer-to-peer education among morans) or when
those groups may provide particular opportunities for improving sanitation (e.g., solidarity funds).
4) Consider pro-poor initiatives in challenging contexts, where assistance may be needed to
ensure that households with high poverty levels and/or limited market access have the ability to
install durable latrines.
5) Among highly nomadic groups, focus on sensitization rather than full CLTS
implementation, as these communities continue to perceive open defecation as the best option
for their mobile lifestyle, are unlikely to adopt latrines at this point, and may be less vulnerable to
health risks associated with open defecation due to frequent movement. WASHPaLS is not
recommending pushing communities toward more settled lives. Rather, implementers should meet
communities where they are, and these sensitization efforts will be particularly valuable as existing
trends toward more permanent settlement progress and people begin to consider latrine adoption.
Moving forward, this knowledge on constraints, opportunities, and strategies for tailored
implementation can inform rural sanitation programs that are equitable, sensitive to local considerations,
and effective in reducing open defecation among pastoral populations.
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT vi
1.0 MOTIVATION AND OBJECTIVES
1.1 THE NEED TO ADAPT COMMUNITY-LED TOTAL SANITATION FOR
PASTORAL COMMUNITIES
Community-led total sanitation (CLTS) has been widely used and adapted as a strategy for
reducing open defecation, but it has achieved limited success in certain contexts (Rama,
2016). The CLTS approach is based on the premise that changes in sanitation behavior must come from
within a community through psychosocial mechanisms and collective action. It focuses on stopping open
defecation by guiding community members to become more aware of the social and public health
consequences of poor sanitation. This strategy has found success in some settings, especially in
communities with high initial rates of open defecation, no prior history of subsidies, high social cohesion,
and strong leadership (Rama, 2016). Generally, a range of environmental and contextual factors likely
contribute to CLTS outcomes, requiring nuanced and adaptable approaches for targeting populations
across different contexts (Tillett & Jones, 2021; USAID, 2018). CLTS has been adopted in official rural
sanitation strategies or policies in 31 countries (Zuin et al., 2019), and Kenya adopted CLTS as a core
strategy within its Open Defecation Free (ODF) Rural Kenya Campaign, initiated in 2011.
However, CLTS has not always led to the adoption or sustainability of improved sanitation
facilities, and efforts in pastoral communities have been particularly unsuccessful (Karanja et
al., 2018; Otieno, 2015). Pastoral populations are prominent in Kenya’s arid and semi-arid lands (ASALs),
which include 23 counties and are defined by annual rainfall that ranges from 150–500 mm per year in
arid areas to 550–850 mm in semi-arid areas (Government of Kenya, 2013). The ASALs cover 89
percent of Kenya’s landmass, support 70 percent of its livestock, and contain 36 percent of the total
human population (State Department For Development of the Arid and Semi Arid Lands, 2019). ASAL
counties tend to be poorer than other areas, and CLTS has been largely unsuccessful in reducing high
rates of open defecation, moving households up the sanitation ladder, and preventing slippage among
communities that had been declared open-defecation (Brian Atuhaire, 2013; Karanja et al., 2018; Otieno,
2015). Recent data from Kenya’s 2019 Census (Kenya National Bureau of Statistics, 2019) reveals high
open defecation rate in many ASAL counties, particularly those in more arid regions (Figure 1).
SANITATION ACCESS IN PASTORALIST AREAS WITHIN THE ASALS OF KENYA: FINAL REPORT 1
Accordingly, rural sanitation programs must be adapted to effectively support efforts
toward reducing open defecation within pastoral communities in the ASALs, but there is
limited evidence concerning the factors that influence CLTS success in these settings
(Fostvedt-Mills et al., 2018). Numerous contextual, technological, and psychosocial constraints hinder
sanitation implementation in the ASALs, and previous work has begun to identify some important
factors associated with latrine installation and use, such as soil conditions, durability of local materials,
and availability of sanitation products and suitable financing mechanisms (Table 1) (Karanja et al., 2018;
Rama, 2016). However, a deeper understanding is needed to uncover the precise constraints that affect
different groups, the local perceptions and practices that contribute to how people define acceptable
sanitation standards in these contexts, and the means to overcome persistent social and environmental
challenges (Tillett & Jones, 2021). This knowledge can inform appropriate sanitation interventions and
CLTS adaptations, providing guidance for context-specific rural sanitation strategies that produce
equitable outcomes, are sensitive to local considerations, and are effective in significantly reducing open
defecation.
Table 1. Factors identified from previous work that may affect latrine adoption among pastoralists.
Category Factor Key points References

• Unstable, rocky, or flood-prone soils can hinder pit
construction.
• Unstable and flood-prone soils can lead to pit (Karanja et al., 2018;
Soil
collapse, especially during rains. Munai et al., 2018; Thitu
conditions
• Pits that are shallow (due to unstable soils) can fill & Augustine, 2017)
quickly and flood during rainy seasons.
• Tailored design guidelines may be needed.
Physical (Thitu & Augustine,
Weather • Flash flooding and drought can exacerbate poor soil
2017; World Vision,
patterns conditions.
2020)
• Low-quality materials may not be able to support
Durability of the slab or superstructure, causing latrines to fall
local into disrepair. (Karanja et al., 2018)
materials • This experience may discourage households from
repairing or replacing latrines when they fail.
• Limited knowledge on toilet construction may deter (Axweso, 2011; Brian
their installation. Atuhaire, 2013;
Knowledge
• Toilets are often seen as dirty, smelly, and full of Cummings et al., 2011;
and
flies. Greaves, 2016; Karanja
perceptions
• Risks associated with open defecation in dry, et al., 2018; Mshida et
of toilets
sparsely populated regions may be relatively low, al., 2018; Munai et al.,
reducing the perceived need for latrines. 2018)
Socio- Familiarity • Pastoralists’ close association with animals and their
(Fostvedt-Mills et al.,
cultural with animal feces reduce the effectiveness of triggers related to
2018)
and feces shame and disgust concerning human feces.
gender (Greaves, 2016; Hazard
Ethnic • Heterogeneous cultures with ethnic differences may
et al., 2012; Karanja et
differences limit social cohesion and collective action.
al., 2018)
• Men are responsible for latrine construction, while
(Axweso, 2011; Kayser
women are responsible for latrine cleanliness.
Gender roles et al., 2019; Maro et al.,
• Some traditions prevent men and women from using
and traditions 2012; Mshida et al.,
the same latrines or forbid men from being seen
2018; Otieno, 2015)
entering a latrine.
Category Factor Key points References
• Appropriate sanitation facilities may be unaffordable
Income and
for poor households. (Otieno, 2015;
poverty
• High poverty levels and other household needs WaterAid, 2009)
status
make sanitation less of a priority.
• Communities in regions with harsh weather or
Economic unstable soils lack appropriate local materials for
Availability of
durable structures.
sanitation (Karanja et al., 2018;
• Insufficient support has been given to households to
products and Rama, 2016)
improve the latrines they have constructed, and
financing
availability of appropriate sanitation products is
limited.
1.2 RESEARCH QUESTIONS

CLTS has been the primary approach for reducing open defecation in Kenya’s rural areas. However,
standard CLTS methods have been largely unsuccessful among pastoralist groups and communities
located in low-density, water-scarce regions. Achieving sustainable sanitation improvements in these
contexts will likely require adaptations to CLTS approaches or other interventions that address distinct
social, environmental, economic, and political conditions. USAID’s Water, Sanitation, and Hygiene
Partnerships and Learning for Sustainability (WASHPaLS) project has undertaken research to investigate
how rural sanitation programs must adapt to respect and account for the distinctive characteristics of
pastoral communities in Kenya’s ASALs.
Specifically, to generate the information necessary for developing appropriate intervention strategies in
the ASALs, the team has focused on answering the following three research questions (RQs):
1. What are the underlying factors and constraints affecting sanitation adoption in the
ASALs?
2. What are acceptable standards for sanitation in pastoralist communities, with regard
to both user experience and public health?
3. What potential adaptations to CLTS will address the challenges associated with
sanitation among pastoral communities in the ASALs?
2.0 SUMMARY OF CONTEXT AND
METHODS
2.1 CHARACTERISTICS OF SELECTED COUNTIES
This work involved qualitative research in three counties located within the ASAL region of Kenya. The
team selected the three ASAL counties (of the 23) to ensure that they could collect qualitative data of
sufficient depth to identify key sanitation constraints and inform future sanitation programming.
WASHPaLS selected the three counties—Samburu, Turkana, and Kitui—to provide insight into a variety
of pastoral contexts (e.g., differing pastoral mobility, sanitation status) where sanitation remains a
challenge, while also avoiding major security concerns. Some of key characteristics of the three counties
are summarized below.
Pastoral mobility. Samburu and Turkana represent arid regions of the country with high levels of
pastoralism and small-scale crop farming in rural areas. Pastoralists tend to be at least partially mobile,
with many communities falling along a continuum of mobility (Table 2). Commonly, the men of the
household (including morans, who are young men with traditional warrior roles) move with livestock
during the dry season, while women, children, and the elderly remain at the homestead (Axweso, 2011;
FAO, 2001). Splitting responsibilities in this way enables children to attend school throughout the year.
Another common model involves households with multiple wives, where the husband will move with
one wife, while the other(s) remain at home to care for the children. Finally, especially in areas closer to
urban centers with alternative livelihood opportunities, households may entrust the care of livestock to
relatives in more remote rural areas, while culturally they continue to consider themselves pastoralists
(Balfour & Mutuku, 2018).
These two counties also contain highly nomadic communities (e.g., especially in Turkana West, North,
and East Subcounties). These groups are pure pastoralists and move frequently in response to
seasonality and insecurity (Hazard et al., 2012). At the extreme, communities may move with housing
and other materials to use wherever they stop, while others may have a permanent base where they
return periodically. In remote areas of Samburu East and Samburu North, for example, many
communities are reported to periodically migrate with their whole family, demolish their previous
housing, and bring everything with them. They may eventually come back to the same area but do not
return to a specific homestead there.
In contrast, communities in Kitui tend to be settled and practice agro-pastoralism, with large cropland
areas and relatively small livestock herds (de Glanville et al., 2020). Households’ primary economic
activity tends to be crop farming (e.g., maize, sorghum, and millet) while they raise livestock in clearly
demarcated areas. Some limited livestock movement occurs in parts of Mwingi North and Kitui East
Subcounties bordering Tsavo National Park, where pasture is scarce during the drought season.
Households maintain permanent structures, while men move with livestock during this period.
Table 2. Refined definitions of pastoral mobility categories based on field experiences.
Pastoralist category Mobility characteristics Livelihood characteristics

a) Whole family moves in irregular
Highly nomadic patterns with household structure and
Full mobility household assets. • Exclusively livestock producers
(Turkana, Samburu) b) Whole family moves with household
assets but has a permanent homestead.
Pastoralist category Mobility characteristics Livelihood characteristics
a) Some family members (e.g., young men,
Transhumance • Primarily livestock producers
husbands) move seasonally.
Partial mobility • May also produce some crops for
b) Household hires laborers to move with
(Turkana, Samburu) their own use
livestock during dry seasons.
• Combine mixed crop production
Agro-pastoralism Limited movement (practice tethering of
and livestock keeping
Sedentary livestock) with greater investment in local
• Herds tend to be smaller than other
(Kitui) infrastructure
categories
Sanitation status and other characteristics affecting sanitation adoption. The three counties
tend to have high poverty rates (particularly Turkana) and low population density (Table 3). Kitui has a
higher population density than the other two counties, but the more remote regions where the team
focused tend to have lower densities, due to large areas of farmland and highly dispersed communities.
Improved sanitation coverage in Samburu (26%) and Turkana (23%) remains quite low while open
defecation remains high, at nearly 70 percent of households (Kenya National Bureau of Statistics, 2019).
However, similar to the rest of the country, some gains were made between 2009 and 2019, with
Turkana seeing more of an improvement than Samburu (e.g., open defecation dropped by 14% in
Turkana and 8% in Samburu; Table 3). Sanitation coverage in Kitui is better (e.g., 68% of households with
improved sanitation in 2019), similar to levels within Kenya as a whole (74%) (Kenya National Bureau of
Statistics, 2019). However, while all of Kitui is reported to be ODF certified (defined in Kenya as all
households using a latrine with no active open defecation sites (GoK, 2012)), census statistics indicate
that nearly 10 percent of households still practice open defecation. WASHPaLS’ field work in difficult-to-
reach communities confirmed that open defecation persists, at least in these more challenging contexts.
CLTS implementation progress is also different across these three counties, with Kitui reported to be
fully ODF, while triggering and certification is ongoing in Samburu and Turkana. According to Kenya’s
CLTS Real-Time Monitoring System (RTMS), approximately half of Vijiji (sub-villages, the primary unit for
CLTS implementation) in Samburu and Turkana have been triggered, while substantially fewer have
achieved ODF certification, particularly in Samburu (Table 3). However, the team’s findings from the
villages visited, along with local Community Health Volunteer (CHV) reports, suggest that there may be
some confusion regarding what truly constitutes CLTS triggering and certification. In Kitui, although all
villages are recorded as ODF certified in Kenya’s CLTS RTMS, CHVs in some villages reported never
having been formally triggered (discussed further in later sections). WASHPaLS encountered some
similar circumstances in Samburu and Turkana, and it is worth noting that some highly nomadic
communities in these two counties may not be captured in the CLTS RTMS, given the difficulties
associated with tracking these more mobile groups (Randall, 2015). For example, security challenges
(often along national or county borders) can constrain where sanitation interventions can occur and
implementing partners can operate.
Several partners, such as UNICEF; the USAID Kenya Integrated Water, Sanitation, and Hygiene Project
(KIWASH); and the African Medical and Research Foundation (AMREF), have been involved in CLTS
implementation across these three counties (Serem, 2012; IFRC, 2018; KIWASH, 2017), with many
nongovernmental organizations (NGOs) working in Turkana because of the refugee populations there.
While county governments have adopted “no subsidy” policies for sanitation, implementers often used
subsidies in the past, and some continue to employ them for sanitation or other projects. As a result,
communities come to expect material or monetary aid, whether for water, sanitation, and hygiene
(WASH) programs or other types of interventions.
Table 3. Sanitation status and other characteristics in Samburu, Turkana, and Kitui. In the CLTS RTMS,
sub-villages (“Vijiji”) are the primary unit for CLTS implementation.
Improved
Pop. Open defecation CLTS CLTS
Population in sanitation
density rates triggered certified
County poverty (%)a coverage
(per km2)b (% of HHs)c (% of Vijiji)d (% of Vijiji)d
(% of HHs)c
2017 2019 2009 2019 2009 2019 2021 2021
Samburu 78% 15 73% 66% 19% 26% 50% 2%
Turkana 93% 14 82% 68% 13% 23% 47% 21%
Kitui 62% 37 20% 9% 58% 68% 100% 100%
Kenya 45% 82 14% 7% 65% 74% 45% 24%
a Njuguna & Muruka (2017)
b Kenya National Bureau of Statistics (2019)
c Estimated from Kenya National Bureau of Statistics (2009, 2019)
d As of April 12, 2021, according to the Kenya CLTS RTMS (GoK, 2021)
2.2 CHARACTERISTICS OF SELECTED VILLAGES

The 17 villages that were selected for field work span fairly large geographic areas in each county.
However, it is important to note that these villages do not necessarily provide a representative sample
of the entire county, as WASHPaLS focused on depth within villages and was unable to visit certain
areas because of security concerns. When selecting villages in collaboration with county officials, the
team generally focused efforts on difficult contexts and villages where CLTS implementation has been
particularly challenging, although they did seek to include a more successful village in each county for
comparison. While the selected villages generally aligned with WASHPaLS’ initial set of selection criteria,
the team did make slight adjustments based on available information from local officials (more details on
village sampling are provided in Appendix A). The team often used CLTS status (e.g., untriggered,
triggered, certified) when selecting villages with county officials, but what was observed or reported on
the ground did not always agree with Kenya’s CLTS RTMS (GoK, 2021). A summary is provided here,
with further details on selected villages in Appendix B and representative photographs in Appendix C.
Generally, the five villages visited in Samburu County had a number of similar characteristics, with all
practicing transhumance pastoralism and most exhibiting low latrine coverage (Table 4). Villages tend to
have low household density, and soil conditions often create difficulties for pit latrine construction and
maintenance, either due to difficult excavations (in rocky conditions) or pit collapse (in sandy
conditions). Of these five villages, local CHVs reported that two were untriggered, two were “officially”
triggered, and one had recently been triggered by an NGO but had not been recorded as such by the
government. However, both the officially triggered villages had failed ODF certification.
Table 4. Characteristics of study villages reported by CHVs and verified by WASHPaLS’ rapid observational
surveys.
Village characteristics Samburu Turkana Kitui

Total villages visited 5 7 5
Range of village size (approximate number of households) 80–400 20–100 40–126
Primary mobility category
Highly nomadic 0 1 0
Transhumance 5 6 0
Agro-pastoralism 0 0 5
CLTS status
Untriggered (some sensitization) 2a 4a 4a,b
Recently triggered 1c 0 0
Village characteristics Samburu Turkana Kitui
Triggered, failed certification 2d 1b 0
Certified, reverted to open defecation 0 1 0
Certified, maintaining ODF status 0 1 1
Sanitation conditions
Functional latrine coverage ≤35% 4 6 2
Functional latrine coverage ≥50%e 1 1 3
Diarrhea is common 4 4 4
Remoteness
Close to urban centers (3–20 km) 2 1 4
Far from urban centers (40–200 km) 3 6 1
a “Informal” triggering by NGOs may have occurred in some villages.
b Recorded as certified in CLTS RTMS.
c Not found in CLTS Database.
d One recorded as certified in CLTS Database.
e No villages were reported to have 35–50% functional latrine coverage.
The seven Turkana villages were a bit more diverse than those from Samburu. Most are located in
remote areas, with one community being a highly nomadic group known as a Kraal. In contrast, another
village was located fairly close to an urban area and was more settled (though some transhumance
pastoralism was still practiced), and these characteristics may play a role in its greater success with
regard to ODF achievement and sustainability. Some other villages were extremely remote (up to 200
kilometers from a major urban center). Four villages were reported to be untriggered by local CHVs,
one village was triggered but failed ODF certification, while another was ODF certified but had reverted
to significant levels of non-functional latrines and open defecation. Finally, one village was certified and
has maintained its ODF status (Table 4).
Although CLTS implementation in Kitui County is more widespread, the team found some villages in
more remote areas where latrine coverage remains fairly low. Residents of these villages tend to
practice agro-pastoralism with small numbers of livestock, and household density was low. These
remote communities are generally dynamic, evolving as new families arrive seeking safety. These
frequent changes can contribute to lower levels of latrine coverage and social cohesion.
WASHPaLS did note some discrepancies between the CLTS status reported by local CHVs and the data
available in Kenya’s CLTS RTMS (according to a full download accessed in February 2021; Table 4). For
example, in Samburu and Turkana, CHVs reported that some villages had been triggered but failed to
achieve ODF certification, while the database records them as having been certified. Of the five Kitui
villages, local CHVs reported that four were untriggered, despite the fact that the CLTS RTMS records
all Kitui villages as ODF certified. According to the local CHVs, other sanitation interventions and
sensitization efforts had occurred, and sometimes a few village members had attended triggering events
in other communities. However, according to CHVs’ perceptions and understanding, these specific
villages had not been formally triggered. Additionally, the team was unable to match certain communities
with database records (one of these was the highly nomadic Kraal in Turkana; see Table B1). WASHPaLS
expects that data may be especially sparse for highly mobile communities, which are likely difficult to
identify and track (Randall, 2015; Tillett & Jones, 2021).
2.3 SUMMARY OF QUALITATIVE DATA COLLECTION

The WASHPaLS team spent two days in each of the villages leading focus group discussions (FGDs),
conducting interviews among households and community leaders, and performing a rapid observational
survey. In each village, the team completed two FGDs: one among males and one among females, each
typically made up of eight to ten participants. WASHPaLS conducted six interviews with households
representing different levels of sanitation status (functional latrine, non-functional latrine, or no latrine
when various levels existed within the village). On average, they interviewed two community leaders,
typically CHVs or Community Health Extension Workers (CHEWs) as they are the most familiar with
sanitation interventions and conditions. The team performed a rapid observational survey in each village
with assistance from the CHV, consisting of visiting and observing numerous households within the
community to understand such factors as environmental conditions, typical construction materials,
household density, and available water sources.
WASHPaLS complemented this village-level data collection with additional key informant interviews
(KIIs) among local government officials (typically Public Health Officers [PHOs] at the county and sub-
county level) and with implementing partners playing a role in CLTS or other sanitation interventions.
Across the three counties, the team completed the following data collection activities:
• 14 KIIs with local government officials
• 10 KIIs with implementing partners
• 17 rapid observational surveys in selected villages
• 34 interviews with community leaders in selected villages
• 34 FGDs in selected villages
• 96 household interviews in selected villages
Fortunately, COVID-19 did not deter WASHPaLS’ data collection efforts. The team took the necessary
precautions (e.g., wearing masks, using hand sanitizer frequently) and was often able to conduct FGDs
and interviews outdoors. As noted above, the team did avoid certain regions due to security concerns
and traveled with security guards when visiting more remote areas of each county. Accordingly,
WASHPaLS cautions that the set of study villages does not necessarily provide a fully representative
picture of each county.
2.4 SUMMARY OF QUALITATIVE DATA ANALYSIS

With the aid of local translators, the team conducted interviews and FGDs in local languages and
transcribed them into English. From the transcriptions, they coded and analyzed the data using the IBM-
WASH framework (Dreibelbis et al., 2013) to sort responses according to the dimensions in the IBM-
WASH matrix (made up of contextual, psychosocial, and technological dimensions) and to identify
patterns and themes across counties and communities. The team used these results to explore
constraints related to sanitation adoption (RQ1), define acceptable standards of sanitation in pastoral
communities (RQ2), and offer recommendations for how sanitation interventions can be supported and
adapted to effectively promote sanitation among pastoralists. WASHPaLS used Nvivo software to
support coding and analysis.
3.0 FINDINGS
The findings presented here represent the WASHPaLS team’s observations during data collection and
the results of the data analysis. The team cites existing literature primarily to show when findings agree
with or relate to results from previous work, and they note explicitly when findings appear to show
something novel or a departure from previous work.
3.1 CONSTRAINTS AND BARRIERS TO LATRINE ADOPTION (RQ 1)

Through analysis of village- and county-level interviews and FGDs, the team identified several constraints
on latrine adoption and sanitation programming. Generally, the team categorized these into the three
dimensions of the IBM-WASH framework (contextual, psychosocial, technological). WASHPaLS also
incorporated a fourth category specifically related to the enabling environment, as interviews with local
government officials and CHVs revealed a number of challenges concerning local government policies,
funding, capacity, and structure. The team did identify constraints common across all counties and
mobility levels, including water scarcity, a lack of accessible and affordable appropriate materials, and
limited willingness to share latrines, which generally agreed with the findings of existing literature (Table
1), but they also noted numerous issues that were especially prominent among villages in certain
mobility categories or in specific counties (Table 5).
Among the study villages characterized by partial mobility (often located in Samburu), current latrines do
not align with cultural beliefs against toilet sharing among relatives or neighbors (e.g., in-laws may not
share a facility, or men may not share with women) and against storing feces in a housing structure
(which is how some people see latrines). Latrines also do not account for beliefs concerning the
defecation habits of certain groups (e.g., morans), who must not be seen defecating or entering a toilet.
In Turkana, similar cultural beliefs play a role among more mobile populations, but especially in
communities with high poverty levels, respondents noted that providing for basic needs (e.g., food,
water) takes precedence over sanitation infrastructure (Rama, 2016), and these considerations seemed
to override any other potential constraints. The high number of NGO interventions and sensitization
efforts in Turkana county may also be reducing the importance of cultural barriers. In Kitui, where
village residents were commonly practicing agro-pastoralism, the team saw substantial environmental
challenges (e.g., difficult soil conditions, water scarcity), reducing the effectiveness of latrine structures
built using locally available materials. Some communities were also located in more remote areas of the
county and were newly formed due to migration, relocation, and insecurity associated with bordering
counties. Implementers have difficulty reaching these locations, and communities exhibit varying levels of
social cohesion because of their dynamic nature. Further details are provided below.
Table 5. Constraints on latrine adoption and sanitation programming. Points in italics represent findings
that, to the team’s knowledge, have not been identified in previous work.
Dimension
County Enabling
Contextual Psychosocial Technological
environment
General • Area is • Dynamic communities • There is a lack of • Funding constraints
characterized by (i.e., new or access to and limit capacity to
water scarcity. frequently changing in unaffordability of monitor CLTS
• Low density affects composition) impact appropriate progress.
behaviors and social cohesion. materials. • Presence of
reduces the • Willingness to share • Collapsing latrines untrained staff and
perceived risk of latrines with (due to wind, rain, lack of coordination.
open defecation neighbors is limited. soil, termites) are
Dimension
County Enabling
environment
• Area is • Perceived value of demotivating and • Previous subsidy
characterized by latrine relative to costly. programs cause
insecurity. other needs is low. challenges for
• Some community coordination among
resistance to shaming government actors
exists. and implementing
partners.
Samburu • Presence of land • People open defecate • Temporary • There is no county-
study ownership disputes. far away from villages, latrines (i.e., built specific policy on
villages • Households causing fewer from local, non- sanitation.
(mostly categorized as opportunities for durable materials) • There are no
transhumance partially mobile/ shame. are susceptible to dedicated funds to
or semi- presence of • There is a belief that extreme weather. facilitate CLTS
settled temporary housing. feces should not be • Partially damaged activities (any funds
communities) • There are episodes indoors. latrines are come from a general
of heavy rainfall and • People experience unlikely to be pool).
flooding. challenges sharing used due to a lack • County officials
• There is limited among in-laws, and of privacy. typically do not try to
access to skilled between men and • High costs are the trigger satellite camps
labor/artisans. women. main reason many or highly nomadic
• Rocky soils make for • Beliefs about morans households (HHs) communities.
difficult excavation. limit their latrine use. do not construct
• Communities are or rebuild latrines.
accustomed to • Pit excavation
receiving aid and cost is high (due
expect support. to rocky soils).
• New community
members come from
areas without latrines.
Turkana • Poverty and food • Cultural beliefs limit • Access to building • Community health
study scarcity mean that latrine sharing among materials such as strategy and funds
villages basic needs take more mobile groups. cement and iron for sanitation exist,
(mostly semi- priority over • Groups experience sheets is especially but funds have not
settled or sanitation. fear (collapse) and limited and costly. been allocated
settled • More nomadic discomfort with • There is a lack of carefully.
communities, communities do not latrines (smell, dirty). digging tools and • Limited funds for CLTS
one nomadic have permanent • Community members excavation facilitation are not well
community) structures. are accustomed to presents allocated: CHVs have
• Some communities receiving aid and challenges. not been paid for 1
move frequently due therefore expect • Latrines made year.
to insecurity. support. with local wood • There is a long
• Rocky and sandy • Groups prioritize are destroyed by history of aid and
soils and heavy rains education above termites. subsidies (linked with
cause challenges. sanitation. • Frequent latrine refugees).
collapse is
demoralizing.
Kitui study • Nomadic lifestyles • HHs cannot or are • Most latrines built • Previous governor was
villages are rare. unwilling to share from local engaged in sanitation,
(mostly • Many study with neighbors. materials only last but there has been a
settled communities have a few months. change in leadership.
communities) been recently settled
Dimension
County Enabling
environment
or experienced • Social cohesion is • Wood slabs are • During devolution,
migration. especially variable vulnerable to some sub-villages were
• Houses are far (dynamic communities). termites. combined into large
apart, making open • Some HHs will excavate • SaTo Pan villages that are
defecation easier. a pit out of pressure products are difficult to trigger.
• Area experiences from the CHV or PHO, available, but • Regarding sanitation
instances of heavy but do not complete the there is low marketing, there is
rains and has sandy/ latrine. uptake among minimal uptake in
loose soils. study remote communities.
communities.
3.1.1 CONTEXTUAL CONSTRAINTS

Nomadic lifestyles and low population densities hinder the motivation for latrine building.
Communities, households, and individuals with higher levels of mobility generally see less tangible value
in permanent latrine structures built in a single location. Among partially mobile communities where
only certain household members move with livestock, those who move (e.g., men, morans) are most
likely to express this view: “When you consider the time required to build a proper house and a latrine, you
will prioritize how to look after the livestock, which will be moved several times in a year, rather than a settled
lifestyle. When you move and you have built a latrine, people who are left behind will use the latrine and most
probably destroy the latrine. Therefore, you do not need to have the latrine” (Male FGD participant, Samburu
County). Additionally, low household densities offer large open spaces where individuals can defecate in
the bush with a reasonable level of privacy, reducing the perceived need for a private latrine: “The
scattered nature of our families is also a reason. People are in remote areas and have no neighbors with different
latrines to emulate. There is also availability of bushes where people can hide and defecate without being seen”
(Male FGD participant, Kitui County). In a few other contexts, the WASHPaLS team found evidence of
the opposite: households in settled and partially mobile communities might copy neighbors who were
digging latrine pits. However, in nomadic settings and locations where households are far apart (and
neighbors are not regularly seen), emulating those who have installed latrines is less of a possibility.
Particularly for nomadic populations that frequently move throughout arid, low-density areas, the public
health risks associated with open defecation are also likely to be lower than for more settled
communities. Additionally, the lack of motivation to construct latrines in these contexts may be
compounded by prior sanitation programs that have set a general precedent for subsidized latrine
construction across various types of communities, despite current government policies against sanitation
subsidies.
Though women are more likely to adopt latrines, men are often the decision-makers.
Gender roles and decision-making structures can also play a role in latrine construction and use.
Women tend to be the ones encouraging latrine adoption and use, and among partially mobile
communities in Turkana and Samburu, they are often responsible for building the facility. However, men
are typically the final decision-makers in the household, and they see less need for a latrine. Men are the
ones who commonly move with livestock and they are accustomed to open defecation during these
times. Therefore, they see less value in a permanent structure located at the homestead. These trends
suggest that it can be particularly important to reach men in sensitization and education efforts. In
addition, highly gendered household tasks, such as water collection (that requires long travel distances
and wait times), leave women with limited time to participate in latrine construction (Kariuki et al.,
2012).
Soil conditions result in challenges with pit excavation and pit collapse. In some areas, rocky
soils also make pit excavation difficult (Thitu & Augustine, 2017), and there is limited access to skilled
labor and artisans with the tools and experience to handle such challenges: “We stopped [excavating the
pit] because the soil was rocky, and we also did not have money to pay someone to dig the latrine” (Household
interview, without latrine, Samburu County). Unstable soils, combined with heavy rains and flooding
during wet seasons, often cause pit collapse (Karanja et al., 2018; Thitu & Augustine, 2017). The
WASHPaLS team saw these conditions in study villages in all three counties. The frequent and repeated
collapse of latrines caused by these conditions (especially when local materials are used for
construction) becomes demoralizing and, over time, reduces the likelihood of rebuilding (Munai et al.,
2018). However, the team did find a few villages where rebuilding was common, often due to high levels
of county government and/or CHV engagement.
Other basic needs take priority over sanitation, particularly for highly nomadic
populations. Poverty, food insecurity, and water scarcity are characteristic of many rural pastoral
households (Balfour et al., 2020), and many communities engage in frequent movement to provide
themselves and their livestock with basic necessities. Movement of more nomadic communities is also
often linked with avoiding unsafe areas. The team observed the most severe challenges related to
poverty and a lack of basic needs in Turkana villages, where these concerns take precedence over the
installation of sanitation infrastructure (Rama, 2016). “The benefits of these toilets are that they make the
nation developed, but here we have shortage of water. Latrines need water, issues of hygiene need water, and
your body depends on water; if there is no water and you have a toilet—if you have a visitor and children are
there—how will you clean the latrine without water?” (Male FGD participant, Turkana County). Even among
more settled communities in Turkana, the lack of basic household needs and poverty were still barriers
to latrine adoption.
Remoteness and insecurity limit the locations that sanitation programs, including CLTS,
are able to reach. Some county officials in Samburu and Turkana reported that they and implementing
partners tend to avoid communities that are highly nomadic or located in insecure areas, due to the
difficulties involved. Nomadic lifestyles are rare in Kitui, but some of the rural, settled, agro-pastoral
communities WASHPaLS visited had recently expanded due to migration—either because larger plot
sizes attracted them to the area (linked with land demarcation) or because of security concerns where
people lived previously. While Kitui is classified as a semi-arid county overall, some of the more remote
and dynamic communities visited were located in more marginal and arid areas. According to Kitui’s
CLTS Coordinator, approximately 200 villages in the county are similar to the remote, dynamic ones
the team visited, and he confirmed that CLTS messaging and implementation had not yet reached many
of these communities. To the team’s knowledge, these communities have not been studied previously,
and untriggered status is not reflected in Kenya’s CLTS RTMS (GoK, 2021).
3.1.2 PSYCHOSOCIAL CONSTRAINTS

People dislike sharing latrines, and social cohesion is low. People are often unwilling to share
latrines with neighbors: “We share when you are a visitor to my family but coming to my household solely to
use my latrine is very wrong and it is not done here. I can even [scold] that person” (Male FGD participant,
Kitui County). The variable levels of social cohesion among Kitui study communities (related to their
dynamic nature) seem to play a large role in this unwillingness to share latrines. Sharing may also be
impractical in some cases when households are surrounded by bushes and separated by large distances.
Among study villages with low latrine coverage, it was also uncommon for households to support
neighbors with latrine construction. Generally, study communities tend to be somewhat dynamic, with
frequent migration due to security concerns, land tenure disputes, and seasonal movement with
livestock. This ever-changing community composition can negatively impact social cohesion and could
limit the effectiveness of approaches like CLTS that rely on collective action.
Sociocultural beliefs related to latrine sharing and the defecation habits of certain groups
are barriers to latrine construction and use, particularly among communities with higher
levels of mobility. Certain beliefs state that defecation should not occur within a house, and some
people see a latrine structure in this way. When a household does build a latrine, it may not be
acceptable for every household member to use it (SNV, 2020). It is often seen as taboo for certain in-
laws (e.g., a man’s mother-in-law) to share the same latrine with the man, and more generally, men
might not want to share latrines with women: “It’s very shameful for men to share a toilet with women
because they should not see sanitary pads inside the toilet. Sometimes someone can just drop a sanitary pad on
the slab and that is bad if men see them” (Female FGD participant, Samburu County). Finally, specific
beliefs related to morans often hinder their use of latrines. Morans often move with livestock, but there
are taboos against anyone (especially women) discussing or witnessing the eating or defecation habits of
morans even in the community, which limits any sensitization efforts. Because others are not supposed
to see morans going to defecate, they often openly defecate far from households in the community.
According to one woman, “It is also shameful for a woman to see a moran going or coming out of the toilet
… It is believed morans do not defecate” (Female FGD participant, Samburu County). However, many
communities, especially those that are partially or fully settled, acknowledged that these cultural beliefs
are changing over time as people send their children to school and become more educated: “This cultural
belief is observed by those who are not educated and do not understand about the latrine, because they see it as
a house and considered it to be a house” (Male FGD participant, Samburu County). Among more settled
study communities, these taboos did not seem to be as prevalent, but people did express fear related to
the possibility of latrine collapse (while someone is using it) and concerns about smells and cleanliness.
3.1.3 TECHNOLOGICAL CONSTRAINTS

Generally, households are not satisfied with their existing sanitation facilities, which are
prone to collapse. Current latrines typically are not sufficiently durable for the difficult environmental
contexts in these regions. Latrines, especially those made using local materials, frequently collapse (in
some cases, they only last a few months) due to unstable soils, heavy rains, high winds, or termites (e.g.,
in latrines with wood slabs) (Karanja et al., 2018). Some respondents (particularly in partially mobile
communities) noted that even facilities that are only partially damaged might not be used because they
do not provide adequate privacy, or they increase fears of collapse. Repeated collapse is demotivating
and becomes quite costly over time.
Higher-quality sanitation is largely unaffordable. Across all three counties, respondents
mentioned the high costs of pit excavation and latrine construction: “We don't have toilets because we
don't have the financial ability to purchase materials required to put up a good toilet. We have other financial
responsibilities such as school fees and food, and we try to minimize sale of livestock often since it’s our main
source of income” (Female FGD participant, Samburu County). In rocky soils, pit excavation might cost a
household 1,000 to 2,000 KES (approximately 10 to 20 USD) per foot. For a latrine that is at five to
seven feet deep, excavation can represent a major portion of the total latrine cost. Respondents
estimated that a “permanent” latrine structure (built using materials such as cement blocks, bricks, iron
sheets, and concrete slabs) can cost 20,000–50,000 KES (200–500 USD), while a “temporary” latrine
(built using local materials) might cost 10,000 KES (100 USD). For comparison, previous research has
estimated that rural households in Kenya might consider a price up to 140 USD as being affordable
(Otieno et al., 2013). Other research focusing on three Kenyan cities estimated that the cost of
constructing a lined pit latrine is between 854 and 1,041 USD, while households are willing to pay an
average of 210–367 USD (Delaire et al., 2021). The WASHPaLS team would expect households’ ability
to pay to be considerably lower in rural areas of the ASALs.
3.1.4 CONSTRAINTS RELATED TO THE ENABLING ENVIRONMENT
County-level funding for sanitation programming, particularly in nomadic communities, is
limited. Officials in Samburu report that there is no county-specific sanitation plan and no dedicated
funding to facilitate CLTS activities (they must pull from more general health funding), limiting what
county officials are able to do even if they are motivated to work toward improving sanitation. “During
implementation, there is concern of inadequate budgets and low staff levels not matching with the population
size and acreage of the county. The county size is 21,119 km2. The number of staff vs. population indicates a
huge gap that needs to be addressed” (Key Informant Interview, Samburu County Official). These officials
note that they typically cannot trigger highly nomadic communities and satellite camps (where herders
stay temporarily during dry months), as these are more difficult contexts in which to work. In Turkana,
available funding to facilitate CLTS is limited, and CHVs (who are supposed to receive monthly stipends
for their work) have not been paid for approximately one year. Generally, the limited funding available
can result in rigid and rushed interventions with little flexibility for the specific characteristics of a given
community. As a counterexample, Kitui officials reported that the county had allocated an estimated 78
million KES (780,000 USD) to be used specifically for CHV stipends, allowing them to support 2,100
CHVs for approximately 18 months (with stipends of 2,000 KES [20 USD] per month) during their
efforts to achieve ODF across the 4,931 sub-villages that exist within the county. This dedicated funding
enabled monitoring and follow-up activities to track community progress toward ODF status.
Capacity for monitoring and follow-up by community- and county-level staff is limited. Low
capacity and funding levels also limit the ability of local staff to conduct follow-ups and monitoring,
document learnings, and train staff and the degree to which staff can coordinate with implementing
partners (e.g., related to how CLTS is implemented and enforcement of no-subsidy policies). Disparities
in staff training and coordination can lead to differences in people’s understanding of CLTS (e.g., specific
triggering activities), uncertainties regarding the CLTS status of communities, and discrepancies in
reporting. Additionally, Kitui officials noted that some sub-villages had been combined to form much
larger administrative units during the devolution process, and these larger groups of households are
more difficult to trigger (Stuart et al., 2021), due in part to the large amount of monitoring and follow-up
needed.
Some contexts lack leadership that prioritizes sanitation, while others push for progress
with aggressive approaches that do not sustain the desired behavior change. If there are no
personnel dedicated to supporting sanitation at the highest levels of the county government, progress
can be difficult. These individuals set priorities for the county and have some control over where funding
is allocated. As an example of the impact of top-level leadership, the previous county governor in Kitui
made sanitation a key priority, ensuring that funding was available and that the government was engaged
in local efforts to eliminate open defecation and encourage latrine adoption. While other sanitation
champions continue to work within various levels of the county government, that top-level prioritization
has changed with the current office holder, and now less funding is available for sanitation activities. At
the community level, some people in more settled communities reported aggressive tactics from local
CHVs or PHOs, who might threaten to jail someone without a latrine, but this pressure does not result
in sustained motivation to complete the latrine. In other research, the team found that traditional
leaders in Cambodia who take a more casual approach toward persuading households to construct
latrines were more successful, and by-laws with consequences enforced by traditional leaders were
widely accepted by community members in Ghana. Critically, without support from multiple actors
internal and external to the community (e.g., follow-up from CLTS facilitators, active traditional leaders),
sustained success is difficult to achieve (Tribbe et al., n.d.).
County government frameworks for CLTS reporting and implementation can be complex
and unclear. Through interviews with government officials in each county, the WASHPaLS team
learned about differences in the structures used to implement and report on CLTS programming, from
the upper levels of the county government to the village-level staff working within specific communities.
The team does not know the full extent to which individual county governments are able to alter the
structure of their departments and personnel under devolution, but the differences observed suggest
that they do have a certain degree of latitude. Generally, the team found that the reporting structure is
well coordinated and clear in Kitui, where the environmental health department (containing public
health officers) and the community health services department have implemented CLTS collaboratively.
Certain roles within these two departments have been consolidated, being performed by single
individuals, which limits confusion and complexity and improves coordination (Figure 2). In contrast,
structures are more complex in Samburu and Turkana, where public health departments are primarily
responsible for implementation and community health officers operate in parallel, with limited
coordination. In Samburu, the formal structure differs from the reality on the ground. The public health
and community health departments are meant to implement CLTS collaboratively, but in reality, they
conduct separate, independent activities in parallel. Because local CHVs and CHEWs tend to work more
closely with the community health department, the PHOs within the public health department can
become sidelined in the CLTS process, not being aware of planned or ongoing activities. In Turkana,
there does appear to be a clear line of reporting (in principle) from the community level to the county-
level Directors of WASH and Public Health. However, this line involves a number of officials operating
in different sub-departments, some of which are not directly connected to WASH programming. This
level of complexity can hinder reporting and implementation processes, leading to inconsistencies or
discrepancies when tracking CLTS progress. Additionally, supervisors may not be aware of all activities
being undertaken by their subordinates, and reports made by subordinates may not reach the correct
individuals higher up in the structure.
Figure 2. Framework for CLTS reporting in Kitui. Dark blue shading indicates actors directly involved in
CLTS reporting and implementation at multiple levels, while white/no shading indicates upper-level
management overseeing all health-related activities in the county.
3.2 ACCEPTABLE SANITATION STANDARDS (RQ 2)

In this section, the WASHPaLS team presents a few different approaches to identifying what pastoral
communities consider to be acceptable standards for sanitation. First, the team considers direct
statements from respondents in different types of communities (semi-settled/settled, and nomadic) to
understand what they feel appropriate latrines should include or whether they perceive open defecation
as an acceptable sanitation strategy. Second, the team records specific reasons why respondents stated
they would be interested in adopting latrines (or what reasons led to adopt latrines they already have).
Third, WASHPaLS considers direct suggestions from respondents on how communities could improve
sanitation and reach acceptable standards. Section 3.3 then presents three case studies of villages that
have seen greater success and consider the key factors at play in each circumstance.
3.2.1 SEMI-SETTLED AND SETTLED: DURABLE, PRIVATE, AND APPROPRIATE FACILITIES

Semi-settled and settled populations want durable latrine structures. Despite the common
programmatic emphasis on local materials, nearly all respondents indicated a preference for durable
technologies constructed from materials that would typically be purchased in an urban center. In
Samburu study villages, households discussed preferences for latrines with concrete slabs, iron sheets
(walls and roof), and a vent pipe. Respondents in Turkana and Kitui study villages prefer cement/iron
mesh slabs, brick or cement block walls, and iron sheet roofing. These preferences for durable materials
align with previous findings from research conducted in other pastoral and agrarian communities across
rural Kenya (Otieno et al., 2013). In all cases, respondents indicated a desire for strong doors that
would ensure high levels of privacy and not damage the superstructure. Respondents also suggested
two-door designs in cases when sharing between men and women, or with in-laws, is a concern. Given
the unstable soil conditions common in many villages, households often discussed the importance of
including a lined pit (referred to as “building from the bottom up”). Some households also mentioned
the importance of including handwashing facilities with soap (in particular, this sentiment was expressed
in an FGD from the second village in Turkana, which is currently maintaining its ODF status).
The exact location of latrines is important for durability, privacy, and safety. Appropriate
siting is also a key concern to provide sufficient levels of privacy, prevent flooding, and ensure prevailing
winds carry smells away from the house. According to a male FGD participant in Samburu, “Again in
regard to the location of the latrine, it should be built in a hidden area within the homestead so that someone is
not seeing when someone is going to the toilet” (Male FGD participant, Samburu County). Others (e.g.,
among Turkana study villages) feel the latrine should be located outside the compound. With regard to
safety, people feel latrines should be designed and sited to minimize the risk of children or livestock
falling into the pit.
SaTo Pans have been introduced, but there is limited uptake. Households in Kitui are aware of
SaTo Pans (plastic toilet pans designed to provide a seal between the latrine pit and outside
environment) becoming available and see them as being easy to clean. A separate product (the SaTo
Stool) is considered to be a good option for elderly individuals. However, uptake of these products was
low in the team’s remote study communities. Implementing partners reported that although SaTo Pans
were being purchased, installation is a challenge due to lack of trained artisans.
3.2.2 NOMADIC: OPEN DEFECATION IS PERCEIVED AS THE BEST OPTION

There is limited interest in latrine facilities among nomadic populations who generally
perceive open defecation to be the best option for their mobile lifestyle. Generally, all
households who grazed cattle away from their villages for extended periods practiced open defecation
during these times, including those with latrines at their homestead in the settled village. Because these
households move frequently and do not have permanent structures in the remote areas where they are
grazing cattle, they are not interested in carrying additional materials for constructing temporary latrines
(a strategy suggested by individuals in more settled communities). People would consider installing a
latrine if they could transition to a more settled lifestyle. “A latrine is not something I can carry around when
moving from one place to another. If you want me to have a latrine, then build a permanent house for me and
relocate me to a different area” (Female Focus Group Discussion participant, highly nomadic community, ,
Turkana County). Additionally, given that there is plenty of space to offer privacy, they do not find a
latrine necessary. Some semi-settled communities offered suggestions for nomadic households and
individuals, such as: public latrines in areas where cattle are grazed (forests or near water bodies)
promoting the “cat” method (i.e., digging holes and burying feces), or provision of iron sheeting for
temporary latrines. Providing mobile herders with dedicated sanitation facilities at grazing locations
could have the additional advantage of providing a high level of privacy, far removed from the village
where others might see someone entering a latrine. However, few of these suggestions were validated
by nomadic households themselves, who expressed concerns regarding the maintenance and durability
of dedicated facilities in grazing areas.
3.2.3 REASONS FOR ADOPTING LATRINES
People adopt latrines because of privacy, safety, and pride. In general, many respondents
demonstrated a basic understanding of WASH knowledge, specifically with regard to the health risks
associated with open defecation. However, as described previously, the team’s findings suggest that
open defecation remains common in many communities, and there are numerous constraints limiting
latrine uptake. Accordingly, it may be worthwhile to consider and incorporate other reasons for
adopting latrines when sensitizing communities. Despite the various constraints enumerated in Section
3.1, many people do want to use latrines. Respondents that the team interviewed emphasized the
importance of privacy and safety (from wild animals or from crime), noting that well-built latrines offer a
private place to defecate without having to walk long distances. Pride is another key consideration,
particularly when a household receives visitors from outside the community. Having a latrine allows
them to feel a sense of pride, because they will not be forced to ask visitors to walk long distances and
open defecate. “If a visitor comes from Nairobi, they don't know how to go and defecate in the bush. Therefore,
you have to have a latrine in your homestead, and when the visitors come they feel comfortable and safe”
(Household interview, Samburu County). This sense of pride is also linked to land tenure. For example,
current efforts to transition from communal land to an individual land ownership model are underway in
Samburu, while land demarcation is largely complete in Kitui. The status and personal satisfaction that
comes with legally owning a piece of land can lead people to want to develop that land by installing
infrastructure such as a latrine. Where land has not yet been officially demarcated but the process is
underway, households may prefer to wait to construct latrines until the process has been completed
and they feel confident in the legal status of their residence.
Some pastoralist populations believe that sanitation facilities have the potential to increase
the safety of livestock, which have high perceived value. Of particular interest is the fact that
pastoralists often see livestock as having high inherent value or as representing a type of wealth that
surpasses their strict monetary value. As a result, people whose wealth consists primarily of livestock
herds may be unwilling to sell one or more animals to construct a latrine. One relevant strategy could
be to promote latrines as providing safety for livestock. Particularly in Samburu, respondents noted
concern related to livestock eating or coming into contact with human feces: “I think livestock get sick by
eating fecal matter left open after open defecation. Having a latrine reduces incidences of animals getting sick”
(Female household interviewee, Samburu County). Although the WASHPaLS team is not aware of
specific evidence confirming that livestock can contract diseases from consuming human feces,
promoting latrines as a physical barrier between livestock and human feces may be a worthwhile
strategy to capitalize on the perceived value of livestock. Similarly, people expressed concern about
livestock falling into latrines, so it is important to ensure that latrine designs will minimize these risks.
Alternatively, education efforts could be developed to promote latrines as a different type of value from
livestock, perhaps one that can reduce a household’s health care costs (and the need to sell livestock to
cover these costs).
Exposure to latrines in urban areas has encouraged latrine adoption. Respondents also noted
that exposure to other communities and ideas has increased their interest in latrines. People experience
modern latrines while visiting towns or attending school, and they bring these ideas with them when
they return to their households and communities. “Youth who are educated and have jobs [outside the
community] are also coming back to help build latrines for their parents” (Community Leader, Samburu
County). Similarly, relatives or friends from other areas might visit a family and encourage them to build
a latrine: “I saw it as a good thing; even when you have a visitor, the first thing he or she asks is about the toilet.
Will you let your visitor go to the bush at 10:00 pm at night?” (Male Focus Group Discussion participant,
Turkana County).
3.2.4 SUGGESTIONS FROM COMMUNITIES ON HOW TO IMPROVE SANITATION
Education. With regard to behavior change, many people feel that cultural beliefs constraining latrine
adoption are evolving, and that education (which is highly valued) combined with latrine sensitization
efforts will help to overcome remaining cultural barriers. For more nomadic populations, sensitization
efforts can specifically target individual groups within a community. For example, peer-to-peer education
for morans could allow those who are older, more respected, and/or more educated to provide tailored
messaging related to latrine use. This type of strategy may be especially necessary for morans, as other
members of the community may feel unable to discuss such topics with them (due to cultural norms).
Community leadership. To ensure that sensitization efforts are conscious of any special local issues
or difficulties, community leaders (i.e., chiefs, village elders) can be involved in the process, both to
inform implementing organizations before programming and to participate directly in activities.
Community leaders can construct their own toilets as examples to the rest of the community. As an
additional approach to sensitization, a community can also develop by-laws to restrict open defecation
or require new households to construct latrines when they arrive. Some communities already have such
by-laws and enforcement mechanisms (e.g., requiring someone caught open defecating to carry the feces
to a latrine), and they have seen success in using them. Other communities have similar considerations
in place to regulate cattle grazing, providing a foundation to adapt and use for sanitation.
Financial support. Given the high poverty levels of communities and the need for durable latrine
structures to handle challenging environmental conditions, many respondents suggest that some form of
support is necessary. People typically understand what is required (materials, skilled labor) to install a
more permanent toilet, and they want to have greater access to (or be given) the appropriate items.
Demonstration facilities that model suitable construction materials and techniques are also desired.
These could, for example, be installed in local institutions (e.g., school, health center) or at the homes of
respected leaders. To incentivize latrine construction, respondents suggested offering gifts or financial
assistance to households after installing a latrine, while sanitation-focused savings groups can provide an
opportunity for members to collectively support one another, constructing one latrine at a time.
3.3 CASE STUDIES OF SUCCESS

While high levels of open defecation and limited latrine coverage are characteristic of many communities
studied, the WASHPaLS team identified a few that have seen greater success. Generally, these villages
typically had highly motivated CHVs and community leaders who were dedicated to improving sanitation
conditions, and they also tended to have higher levels of market access (e.g., less than 10 kilometers
from an urban center), making it easier to source construction materials and engage with skilled labor
for latrine construction. However, the team also found some distinctive characteristics in each village
that may have contributed to success. We describe these details below, as this information may offer
lessons that can be applied in other communities. Photographs from these villages are included in
Appendix C.
3.3.1 SAMBURU VILLAGE 1: SUBSIDIES AND HIGH-LEVEL COUNTY ENGAGEMENT
One village in a sandy area of Samburu Central Sub-County was reported to
have failed ODF certification, but the team observed that it exhibited relatively
good sanitation behaviors. Approximately a quarter of households still practiced
open defecation, but most households (50–63%) had functional latrines, with
nearly all latrines built from “permanent” materials such as concrete slabs and
iron sheets, which are likely less prone to collapse than “temporary” latrines
constructed from local materials. Many of these facilities had been constructed
with support from the AMREF, which provided cement and iron sheets after a
household had excavated a pit and then employed a mason to install the slab and
superstructure. While not all households had latrines, many of those who
received the subsidy seemed to be using and maintaining their facilities.
Additionally, the county CLTS Coordinator was directly involved in triggering and follow-up activities,
and this commitment from the county government likely provided strong additional motivation for
households to adopt and use latrines. Generally, this case represents an instance where material
subsidies were combined with CLTS’s behavior change messaging and follow-up from multiple levels of
the county government. This combination gave households the desire to use latrines, as well as the tools
they needed to install appropriate facilities.
3.3.2 TURKANA VILLAGE 2: INSTITUTIONAL TRIGGERING, BY-LAWS, AND SHARING

A village in Turkana South Sub-County was the first to be certified in the
county and continues to maintain its ODF status. While only 74 percent of
households had latrines, no open defecation was occurring because
households were willing to share with one another. Most latrines were
“permanent,” constructed using concrete slabs, brick or block walls, and
iron sheet roofing, while a few are made from local materials. In this village,
CLTS implementation began with “institutional triggering,” in which the
CHEW (in collaboration with the Fred Hollows Foundation) initially
targeted local schools and community leaders. The CHEW selected and
trained teachers from different villages, giving them tailored sanitation
lessons to teach in schools. After triggering at the school, children became
change agents within the community, promoting latrines to their families and friends. Students were also
involved in sanitation promotion through art and drama (e.g., skits, songs, poems). After triggering,
households’ willingness to share (and to help poor households build basic latrines) had been encouraged
through by-laws against open defecation, which the community developed to arrest or publicly shame
those who are found open defecating. Additionally, the community was holding monthly sanitation
meetings and village cleanup initiatives. It is also worth noting that this village had access to livelihood
opportunities (e.g., nearby oil exploration) that were not available in other Turkana villages, and these
improved economic conditions may have also contributed to households’ ability and willingness to pay
for constructing latrines. Generally, this case may involve fewer contextual challenges than other areas
of the county (e.g., greater livelihood opportunities due to local oil exploration and a nearby urban
center), but the development of local institutions (school and community leader triggering, community
by-laws, monthly sanitation meetings, and village cleanups) also contributed to the village’s success.
3.3.3 KITUI VILLAGE 1: HOUSEHOLD TRIGGERING AND GOVERNMENT ENGAGEMENT
One village in Kitui Rural Sub-County was also the first to be certified in its
county and was maintaining its ODF status. In this case, in contrast to the
typical practice of starting triggering at the community or institutional level,
triggering began with individual households (i.e., each household would be
made aware of open feces in or near their compound). Community
triggering followed and also involved targeted sensitization of children in
schools (similar to the Turkana case). Local CHVs followed up with
households and were directly incentivized by the government to assist
vulnerable households with latrine construction (i.e., a CHV received 2,500
KES [25 USD]) after building a latrine for a vulnerable household). The
county governor (who has since left office) also demonstrated high levels of county government support
and engagement by being present at the community’s certification celebration. Many members of the
community remember and are proud of this fact, and it provides motivation for them to rebuild latrines
if they collapse. Generally, this case involves more intensive activities in the early parts of CLTS
implementation (e.g., household triggering, CHV incentives), but these activities, coupled with political
goodwill from the previous county government, seem to have increased the sustainability of latrine use
in this community.
4.0 RECOMMENDATIONS (RQ 3)
The WASHPaLS team’s analysis explored the characteristics of pastoral communities, the constraints
that limit latrine adoption and the effectiveness of sanitation programming (RQ 1), and opportunities for
promoting and implementing sanitation in acceptable and appropriate ways (RQ 2). Based on these
findings, the team developed recommendations on potential adaptations to address the challenges in
pastoral communities within the ASALs of Kenya. These recommendations fall into two categories: (1)
strengthening the enabling environment for sanitation programming, and (2) tailoring implementation
strategies to better address the specific needs, concerns, and barriers that exist within pastoral
communities. A central recommendation involves a concept for a new and easily implementable
questionnaire to aid in contextual analysis of pastoral communities during pre-triggering. Implementers
can use such a questionnaire prior to initiating a sanitation intervention to establish an understanding of
the key characteristics that may affect sanitation in a particular community, leading to specific tailored
strategies that can overcome constraints and capitalize on opportunities. The set of questions and
illustrations of tailored implementation approaches provided here offer a starting point that can be
refined through additional research and piloting.
4.1 ENABLING ENVIRONMENT: RECOMMENDATIONS FOR GOVERNMENT

The Government of Kenya has prioritized sanitation in the ASALs through its Vision 2030 Development
Strategy for ASALs (Government of Kenya, 2012), which includes a policy focus on pastoralism. Kenya’s
constitution, adopted in 2010, also committed to investing in improved sanitation access in pastoralist
areas within the ASALs (Odhiambo, 2013). Currently, county governments are responsible for delivering
public services such as sanitation, but reduction of open defecation has become a relatively low priority
due to competing concerns such as drought resilience (Karanja et al., 2018). Additionally, Axweso
(2011) has argued that pastoralists have been sidelined in decision-making processes, resulting in chronic
under-investment in pastoralist communities. These concerns, combined with institutional challenges
identified during the study, suggest a need for stronger enabling environments within county
governments to support partners in developing and implementing appropriate intervention strategies.
Recommendations that may provide a starting place for county governments to strengthen the enabling
environment are provided below.
Clarify and consolidate government structures to strengthen sanitation reporting and
implementation. An important first step in ensuring effective support and monitoring of sanitation
programming involves developing reporting and implementation structures that are clear and
streamlined. All three counties have existing structures in place, but their effectiveness varies. Generally,
as the structure becomes more complex, involving individuals from multiple departments and
uncoordinated activities operating in parallel, discrepancies can arise in monitoring and documentation,
duplication of efforts can occur, roles and responsibilities can become confused or ill-defined, and high-
level actors may not be aware of important developments on the ground. These issues can lead to
inconsistent program implementation, especially if different contact points in the local government have
different conceptions of CLTS programming and are not coordinating with one another. Additionally,
the structures that develop in practice may not align with the formal frameworks that have been defined
on paper (as was seen in Samburu). Kitui’s approach of consolidating the public health and community
health divisions to jointly implement and oversee CLTS activities seems to have worked relatively well,
and other counties may consider learning from this strategy to strengthen the overall structure and
ensure that at least one department has sanitation as a core aspect of its mission. Furthermore, with
respect to sanitation programming, each actor’s specific role should be clearly defined, especially when
someone working at the community level reports to multiple individuals, to ensure all parties are aware
of conditions on the ground and how to report any challenges or successes.
A good starting place to build toward these changes may be to map the relevant actors across multiple
levels (as presented in Appendix D) and precisely define each actor’s role within sanitation
programming. More broadly, Kenya’s Public Service Commission has issued guidance on the design of
public sector organizational structures (Government of Kenya, 2015), which noted similar challenges
throughout the government such as functional overlaps, duplication of roles, and undefined
responsibilities. The guidelines emphasize mapping what is currently in place, identifying strengths and
weaknesses with respect to achieving priorities and goals, and revising the structure with stakeholders
to remove redundancy, facilitate effective communication, and reflect the overarching strategy for
meeting objectives (Government of Kenya, 2015). Coordination and learning, both within and across
counties, can provide avenues for identifying structures and strategies that have been successful in other
departments or contexts, while still allowing individual county governments the freedom to craft an
approach that will work for them. In addition to strengthening programming, these measures may also
help to minimize discrepancies in reporting (e.g., observed when comparing local perceptions of CLTS
status to what is recorded in the national online database) and promote effective documentation of
lessons learned.
Identify, engage with, incentivize, and support committed sanitation champions. In many
contexts, the progress and success of CLTS implementation have been connected with the presence and
engagement of sanitation champions, both in and out of government (Chambers, 2009; Venkataramanan
et al., 2018). Within each county structure, identifying one or more individuals who are especially
committed to sanitation improvements can be a key factor in ensuring that sanitation programming has
continued momentum. (Along with governments, implementers can also benefit from engaging with
champions.) At higher levels of the county government, these individuals can act as a keystone within
the structure, continuing to make progress despite changes in leadership or available funding. At the
community level, local health workers who are particularly dedicated to sanitation improvement can
often find creative ways to promote latrine adoption and sustained use. A strong reporting structure can
ensure others learn from these experiences, while programs that provide direct incentives for CHVs
who are able to trigger and certify villages (and sustain ODF status) may engender healthy competition
among community-level staff and increase interest in sanitation interventions. In general, sharing
performance of neighboring communities, sub-counties, or counties would help promote competition
that could engage even high-level officials in sanitation. For example, the CLTS RTMS provides ongoing
comparisons of progress toward triggering and ODF certification across counties and sub-counties
(GoK, 2021), while stakeholder meetings among government officials and implementing partners can be
effective avenues for sharing experiences, success stories, and ideas for addressing common challenges.
The WASHPaLS team was able to attend a few meetings in Turkana initiated by donor organizations
(e.g., Water Sector Trust Fund), where they heard about funding and implementation challenges that
constrain implementers.
Establish a budget planning process that takes into account all necessary CLTS activities
and accounts for the unique challenges of triggering and monitoring hard-to-reach, difficult
communities. CLTS often relies on CHVs to conduct triggering and follow-up with households, and
monetary incentives are often required to compensate CHVs for these activities. Because these
incentives require funding, it is important to ensure these funds are provided for and effectively
allocated. According to county officials, Kitui already has a dedicated budget for sanitation, but in other
cases sanitation typically falls under the health department’s purview. Functionally, within the health
department, funds act as pools for broad programs (e.g., public health and sanitation, which includes all
public health activities), and those funds end up being allocated based on the priorities, interests, and
experiences of high-level staff. A first step in many cases, then, is to dedicate specific funding for
sanitation as a separate line item. After that, the next step would involve developing a detailed sanitation
budget to reduce the possibility of misallocation of funds. For example, the team was informed that the
Kenya Sanitation and Hygiene Improvement Program has spent 70,000-120,000 KES (700-1,200 USD)
per village in ASAL counties for CLTS activities (excluding administrative costs), compared with 12,000
KES (120 USD) per village in other counties. In a specific county, details can be developed using
strategies such as micro-planning, which has been employed in Kitui to estimate specific funding needs
for CLTS implementation in individual villages. ASAL counties are likely to have additional cost
requirements in order to sufficiently staff and implement CLTS due to remoteness and insecurity levels
or costs of goods and services. Using a micro-planning approach would help government staff to think
through the costs associated with implementation and staff training in difficult and hard-to-reach
contexts before interventions occur. Developing detailed cost estimates in different local contexts, in
conjunction with identifying opportunities for cost savings, may be a valuable area of future study.
Detailed sanitation budgets should include transportation funding for follow-up monitoring (post
triggering), as this is critical in promoting sustained engagement and helping to address any challenges to
latrine adoption that remain after the triggering process. For example, the estimated 78 million KES
(780,000 USD) allocated in Kitui provided 2,100 CHVs with stipends of 2,000 KES (20 USD) per month
for approximately 18 months. However, as noted above, different counties and sub-counties may have
different cost requirements. For example, on average, a sub-village in Turkana contains nearly twice as
many people than in Kitui (Kenya National Bureau of Statistics, 2019); moreover, Turkana is one of the
largest counties in Kenya, with a land area more than twice that of Kitui (Kenya National Bureau of
Statistics, 2019). On a per village basis, Turkana may require levels of transportation and follow-up
funding that were higher than those provided in Kitui. Also, additional funding may need to be allocated
for contextual and baseline analysis, as well as training of government staff and implementing partners
who do not have previous experience with CLTS and behavior change programs, as county officials
often this as a challenge during interviews.
As above, sharing experiences across counties, and combining that knowledge with a local understanding
of factors such as village size and spatial requirements, could help governments to plan for appropriate
levels of funding. It is also possible to use existing datasets to identify local conditions that may influence
CLTS program outcomes and requirements (Stuart et al., 2021), based on the understanding developed
in this study. Finally, implementing improved budget tracking mechanisms could improve the sector’s
understanding of how funding for CLTS is utilized in practice, which could inform where budget
shortfalls are impacting implementation. Alternatively, adopting performance-based approaches to
funding could help ensure budgets and activities are aligned, while also incentivizing key staff involved in
implementation.
Consider assistance programs to ensure that no one is left behind. Especially in contexts with
high levels of poverty and challenging environmental conditions that lead to frequent collapse of latrines
made from local materials, it may be particularly valuable to provide guidance and funding for pro-poor
initiatives that support construction of more durable latrines by households that are most in need
(Karanja et al., 2018). Such approaches should act in concert with other activities recently found to be
effective such as institutional triggering and Follow-Up MANDONA (FUM), which involves a series of
facilitated community sessions after initial CLTS triggering to collectively identify and undertake small,
immediate, and doable actions toward ending open defecation (England, 2016). For example, Ghana has
developed guidelines for pro-poor targeting to support households that would not otherwise have the
capacity to construct appropriate latrines (Ghana Ministry of Sanitation and Water Resources, 2018).
Current work in Northern Ghana is testing the efficacy of a pro-poor approach that identifies poor and
vulnerable households through community consultation meetings and provides these households with
vouchers for durable latrines that are available in local markets and installed by local artisans (USAID,
2020). Such an approach is distinct from blanket hardware subsidies, which have typically been
ineffective in the team’s ASAL study areas. Rather, strategies that are more market-based and focused
on accurate and transparent targeting offer opportunities to ensure that the most vulnerable households
and most challenging contexts are not left behind. Guidance on effective targeting of poor and
vulnerable households could come from the Equality and Non-Discrimination (EQND) Handbook for
CLTS Practitioners (WSSCC, 2019) that, for example, defines the most disadvantaged households
(“Category C”) as those without support from extended family members and with limited means to pay
for latrine installation. In addition, there may be lessons about how to target households in need from
the Government of Kenya’s Hunger Safety Net Programme, which is implementing unconditional cash
transfers to poor and vulnerable households in the ASALs. One implementing partner in Kitui noted
that their NGO-led cash transfer program appeared to have positive spill-over effects on sanitation in
their program communities.
4.2 TAILORED IMPLEMENTATION STRATEGIES: RECOMMENDATIONS FOR

IMPLEMENTERS
Some implementing organizations and governments have already incorporated effective adaptations and
experimental ideas into CLTS interventions for pastoral communities (see the case studies in Section
3.3; other recent interventions have also found success by incorporating institutional triggering and
FUM, used by the NGO Peace Winds Japan in Turkana), but these have not been implemented broadly
across the ASALs. Here, WASHPaLS provides specific recommendations of strategies (some that align
with existing adaptations) that may be especially effective in settled or semi-settled pastoral contexts,
given the constraints and opportunities identified.
First, however, the team notes an overarching theme from this work: each community is unique, with
distinct characteristics related to leadership, environmental conditions, social cohesion, cultural norms,
exposure to outside ideas, and numerous other factors. Many of these considerations can impact the
success of sanitation interventions, and tailoring implementation strategies to align with the features of a
given community is key in improving the likelihood that households will adopt, use, and maintain
appropriate latrines.
Accordingly, the team recommends employing an easily implementable questionnaire to
accompany pre-triggering to tailor interventions for pastoral communities. Evidence from
this study indicates that CLTS can be effective, particularly among settled and semi-settled communities,
but it is important to ensure that implementation is tailored to the specific needs, constraints, and
opportunities that exist within different pastoral communities. Many organizations conduct baseline
analyses to understand existing sanitation infrastructure and community entry points, and existing CLTS
guidelines already recommend that pre-triggering activities include assessments of social, physical, and
institutional conditions (Kar & Chambers, 2008). However, further guidance on how to collect
information in a rapid, systematic way, particularly among pastoral communities in challenging contexts,
can ensure that implementers with limited time and funding uncover the most salient points.
The WASHPaLS team has built upon the IBM-WASH framework to develop a concept for a
questionnaire that can supplement implementers’ existing baseline assessments and provide guidance on
how programs might be tailored to best serve a given pastoral community (Figures 3 and 4). As
illustrated here, the team recommends that CLTS facilitators gather data using a set of several simple
questions focused on characterizing the key contextual, psychosocial, and technological constraints and
opportunities identified here as particularly important among pastoral communities. The questions cover
topics such as exposure to outside contexts, market access, household priorities, and cultural norms,
and the relevance of certain topics may depend on the community’s level of mobility (Figure 3). These
questions can be asked of a community leader and/or a CHV to provide a general understanding of the
community’s characteristics. The team designed this illustrative set of questions to be easy for an
implementer to include while performing a typical baseline analysis, without requiring additional time or
funding. The information gained could be particularly valuable in developing or identifying specific
strategies to improve the success of sanitation interventions within the community.
Figure 3. Incorporating a simple contextual analysis into pre-triggering to guide sanitation implementation
for individual pastoral communities with differing levels of mobility.
Once these key points about the community are understood, a team could use them to tailor
interventions by focusing on certain individuals or institutions, promoting certain types of toilet designs
(or working with additional partners and local institutions, artisans, and material suppliers to develop
new ones, if possible), designing behavior change messaging that emphasizes how toilet features align
with cultural beliefs, or coordinating with complementary programs. Based on responses to the
questions in the assessment, certain constraints or opportunities can suggest which intervention
approaches may be most appropriate (examples provided in Figure 4) and the ways in which those
approaches can be integrated together (e.g., through specific sequencing or complementarity). These
examples correspond with many of the specific implementation recommendations described below.
Table 5. Examples of potential implementation approaches tailored to a specific community based on
constraints or opportunities identified during a contextual analysis. For each of these strategies, the team
found or heard about at least one example in the field (except for CLTS implementers working with non-
sanitation actors to address other issues simultaneously). However, conducting additional field piloting
would likely be appropriate to test the strategies on a broader scale.
Community Constraint/ Opportunity Implementation Approach
Schools/ high enrollment Coordinate with WASH in Schools Programs, engage schools in triggering.
Context
Complement standard CLTS with interventions that seek to address basic needs;
Struggling to meet basic needs (e.g., food, water).
identify non-sanitation implementing partners working in the area.
Strong cultural barriers around latrine use/sharing; low Promote designs that counteract cultural barriers and privacy concerns
social cohesion reduces willingness to share (e.g., 2-door toilets or separate facilities for males and females).
Household or community decision-makers, or specific Start by triggering individual groups (e.g., women, morans) and change agents
household members, unlikely to use latrines. (elders, church leaders) before communal triggering
Psychosocial
Previous cholera outbreaks, or demonstrate basic Target sanitation and health messaging during the onset of rainy season when
knowledge on water quality. households are experiencing diarrhea cases
Limited exposure to urban environments/ modern Share success stories through village/household exchange programs; emphasize
latrines. pride in having a latrine for visitors to use
High perceived inherent value of livestock; resistance to Emphasize latrines as protecting livestock safety; promote latrines as alternative
selling livestock for latrine construction. type of wealth
Existing savings groups, limited resources, and/or low Leverage existing groups (or promote new ones) for shared financing of
nolog
Tech
market access. latrines/division of labor/procurement of supplies
Rocky or sandy soils. Promote appropriate designs (e.g., offset pits, Sato pans, brick-lined pits).
Lack access to markets/ artisans; strong leaders/ change

Construct demonstration toilets for institutions or leaders/change agents
agents; dynamic communities
The following specific recommendations may be appropriate in a given community, depending on the
results of the contextual analysis. With each recommendation, the WASHPaLS team notes key
questions that may provide the most salient information regarding its appropriateness, as well as
suggestions for how it should be integrated into broader sanitation programming.
Tailor durable latrine designs to pastoralists’ values and contextual challenges.
Key contextual questions: What cultural beliefs and norms exist related to defecation and latrine use?
What are the soils like in this area?
Integration into broader programming: Ask community members and leaders about any concerns related to
cultural requirements, sharing, or livestock health during triggering (or pre-triggering), and then
collaborate with local artisans and material suppliers to return with siting strategies or designs that
address those concerns (e.g., separate facilities, separate doors, fences around latrines). Accordingly,
developing these designs can become part of the follow-up process.
To promote adoption and sustained use of latrines, the facilities should meet certain minimum standards
that reflect pastoralists’ values and the environmental challenges they often face.
• A key concern for many people is privacy, so latrines should be designed and sited in locations to
promote privacy and safety (e.g., fully enclosed with strong doors to enable discreet entry).
• Latrines designed to prevent animals from falling in could also be promoted, as livestock are highly
valued in these contexts.
• With regard to environmental challenges, common factors such as unstable soils and flooding
increase the likelihood of pit collapse in pastoral communities, and frequent collapse can become
demoralizing. Latrine designs should be specifically tailored to address local environmental
challenges, and implementers can explore opportunities to scale solutions that are currently
working well in certain settings. For example, some adaptations the team observed included: lining
pits with bricks to increase their stability, using wood treatment to guard against termites, or
offsetting pits from superstructures to reduce the weight on the pit and address safety concerns
related to falling in.
Focus on messaging that emphasizes privacy, pride, and value.
Key contextual questions: Who in the household is most likely to continue practicing open defecation
despite having a latrine at their homestead? How much are people exposed to outside contexts (e.g.,
through visiting relatives)?
Integration into broader programming: This recommendation may be especially valuable among
communities that are transitioning toward more permanent and densely populated settlement patterns,
placing emphasis on the greater privacy provided by latrines (compared with open defecation). Privacy
was a key concern among many respondents. Messaging can be integrated into triggering events,
complementing (or perhaps replacing) more conventional techniques related to shame and disgust.
• In particular, messaging can focus on the pride that people feel when they are able to offer visitors a
private facility to use, as respondents often reported that they would feel embarrassed if they are
unable to provide this convenience to visitors from outside the community.
• Messaging could emphasize the value of latrines in forming a physical barrier between livestock and
human feces, to capitalize on the fact that many pastoralists view livestock as having high inherent
value and want to ensure their safety.
• Highlighting the value of latrines as an alternative type of wealth (representing, for example, modern
infrastructure and healthy living) may help to persuade households that are resistant to selling
livestock to finance latrine installation. Essentially, they would be diversifying their wealth portfolio
beyond their (highly valued) livestock herds.
Engage schools and community leaders.
Key contextual questions: Do children remain in school during the grazing period? What institutions are
available in or near the community?
Integration into broader programming: Triggering activities at schools reach students as well as others
(peers, family, community members). Accordingly, engaging schools either before or in parallel with
community triggering can create additional triggering agents (teachers and schools) who perform a
nexus role during community activities and can participate in or coordinate promotion for activities such
as poems, quizzes, drama skits, or songs.
Including school-based interventions and other key actors (e.g., community leaders) in CLTS
implementation can make an impact on the triggering process (van den Ouden, 2013). In communities
with schools (and particularly those with high enrollment and/or where households highly value
education), inclusion of school-based interventions can enhance both short-term and long-term efforts
(e.g., short-term improvements in receptivity to latrines as well as longer-term shifts in culture around
sanitation) (Magogwa & Olekao, 2013). The WASHPaLS team encountered five communities (including
at least one in each of the three counties) where residents reported that school-based sanitation
interventions, or simply the presence of latrines at schools, had exposed students to latrines and
improved attitudes toward these facilities in the communities, providing a better starting point for
community-based interventions and messaging.
• Triggering activities in schools can begin with external facilitators training teachers and/or WASH
club members, who in turn trigger the rest of the school. During subsequent community triggering,
children can increase community awareness through activities such as sanitation skits, poems, and
songs, while teachers, community leaders, and external facilitators back up the legitimacy of the
children’s activities. In the long run, this strategy can create momentum among children for self-help
local initiatives such as digging pits, constructing latrines, installing handwashing facilities, and cleaning
the community. These strategies may be especially effective in communities where households highly
value education (for example, ensuring that children are able to stay at the permanent homestead
throughout the school year, even while other members of the household move with livestock). The
team notes that this recommendation may raise concerns around the social implications of
children’s participation in relation to local cultural norms, respect for elders, and hierarchical
decision-making structures. Accordingly, such approaches should be designed to suit the local
context by employing the simple contextual analysis provided above to tailor and adapt triggering
activities led by children (if appropriate) so that they can impart a greater sense of understanding
and tolerance among community members. Generally, school-based interventions may be an
important area for further research concerning the degree to which these activities create
sustainable sanitation improvements within the broader community (including adults and households
beyond the school itself).
• Triggering efforts can also begin by focusing on community leaders who can act as exemplars within
the community, perhaps by constructing demonstration latrines that provide models of durable
structures appropriate for local conditions. This strategy would likely be most effective when such
leaders are strong and/or charismatic, act within clear leadership structures, and are able to
influence behavior within the community.
Target specific groups for education.
Key contextual questions: What non-sanitation programs or interventions exist in the community? Who in
the household is most likely to continue practicing open defecation despite having a latrine at their
homestead?
Integration into broader programming: Before triggering the community as a whole, it may be valuable to
engage in specific education efforts when there are groups that may be especially resistant to latrine use
and/or groups that may have particular insight into what resources are available and needed for latrine
installations (e.g., village saving and loan associations [VSLAs] or solidarity funds).
• For example, peer-to-peer education among morans of the same age group may help to circumvent
the cultural taboos related to others discussing the defecation habits of this group and make them
more receptive to conventional CLTS programming once triggering begins.
• Triggering other key influential figures, such as elders or religious leaders, prior to communal
triggering may also facilitate greater support for sanitation programs.
CLTS programming can also focus on leveraging existing internal support mechanisms such as VSLAs (in
some communities, these may be referred to as “merry-go-rounds” or “solidarity funds”). These groups
offer an opportunity to promote shared financing of latrines (e.g., many households contribute to help
one household build a latrine, and the process is repeated for other households in the group). Similar
types of collective action may also help to procure the necessary supplies for installing more durable
facilities. Previous programs in Madagascar, Ethiopia, Uganda, and Ghana have reported at least
preliminary success leveraging VSLAs or self-help groups to improve WASH outcomes. While many of
the programs did see utilization of the groups for construction of latrines, some of the challenges noted
in these programs included: not all households in a community are involved, establishment of new VSLAs
can be challenging, and the focus on income-generating activities can result in strict requirements on
repayments and interest rates, which may not be well-suited for latrine construction
(Aboma & Osterwalder, 2020; Prottas et al., 2018; USAID, 2013; Zares, 2015). Many villages the
WASHPaLS team visited already had VSLAs, women’s groups, or similar local support mechanisms,
although they had not typically been used for sanitation loans. However, respondents discussed how
these groups could help to finance and/or build latrines one member at a time, particularly in cases
where sanitation facilities are already desired.
While a more complex sanitation financing program utilizing VSLAs may not be realistic in the ASAL
communities (especially for more remote communities with limited access to supplies or sanitation
marketing opportunities), these groups still offer an additional entry point for sensitization and action-
planning exercises. Action planning is highlighted in the CLTS handbook (Kar & Chambers, 2008) and in
adaptive strategies like FUM as an effective way to establish concrete next steps toward latrine
construction. While action planning is typically done at the household level, VSLAs could offer a way for
communities to view sanitation as a community-wide challenge that can be addressed with community
resources—a practice they are already familiar with in the operation of the VSLA. Action planning with
VSLAs might include taking an inventory of locally available materials, assessing the product needs for an
entire community to construct latrines, and identifying whether or not resources can be pooled to
purchase supplies and support latrine construction.
Consider pro-poor support to ensure no one is left behind, especially in challenging contexts.
Key contextual questions: How much access do people have to markets?
Integration into broader programming: In several of the WASHPaLS team’s study locations, previous
implementation of blanket hardware subsidies (e.g., provision of latrine slabs) was unsuccessful, but
challenging soil conditions that promote latrine collapse and limited access to markets make it very
difficult for households to install latrines that will be resistant to collapse. In these challenging
environmental conditions, some assistance may be needed to ensure that households with high poverty
levels have the ability to install durable latrines. Depending on the degree to which markets are
accessible, this assistance may take the form of unconditional cash transfers, vouchers, or rebates for
durable toilet construction. Any efforts in this area should occur through government systems and align
with any policies or guidance developed by local or national governments, including those on how to
target the most vulnerable or disadvantaged households. Implementing partners should ensure that any
such programs operate at a level that is feasible given government capacity and funding constraints, and
these programs should be implemented after initial behavior change efforts have achieved success, to
increase the likelihood that facilities will be used.
• The effectiveness of a program that targets poor and vulnerable households through community
consultation and provides vouchers redeemable with local artisans for durable latrine substructures
is currently being tested in Ghana (USAID, 2020). Learning lessons from this or other pro-poor
initiatives will help to determine the effect they can have on sanitation in the ASALs. Guidance on
key targeting criteria could come from the EQND Handbook for CLTS Practitioners (WSSCC,
2019).
• The Government of Kenya’s Hunger Safety Net Programme currently provides unconditional cash
transfers to poor and vulnerable households in the ASALs. Learning lessons from this program or
other similar programs may provide useful insight into how such programs could support
improvements in sanitation.
Complement standard CLTS with other relevant interventions.
Key contextual questions: How difficult is it for households to obtain food, water, and other basic needs?
What non-sanitation programs or interventions exist in the community? Have there been any recent
disease outbreaks?
Integration into broader programming: Households that are struggling to meet basic needs are unlikely to
see latrines as a high priority. Accordingly, partnering with interventions that seek to address basic
needs such as health, water, food, nutrition, veterinary services, or solid waste management may offer
opportunities to remove barriers and combine efforts in hard-to-reach areas. These other interventions
can use, reorient, or add to their own platforms to assist in introducing sanitation components.
• Communities may be particularly receptive if sanitation is linked with a program that has previously
led to benefits and has the potential to demonstrate the value of latrines. In Samburu, the team saw
an example of this type of synergy where Feed the Children was implementing a maternal health
intervention in a hard-to-reach area. They used the opportunity of the positive impact derived from
that program (and the trust that was built as a result) to introduce a sanitation intervention that
resulted in the construction of a communal sanitation facility.
• Rather than incorporating health education as a primary element of sanitation interventions, it can
be linked with the challenges that have direct causal relationship with sanitation. For example,
diarrhea outbreaks often experienced during the onset of the rainy season can offer one
opportunity to sensitize the community on the causes of diarrhea and the need for latrines to
prevent future occurrences. Livestock disease outbreaks or wild animal attacks at night that result
from open defecation are other potential entry points to introducing sanitation components. This
information provided can include strategies for reducing risks including latrines and appropriate
hygiene behaviors. As above, communities are more likely to be receptive to this information when
provided by individuals who already engage with and are trusted by the community. Local health
workers and veterinarians may be appropriate people to spearhead such an approach.
• Another valuable area of further research is to assess the cost-effectiveness of these more
integrated approaches in these contexts.
Incorporate exchange programs into sanitation interventions.
Key contextual question: How much are people exposed to outside contexts?
Integration into broader programming: Especially in more remote locations, communities may have limited
exposure to more built-up environments, potentially lessening awareness of health concerns related to
open defecation. Beginning sanitation programming with exchange visits, in which households from
remote locations with limited latrine exposure travel to contexts where latrines have been installed
successfully, can give households the opportunity to see and experience these facilities. This exposure is
often critical in the beginning to change attitudes and perceptions of defecation behaviors.
Focus on sensitization (rather than full CLTS implementation) among highly nomadic groups.
Key contextual question: How much time do households spend in a settled or permanent location?
Integration into broader programming: The study team notes that this recommendation may raise concerns
regarding equity between highly nomadic groups and more settled populations (and nomadic groups are
often marginalized already). However, as pastoral behaviors evolve with time, and as processes such as
land demarcation progress, the team also notes that these people may eventually settle into a less
mobile lifestyle, at which point latrine adoption will be an important consideration (and the examples of
nearby settled communities may encourage emulation and latrine construction). Accordingly, the team
recommends sensitizing these groups on the benefits of latrines now to ease any future transitions to a
more settled life. It is not being recommended that sanitation programming push communities toward
more settled lifestyles. Rather, the recommendation is to meet communities where they are with an
understanding of the public health implications of different settlement patterns.
Public health risks associated with open defecation are likely lower for highly nomadic populations
moving frequently throughout arid regions. The team’s findings also indicate that these groups perceive
open defecation to be their best option, and they are not interested in carrying additional materials to
build temporary latrines wherever they stop. Pushing them to construct latrines at this stage would
likely require large amounts of resources (on a per capita basis) while being ineffective. One
implementing partner reported initial success with the introduction of “trench latrines” for more
nomadic communities, but more research is needed to understand the uptake rate and potential public
health risks of this practice. Additionally, the sector may benefit from additional research to quantify the
health risks of open defecation for certain populations in remote, arid regions versus the costs of
constructing and sustaining traditional latrines in these locations.
5.0 CONCLUSIONS AND KEY TAKEAWAYS
Based on the study team’s findings from three counties (Samburu, Turkana, Kitui) in Kenya’s ASAL
region, pastoralists face a number of distinct and intense barriers to latrine adoption, many
of which concur with those reported in previous literature. These tend to relate to the fact that
pastoralists often live and move throughout remote, difficult-to-reach areas characterized by arid and
relatively unproductive land, water scarcity, poverty, and insecurity. These conditions can reduce the
effectiveness of conventional CLTS approaches and often result in dynamic settlements that change in
composition due to migration, seasonal movement, and other factors. Accordingly, sustainable sanitation
progress is difficult and social cohesion can be low, limiting collective action to make improvements.
Additionally, low access to durable materials and challenging environmental conditions (particularly
unstable or rocky soils) make pit excavation difficult and lead to frequent latrine collapse.
Despite these numerous constraints, pastoralists are interested in latrines and would use them,
if they conform to certain standards. However, the team does see a stark distinction between
populations that are more settled and those that are nomadic. Nomadic communities see open
defecation as the best option for their mobile lifestyle and are resistant to latrine use. In contrast,
households in settled and semi-settled communities want durable latrines that do not collapse and that
offer adequate privacy. Designing latrines to maximize privacy and the safety of livestock and children
are key concerns.
The team also sees several opportunities for improved sanitation adoption, some of which are related to
trends independent of sanitation programming. In particular, pastoral lifestyles, beliefs, and values
are evolving, with communities often becoming more settled and involving greater interaction with
other (e.g., more urban) contexts. These trends reduce barriers to latrine adoption, enable children to
attend school throughout the year (which is highly valued), and expose people to new ideas concerning
the dangers of open defecation and the value of latrines. Cultural beliefs that constrain latrine adoption
are also becoming less prevalent, and many feel that sanitation designs can align with remaining cultural
considerations.
Effectively capitalizing on these opportunities requires a strong enabling environment and a simple
process for tailoring interventions to specific communities. Governments can cultivate stronger
enabling environments by streamlining implementation and reporting structures, identifying committed
sanitation champions at multiple levels, dedicating line item funding to sanitation in county budgets, and
providing nuanced guidance on targeted subsidies or cash transfer programs when they may be
appropriate.
Implementers can tailor interventions to address key constraints and opportunities in individual pastoral
communities. For example, a focus on durable latrine designs and messaging related to privacy, safety,
and pride can align with pastoralists’ values and contextual challenges, while specific institutional
targeting of schools, community leaders, and special groups prior to full community triggering can
cultivate champions and preemptively address populations that may be most resistant to latrine
adoption. Implementers can use rapid contextual assessments and questionnaires to help identify key
community features and select specific strategies for adapting sanitation programming to that
community.
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APPENDIX A. SELECTION OF STUDY
VILLAGES
The WASHPaLS team worked
closely with the local governments
in Samburu, Turkana, and Kitui to
identify a list of randomized villages
with the desired characteristics
that the team had identified
previously in collaboration with
USAID. The criteria did need to be
modified slightly in each county,
due to the knowledge and data that
were available (Figure A1). The
specific criteria used to identify and
select villages are described below.
Samburu County
In Samburu, the team categorized
the villages according to two
criteria: mobility and CLTS
implementation. The sub-county
officials selected multiple villages
that fit each combination of criteria. Figure A1. Criteria for village selection in each county, including
adaptations based on available information.
The team asked local government
officials to purposively select ten un-triggered villages from Samburu East and Samburu Central. The
team did not include Samburu North due to security concerns. To ensure difficult contexts were
identified, and to reduce the possibility of biased selection, WASHPaLS specified the following additional
sub-criteria:
• Nearby triggered villages
• Hard-to-reach areas rarely targeted for interventions
• Marginalized with little or no access to development projects
• No access to latrines
The team randomly selected one village from Samburu Central and two from Samburu East out of those
identified by local officials. WASHPaLS also targeted villages that had been triggered or certified but that
had slipped back to open defecation. At this point, few of these villages exist. The team identified one
village that failed certification in Samburu East and four in Samburu Central. The team selected the
village in Samburu East and used random sampling to pick one from Samburu Central.
Sub-county Characteristic Village category
a) Samburu Central More settled populations (agro-pastoralists), Slippage (1), un-triggered (1)
high sanitation interventions
b) Samburu East Highly and partial nomads, fewer sanitation Slippage (1), un-triggered (2)
interventions
The team targeted more villages in Samburu East because it has more livestock keepers, has fewer
targeted interventions, and is drier than Samburu Central.
Turkana County
The team selected villages from five sub-counties, excluding one sub-county with high security risks
(Turkana East). Village selection was a determined using mobility and CLTS implementation status, and
sub-counties were targeted to cover various levels of latrine coverage, poverty level, and accessibility
indicators. For the village types targeted, local officials purposively selected five villages in each county,
and the team used random sampling to determine the final selection, as detailed below.
Sub-county Characteristics Village category
a) Turkana Central More settled populations, more sanitation 1: Slippage
interventions
b) Turkana South First to implement and certify CLTS 2: Maintained ODF, un-triggered
c) Loima High slippage rates 1: Slippage
d) Turkana West High sanitation interventions, existence of highly 1: Un-triggered (highly nomadic)
mobile communities (low insecurity compared to
the other areas having a high number of nomads)
e) Turkana North High poverty level, minimal sanitation 2: Slippage, un-triggered
interventions, hard to reach
Kitui County
The team began by characterizing CLTS implementation status and socio-economic activities for each
sub-county (see below). They then defined specific village types for each sub-county based on the sub-
county CLTS implementation period (indicators: CLTS triggering, ODF certification, slippage after
attaining ODF status). In each sub-county, five villages with the defined dimensions were purposively
selected. Further, the team ensured that villages were selected from every ward to promote fair
representation. Local government officials purposively identified five villages from each sub-county, and
the team used random selection to determine the final list of villages.
Sub-County Characteristic Village Category
a) Kitui South Very remote, low exposure to sanitation, development Challenging to implement
projects, low socio-economic status
b) Kitui Rural CLTS implementation started, with the first villages Successful and sustained
certified ODF ODF status
c) Kitui East High slippage rates due to loose soils with high Slippage
incidences of latrine collapse, remote
d) Mwingi High exposure to development activities, majority are Challenging to implement
Central economically well off, existence of religious beliefs
related to health issues
e) Mwingi North Hardship area, high poverty level, very remote Successful and sustained
ODF status
APPENDIX B. DETAILED SUMMARY OF
STUDY VILLAGE CHARACTERISTICS
SAMBURU COUNTY
The five villages visited in Samburu County had a number of similar characteristics, with all practicing
transhumance pastoralism and most having low latrine coverage rates. Villages tend to have low
household density, and soil conditions often create difficulties for pit latrine construction and
maintenance, either due to difficult excavations (in rocky conditions) or pit collapse (in sandy
conditions). Further details are described below.
Water, sanitation, and health. Of the five villages visited in Samburu County, local CHVs reported
that two were untriggered (S2, S5), two were triggered (S1, S3), and one (S4) had recently been
triggered by an NGO but had not been recorded as such by the government (Tables B1 and B2).
However, villages S1 and S3 had both failed ODF certification. It is worth noting that Kenya’s CLTS
RTMS records village S1 as certified (according to a full download of Samburu data accessed in February
2021), while the study team was unable to match S3 with any records in the monitoring system (Table
B1).
Generally, the number of households with functional latrines was quite low (≤10%) in four of the
villages, while S1 had higher latrine coverage (≥50%). Four of the five villages reported that organizations
(e.g., AMREF, World Vision, Kenya Red Cross) had implemented other sanitation interventions beyond
CLTS. These interventions included: education on latrines and the health risks of open defecation,
construction of latrines in schools, and subsidized provision of concrete latrines slabs. However, the
government stopped a subsidized latrine slab program that had begun in S5 because it was in conflict
with the no-subsidy approach promoted as part of the CLTS framework, and latrine construction was
not completed for any of the slabs that had been distributed.
Most villages collect water from seasonal streams and rivers during the rainy season, but solar-powered
boreholes have been installed in two of the villages. Typically, collecting water from these sources takes
households approximately 30 minutes, but some households in S2 may need to set aside about five
hours for water collection, due to their distant locations relative to the borehole. Diarrhea is reported
to be common in four of the five villages (all except S1), likely due to contaminated water sources,
especially during the rainy season. Two of the villages (S4 and S5) also contain health clinics that provide
health care to members of the community.
Socioeconomic conditions. The predominant economic activity in all five villages is pastoralism,
although some households also participate in additional activities. For example, households in two
villages (S1 and S2) engage in small-scale crop farming. Some households in S3 collect and sell firewood
and sand from nearby river banks, a few members of S4 are employed by local conservancies, and S5
contains some traders who purchase goods from other locations to sell locally. Some form of
transhumance pastoralism is practiced across all villages, involving partial movement with livestock
during the dry seasons. This practice typically involves adult men and morans moving with the livestock,
but two villages (S3 and S4) contained households with multiple wives who separate during the dry
season. One wife remains at the permanent homestead to care for the elderly and the children attending
school, while the other wife accompanies the husband with the livestock.
Housing and latrine characteristics. Generally, household density in the five villages is low, with
households dispersed across wide areas of land (providing substantial room for large herds of livestock).
Sometimes, households are found in small clusters, but the broader community still covers a large area.
Typically, wealthier households build more permanent structures using materials such as iron sheet
roofing, concrete floor slabs, and cement block walls, while poorer households live in temporary
structures (manyattas) built from materials including mud, polythene sheets, sticks, and boxes. Manyattas
were especially common in villages S1 and S5. Similarly, latrines tended to be either permanent facilities
made using iron sheets and concrete slabs or temporary structures built from mud and sticks.
Permanent latrines structures were more prominent in villages S1, S2, and S3 (despite the fact that
housing in S1 tended to be more temporary), while temporary latrines dominated in villages S4 and S5.
Additionally, it may be easier for villages S1 and S3 to obtain construction materials from urban centers,
as centers are only about 3 kilometers away in both cases. In contrast, villages S2 and S4 are
approximately 30 and 40 kilometers from urban centers, and S5 is 90 kilometers from an urban center
but has only been using locally available materials to build the temporary housing and latrine structures
found there.
Environmental context. Villages are typically located in areas with sandy and/or rocky soils. Rocky
soils are especially dominant in villages S3 and S4, making it difficult to dig latrine pits (although toilets in
these villages tend to collapse less frequently). Some rocky areas where digging is difficult are also found
in village S2, and pit latrines also often collapse there during the rainy season. Village S5 has sandy soil
with some patches of clay. Excavation is not difficult, but pits do tend to collapse. Residents of village S4
noted that high winds can also cause latrine collapse. Finally, village S1 has sandy and loamy soil, with
easy excavation and rare instances of collapse. Generally, flooding is rare across the five villages,
although it does sometimes occur in certain areas of village S2.
TURKANA COUNTY
The seven villages the team visited in Turkana County were perhaps a bit more diverse than those from
Samburu County. Most were found in remote locations, with one community (T1) being a highly
nomadic group known as a Kraal, which moves from place to place in search of water. In contrast, village
T2 was located fairly close to an urban area and was more settled (though some transhumance
pastoralism was still practiced), characteristics that may play a role in its greater success with regard to
ODF certification and sustainability. Some other villages were extremely remote; T7 is located
approximately 200 kilometers from a major urban center (Table B2). Further details are below.
Water, sanitation, and health. Of the seven villages visited in Turkana, three were reported to be
untriggered by local CHVs (T1, T5, T7), although there seemed to be some confusion about the status
of T7, as the local CHEW reported it as triggered. Recent sensitization efforts have occurred in village
T6, but the government records it as untriggered and nearly all households still practice open
defecation. Village T4 was triggered but failed ODF certification. Similarly, T3 was certified but has
slipped back to open defecation, with most households having latrines that are no longer functional.
Finally, T2 was certified and has thus far maintained its ODF status, and households without latrines
share with others. As with Samburu, the team did note some discrepancies with the data available in
Kenya’s CLTS Monitoring System. In particular, T4 is shown to be certified, although the local CHV
reports it failed certification. Additionally, the study team was unable to match T1 and T5 with database
records. It is expected that data may be especially sparse with regard to highly mobile Kraals (such as
T1) that are likely difficult to identify and track (Randall, 2015; Tillett & Jones, 2021) and that represent
cases where construction of permanent latrines may be extremely rare.
Coverage rates of functional latrines in most villages were low, including 0 percent coverage in T1 and
T5. The exception to this trend is T2 (74%), which has been certified and is maintaining ODF status. The
success of T2 may be related to its proximity to an urban center and the larger number of economic
and employment opportunities available.
The seven villages use different types of water sources. Five of the villages (T2, T4, T5, T6, T7) typically
use either boreholes or water kiosks, but some households in T4 reportedly have access to piped
water. While water kiosks are located within the village and are usually easy to access, some of the
boreholes may be quite far away (e.g., two to three hours). Village T3 commonly uses a river that is
located approximately two hours away, while T1 migrates to find seasonal water sources such as rivers
and springs. Diarrhea is reported to be common in four of the villages (T1, T3, T6, T7), and malaria is
also highly prevalent in T3. Two villages contain health facilities (T6, T7), while T2 and T3 have access to
facilities in nearby areas (within a few kilometers). Residents of T5 must travel farther to reach a health
facility (approximately 25 kilometers), while T1 and T4 have no facilities in surrounding areas.
Socioeconomic conditions. The primary economic activity is pastoralism, particularly in villages that
are more remote. Members of the Kraal are exclusively engaged in raising livestock, while other
activities are also present in other villages. These activities include small-scale farming during the rainy
season, selling firewood and charcoal, small businesses and trading, and casual labor. In particular,
residents of T2 have opportunities to engage in other work, likely due to this village’s proximity to an
urban center. This village is also somewhat more settled. Few households do own livestock, and some
household members may relocate to raise the livestock in different areas. Movement during the dry
season to find pasture is characteristic of most other villages, while T1 is highly nomadic. This
community does have a permanent location where elderly people remain, but all others move frequently
to find water and protect against insecurities due to land conflicts and livestock theft (this community is
located in Turkana West, which is very close to the border with Uganda).
Housing and latrine characteristics. Household densities across the seven villages were somewhat
variable, ranging from a low-density, scattered community (T5) to denser settlements (T2, T4). The
other four villages fall in between these extremes, often with households clustered in small groups. The
housing in five of the communities (T1, T3, T5, T6, T7) in mostly temporary (constructed from materials
such as mud, twigs, leaves, and reeds), while the remaining two communities contain a mixture of
temporary and more permanent housing structures. Where latrines exist in villages T2, T4, and T7, they
are typically constructed using materials such as concrete slabs and iron sheet roofing, while T3 contains
latrines made from locally available materials (e.g., reeds, twigs). It is worth noting that many of the
latrines in T3 have become non-functional. As discussed below, this situation may be related to the soil
conditions that make latrines (perhaps especially those made from local materials) prone to collapse.
The remaining communities contain no or very few latrines. The prominence of more durable
construction materials in T2 is likely related to its proximity to an urban center, while the other villages
tend to be much farther from areas where such materials can be purchased. For example, T7 (located in
Turkana North) is reported to be approximately 200 kilometers from Lodwar, the major urban center
in the county where construction materials are obtained.
Environmental context. These villages tend to be located in areas with sandy and/or rocky soils. In
five villages (T2, T4, T5, T6, T7), residents reported that pit latrine excavation was difficult because of
the rocky conditions. In T7, for example, a household may have to pay 1,000-1,500 KES per foot when
digging a pit, as the rocky soil requires experienced labor and specialized techniques. In contrast, the
sandy soil in T3 allows for easier excavation, but latrines are prone to collapse. It is worth noting that
the team found numerous non-functional latrines in T3 that were typically constructed from local
materials that may not be durable enough to prevent issues of collapse. Additionally, flooding (during the
rainy season) was reported as a challenge in five of the communities (T1, T3 T5, T6, T7).
KITUI COUNTY
Although CLTS implementation in Kitui County is more widespread than it is in Samburu or Turkana,
the WASHPaLS team found some villages in more remote, harder-to-reach areas where latrine coverage
remains fairly low. Residents of the villages visited in Kitui tend to practice agro-pastoralism with
relatively small numbers of livestock, and household density was observed to be low (Table B2). Further
details are described below.
Water, sanitation, and health. Of the five villages visited in Kitui County, four were reported to be
untriggered by the local CHVs (all except K1). Notably, these reports stand in contrast to the fact that
the CLTS RTMS records all Kitui villages as certified. According to the local CHVs, other sanitation
interventions and sensitization efforts have occurred, and sometimes a few members of a village had
attended triggering events in other communities. However, at least according to CHVs’ perceptions and
understanding, these specific villages had not been formally triggered.
Latrine coverage levels vary considerably across the five villages. In the village reported to be certified by
the local CHV (K1), nearly all households (99%) have a functional latrine. Village K3 also has a high level
of functional latrine coverage (94%), while K2 and K5 exhibit much lower levels (14%). Village K4 stands
at an intermediate level (65%). Four of the five villages use rivers (between 2 and 20 kilometers away) as
their primary water source, while K5 uses a borehole.
Village K1 contains a health center, while residents of K3 and K4 can access health facilities nearby
(between 5 and 12 kilometers). Diarrhea is reported to be rare in K1 and either occasional or common
in the other villages. Malaria is also a frequent issue during the rainy season in K5.
Socioeconomic conditions. Households across the five villages engage in crop farming as their
primary economic activity, growing crops such as maize, sorghum, and millet. Households generally raise
small numbers of livestock and lead settled lifestyles (practicing agro-pastoralism). Some also engage in
other economic activities including small-scale trading, and there are a few teachers living in K2. Villages
K1 and K4 are located close to urban centers (between 5 and 8 kilometers away), while K2 is much
more remote (100 kilometers from an urban center)—perhaps contributing to its lower levels of latrine
coverage. Villages K3 and K5 are both approximately 20 kilometers from an urban center.
Housing and latrine characteristics. Household densities are fairly low across the five villages, and
most housing tends to consist of lower-cost structures made from locally produced mud bricks, mud
flooring, and iron sheet or thatched roofing. A few houses are built using materials such as kiln-fired
bricks, cement blocks, and cemented floors. Village K4 includes a larger proportion of houses built from
these types of materials. Most latrines might also be classified as temporary structures, built from
materials such as mud, local mud bricks, and iron sheets. Villages K1, K2, and K4 include a more
balanced mix of permanent and temporary latrine structures (although the total number of latrines in K2
is relatively low).
Environmental context. As with the other two counties, the villages the team visited tend to be
located in regions with sandy and/or rocky soils, and pit excavation was reported to be difficult due to
rocky conditions across all five villages. Latrine collapses were also reported to be common during the
rainy season in K3 and K5. Flooding does not appear to be as much of a challenge in these five villages,
although some flooding is reported to occur near the rivers in K3 and K4.
Table B1. Sanitation status of study villages, as reported by local CHVs during rapid observational surveys and as recorded in Kenya’s CLTS Real-
Time Monitoring System (GoK, 2021).
Information from field data collection and reported by local CHVs Data from Kenya CLTS Data Hub
(December 2020–February 2021) (accessed February 2021)
Sub- HHs
County Village HHs HHs with
county Mobility Total practicing CLTS Total Households
CLTS status with functional
category HHs open status households with toilets
toilets toilets
defecation
Samburu Triggered, failed ODF 55-70 40-50 Certified
S1 Transhumance 80 20 (25%) (No data) (No data)
Central certification (69-88%) (50-63%) (no date)
Samburu 23-30 20
S2 Transhumance Untriggered 400 350 (88%) Untriggered (No data) (No data)
Central (6-8%) (5%)
Samburu Triggered, failed ODF 22 20
Samburu S3 Transhumance 240 220 (92%) (Not found in CLTS Database)
East certification (9%) (8%)
Samburu Triggered by NGO, but not 24 24
S4 Transhumance 230 206 (90%) Untriggered (No data) (No data)
East recorded by government (10%) (10%)
Samburu 1 1
S5 Transhumance Untriggered 84 83 (99%) Untriggered (No data) (No data)
East (1%) (1%)
Turkana Highly 0 0 57
T1 Untriggered 57 (Not found in CLTS Database)
West nomadic (0%) (0%) (100%)
Turkana 43 43 0 Certified 42
T2 Transhumance Certified 58 42
South (74%) (74%) (0%) (7/26/17) (100%)
Turkana Certified, but has slipped back to 30 4 31 Certified 33
T3 Transhumance 35 33
Central open defecation (86%) (11%) (89%) (2/13/19) (100%)
Triggered, failed ODF 16 15 32 Certified 23
Loima T4 Transhumance 48 28
Turkana certification (33%) (31%) (67%) (11/2/18) (82%)
Turkana 0 0 100
T5 Transhumance Untriggered 100 (Not found in CLTS Database)
South (0%) (0%) (100%)
Officially untriggered, but
Turkana 2 2 18
T6 Transhumance recently sensitized by NGO on 20 Untriggered (No data) (No data)
North (10%) (10%) (90%)
latrine construction
Turkana Untriggered, but CHEW thinks 7 3 31
T7 Transhumance 35 Untriggered (No data) (No data)
North it had been triggered (20%) (9%) (89%)
Agro- 67 66 0 Certified
Kitui Rural K1 Certified 67 (No data) (No data)
pastoralism (100%) (99%) (0%) (no date)
Untriggered, but PHOs
Agro- 20 18 108 Certified 71
Kitui East K2 threatened to put people 126 71
pastoralism (16%) (14%) (86%) (4/11/18) (100%)
Kitui without latrines in jail
Agro- Untriggered, but other latrine 50 47 3 Certified
Kitui South K3 50 (No data) (No data)
pastoralism sensitization efforts (100%) (94%) (6%) (no date)
Mwingi Agro- Untriggered, but a few were 29 26 14 Certified 33
K4 40 33
Central pastoralism selected to attend triggering in (73%) (65%) (35%) (3/28/18) (100%)
Information from field data collection and reported by local CHVs Data from Kenya CLTS Data Hub
(December 2020–February 2021) (accessed February 2021)
Sub- HHs
County Village HHs HHs with
county Mobility Total practicing CLTS Total Households
CLTS status with functional
category HHs open status households with toilets
toilets toilets
defecation
neighboring village and other
latrine promotion efforts
Mwingi Agro- 8 8 50 Certified
K5 Untriggered 58 (No data) (No data)
North pastoralism (14%) (14%) (86%) (no date)
Table B2. Additional information gathered on each study village from rapid observational surveys.
Reports and observations from rapid observational surveys

Sub-
County Village CLTS Water Economic HH Soil Housing Latrine Proximity
county Health Mobility Flooding
status sources activities density conditions materials materials to urban
Triggered, Seasonal Regular Transhumance; Pastoralism, Clustered Sandy, Temporary Permanent 3 km No
failed rivers, PHO men and small-scale households, loamy; manyattas structures flooding
Samburu
S1 certification 20–30 min. visits, rare morans move farming but clusters toilets rarely (mud, (iron
Central
diarrhea during dry are far apart collapse polythene) sheets,
season concrete)
Untriggered River, solar Diarrhea Transhumance; Pastoralism, Scattered Sandy, some Mostly Permanent 30 km Rare
but borehole common men and small-scale households rocky areas; permanent structures flooding,
education 1–10 km during morans move farming collapses housing (iron but occurs
on latrine (0.5–5 rains during dry common; (cement sheets, more
Samburu
S2 importance hours) season excavation blocks, concrete) often in
Central
difficult iron roofs); certain
poorer areas
HHs have
Samburu
manyattas
Triggered, Seasonal Diarrhea Transhumance; Pastoralism, Highly Sandy, Some Permanent 3 km No
failed rivers, 1.5 common 1 wife goes some sell dispersed rocky; permanent structures flooding
Samburu
S3 certification hours during with husband, firewood and households excavation housing, (iron
East
rains other remains sand difficult some sheets,
manyattas concrete)
Streams Diarrhea Transhumance; Pastoralism, a Dispersed Sandy, Some Temporary 40 km No
Triggered by during rains, common, 1 wife goes few employed but rocky; permanent structures flooding
NGO, but solar health with husband, in local clustered excavation housing, (no roof,
Samburu
S4 not borehole center in other remains conservancies households difficult some mud,
East
recorded by (20–30 village manyattas sticks)
government min.)
Sub-
Untriggered, River, 20– Diarrhea Transhumance; Pastoralism, Dispersed Sandy, Temporary Temporary 90 km; No
some slabs 40 min. common, men and some small- but rocky, some manyattas structures local flooding
Samburu donated, but health morans move scale clustered clay; (mud, (no roof, materials
S5
East local gov. center in during dry businesses households collapses polythene) mud, used for
stopped village season (traders) common sticks) latrines
subsidies.
Untriggered Varies with Diarrhea Highly Pastoralism Clustered Loose sand Temporary (No Approx. Flooding
location; common nomadic; households and loam, manyattas latrines) 100 km during
Turkana
T1 seasonal elderly stay at some rocky (mud, rains
West
rivers, permanent areas twigs)
springs residence.
Certified Water No Transhumance; Informal jobs, High Sandy, Some Mostly 3 km No
kiosk diarrhea, some family small household rocky; permanent permanent flooding
Turkana (20 min.), health members take businesses in density excavation housing, structures,
T2
South borehole facility in livestock to nearby town, a difficult some a few
(3 hours) nearby other locations few teachers & manyattas temporary
town doctors
Certified River Diarrhea Transhumance; Pastoralism, Clustered Loose sand;Temporary Temporary 40 km; Flooding
but slipped (2 hours) & malaria youth move small-scale households collapses manyattas structures local during
Turkana back common, for approx. 1 farming, common (reeds, (reeds, materials rains
T3
Central health month charcoal selling twigs) leaves, used for
facility 5 mud, latrines
km away twigs)
Turkana Triggered, Borehole Diarrhea Transhumance; Pastoralism, High Sandy, Some Mostly 90 km No
failed (0.5-1 rare children not in
gold mining, household rocky; permanent permanent flooding
certification hours), few school take
sell charcoal & density excavation housing, VIPs, a few
Loima T4
have piped livestock to
firewood, difficult some temporary
water nearby hills small manyattas
businesses
Untriggered Borehole Diarrhea Transhumance Pastoralism, Scattered Sandy, Temporary (No 70 km Flooding
5 km away rare, small-scale households rocky; manyattas latrines) during
Turkana
T5 (2 hours) health farming, excavation rains
South
facility 25 charcoal selling difficult
km away
Officially Borehole Diarrhea Transhumance Pastoralism, Clustered Sandy, Mostly One 150 km Flooding
untriggered, (0.5 hour) common, small-scale households rocky; temporary temporary during
but recently health farming, excavation manyattas latrine, one rains
Turkana
T6 sensitized by center in charcoal & difficult permanent
North
NGO on village firewood latrine
latrine selling
construction
Sub-
Untriggered, Water Diarrhea Transhumance Pastoralism, Clustered Sandy, Mostly Mostly 200 km Flooding
but CHEW kiosk common, small-scale households rocky; temporary permanent during
Turkana
T7 thinks it had (5 min.) health farming, excavation manyattas structures rains
North
been center in charcoal selling difficult
triggered village
Certified River 6–10 Diarrhea Agro- Farming, few Scattered Sandy, rocks Mostly Some 5-8 km Flooding
km away rare, pastoralism livestock households deeper; temporary temporary rare
Kitui
K1 (4 hours) health excavation housing latrines,
Rural
center in difficult some
village permanent
Untriggered River 20 km Diarrhea Agro- Farming, few Scattered Sandy, some Mostly Some 100 km No
away common pastoralism livestock, a households rocks; temporary temporary flooding
Kitui East K2 (6 hours) few teachers excavation housing latrines,
difficult some
permanent
Untriggered River 2 km Some Agro- Farming, few Scattered Sandy, some Mostly Mostly 20 km No
away diarrhea, pastoralism livestock, households rocks; temporary temporary flooding,
Kitui (3 hours) health small-scale excavation housing structures except
K3
Kitui South center traders difficult, near river
10–12 km collapse
away during rain
Untriggered River 3 km Some Agro- Farming, few Scattered Sandy, Some Some 5 km No
away diarrhea, pastoralism livestock, sell households rocky; permanent temporary flooding,
Mwingi
K4 (3 hours) health rocks excavation and some latrines, except
Central
center 5 difficult temporary some near river
km away housing permanent
Untriggered Borehole 1 Diarrhea Agro- Farming, few Scattered Sandy, Mostly Mostly 20 km No
km away & malaria pastoralism livestock, households rocky; temporary temporary flooding
Mwingi (1 hour) common small-scale excavation housing structures
K5
North during traders difficult,
rain collapse
during rain
APPENDIX C. REPRESENTATIVE
PHOTOGRAPHS
1. Latrine and Housing Structures
a. Housing Structures
Samburu Village 5 Kitui Village 4
Kitui Village 2 Turkana Village 6
b. Latrine Structures
Turkana Village 6 Turkana Village 2
Kitui Village 1 Samburu Village 4
2. Soils/Landscapes
Samburu Village 3 Turkana Village 1
Kitui Village 4 Turkana Village 3
APPENDIX D. COUNTY GOVERNMENT CLTS
REPORTING AND IMPLEMENTATION
STRUCTURES
SAMBURU
Limited coordination between parallel departments hinders reporting and awareness of
activities in Samburu. In Samburu, decisions about CLTS strategy and implementation come from the
upper levels of the county government, in consultation with implementing partners. Within the Public
Health Department, the three key players at the county level are the County PHO, the CLTS
Coordinator, and the County Community Focal Person. Formally, the County PHO is the leader of this
group, but in practice these individuals operate on more equal footing (see formal and informal
structures in Figure D1).
Below these three county-level officers, local officials support CLTS implementation within their areas of
operation. Community CLTS Coordinators assign CLTS-related activities to CHEWs and CHVs, who
play a large role in CLTS triggering and follow-up at the village level, helping to shepherd their
communities toward ODF certification. Formally, these actors are also expected to report to the
Divisional PHO (equivalent to the Ward PHO in other counties) and Sub-County Community Focal
Person. In practice, however, a separation has developed between the department’s community and
public health streams, and generally CHVs and CHEWs work under the Sub-County Community Focal
Person. With the CHEWs and CHVs not reporting to their supervisors in the public health stream, Sub-
County and Divisional PHOs can become sidelined in the CLTS process, and they may not be aware of
planned or ongoing activities. Accordingly, documentation and reporting of CLTS implementation may
not reach the County PHO, while implementing partners or funding agencies working with PHOs across
all levels may not be able to connect effectively with activities on the ground. Similarly, at higher levels,
the County Community Focal Person should report to the County PHO, but these two actors actually
run parallel programs, with each sub-department engaging in independent activities (Figure D1).
Figure D1. Framework for formal (left) and informal (i.e., actual; right) CLTS reporting in Samburu. Dark blue shading indicates actors directly
involved in CLTS reporting and implementation at multiple levels, while white/no shading indicates upper-level management overseeing all health-
related activities in the county.
TURKANA
Complex structures can create challenges or inconsistencies in Turkana. At the community
level in Turkana, CHEWs and CHVs work to implement and support WASH activities, and these actors
report to their Ward PHO. As in Samburu, CHEWs and CHVs are also directed by the Sub-County
Community Health Focal Person, who collaborates with the Sub-County WASH Coordinator to define
and support WASH-related activities. At this intermediate level, Ward PHOs report to their Sub-
County WASH Coordinator with respect to WASH activities but also report to the Sub-County PHO
in a more general capacity. However, the Sub-County PHO reports to the Sub-County Medical Officer
of Health, who operates within Medical Supplies, an entirely different section of the Health and
Sanitation Department that is separate from WASH activities (Figure D2). Overall, while there does
appear to be a clear line of reporting in principle from the community level up to the Directors of
WASH and Public Health at the county level, the multiple layers of officials operating in different sub-
departments can hinder reporting or implementation processes. Supervisors may not be aware of all
activities being undertaken by their subordinates, and reports made by subordinates may not reach the
correct individuals higher up in the structure. The large number of NGOs that implement various
programs in Turkana may also contribute to inconsistent programming and reporting, potentially
confusing or conflicting with strategies and policies adopted by the government.
Figure D2. Framework for CLTS reporting in Turkana. Dark blue shading indicates actors directly involved
in CLTS reporting and implementation at multiple levels, while white/no shading indicates upper-level
management overseeing all health-related activities in the county.
KITUI
Consolidated and clear structures in Kitui enable streamlined coordination. In Kitui County,
CLTS implementation is implemented collaboratively by the county government and implementing
partners. Generally, existing structures for implementation and reporting are well defined and help to
ensure institutional accountability. Certain roles have been combined to minimize duplication and
promote a high level of involvement from all parties. In particular, similar activities falling under the
community health and public health sections have been combined (Figure 2), whereas they are
implemented separately in Turkana and Samburu.
At the county government level, the health and sanitation department heads high-level decision-making
with implementing partners. The Public Health Division acts as the anchor for all health-related issues,
with WASH activities streamlined under the environmental health section. This section is headed by the
County PHO, who directs WASH interventions jointly with the County WASH Coordinator and the
Community Strategy Focal Person (who leads the community health services section). The WASH
Coordinator organizes county-level WASH activities and manages the real-time CLTS monitoring
system.
Beneath the county-level structure, PHOs oversee CLTS implementation at the sub-county level, but
they also act as sub-county Community Strategy Focal Persons, reporting to the County PHO. Ward
PHOs play a critical role in managing CLTS activities at the ward level while also functioning as CHEWs,
working to strengthen CLTS implementation activities at the community level. Below them, CHVs
engage in sensitization and follow-up exercises to support a community’s efforts toward achieving ODF
status, and they report the community’s progress and current status to the Ward PHO.
Combining roles and responsibilities in this way has helped local officials to maximize the usefulness of
existing structures and coordinate and effectively track CLTS implementation. In particular, the
streamlined structure and high level of coordination, from top-level management to the community
level, has led to strong social cohesion between communities and the county government (although this
is not always the case for the more remote communities the team visited).
U.S. Agency for International Development
1300 Pennsylvania Avenue, NW
Washington, DC 20523
Tel: (202) 712-0000
Fax: (202) 216-3524
www.usaid.gov

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APPROACHES FOR SANITATION ACCESS IN

PASTORALIST AREAS WITHIN THE ARID AND

Cover Photo: Focus group discussion in Turkana County

Tetra Tech Contacts: Morris Israel, Project Director

Jeff Albert, Deputy Project Director

Lucia Henry, Project Manager

Category Factor Key points References

1.2 RESEARCH QUESTIONS

Pastoralist category Mobility characteristics Livelihood characteristics

2.2 CHARACTERISTICS OF SELECTED VILLAGES

Village characteristics Samburu Turkana Kitui

2.3 SUMMARY OF QUALITATIVE DATA COLLECTION

2.4 SUMMARY OF QUALITATIVE DATA ANALYSIS

3.1 CONSTRAINTS AND BARRIERS TO LATRINE ADOPTION (RQ 1)

3.1.1 CONTEXTUAL CONSTRAINTS

3.1.2 PSYCHOSOCIAL CONSTRAINTS

3.1.3 TECHNOLOGICAL CONSTRAINTS

3.2 ACCEPTABLE SANITATION STANDARDS (RQ 2)

3.2.1 SEMI-SETTLED AND SETTLED: DURABLE, PRIVATE, AND APPROPRIATE FACILITIES

3.2.2 NOMADIC: OPEN DEFECATION IS PERCEIVED AS THE BEST OPTION

3.3 CASE STUDIES OF SUCCESS

3.3.2 TURKANA VILLAGE 2: INSTITUTIONAL TRIGGERING, BY-LAWS, AND SHARING

4.1 ENABLING ENVIRONMENT: RECOMMENDATIONS FOR GOVERNMENT

4.2 TAILORED IMPLEMENTATION STRATEGIES: RECOMMENDATIONS FOR

Community Constraint/ Opportunity Implementation Approach

market access. latrines/division of labor/procurement of supplies

Lack access to markets/ artisans; strong leaders/ change

Reports and observations from rapid observational surveys

Samburu Village 5 Kitui Village 4

Kitui Village 2 Turkana Village 6

Turkana Village 6 Turkana Village 2

Kitui Village 1 Samburu Village 4

Samburu Village 3 Turkana Village 1

Kitui Village 4 Turkana Village 3

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