Water and Keeping Clean

At Children for Health, and during this month of October, we have a focus on handwashing and other aspects of keeping clean as October 15th is Global Handwashing Day!

We wanted to share here a post originally on the blog of our director, Clare Hanbury, in which she celebrates the work of a project in Indonesia where children were involved with efforts that led to one village achieving Open Defecation Free (ODF) status in 2009.  Experience suggests that achieving ODF plays an important foundation for communities and leads to the adoption other hygiene behaviours.

This case study and photos were written by Afrianto Kurniawan who facilitated the work and gave permission for me to reproduce it here for you today. The process is based on the original 6-step developed in the 1990s by Child to Child.

What to do:

After some triggering* had been conducted for the community members in the villages, we met with some children and this is how we proceeded.

Step 1 – Choose and Understand

In the first meeting, we asked children to identify and assess their health problems and priorities. As our work was in CLTS, they raised the issues of faeces, open defecation, and diarrhoea cases in their village. During the discussion, we used questions which we usually use in triggering* in order to ignite a sense of disgust and shame about open defecation. At the end of discussion, we challenged the children to find out more about using a list of questions related with the topics they have been discussed before.  The list of questions guided guiding them to do some research within their community. Finally, we arranged the next meeting to discuss their research findings.

Step 2 Find out More

In this step, we let the children do their own research. Through this activity, the children were encouraged to find out how these issues affected them and their communities. They asked their family members, community members, or their colleagues about the issues base on the guiding questions. The questions can be about how many times people has got diarrhoea, why people in their village usually got diarrhoea, etc. They are also encouraged to take transect walk and make some mapping of open defecation situation in their village.

Step 3 – Discuss What We Found and Plan Action

We started the discussion by asking children about general things, such as how are their lives, school, and family. After that we continued to facilitate them in discussion on their findings. Based on their findings children planned actions  they can take individually or together. During the discussion of the plan of action, we  inspired them by telling them stories about what other children in other countries  have been doing regarding their action in helping their village to achieve ODF.

Step 4 – Take Action

Based on their agreement in the previous meeting, the children took various actions with support that they identified as needed – from adults. The actions depended on their age and ability. They persuaded community members to stop open defecation by singing songs, reading poetry, drama and puppet shows. Older children helped other community members  build latrines, or pressured their parents to build latrines. 

Step 5 – Evaluate

After children have finished their action, we asked them to gather again. In the meeting, we facilitated children evaluating the action they took: What went well? What was difficult? Has any change been achieved? Based on their evaluation, we encouraged children to find ways of keeping the action going or improving it.

Step 6 – Do it better

In this step, we supported children to do the action again either the same action or other actions building on what they had done before.


Based on the child-to-child approach principles, programmes using children should:

  1. View health in the wider context
  2. Recognize the role of children as citizens and community members in contributing to the health and development of themselves and others
  3. Engage children in active learning, be inclusive and involve as many children as possible. Facilitate the building of an enabling environment;
  4. Encourage children to work cooperatively to find solutions that are safe and helpful for themselves, their families and communities
  5. Ensure that adult facilitators work in responsible ways with children protecting them from any actions that may physically, emotionally or socially put them at risk
  6. Appreciate that the participation of children should be sensitive to the evolving capacities of children.
  • Don’t forget to do some ice breaker, especially in the first meeting in order to build trust with the children.
  • Make sure some of children group members also have been experiencing the triggering process together with other community members before the first meeting (step 1).
  • During the discussion in step 1 or 3, we can also use ignition methods such as calculations of shit and medical expenses, water contamination, Identifying the dirtiest neighbourhoods, etc.
  • The approach can be started through student councils, or children groups in communities.
  • Involve natural leader or teacher as an observer.

* Triggering is a term used for a series of participatory activities that encourage members of a community to want to take action. The process is facilitated in such a way that the people learn from experiencing and come to their own conclusions that change is essential. It is a vital stage of the community led total sanitation process and has to be led with skill, good humour and subtlety. Learn more about the CLTS process.