Gender Outcomes Of The Community Led Total Sanitation Approach In Selected Counties In Kenya

ABSTRACT

Inadequate sanitation and hygiene contribute to morbidity and mortality. The CommunityLed Total Sanitation (CLTS) approach is used by the Ministry of Health to increase access to sanitation and hygiene in Kenya. This study sought to assess the gender outcomes of the CLTS approach in three sub counties in Kenya. CLTS is considered successful in Kenya, yet its impact on men and women has limited literature available. Therefore, this study sought to document the impact on gender relations as a result of the CLTS implementation in Siaya, Nambale and Teso North Sub Counties. The Moser Framework, the gender socialization concept and the Gaventa Power Framework were applied. A complete census of the households was done, followed by cluster random sampling to determine the households to be interviewed. The Z-Score was used to determine the respondents. Further, 3 Focus group discussions were held with Village Health Committees and 12 key in depth interviews with Public Health Officers from the Ministry of Health. 384 Structured interview guides and observation check lists were applied in the sampled households. Quantitative data yielded was analysed by statistical package for social science and qualitative data was analysed through Atlas t 6.0 and Open Code 3.4. The data was presented in tables. The study found that the Kenya Environmental Sanitation Policy and the CLTS Trainers‟ Handbook did not address gender needs adequately yet CLTS was considered a success in Kenya. That 75% PHOs who were mandated to deliver CLTS were gender blind. That 67% of PHOs made decisions based on general data as they did not have gender disaggregated data on CLTS interventions. Further, it was found that men led in decision making at all levels of CLTS implementation. 64% of PHOs were men at county level and 85% at sub county level. 80% of the people present at community triggering were men and 70% of households reported that men led the decision-making process at the household level in relation to sanitation and hygiene interventions. Men were recognized more during the ODF celebrations as compared to women. 56% of VHCs are women who work without pay. The women provided sanitation and hygiene services in the home as part of their reproductive role and served as VHC resulting to unequal division of labour in CLTS with the women shouldering the heaviest burden. Women faced challenges with limited access to key sanitation resources, such as land and building materials where in households interviewed, 23% were women in Nambale, 15% in Teso and 25% in Siaya. Besides, women had limited access to the latrines and bathrooms, such that it curtailed the benefits at 36% in Nambale, 29% in Teso and 37% in Siaya. Participation of women in decision making in CLTS was tokenistic, whereby there was only an increase of 2.3% of women invited in the decision-making space with minimal strategic benefits, they were not able to claim any space or autonomy in CLTS implementation. The study concluded that despite CLTS being considered a great success in Kenya at 58% as reported by PHOs, it was not applied in a gender sensitive manner thus entrenching unequal outcomes. Teso registered at 23% ODF and Siaya and Nambale registered 93% ODF. The study recommends that there should be a review of the KESH policy and CLTS manual to integrate gender responsive impact assessments and initiate critical enablers. Also, all PHOs should be trained on gender mainstreaming. Similarly, gender mainstreaming should be integrated into CLTS intervention through having flexible gender strategies that would ensure equitable outcomes. The study therefore contributes to the existing literature on community led total sanitation and may inform policy formulation and implementation by the relevant stakeholders.